Who is responsible for conducting investigations into fraud committed by Medicare providers?

The Office of the Inspector General (OIG) plays a crucial role in conducting investigations into fraud committed by Medicare providers. This agency is specifically tasked with overseeing the integrity of healthcare programs, including Medicare and Medicaid. The OIG not only investigates instances of fraud, waste, and abuse but also works to prevent such activities through audits and evaluations of Medicare providers.

The OIG's independent status and its comprehensive authority allow it to enforce federal laws and ensure compliance by healthcare providers. Investigations led by the OIG may result in criminal prosecutions, civil charges, or administrative actions against those who exploit Medicare resources.

While other entities, such as Medicare administrative contractors and the U.S. Attorney General, may also have roles in overseeing health program integrity and pursuing fraud cases, the primary responsibility for initiating and conducting investigations specifically falls under the domain of the OIG. The Centers for Medicare & Medicaid Services (CMS) focuses more on policy implementation and regulatory oversight rather than direct fraud investigations. Thus, the OIG is recognized as the leading authority in addressing Medicare fraud.