Inspector General (OIG) Investigation Defense

An OIG investigation looks less alarming than an FBI one and is frequently more dangerous to a professional, because the administrative consequences arrive faster and are harder to undo.

Exclusion from federal healthcare programmes is career-ending for most providers, and it does not require a criminal conviction.

Which Inspectors General bring cases in Texas

HHS-OIG — healthcare fraud, Medicare and Medicaid, Anti-Kickback Statute, Stark Law. By far the most active in Texas given the size of the healthcare sector.
VA-OIG — veterans benefits fraud and VA contracting and care.
SSA-OIG — disability and retirement benefits fraud, representative payee cases.
DoD-OIG and DCIS — defense procurement fraud, product substitution, bid rigging.
DOL-OIG — unemployment insurance fraud, including the very large volume of pandemic-era cases, and union and benefit plan matters.
ED-OIG — student financial aid fraud.
SBA-OIG — PPP and EIDL fraud.

Administrative subpoena power

Inspectors General can issue administrative subpoenas for documents without a grand jury. A subpoena is often the first sign of an investigation, and it usually goes to the entity rather than the individual.

Note what they cannot do: an IG administrative subpoena generally cannot compel testimony from a private individual. If you are being asked to sit for an interview, that is a request, and it can be declined.

Exclusion: the consequence that is not criminal

This is the part providers underestimate. Under 42 U.S.C. § 1320a-7, HHS-OIG can exclude an individual or entity from participation in Medicare, Medicaid, and all federal healthcare programmes.

Exclusion is mandatory following conviction of certain offenses — programme-related crimes, patient abuse or neglect, felony healthcare fraud, and felony controlled substance offenses — with a minimum five-year term. It is permissive in a wider set of circumstances, including on the basis of conduct that was never criminally charged.

For most clinicians, exclusion is the end of practice. No federal programme will pay for their services, and no employer that bills those programmes can employ them. It frequently matters more than the sentence, and it should be a central term of any negotiated resolution rather than an afterthought discovered later.

Civil monetary penalties and the False Claims Act

OIGs also pursue civil monetary penalties, and their investigations frequently sit alongside a False Claims Act action under 31 U.S.C. § 3729 — often begun by a qui tam relator, typically a former employee, filed under seal.

The seal matters: an FCA complaint can be pending against you for a year or more while the government investigates and you know nothing about it. FCA exposure is treble damages plus per-claim penalties, and it can dwarf any criminal fine.

Three tracks at once

A serious OIG matter can run criminal, civil, and administrative proceedings simultaneously, and information moves between them. Statements in an administrative interview reach the prosecutor. A civil settlement with factual admissions can decide the criminal case. Asserting the Fifth Amendment protects you criminally but permits an adverse inference civilly and may itself trigger administrative action.

These trade-offs cannot be managed by separate lawyers acting independently, and the sequencing — which matter to resolve first, and on what terms — is the core strategic decision.

What an OIG interview actually is

OIG agents are federal criminal investigators. The interview is often framed as an administrative or compliance conversation, which leads people to treat it as routine. It is not: 18 U.S.C. § 1001 applies in full, and a false answer is a felony.

If you are an employee being interviewed about your employer, whose counsel is in the room matters enormously. Company counsel represents the company, and the company's interests and yours can diverge quickly.

What to do if agents contact you

Do not answer questions. Say that you want to speak with a lawyer, and say nothing else. That is lawful and cannot be used as evidence of guilt. Lying to a federal agent is a separate felony under 18 U.S.C. § 1001 — no oath required.

Do not consent to a search. If they have a warrant they do not need permission.

Do not destroy anything. A preservation duty attaches the moment you know of the investigation.

Write down what happened — names, agency, time, what was asked, what was taken — the same day.

Then call (214) 225-7117. The pre-indictment window is the most valuable period you have.