Kusserow on Compliance: Is it an internal investigation, inquiry, audit, or evaluation?

In most organizations, there are many people who may be called upon to respond to a complaint or concern raised by an employee, however only a few of these would rise to the level of requiring an investigation. It can be important on how the response to the issue is labeled and convey meaning to people. Two leading experts on the subject were interviewed recently on this subject and provided useful tips, advice and suggestions.

Al Bassett, former FBI executive and a Deputy Inspector General, as well as extensive health care compliance consultant experience makes it a point that “calling something an investigation is using an emotionally ‘charged term’ that suggests a violation of law and enforcement action. This can have an impact on how individuals will respond when being questioned about a situation or issue. When people hear about an ‘investigation’ their imagination may be excited to infer a lot more about what is occurring than is factually correct.”

Emil Moschella, a career investigator and former FBI executive, observed that “Someone announcing they are conducting an investigation generally has the effect of making people more defensive and cautious in responding to questions. Many develop a very cautious attitude, if they believe they are being asked about something that may result in an enforcement action.” Both Bassett and Moschella believe, wherever possible, it is advisable to use neutral terminology to avoid unnecessarily exciting concerns and speculation among employees.

Investigation defined

  • Search to uncover facts and seek the truth of an issue (who, what, when, where, why, how)
  • Inquiring into something thoroughly and systematically
  • Detailed inquiry or systematic examination to gather facts and information to solve a problem, or resolve an issue
  • An inquiry into unfamiliar or questionable activities.

Steve Forman, CPA, has a long history of involvement in conducting a variety of inquiries. He was not only an executive at the HHS Office of Inspector General (OIG), but served many years as Vice President for Audit and Compliance at a major hospital system. He makes the point that “It is clear there are a number of other activities that could meet the general definition of an investigation, including conducting an audit, evaluation, internal inquiry, or internal review. I have found that characterizing the activity using these terms will avoid potential emotional response if using the term investigation.”

Most issues are resolved without a formal investigation

Carrie Kusserow, with over 15 years experience with reviewing literally thousands of hotline complaints, notes “The vast majority of these complaints and reports can be resolve fairly quickly within a day or two, without a formal investigation. Many complaints, allegations, and concerns are routine in nature and may be resolved through normal management procedures or through HRM. Those matters that may implicate a violation of law or regulation normally involve legal counsel. More complex cases may require a significant commitment of resources over a protracted period. In any case, the elements of any investigation or inquiry will include one or more interviews, gathering documents, and a case file.”

Be prepared

Suzanne Castaldo, JD, who has conducting investigations both in the capacity as an attorney and Compliance Officer, says “Some cases do require an investigation, real and in fact. When confronted with this, the key to resolution is how to do this properly. The real answer is having properly trained individuals to conduct the investigation. Professional investigators cannot be expected to be available for a compliance office to conduct an internal investigation, however certain basic principles should be taught to anyone taking on the role of an investigator, whether they come from the compliance office, HRM, legal counsel, privacy office, etc. These include understanding how to plan an investigation, conduct proper interviews, organize evidence, prepare written reports, and document management. It is advisable to have individuals undergo this basic training by experts. This can be done by participating in investigator training courses through Webinars, at conferences, or having experts provide training on site. If the latter, it is advisable to have all those who might be called upon to conduct an investigation participate (i.e., Compliance Officer, HRM, Privacy/Security Officer, Legal Counsel).”

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2016 Strategic Management Services, LLC. Published with permission.