1.8 Response to an External Auditor/Investigation

  • PURPOSE:

    Government officials/investigators may arrive unannounced at LHCC or at an employee residence in the course of conducting an investigation. The presence of investigators is not a routine matter. In most instances, the purpose of the investigation is to ascertain if criminal conduct has occurred. This policy has been developed to assist all employees of LHCC in responding appropriately to any such investigation.

    POLICY:

    All LHCC employees will cooperate fully with any outside agency duly authorized to examine the records of its’ operations. However, in cooperating with investigators we must continue, without disruption, the care and services we provide to the patients and families we serve. LHCC employees will not waive any rights, privileges and/or protections provided under law. During the course of an investigation LHCC employees shall not willfully obstruct or impede, attempt to obstruct or impede, or aid, abet or encourage obstruction of justice during an investigation; or with knowledge thereof, fail to take reasonable steps to prevent such obstruction or impedance or attempted obstruction or impedance.

    PROCEDURE:

    1. Obtain identification of individuals and review documents authorizing investigation, make copies of these documents and;
    2. Notify individuals authorized to act on behalf of LHCC during such an investigation, ie., CEO, President, Compliance Officer, Director of Operations (Compliance Officer will be your first contact). Request that the investigation NOT BEGIN until one of the listed individuals arrive. Should this request be denied, start a log for the recording of all activities of the government officials/investigators. Any dealings with government officials/investigators should always be conducted in a professional manner. Under no circumstance should government officials/investigators be obstructed and/or prevented from carrying out their assigned responsibilities.
    3. Prevent the disruption of care and services to patients and any other essential aspects of LHCC operations. Service to our patients is always first priority. Government officials/investigators can not enter any area where their presence could have an adverse effect on the care of patients. It is important to inform the government officials/investigators of any concerns and to work cooperatively with them to develop an alternate method for obtaining necessary information.
    4. Assure full cooperation with investigators within the authorized scope of such investigation. During the course of an investigation, LHCC employees shall not willfully obstruct or impede, attempt to obstruct or impede, or aid, abet, or encourage obstruction of justice during an investigation; or with knowledge thereof, fail to take reasonable steps to prevent such obstruction or impedance or attempted obstruction or impedance. The most common conduct constituting obstruction of justice falls into two categories:
      1. the concealment, alteration, or destruction of physical evidence; and
      2. the making or encouraging of false or misleading statements.
    5. Inform LHCC employees of their rights as both individuals and employees of LHCC. One of the basic tools for gathering information is the interview. Investigators will contact employees in one of two ways. One method is to directly contact an employee, usually unannounced, at work or at home. It is important that employees are aware that this can be a very intimidating process and that they have several options regarding interviews. It is LHCCs policy to cooperate with all investigations or government inquiries. Employees have a right to speak with investigators should they so choose, but they also have the right to decline to be interviewed. The time and place of the interview is at the employees discretion as is who may attend the interview, such as personal legal counsel, LHCC legal counsel, etc. Once an employee has granted an interview, he/she has the right to stop the interview at any time. In cooperating with investigators, employees shall only provide information they are authorized to release and/or to which they routinely have access.
    6. Reduce the chaos and fear generated by an investigation of this type. Advanced and ongoing education and training of all employees regarding this guidance on investigations is essential to reducing chaos and fear generated by an unannounced external investigation. Employees shall be informed that they have the right to speak to investigators as well as an equal right to decline to do so.
    7. Ensure that full disclosure of documents and data requested by investigators, within the authorized scope of such investigations, is provided in a timely manner. Unannounced investigations are generally limited to a very defined review of specific materials. The scope of the review is clearly defined in the documents authorizing the investigation. It is essential that LHCC provide requested documents in a timely manner consistent with the document(s) authorizing the investigation. When providing the documents requested by investigators it is important to carefully review the documents presented by government officials/investigators, to identify, at a minimum, the following:
      1. LHCC under investigation
      2. Address of investigation
      3. Authorized date and time for the investigation
      4. Official authorizing the investigation
      5. Documents requested (patient records, corporate records, etc)
    8. Ensure that a detailed log of all events associated with the investigation is maintained. The monitoring and recording of all activities associated with the investigation is critical. The following are some of the important aspects of the investigation to monitor and record:(Note that you should NOT sign this log, even if the investigators insist)
      1. The manner in which the investigation is conducted. Note in detail the precise areas and files searched, the time periods when each of them was searched, the agents who participated;
      2. Log/inventory any records, files, or other property seized;
      3. Copy all records, files, etc. seized especially medical records;
      4. Log/inventory of any records, files, etc., deemed to be privileged and any objection made by investigators;
      5. The date and time the investigation was completed.
      6. (If possible, videotape the search, however, do NOT continue taping if the investigators consider the taping to be an interference with the investigation.)
    9. Provide direction for the temporary removal of all non-essential employees from the area involved in the investigation. To ensure an orderly response to an investigation, employees that are not directly involved in responding to an investigation should be directed to gather their personal belongings (if allowed) and to leave the immediate work area for a location outside the area under investigation. Investigators do NOT have a right to detain any employee.
    10. Electronic records can be seized during an investigation. It is essential to the ongoing operations of LHCC that any such seizure be done in an orderly manner to protect the integrity of the information system (EHR). Electronic records seized must be copied and logged as stated above in number 8. The physical removal of computer equipment, such as personal computers, disk drive, etc., should be monitored carefully. Investigators can have access to our paper records, but generally are not allowed to seize the file cabinets in which they are stored; such is also the case for our electronic records. Every effort should be made to provide investigators with the electronic information they need without the physical removal of the equipment in which they are stored. In those circumstances where the physical removal is required, the IT Director will ensure that adequate steps are taken to prevent the loss of information or data essential to ongoing operations.
    11. Once an investigation has begun, LHCC shall suspend the routine destruction of records by all LHCC EHR system entities.
    12. Do NOT sign anything unless directed to do so by LHCC legal counsel or your personal legal counsel.

    Revised 12/2013

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