HHS OIG Issues Open Letter On Changes In OIG Civil Fraud Settlement Policies and Practices

On November 20, 2001, DHHS Inspector General Janet Rehnquist issued an open letter to health care providers announcing changes to certain Office of Inspector General ("OIG") civil settlement policies and practices in response to concerns expressed by providers.

One change is the development of eight criteria to be considered by OIG staff in determining whether, in a given case, it would be appropriate for the OIG to forego administrative exclusion without imposing a corporate integrity agreement or, if a corporate integrity agreement is deemed appropriate, what the substance of the agreement should be. A second change is the modification of the claims review process mandated in future and, where appropriate, existing corporate integrity agreements to require the use of full statistically valid random samples only in cases where an initial claims review has identified an unacceptably high error rate.
The letter also promises that the OIG will explore ways to increase reliance on providers' internal audit capabilities, and will be more flexible in other integrity agreement requirements, such as employee training.

The letter included two attachments further detailing the new claims review procedures: (1) a summary of the procedures; and (2) a list of frequently asked questions regarding the new procedures.