Investigations and Remedial Measures

Question 1

What is an internal investigation?

Answer 1

A reviewed of the provider’s own programs or activities, conducted by attorneys and/or investigators operating at the provider’s discretion.

Question 2

When establishing an investigative team, what is one area that should be clearly defined?

Answer 2

It is imperative that an investigative team have a clearly defined reporting relationship. The provider needs to define the reporting relationship at the outset and designate one point of contact to direct internal or external legal counsel.

Question 3

Why should a provider retain lawyers during an investigation?

Answer 3

• Regulatory and reimbursement issues typically under review arise from legal requirements
• Often raise ethics, obstruction of justice, and criminal liability
• The work becomes protected under the attorney-client privilege

Question 4

TRUE/FALSE
Is it required that outside consultants and attorney’s used for investigations must confirm that they have complied with HIPAA?

Answer 4

TRUE

Question 5

TRUE/FALSE

Is it required that outside consultants be used for investigations?

Answer 5

• Stabilize the situation, stop any further errors or violations immediately
• Prevent obstruction of justice; destruction of tangible evidence and suborning false testimony from witnesses
• Establish or re-evaluate a document retention plan if one does not already exist

Question 6

What is considered a “document”?

Answer 6

• Paper documents
• Electronic data (filed, spreadsheets, databases)
• Email
• Electronic Transactions

Question 7

What should a provider’s policy state about whistle blowers?

Answer 7

The provider’s policy must be absolutely clear that no one should punish, demote, transfer, or otherwise retaliate against a whistle blower.

Question 8

What should employee’s know about voluntary disclosure to the government?

Answer 8

• They should speak with legal counsel (external) prior to voluntary disclosure
• No employee is obligated to speak with the government
• Tell the truth
• Employee’s are not allowed to provide the investigators with the provider’s property (records, documents, etc.)
• They may stop the interview at any time
• A lawyer can be present
• They can choose the place and time of the interview
• There is no such thing as “off the record”

Question 9

TRUE/FALSE

The provider can pay for an employee’s private legal counsel when seeking legal advice for voluntary disclosure?

Answer 9

TRUE- Although the employee cannot use in-house legal counsel due to conflict of interest, the provider can offer to pay for external counsel

Question 10

What are the components of an investigation Final Report?

Answer 10

• Trigger of the investigation
• the steps the investigator took
• the facts they uncovered and their sources
• an analysis of the nature and extent of the provider’s potential liability, both civil and criminal
• recommendations on how to prevent similar problems in the future
• recommendations on the provider’s obligations upon receiving the report

Question 11

How should recommendations to investigations be handled by compliance?

Answer 11

• Compliance should ensure corrective action plans are developed in response to noncompliance
• Compliance should monitor the effectiveness of corrective action plans in response to noncompliance