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UGU.S. Department of Health and Human Services Office of Inspector General logo

U.S. Department of Health and Human Services Office of Inspector General

Unclaimed
oig.hhs.govWashington, DC, United StatesUpdated

HHS-OIG protects the integrity of HHS programs by auditing, investigating, and evaluating for fraud, waste, and abuse.

Overview

HHS Office of Inspector General (HHS-OIG) conducts independent audits, evaluations, and investigations of U.S. Department of Health and Human Services programs, operations, and beneficiaries to identify waste, fraud, and abuse and to promote economy, efficiency, and effectiveness. It comprises the Immediate Office and five principal components: Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, Office of Management and Policy, and Office of Counsel to the Inspector General. HHS-OIG provides public resources such as a Work Plan and Semiannual Report to Congress, offers advisory opinions and compliance guidance, and operates a Hotline to receive tips about fraud, waste, and abuse. Its mission is to protect the integrity of HHS programs and ensure accountability in the use of federal funds, safeguarding beneficiaries and taxpayers. The Office of Investigations emphasizes a national scope and uses state-of-the-art tools to pursue criminal, civil, and administrative cases, aiming to be the world's premier health care law enforcement agency.

Mission statement

To protect the integrity of Health and Human Services programs by detecting and deterring fraud, waste, and abuse through audits, investigations, evaluations, and guidance.

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What we offer

RAT-STATS

RAT-STATS enables effective claims audits through random sampling and improper payment estimation.

Pricing not published

oig.hhs.gov/compliance/rat-stats/

Advisory Opinions

Service

Provides legal clarity on compliance with fraud and abuse laws for business arrangements.

Pricing not published

oig.hhs.gov/compliance/advisory-opinions/

Corporate Integrity Agreements

Service

Enhances compliance and fraud prevention for healthcare entities through structured agreements.

Pricing not published

oig.hhs.gov/compliance/corporate-integrity-agreements/

A Roadmap for New Physicians

Service

Provides essential guidance for new physicians on compliance with Medicare and Medicaid fraud laws.

Pricing not published

oig.hhs.gov/compliance/physician-education/

General Compliance Program Guidance

Service

GCPG supports health care providers in navigating compliance with Federal health care laws.

Pricing not published

oig.hhs.gov/compliance/compliance-guidance/

OIG Hotline

Service

Provides a confidential way to report healthcare fraud, waste, and abuse.

Pricing not published

oig.hhs.gov/fraud/report-fraud/

Market segments

Market size by segment

Growth potential (CAGR)

Regulatory advisory and legal opinion

0.5 Billion USD9% CAGR

Formal opinions and written guidance that interpret the application of federal health care fraud and abuse laws to specific business arrangements.

Products: Advisory Opinions

Regulatory compliance management

30 Billion USD13% CAGR

Capabilities that monitor regulatory change, centralize compliance tasks, manage regulatory change processes, and surface expert-backed, auditable guidance for compliance teams.

Products: Corporate Integrity Agreements, General Compliance Program Guidance

Fraud reporting and investigations

0.8 Billion USD9% CAGR

Channels and processes to receive, triage, and investigate allegations of fraud, waste, and abuse affecting federal health care programs.

Products: OIG Hotline

Audit sampling and improper payment estimation

87.1 Billion USD7.5% CAGR

Statistical sampling and estimation methods used in claims audits to select samples and estimate improper payments.

Products: RAT-STATS

Provider education and compliance

3.2 Billion USD11.5% CAGR

Access to educational materials, guidance, and regulatory updates that help clinicians and organizations comply with federal program rules and implement best practices.

Products: A Roadmap for New Physicians

More information about our offering

RAT-STATS

RAT-STATS is a free statistical software package developed by the Office of Inspector General to aid in audits of health care programs. It helps users select random samples for claims reviews and to estimate improper payments from sampled data. The software is provided without formal technical support.

Pricing not published

  • Access Free Software
    Users can download RAT-STATS without any cost, ensuring broader access for needs related to health care audits.
  • Select Random Samples
    Enhances the integrity of claims reviews by employing random sampling methods, crucial for effective audit practices.
  • Estimate Improper Payments
    Facilitates accurate estimation of improper payments, helping organizations identify areas of concern in financial audits.
  • Utilize User-Friendly Interface
    Optimized for accessibility, RAT-STATS enables users to navigate and utilize its features without extensive statistical training.
  • Understand Limited Support
    Users should note that while RAT-STATS is user-friendly, they must handle technical inquiries independently.

Advisory Opinions

HHS-OIG issues advisory opinions about the application of fraud and abuse enforcement authorities to the requesting party’s existing or proposed business arrangements.

Pricing not published

  • Clarifies Legal Application
    Provides essential guidance on the application of federal anti-kickback statutes and related laws to various business scenarios.
  • Facilitates Process Requests
    Streamlines the procedure for businesses to seek legal opinions on compliance with applicable laws.
  • Access Recent Legal Opinions
    Allows stakeholders to stay informed about the latest advisories relevant to business practices.
  • Enhances Understanding
    Addresses common concerns and clarifies processes surrounding the advisory opinion requests.

Corporate Integrity Agreements

A Corporate Integrity Agreement (CIA) is an agreement between an entity and the Office of Inspector General (OIG) outlining obligations to improve compliance and prevent fraud, often as part of a civil settlement involving allegations of fraud against Federal health care programs.

