From the Contributor’s Corner: Are You Prepared to Properly Conduct Internal Investigations?

Relatively few compliance officers, HR professionals, safety officers, HIPAA privacy/safety officers, and others charged with determining potential wrongdoing or liability have had any formal training in how to conduct internal investigations. Improperly trained investigators may aggravate matters and create new liability problems, whereas properly trained internal investigators can reduce the exposure to lawsuits, litigation, and government adverse actions.

Failure to act upon allegations and complaints may lead employees to feel their complaints are not taken seriously internally, and cause them to choose to go externally for redress of grievances and concerns. To prevent individuals reporting to a government agency, attorney, or the media, it is critical to have a credible response and investigative response to information received, regardless of the source. Failure here may mean initiation of legal civil action, or a report to a local media outlet about a potential problem.

Matters requiring investigation extend far beyond issues limited to the concern of the compliance office.  The following are examples of the types of cases that may result in an internal investigation that cuts across compliance, human resources, privacy officers, risk management, and others:

  • Violations of laws/regulations
  • Violations of the Code/Policies
  • Unlawful Harassment
  • Discrimination
  • Fraud or Theft
  • HIPAA Privacy/Security Violations
  • Conflicts of Interest
  • Drug or Alcohol Abuse
  • Patient Abuse
  • Safety Violations

There are different ways to answer this need.

  • Expert investigators can be retained to assist whenever a matter arises warranting a serious investigation, but this could be costly, if used very often.
  • Investigations can be turned over to attorneys retained by the organization; however, this is not only very expensive, but the attorneys may not be professional investigators.
  • The organization can develop internal investigation capability to resolve the great majority of issues without having to turn to expert investigators or attorneys.

I believe the last solution is the most cost-effective solution.  It also recognizes that the overwhelming percentage of investigations will be fairly simple and not require a lot of specialized expertise.  However, taking this approach means a training program that includes anyone who may be called upon to conduct an internal investigation or query, including those in the Compliance Office, Human Resource Management, Privacy, Safety and Security Offices, Legal Counsel, Internal Audit, etc.

For best results the training should be offered as a live facilitated program by professional investigators with a great deal of experience and expertise.  A canned seminar approach of an hour or two by someone who is not an expert will not achieve many material results.  The program should be at least a one or two-day effort.  The course itself should focus on how to conduct an internal investigation and address a variety of issues, such as:

  • What types of problems is your organization likely to investigate?
  • What is needed to predicate an investigation?
  • How do you determine who should conduct the investigation?
  • What steps do you need to follow upon receiving complaints and allegations?
  • When should the investigation be under direction of legal counsel?
  • How should someone filing a complaint be debriefed?
  • What are best-practices for getting accurate information about the allegation?
  • How can investigations be conducted, without disrupting your workforce?
  • What documentary evidence should be gathered prior to interviewing?
  • How do you prepare questions for witness interviews?
  • How do you select appropriate interviewing locations and setting?
  • How do you interview witnesses and subjects of an investigation?
  • What types of settings are best for interviewing?
  • How can deception be detected?
  • How should a chain of custody and a confidential retention process work?
  • How do you write reports of interview?
  • How do you develop a standard format for documenting investigative findings?
  • How do you develop a case report and what should be included within it?
  • How do you collect, manage, store, and report on investigations?
  • What investigative policies, procedures, and protocols are needed?
  • How should disciplinary actions arising from an investigation be handled?

Training should stress the practical, not theoretical aspects of investigations and include exercises to give “hands on” experience in different scenario settings.  The training should provide a thorough grounding in internal investigations and provide the knowledge of how to properly conduct internal investigations to minimize legal liability and reduce employee complaints. Trainers should provide training on step-by-step internal investigation techniques and processes that can be applied in all types of investigations.

If this initial investment is made, the health care provider will benefit from it for years to come, as well as avoid making costly mistakes that could give rise to significant penalties, loss of reputation, and conflicts with government regulatory and enforcement agencies.

Richard Kusserow, served as the DHHS Inspector General for 11 years with prior services in the FBI.  He is the author of Conducting Internal Investigations in Health Care Organizations, AIS, 2011, (ISBN 979-1-936230-60-8). He currently is CEO of Strategic Management Services, a firm that provides expert investigators and trainers for conducting investigations.

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Copyright © 2013 Strategic Management Services, LLC.  Published with permission.