FREE CHPC Handling Complaints & Investigations Questions and Answers
What is the first step a Compliance Officer should take upon receiving a compliance-related complaint?
The first step in handling a compliance complaint is to assess the nature of the complaint and determine whether it involves a potential violation of laws, regulations, or internal policies. Reporting to OCR (A) is premature unless a breach or violation has been confirmed. Disciplinary action (D) can only occur after investigation.
Which of the following is a best practice when conducting internal investigations into compliance complaints?
A critical best practice in compliance investigations is thorough documentation of every step, finding, and conclusion. This ensures transparency and accountability. Confidentiality must be preserved, but interviewing only one party (A) would limit a fair investigation.
A patient submits a complaint that their PHI was accessed without authorization. What is the healthcare provider’s responsibility under HIPAA?
Under HIPAA, the healthcare provider must investigate the complaint to determine if an unauthorized access or breach occurred. Immediate disciplinary action (A) without investigation is premature. Reporting to the media (C) is only required if a confirmed breach affects more than 500 individuals.
During an internal investigation, what is the primary purpose of interviewing witnesses?
The primary purpose of interviewing witnesses during an internal investigation is to gather evidence to substantiate or disprove allegations. The investigation must be fair, objective, and fact-driven. Identifying feelings about the compliance program (C) is unrelated to the investigation process.
If an internal investigation uncovers a significant compliance violation, which of the following steps should occur?
Please select 3 correct answers
When a significant compliance violation is identified:
Corrective actions (A) must be implemented to address the root cause.
If required, report the violation to regulatory authorities (B), such as the OCR or CMS.
Conduct staff retraining (C) to prevent recurrence and reinforce compliance standards.
Proper documentation of the investigation must be maintained (D); it cannot be erased for confidentiality.