Pricing not published

  • Enhances Compliance Oversight
    The CIA mandates critical measures for compliance, such as appointing a compliance officer and conducting periodic independent reviews, ensuring adherence to Federal laws.
  • Protects Program Participation
    During the CIA, OIG’s agreement not to exclude the entity from Federal health care programs allows continued participation and mitigates disruptions in services.
  • Ensures Transparency and Accountability
    Regular reporting on compliance activities to OIG promotes transparency, helping prevent future fraud and ensuring accountability for adherence to the CIA.
  • Enables Enforcement of Compliance
    Breach provisions empower OIG to enforce compliance through monetary penalties, ensuring organizations take their obligations seriously.
  • Cultivates a Culture of Compliance
    Training ensures that staff understand legal obligations and ethical standards, fostering an environment that prioritizes integrity.

A Roadmap for New Physicians

Educational materials to assist in teaching physicians about the Federal fraud and abuse laws; includes a booklet, PowerPoint, speaker notes, and narrated content.

Pricing not published

  • Serves as a Self-Study Resource
    The booklet contains comprehensive information on fraud and abuse laws, aiding physicians in their self-education.
  • Enhances Understanding Through Visuals
    The PowerPoint slides provide a structured presentation format to enhance the learning experience for attendees.
  • Supports Effective Presentations
    The speaker notes provide additional context and guidance for presenters, ensuring accurate delivery and clarification of concepts.
  • Facilitates Remote Learning
    The audio narration ensures that remote learners can understand the material clearly, enhancing engagement and retention.

General Compliance Program Guidance

General Compliance Program Guidance (GCPG) provides information about compliance program infrastructure and Federal health care program standards.

Pricing not published

  • Tailor Compliance Programs To Specific Sectors
    Specific guidance is available for diverse health care sectors, helping organizations navigate compliance effectively.
  • Establish Strong Compliance Frameworks
    GCPG provides vital insights on establishing effective compliance programs tailored to meet Federal standards.
  • Stay Updated With Compliance Changes
    Users can access a comprehensive archive of compliance program guidance documents, ensuring they remain informed about the latest updates.
  • Access Legal Clarity On Compliance
    Healthcare organizations can request advisory opinions that clarify how specific laws apply to their arrangements.

OIG Hotline

The Office of Inspector General operates a hotline to receive tips about fraud, waste, and abuse in Federal health care programs via online submission or phone.

Pricing not published

  • Report Online
    Easily submit your complaint through the online form for immediate processing.
  • Report By Phone
    Speak directly to a representative for more personal assistance.
  • Report Anonymously
    Allows individuals to submit tips without revealing their identity.
  • Multiple Reporting Channels
    Provides flexibility in how reports can be submitted.

Sources

Methodology and sourcing behind the figures and links shown above.

Regulatory advisory and legal opinion

Estimated U.S. market size derived by applying the observed share of ‘‘legal representation’’ within broader regulatory‑affairs outsourcing reports (~10–11%) to U.S. regulatory‑affairs market totals. Sources show U.S. regulatory affairs ≈ USD 4.55B (2023) and multiple outsourcing/RA market reports report legal representation ≈ USD 1.0B (2025) and overall CAGRs ~8.5–9.3%. Given these inputs and the niche focus on federal health‑care fraud/abuse legal opinions (a high‑specialty legal subsegment), the estimated market is ~USD 0.5B with growth potential near the legal/RA segment CAGR (~9%).

Regulatory compliance management

Estimation synthesizes overlapping market figures from RegTech, GRC, and quality & compliance segments in the provided results. Grand View (RegTech) reports ~USD 24.3B (2025) with high growth; IMARC (GRC) reports USD 54.7B (2025) with ~10.6% CAGR; Coherent reports quality & compliance ~USD 33.06B (2026) with 9.8% CAGR; Precedence reports healthcare compliance software at USD 3.8–4.31B with ~13.2% CAGR. Regulatory compliance management is a subset spanning these categories; a conservative mid-point market size of ~USD 30B and growth potential ~13% CAGR reflects this aggregation and the acceleration from RegTech-specific forecasts.

Fraud reporting and investigations

Estimation based on global fraud detection & prevention market figures from industry reports (KBV, MarketsandMarkets, LinkedIn post) scaled to the narrow subsegment (reporting, triage, investigation) for federal healthcare programs. Global FDP market mid-range ~USD 25–36B (sources). Assume healthcare vertical represents ~10–15% of global FDP ($~2.5–5.4B). Federal health programs (Medicare/Medicaid) comprise a minority of healthcare vertical FDP spend; applying a conservative 15–25% share yields ~$0.4–1.35B for government healthcare fraud solutions. The reporting/triage/investigations channels/processes are a material portion of program-integrity budgets; selecting a central value yields an estimated market size of ~USD 0.8B. Growth potential is lower than commercial FDP CAGR (reported ~17–18%); federal procurement and regulatory cycles imply steadier growth — estimated CAGR ~9% annually.

Audit sampling and improper payment estimation

Estimated addressable annual value equals the sum of documented improper payments reported by CMS across major programs (Medicare FFS, Part C, Part D, Medicaid, CHIP, APTC) (~$87.1B). USDA APEC II findings show similar improper-payment measurement work in school meal programs (percent-of-reimbursement estimates), supporting that statistical sampling/estimation is applied across government programs. Growth potential (CAGR ~7.5%) is an internal estimate reflecting continued regulatory audit activity, persistent multi‑billion-dollar improper payments, and rising adoption of analytics/AI for continuous monitoring and extrapolation in audits.

Provider education and compliance

Estimated as the healthcare-focused portion of the broader compliance-training market. Zion Market Research reports a healthcare data compliance market of ~USD 3.2B (2023) with ~11.5% CAGR; broader compliance-training reports show larger global market estimates (USD ~4.9–5.2B) and higher CAGRs (≈7.5–12.5%), so the 3.2B / ~11.5% estimate is conservative and aligned to provider-facing healthcare compliance.

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