Internal Investigations

What is an Internal Investigation?

Due to the complex nature of the healthcare industry, there may be a chance your organization comes to face with allegations that may lead to an internal investigation. An internal investigation is an inquiry into an organization’s internal operations after misconduct is reported. A complaint may be made by an employee, whistleblower, regulatory agency, or other parties. However, in some cases, internal investigations are conducted as part of a due diligence process on behalf of the organization. During internal investigations, organizations aim to discover and proactively respond to the reported allegations of misconduct, harassment, and discrimination or dispel suspicions. 

Importance of Internal Investigations

When faced with the existence of a government investigation, a whistleblower complaint, or an internally generated report of misconduct, the value of a competent and thorough internal investigation cannot be understated.  A properly conducted internal investigation provides valuable and timely information which allows management and counsel to make intelligent decisions on how best to respond to the situation.  Sitting back and waiting for the matter to simply go away, or waiting for a government investigation to run its course before reacting is rarely a sound strategy.

Internal investigations play a crucial role in the healthcare industry for several reasons. When an organization becomes aware of allegations or reports of misconduct, it is essential to handle the situation promptly and effectively. Here are some key reasons why internal investigations are important:

  • Gathering accurate information: A competent and thorough internal investigation provides valuable and timely information. It allows management and legal counsel to obtain a comprehensive understanding of the situation, assess the credibility of the allegations, and make informed decisions on how best to respond.
  • Compliance with regulations and laws: Healthcare organizations are subject to numerous regulations and laws governing their operations. Internal investigations help ensure compliance with these regulations, identify any violations, and take corrective measures to prevent further non-compliance.
  • Protecting reputation and credibility: By promptly addressing allegations and conducting internal investigations, organizations can demonstrate their commitment to integrity, ethics, and accountability. This proactive approach can help protect the organization’s reputation and credibility among stakeholders, including patients, employees, partners, and regulatory bodies.<
  • Mitigating legal and financial risks: Internal investigations provide an opportunity to identify and address potential legal and financial risks associated with misconduct. By taking appropriate actions based on the investigation’s findings, organizations can minimize the likelihood of litigation, regulatory penalties, and financial losses.

Conducting an Internal Investigation

The results of an internal investigation are only valuable if the inquiry is done correctly. This involves following an outline of established rules to collect the strongest data. Under the right circumstances, conducting an internal investigation protected by the attorney-client privilege can assist management by identifying the pertinent facts; allow for a timely correction of the conduct in question to prevent further violations; establish the existence of the company’s culture of compliance; and greatly assist in avoiding or defending against a government enforcement action.

Important elements in conducting an internal investigation:

  • Outline essential questions to be addressed: ask the right compliance-related questions to your witnesses
  • Organize and Collect Information: gather and review all documents related to the issue being investigated. These may include medical records, billing practices, emails and claims filed with Medicare.
  • Conduct Interviews: witness interviews are just as essential to the investigation process as the other documented evidence

How Can a Healthcare Law & Regulatory Lawyer Help?

As former prosecutors and investigators with decades of experience handling internal investigations for a large variety of health care and non-health care clients, the attorneys at Nicholson & Eastin, LPP are exceptionally qualified to assist our clients in conducting meaningful internal investigations.  Please feel free to contact us to discuss your concerns and the possible need for an internal investigation.

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