Which organization is responsible for investigating fraud?

The correct answer highlights the collaborative approach to investigating fraud within the healthcare sector, where multiple organizations play significant roles.

CMS, or the Centers for Medicare & Medicaid Services, is responsible for ensuring proper administration of Medicare and Medicaid programs. In this capacity, it investigates potential cases of fraud related to these healthcare services, helping to protect program integrity and federal funds.

The Department of Justice (DOJ) takes on a critical role in criminal investigations and prosecutions related to healthcare fraud. It is responsible for enforcing laws against fraudulent activities that affect both federal and state healthcare programs.

The Internal Revenue Service (IRS) is involved in cases where fraud may also intersect with tax laws, particularly concerning the reporting of income and potential tax evasion associated with fraudulent healthcare practices.

Each of these agencies contributes its specialized expertise and jurisdiction, reflecting a comprehensive strategy in addressing healthcare fraud. This approach is essential because fraud can manifest in various forms and impact multiple areas, necessitating coordination among different governmental bodies to effectively combat it.