Internal Investigations Flashcards
6 cards from real CHC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Internal Investigations flashcards as text
A compliance officer begins an internal investigation into a billing department employee based on a credible whistleblower report alleging upcoding. To best preserve the attorney-client privilege during the investigation, which of the following is the MOST critical step to take at the outset?
Answer: Engage legal counsel to direct and oversee the investigation.
To ensure communications and work products related to the investigation are protected under attorney-client privilege, the investigation should be conducted for the purpose of seeking legal advice. Engaging legal counsel to direct the investigation from the beginning is the most effective way to establish and maintain this privilege.
During an internal investigation interview regarding potential HIPAA violations, the compliance officer is questioning a witness who seems hesitant and fearful of retaliation. Which of the following interview techniques is most appropriate to encourage open communication?
Answer: Explaining the non-retaliation policy and conducting the interview in a private, neutral setting.
To build rapport and encourage a witness to be forthcoming, it is crucial to create a safe and confidential environment. Explaining the organization's non-retaliation policy and choosing a private, neutral location for the interview helps to reduce anxiety and demonstrates the integrity of the process. Threatening discipline or asking leading questions can intimidate the witness, while a non-private setting undermines confidentiality.
A hospital's compliance department concludes an internal investigation that substantiates improper billing to a federal healthcare program, resulting in a significant overpayment. According to federal law and OIG guidance, what is the organization's primary obligation after quantifying the overpayment?
Answer: Report and return the overpayment within 60 days of its identification.
The Affordable Care Act's "60-Day Rule" requires that overpayments from a federal healthcare program be reported and returned within 60 days of the date on which the overpayment was identified. Failure to do so can result in False Claims Act liability. While disciplinary action and training are important corrective actions, the most immediate and critical legal obligation is the timely return of the funds.
Which of the following BEST describes the primary purpose of creating an investigation plan before beginning interviews and data collection?
Answer: To define the scope, objectives, timeline, and resources needed for a thorough and impartial review.
An investigation plan is a critical first step that outlines the scope, key questions, timeline, and necessary resources. This ensures the investigation is structured, efficient, and remains focused on its objectives, promoting a thorough and fair process rather than a predetermined conclusion.
A compliance investigator is collecting electronic evidence as part of an inquiry into data tampering. To ensure the evidence is admissible in potential future legal proceedings, what is the most important principle to follow?
Answer: Interviewing the IT staff about their opinion on who may have altered the data.
Maintaining a chain of custody is a critical forensic principle that involves documenting the seizure, custody, control, transfer, analysis, and disposition of evidence. This process ensures the integrity of the evidence and proves that it has not been tampered with, which is essential for it to be admissible in a formal legal proceeding.
After completing an internal investigation that substantiated a violation of the organization's code of conduct, what is a critical final step in the investigation process?
Answer: Identifying the root cause and implementing corrective actions to prevent recurrence.
A key goal of any investigation is not just to address the specific incident but also to prevent future non-compliance. Therefore, analyzing the evidence to determine the root cause of the issue and implementing a corrective action plan (which may include policy changes, training, or system improvements) is a crucial final step to improve the overall effectiveness of the compliance program.