Health care compliance investigations are not like a fine wine, stressed Kashish Chopra—age may improve a wine, but waiting for an investigation will never make it go more smoothly. Chopra, along with former HHS Inspector General Richard P. Kusserow, both of Strategic Management Solutions, presented a webinar titled Best Practices for Internal Investigations, during which they provided pertinent information on internal investigations. The information included the goals of such investigations, key individuals who should be involved in the process, and necessary steps and precautions. They also provided listeners with a sample Protocol Policy to clarify the relationship between a compliance officer and legal counsel when they have overlapping responsibilities.
Kusserow and Chopra explained the importance of having an internal investigation program as part of a robust compliance program. Internal investigations are a form of risk management, as they can prevent costly mistakes and provide reassurance to everyone that problems and reports are taken seriously and examined carefully. The foundation of a successful investigation is to have a formalized process for everything, including even informal processes, to ensure that complaints can be received, investigated, and, if necessary, mitigated. Chopra noted that although most complaints that anonymous compliance hotlines receive are related to human relations (HR), the type of complaints that are most likely to lead to an investigation include allegations of harassment, discrimination, retaliation, privacy or security threats, theft or fraud, notice of litigation, and inquiries by government agencies or contractors.
It is important for all individuals involved in an investigation to have well-defined roles and to maintain communication and transparency. Kusserow explained how it is important, during an investigatory interview, to minimize note-taking and maintain eye contact; however, he reminded listeners to build in time between interviews to fill in gaps left by minimal note-taking to ensure adequate records are kept. They also provided tips on how to “triage” complaints—ranking tasks according to priority, which requires a quick, accurate assessment of each issue. They especially emphasized the importance of providing individuals the opportunity to report problems both confidentially and anonymously. The difference being that although anonymity is protected, there is no obligation for the compliance department to protect the job of an anonymous source, while confidential sources must be protected against retaliation.