CHC Internal Investigations 2 — Questions and Answers
Question 1: When interviewing a potential whistleblower during an internal investigation, what is the MOST important protection to communicate?
- Their identity will be kept confidential from all parties
- Retaliation for good-faith reporting is prohibited under company policy and law (Correct answer)
- They will receive financial compensation for cooperation
- Their statements will not be shared with legal counsel
Correct answer: Retaliation for good-faith reporting is prohibited under company policy and law
Anti-retaliation protections are a legal and ethical obligation that must be clearly communicated to encourage candid participation.
Question 2: Which privilege protects communications between a healthcare organization's in-house counsel and employees during an internal investigation?
- Work product doctrine
- Attorney-client privilege (Correct answer)
- Peer review privilege
- Common interest privilege
Correct answer: Attorney-client privilege
Attorney-client privilege protects confidential communications between counsel and employees when the communication is for the purpose of obtaining legal advice.
Question 3: A compliance investigation reveals that a physician self-referred patients to a facility in which he has an ownership interest. Which federal law is MOST directly implicated?
- False Claims Act
- Stark Law (Physician Self-Referral Law) (Correct answer)
- Anti-Kickback Statute
- HIPAA Privacy Rule
Correct answer: Stark Law (Physician Self-Referral Law)
The Stark Law prohibits physician self-referrals for designated health services when the physician has a financial relationship with the entity.
Question 4: During an investigation, an employee invokes their Fifth Amendment right against self-incrimination. What should the compliance investigator do?
- Terminate the interview and close the investigation
- Continue the interview using only written questions
- Note the invocation and consult with legal counsel before proceeding (Correct answer)
- Inform the employee they must answer as a condition of employment
Correct answer: Note the invocation and consult with legal counsel before proceeding
The invocation of Fifth Amendment rights in a workplace investigation requires legal guidance to balance investigative needs with employee rights.
Question 5: What does the term 'Upjohn warning' refer to in the context of a healthcare compliance investigation?
- A notice to employees that their communications with company counsel represent the organization, not them personally (Correct answer)
- A mandatory disclosure to regulators about discovered violations
- A warning label required on all investigation reports
- A notification to physicians about their billing audit results
Correct answer: A notice to employees that their communications with company counsel represent the organization, not them personally
An Upjohn warning, derived from Upjohn Co. v. United States, informs employees that legal counsel represents the organization and that communications may be disclosed.
Question 6: Which of the following BEST describes the 'scope creep' risk in healthcare compliance investigations?
- Investigators reviewing too few records
- An investigation expanding beyond its original focus without proper authorization (Correct answer)
- Delays caused by interviewing too many witnesses
- The cost of investigations exceeding the budget
Correct answer: An investigation expanding beyond its original focus without proper authorization
Scope creep occurs when an investigation expands beyond its defined parameters, potentially creating unmanaged legal exposure and resource drain.
Question 7: A compliance investigation uncovers evidence of a criminal act by a hospital employee. What is the FIRST step the compliance officer should take?
- Immediately terminate the employee
- Notify law enforcement without further delay
- Consult with legal counsel and the organization's leadership (Correct answer)
- Publish the findings in an internal newsletter
Correct answer: Consult with legal counsel and the organization's leadership
Discovering criminal activity requires immediate consultation with legal counsel to determine reporting obligations and protect the organization.
CHC Internal Investigations 2
When interviewing a potential whistleblower during an internal investigation, what is the MOST important protection to communicate?