CHC - Certified in Healthcare Compliance Internal Investigations Questions and Answers — Questions and Answers
Question 1: A compliance officer begins an internal investigation into a billing department employee based on a credible whistleblower report alleging upcoding. To best preserve the attorney-client privilege during the investigation, which of the following is the MOST critical step to take at the outset?
- Immediately suspend the employee pending the outcome of the investigation.
- Engage legal counsel to direct and oversee the investigation. (Correct answer)
- Notify the OIG of the potential issue via their self-disclosure protocol.
- Interview the accused employee before they have a chance to alter records.
Correct answer: Engage legal counsel to direct and oversee the investigation.
To ensure communications and work products related to the investigation are protected under attorney-client privilege, the investigation should be conducted for the purpose of seeking legal advice. Engaging legal counsel to direct the investigation from the beginning is the most effective way to establish and maintain this privilege.
Question 2: During an internal investigation interview regarding potential HIPAA violations, the compliance officer is questioning a witness who seems hesitant and fearful of retaliation. Which of the following interview techniques is most appropriate to encourage open communication?
- Reminding the employee that failure to cooperate could result in disciplinary action.
- Conducting the interview in a busy, open-plan office to appear less formal.
- Asking leading questions to quickly confirm the suspected violations.
- Explaining the non-retaliation policy and conducting the interview in a private, neutral setting. (Correct answer)
Correct answer: Explaining the non-retaliation policy and conducting the interview in a private, neutral setting.
To build rapport and encourage a witness to be forthcoming, it is crucial to create a safe and confidential environment. Explaining the organization's non-retaliation policy and choosing a private, neutral location for the interview helps to reduce anxiety and demonstrates the integrity of the process. Threatening discipline or asking leading questions can intimidate the witness, while a non-private setting undermines confidentiality.
Question 3: A hospital's compliance department concludes an internal investigation that substantiates improper billing to a federal healthcare program, resulting in a significant overpayment. According to federal law and OIG guidance, what is the organization's primary obligation after quantifying the overpayment?
- Discipline the employees responsible for the improper billing.
- Wait for the next scheduled quarterly audit to report the findings.
- Report and return the overpayment within 60 days of its identification. (Correct answer)
- Implement a new training program for the entire billing department.
Correct answer: Report and return the overpayment within 60 days of its identification.
The Affordable Care Act's "60-Day Rule" requires that overpayments from a federal healthcare program be reported and returned within 60 days of the date on which the overpayment was identified. Failure to do so can result in False Claims Act liability. While disciplinary action and training are important corrective actions, the most immediate and critical legal obligation is the timely return of the funds.
Question 4: Which of the following BEST describes the primary purpose of creating an investigation plan before beginning interviews and data collection?
- To satisfy the Board of Directors that the compliance department is taking action.
- To provide a formal report to the government in case of a future inquiry.
- To predetermine the outcome and identify the responsible parties quickly.
- To define the scope, objectives, timeline, and resources needed for a thorough and impartial review. (Correct answer)
Correct answer: To define the scope, objectives, timeline, and resources needed for a thorough and impartial review.
An investigation plan is a critical first step that outlines the scope, key questions, timeline, and necessary resources. This ensures the investigation is structured, efficient, and remains focused on its objectives, promoting a thorough and fair process rather than a predetermined conclusion.
Question 5: A compliance investigator is collecting electronic evidence as part of an inquiry into data tampering. To ensure the evidence is admissible in potential future legal proceedings, what is the most important principle to follow?
- Making multiple copies of the data and distributing them to the investigation team.
- Maintaining a clear and documented chain of custody for the evidence.
- Interviewing the IT staff about their opinion on who may have altered the data. (Correct answer)
- Printing hard copies of all electronic files for the investigation binder.
Correct answer: Interviewing the IT staff about their opinion on who may have altered the data.
Maintaining a chain of custody is a critical forensic principle that involves documenting the seizure, custody, control, transfer, analysis, and disposition of evidence. This process ensures the integrity of the evidence and proves that it has not been tampered with, which is essential for it to be admissible in a formal legal proceeding.
Question 6: After completing an internal investigation that substantiated a violation of the organization's code of conduct, what is a critical final step in the investigation process?
- Informing all employees via a company-wide email about the outcome.
- Archiving the investigation file in a publicly accessible folder for transparency.
- Identifying the root cause and implementing corrective actions to prevent recurrence. (Correct answer)
- Immediately terminating the subject of the investigation without further review.
Correct answer: Identifying the root cause and implementing corrective actions to prevent recurrence.
A key goal of any investigation is not just to address the specific incident but also to prevent future non-compliance. Therefore, analyzing the evidence to determine the root cause of the issue and implementing a corrective action plan (which may include policy changes, training, or system improvements) is a crucial final step to improve the overall effectiveness of the compliance program.
CHC - Certified in Healthcare Compliance Internal Investigations Questions and Answers
A compliance officer begins an internal investigation into a billing department employee based on a credible whistleblower report alleging upcoding.
To best preserve the attorney-client privilege during the investigation, which of the following is the MOST critical step to take at the outset?