HHS OIG Issues Open Letter On Changes In OIG Civil Fraud Settlement Policies and Practices
Client Alert | 1 min read | 11.21.01
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.
Insights
Client Alert | 3 min read | 11.21.25
On November 7, 2025, in Thornton v. National Academy of Sciences, No. 25-cv-2155, 2025 WL 3123732 (D.D.C. Nov. 7, 2025), the District Court for the District of Columbia dismissed a False Claims Act (FCA) retaliation complaint on the basis that the plaintiff’s allegations that he was fired after blowing the whistle on purported illegally discriminatory use of federal funding was not sufficient to support his FCA claim. This case appears to be one of the first filed, and subsequently dismissed, following Deputy Attorney General Todd Blanche’s announcement of the creation of the Civil Rights Fraud Initiative on May 19, 2025, which “strongly encourages” private individuals to file lawsuits under the FCA relating to purportedly discriminatory and illegal use of federal funding for diversity, equity, and inclusion (DEI) initiatives in violation of Executive Order 14173, Ending Illegal Discrimination and Restoring Merit-Based Opportunity (Jan. 21, 2025). In this case, the court dismissed the FCA retaliation claim and rejected the argument that an organization could violate the FCA merely by “engaging in discriminatory conduct while conducting a federally funded study.” The analysis in Thornton could be a sign of how forthcoming arguments of retaliation based on reporting allegedly fraudulent DEI activity will be analyzed in the future.
Client Alert | 3 min read | 11.20.25
Client Alert | 3 min read | 11.20.25
Client Alert | 6 min read | 11.19.25
