The Office of Inspector General (OIG) has announced the launch of a new tool, which OIG has titled the “Fraud Risk Indicator.” A preliminary page for the Fraud Risk Indicator is available here on OIG’s website. OIG’s stated purposes for the tool are to provide guidance as to how it has evaluated risk in settling False Claims Act (FCA) cases and publicize information about where FCA defendants fall on OIG’s risk spectrum for the benefit of patients, healthcare industry professionals and other stakeholders who may consider such information relevant. Greg Demske, Chief Counsel to the Inspector General, provided details of OIG’s plans for the Fraud Risk Indicator during last week’s AHLA Fraud and Compliance Forum.

Mr. Demske explained that OIG will use the Fraud Risk Indicator to track resolutions that fit within each of the five categories of determinations on the risk spectrum bar set forth in OIG’s 2016 guidance for implementing exclusion authority. Those categories are as follows:

• Highest Risk – Exclusion: Parties that OIG has excluded from Federal healthcare programs.
• High Risk – Heightened Scrutiny: Parties that OIG has determined to pose “significant risk” to Federal healthcare programs because these parties have refused to enter into CIAs despite OIG’s determination that additional oversight is needed.
• Medium Risk – CIAs: Parties that have signed CIAs with OIG in settling investigations. Mr. Demske noted that OIG intends to list older CIAs that have already closed.
• Lower Risk – No Further Action: Parties with cases that have been closed without OIG seeking exclusion or requiring a CIA based on OIG’s determination that they present a “relatively low risk” to Federal healthcare programs.
• Low Risk – Self-Disclosure: Parties that have self-disclosed potential fraud and abuse to OIG.

Describing the rationale for the new tool, Mr. Demske stated that visibility into where an entity stands has historically been opaque where there has been an FCA settlement without a CIA. More specifically, Mr. Demske explained, parties have been unable to know whether such an entity belonged on the high-risk end of the spectrum—having refused to enter a CIA—or on the opposite end of the spectrum—having been determined by OIG to be low risk. Mr. Demske indicated that the Fraud Risk Indicator will provide more transparency in this regard.

Please click here to access the new Fraud Risk Indicator site.