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.

Kusserow on Compliance: 3-Part Webinar

Internal Investigations: Managing Risk and Executing with Excellence

3-Part Webinar Series
Thursday, September 1, 15, and 29, 2016
1:00 PM – 2:30 PM Eastern Time

(5.4 CEUs; 3.75 CLE hours, 0.75 ethics hours)

Organizations must be prepared to address allegations of fraud, misconduct, harassment, retaliation, safety and code violations, among others.  It is imperative that all organizations, regardless of their place in the healthcare industry, develop an internal investigations program to address these circumstances properly, as failure to do so can escalate the problem and increase exposure to legal liability. Join former HHS Inspector General, Richard Kusserow, and his faculty for best practices, sample policies, and continuing education credits.  Over the course of this 3-part webinar series, the faculty of career federal investigators and attorneys will provide guidance on how to develop an internal investigation program, respond to employee complaints, prepare for investigations, conduct interviews, write final reports to close investigations, and communicate findings to executives and boards of directors.  Each webinar in the series will clearly detail the phases of an internal investigation, pitfalls to avoid, and how to execute with excellence while mitigating risk.  Register today for this webinar on executing effective internal investigations:

  • Establishing internal investigation program and policies and procedures to support action.
  • Perspective on the roles Legal, Compliance, and Human Resources in investigations
  • The 7 steps to an investigation
    • Gathering background information
    • Planning the investigation
    • Initiating the investigation
    • Executing interim actions in an organization
    • Gathering documentary evidence and conducting interviews
    • Writing the final investigation report
    • Closing the case and communicating findings
  • Guidance on how to conduct interviews, fact finding, and the art of questioning.
  • Interview tips for dealing with deception.
  • Best practices for managing information and documentary evidence.
  • Effective report writing and disclosures.
  • Best practices for communicating to management, the Board, and outside agencies.
  • An opportunity to get answers to your specific questions.
Faculty: Richard Kusserow
Emil Moschella, JD
Suzanne Castaldo, JD, CHC
Kashish Chopra, JD, MBA, CHC
Register Now
Dates: Part I: Establishing an Internal Investigation Program: Protocol, Planning, and Investigation Initiation. Thursday September 1, 2016, 1:00-2:30 PM Eastern Time

Part II: Gathering Documentary Evidence and Conducting Interviews. Thursday September 15, 2016, 1:00-2:30 PM Eastern Time

Part III: Writing an Investigation Report and Closing Actions. Thursday September 29, 2016, 1:00 -2:30 PM Eastern Time

Fees: $495 per site for the complete 3-Part series – 15% Discount
(5.4 CEUs, 3.75 CLE hours, 0.75 ethics hour total)$195 per site per session if registering a-la-cart
(1.8 CEUs, 1.25 CLE hours, 0.25 ethics hours per session)
Registration: Click “Register Now” or use the following link:  http://goo.gl/g8gp3U
(Registration is open, feel free to forward to colleagues)

 

For more information about this webinar series or CLE/CEU approval, please contact Kashish Chopra, kchopra@strategicm.com or call 703-535-1413. CLE credit approval: TX
For compliance information on internal investigation services visit:

Strategic Management brings an unparalleled depth of knowledge and experience to the compliance risk issues facing health care organizations.  More information on the firm can be found at www.compliance.com or by contacting us at (703) 683-9600.