CHC Internal Investigations 4 — Questions and Answers
Question 1: What ethical obligation does a compliance officer have when an internal investigation implicates senior leadership?
- Close the investigation to protect the organization's reputation
- Proceed with the investigation objectively and report findings to the board or audit committee (Correct answer)
- Transfer investigative authority to the implicated executive's supervisor
- Conduct the investigation privately without documenting findings
Correct answer: Proceed with the investigation objectively and report findings to the board or audit committee
When leadership is implicated, the compliance officer must maintain independence and escalate findings to the board or audit committee to ensure objectivity.
Question 2: During an internal investigation, an employee asks if they can have a personal attorney present during their interview. What is the appropriate response?
- Deny the request, as personal attorneys have no role in internal investigations
- Permit it, as employees retain the right to counsel, though counsel represents the employee, not the company (Correct answer)
- Allow it only if the employee has been formally accused of wrongdoing
- Require a written waiver from the employee before proceeding
Correct answer: Permit it, as employees retain the right to counsel, though counsel represents the employee, not the company
Employees have the right to retain personal counsel during internal interviews; this counsel represents the employee, not the organization.
Question 3: A compliance officer discovers that a vendor has been paying for physician meals that exceed allowable thresholds under the Anti-Kickback Statute safe harbor. What is the NEXT step?
- Immediately terminate the vendor contract
- Quantify the total value, consult legal counsel, and assess whether voluntary disclosure is warranted (Correct answer)
- Require the vendor to reimburse the physicians directly
- Notify the physicians and request they return the value of the meals
Correct answer: Quantify the total value, consult legal counsel, and assess whether voluntary disclosure is warranted
Potential AKS violations require legal analysis of exposure, the nature of any remuneration, and a deliberate decision about voluntary disclosure.
Question 4: Which document BEST establishes the authority and methodology for a healthcare compliance investigation?
- An email from the CEO authorizing the investigation
- A formal investigation charter or mandate signed by appropriate leadership (Correct answer)
- A verbal agreement between the compliance officer and department head
- The organization's general employee handbook
Correct answer: A formal investigation charter or mandate signed by appropriate leadership
A formal investigation charter defines scope, authority, methodology, and reporting structure, providing the legal and operational foundation for the inquiry.
Question 5: What is 'parallel proceedings' in the context of a healthcare compliance investigation?
- Conducting two separate internal audits simultaneously
- When civil and criminal government investigations proceed at the same time regarding the same conduct (Correct answer)
- Investigating two different departments for the same type of violation
- Running compliance training during an active investigation
Correct answer: When civil and criminal government investigations proceed at the same time regarding the same conduct
Parallel proceedings occur when the DOJ or HHS pursues both civil (FCA) and criminal charges simultaneously, creating heightened legal exposure.
Question 6: When preserving electronically stored information (ESI) for a compliance investigation, what is a 'litigation hold'?
- A court order requiring the production of all electronic records
- A formal directive suspending routine document destruction to preserve potentially relevant records (Correct answer)
- An agreement with opposing counsel to limit ESI discovery
- A technical process for encrypting sensitive investigation files
Correct answer: A formal directive suspending routine document destruction to preserve potentially relevant records
A litigation hold is an internal directive that suspends normal document retention policies to preserve evidence that may be relevant to anticipated or pending litigation.
Question 7: A compliance audit identifies that a coder has been consistently adding diagnosis codes not documented by the physician. This practice is BEST classified as:
- A billing error requiring a simple correction
- Upcoding fraud with potential False Claims Act liability (Correct answer)
- A documentation deficiency attributable to the physician
- An acceptable coding shortcut under Medicare guidelines
Correct answer: Upcoding fraud with potential False Claims Act liability
Adding unsupported diagnosis codes inflates reimbursement claims, constituting upcoding that may create FCA liability for both the coder and the organization.
CHC Internal Investigations 4
What ethical obligation does a compliance officer have when an internal investigation implicates senior leadership?