Which organization is primarily responsible for investigating healthcare fraud, waste, and abuse?

The Office of Inspector General (OIG) is primarily responsible for investigating healthcare fraud, waste, and abuse. This organization plays a crucial role in safeguarding public health programs and ensuring the integrity of Federal health care benefit programs. The OIG conducts evaluations, audits, and investigations to identify and address issues related to fraud and abuse within healthcare services.

The OIG is tasked specifically with enforcing compliance within healthcare entities, particularly those that participate in Medicare and Medicaid. Their authority allows them to monitor and evaluate the operations of these programs, identify areas of risk, and implement measures to prevent fraudulent activities. This focus on compliance and oversight is vital for maintaining the integrity of the healthcare system, protecting public funds, and ensuring that beneficiaries receive the services they are entitled to.

Other agencies, such as the Department of Justice (DOJ) and the Centers for Medicare and Medicaid Services (CMS), also play important roles in the broader context of healthcare enforcement and regulation. The DOJ primarily handles prosecutions and legal actions against fraud once investigations have been conducted, while CMS oversees the administration of the Medicare and Medicaid programs but does not focus specifically on fraud investigations. The Federal Trade Commission (FTC) primarily deals with consumer protection and marketplace competition and is not directly involved in the oversight of healthcare