Forget the Duct Tape

Suppose one of your employees reports trouble with your billing department or your sales force or your therapists. Perhaps an anonymous tip came to your hotline or maybe an employee discussed his concern with a supervisor who passed it on to you. Your reporting system works! Congratulations.

Now it is time to investigate.

Investigation is not a one-size-fits-all proposition. Sometimes the compliance officer will handle the matter alone, asking questions and seeking documents. Other times, it makes sense for the compliance officer to enlist assistance from others. A supervisor may question personnel or a billing expert may analyze claims. Regardless, it is best for the compliance officer to do the necessary legwork and open all doors to the receipt of such information. In an effective compliance program, everyone in the organization — everyone — must cooperate with the compliance officer.

Do you need to call in an outside expert? It depends. If the problem is isolated, so that knowledgeable people in your organization can help assess its nature and scope, then handle it internally. But if there is reason to suspect that the problem is endemic, pervading all elements within the company or a particular department, then it makes no sense to use inside people to investigate. In this case, an outsider will provide the necessary objectivity and plausibility for any findings, adverse or positive.

Do you need to bring in a lawyer? That, too, depends on the situation. If the investigation is likely to lead to legal concerns, or if legal concerns turn up after the investigation begins, counsel is essential. At this point, stop the investigation, contact competent counsel, explain what has happened and ask whether counsel needs to take over. If you are using the right person, he or she will give you an honest answer. The compliance officer will still have a key role after that point, but the investigation will be under the direction and authority of counsel, with appropriate paperwork documenting the change in the relationship.

This is important for two reasons. First, if there is a concern about problems that suggest fraud, abuse or other legal violations, then counsel will be essential to assess the evidence and its implications.