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Fraud Risk Indicator
OIG assessment of future risk posed by persons who have allegedly engaged in civil healthcare fraud.

This is a graphic that shows high risk to low risk respectfully: Exclusion; Heightened Scrutiny; CIAs; No Further Action; Self-Disclosure

False Claims Act Settlements on the Risk Spectrum FY 2019 Q1

The government's primary civil tool for addressing healthcare fraud is the False Claims Act (FCA). Most FCA cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. Based on the information it gathers in an FCA case, OIG assesses the future trustworthiness of the settling parties (which can be individuals or entities) for purposes of deciding whether to exclude them from the Federal healthcare programs or take other action.

OIG applies published criteria to assess future risk and places each party to an FCA settlement into one of five categories on a risk spectrum. OIG uses its exclusion authority differently for parties in each category (as described in the criteria and below). OIG bases its assessment on the information OIG has reviewed in the context of the resolved FCA case and does not reflect a comprehensive review of the party. Because OIG's assessment of the risk posed by a FCA defendant may be relevant to various stakeholders, including patients, family members, and healthcare industry professionals, OIG makes public information about where a FCA defendant falls on the risk spectrum.

Risk Categories