CHC Internal Investigations 5 — Questions and Answers
Question 1: What is the purpose of a 'non-retaliation attestation' collected from managers during a healthcare compliance investigation?
- To waive the manager's right to an attorney
- To document that managers understand and commit to protecting reporting employees from adverse action (Correct answer)
- To certify that managers had no knowledge of the alleged violation
- To authorize the compliance officer to access the manager's personnel file
Correct answer: To document that managers understand and commit to protecting reporting employees from adverse action
Non-retaliation attestations from managers reinforce the organization's commitment to anti-retaliation policies and create accountability.
Question 2: Under an OIG Corporate Integrity Agreement (CIA), what obligation does a healthcare organization typically have regarding internal investigations?
- Notify the OIG within 30 days of initiating any internal investigation
- Report certain investigations, findings, and corrective actions to an Independent Review Organization (IRO) (Correct answer)
- Cease all operations under investigation until the CIA expires
- Share all attorney-client privileged investigation documents with the OIG
Correct answer: Report certain investigations, findings, and corrective actions to an Independent Review Organization (IRO)
CIAs typically require reporting of significant compliance matters and corrective actions to an IRO that reports to the OIG.
Question 3: Which best describes the 'reasonable inquiry' standard a compliance officer should apply before closing an investigation?
- Determining that no employees were harmed by the potential violation
- Ensuring the inquiry was sufficiently thorough that a competent professional would be satisfied the matter is resolved (Correct answer)
- Confirming that the original complainant is satisfied with the outcome
- Verifying that no government agencies are aware of the issue
Correct answer: Ensuring the inquiry was sufficiently thorough that a competent professional would be satisfied the matter is resolved
The reasonable inquiry standard requires that the investigation was conducted with appropriate diligence and that conclusions are well-supported by evidence.
Question 4: A compliance officer suspects that destroying certain emails before a government subpoena would help the organization. What is the CORRECT response?
- Delete the emails quickly before the subpoena arrives
- Issue an immediate litigation hold and preserve all potentially relevant communications (Correct answer)
- Consult only with operations staff, not legal counsel, to assess document relevance
- Archive the emails in an external location not subject to subpoena
Correct answer: Issue an immediate litigation hold and preserve all potentially relevant communications
Destroying documents in anticipation of a subpoena constitutes obstruction of justice; an immediate litigation hold is the only lawful response.
Question 5: What does 'materiality' mean in the context of evaluating potential False Claims Act liability during an investigation?
- Whether the violation involved physical harm to a patient
- Whether the false statement or omission had a natural tendency to influence the government's payment decision (Correct answer)
- Whether the dollar amount of the overpayment exceeds $10,000
- Whether the conduct was intentional rather than negligent
Correct answer: Whether the false statement or omission had a natural tendency to influence the government's payment decision
The Supreme Court's Escobar decision established that FCA liability requires the false statement to be material to the government's decision to pay.
Question 6: An internal investigation concludes with findings that are inconclusive due to insufficient evidence. What is the MOST appropriate action?
- Close the investigation and assume no violation occurred
- Document the inconclusive findings, preserve all evidence, and monitor for future indicators (Correct answer)
- Terminate the employee who was the subject of the complaint as a precaution
- Immediately disclose the inconclusive findings to the OIG
Correct answer: Document the inconclusive findings, preserve all evidence, and monitor for future indicators
Inconclusive investigations should be formally closed with documented findings and evidence preserved, with enhanced monitoring to detect future indicators.
Question 7: Which element is MOST critical to include in a final compliance investigation report?
- The personal opinions of the investigative team on employee culpability
- A factual summary, evidence reviewed, findings, conclusions, and recommended corrective actions (Correct answer)
- The exact salaries of all employees interviewed
- A public-facing press statement about the investigation outcome
Correct answer: A factual summary, evidence reviewed, findings, conclusions, and recommended corrective actions
A thorough investigation report documents the process, evidence, factual findings, and actionable recommendations to support remediation and defensibility.
CHC Internal Investigations 5
What is the purpose of a 'non-retaliation attestation' collected from managers during a healthcare compliance investigation?