Details about HHS-OIG's enforcement actions and how we categorize them.
On this page
- Criminal and Civil
- Corporate Integrity Agreement Enforcement
- Civil Monetary Penalties and Affirmative Exclusions
Criminal and Civil
Actions related to the Office of Inspector General’s investigative and legal work. These cases often result from OIG’s work as part of its Most Wanted Health Care Fugitives initiative, the Medicare Fraud Strike Force, and other similar efforts. Since this work culminates in legal action by the U.S. Department of Justice (DOJ), links are provided to relevant news releases issued by DOJ or one of their 93 U.S. Attorneys.
Medicaid Fraud Control Units (MFCUs) and Other State Agencies
The MFCUs, typically a part of the State Attorney General’s Office, investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities. MFCUs operate in all 50 States, the District of Columbia, and the territories of Puerto Rico and the U.S. Virgin Islands.
Corporate Integrity Agreement Enforcement
Providers under a Corporate Integrity Agreements (CIA) or Integrity Agreements (IA) with the OIG are required to disclose certain "Reportable Events" which include: a substantial overpayment, a matter that a reasonable person would consider a probable violation of criminal, civil, or administrative laws applicable to any Federal health care program for which penalties or exclusion may be authorized; and the employment of or contracting with an excluded individual. Matters disclosed to the OIG as a Reportable Event may implicate OIG's Civil Monetary Penalty authorities.
Stipulated Penalties and Material Breaches
OIG enters into Corporate Integrity Agreements (CIAs) and Integrity Agreements (IAs) with health care providers and other entities as part of the settlement of Federal health care program investigations arising under a variety of civil false claims statutes. The CIA/IA breach and default provisions allow the OIG to impose certain monetary penalties (referred to as Stipulated Penalties) for the failure to comply with certain obligations set forth in the CIA/IA. In addition, a material breach of the CIA/IA constitutes an independent basis for the provider’s exclusion from participation in the Federal health care programs.
Civil Monetary Penalties and Affirmative Exclusions
OIG has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct. In each CMP case resolved through a settlement agreement, the settling party has contested the OIG’s allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.
Provider Self-Disclosure Settlements
Providers who wish to voluntarily disclose self-discovered evidence of potential fraud to OIG may do so under the Provider Self-Disclosure Protocol (SDP). Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.
Grantee Self-Disclosure Settlements
Recipients of HHS awards may voluntarily disclose conduct creating liability under the Civil Monetary Penalty Law (CMPL), 42 U.S.C. § 1320a-7a, or any other conduct—such as conduct that might violate civil or administrative laws—that does not clearly fall within the scope of offenses described at 45 C.F.R. § 75.113.