12 Rules for Conducting Successful Compliance Investigations

Conducting successful internal investigations depends on following the proper guidelines. It is too easy for individuals inexperienced in conducting investigations to make a simple procedural error that could seriously compromise the entire process. The following are a dozen rules to consider:

1. Need to Know. The general rule for all internal investigations or inquiries should be under a “need to know” standard – all discussions regarding the investigation should be restricted to only those circumstances where there is a “need to know.” This means there should be no sharing of information regarding the predication, direction, or findings of the process with any unauthorized parties. In any inquiry, the facts will dictate how to address the issue.

2. Controlling and Tracking Information. All “cases” should be stamped, logged, and numbered as part of records management.

3. Promptly Debriefing Complainants. All complainants need to be fully debriefed as to the basis of their allegations, concerns, and complaints. All facts should be gathered promptly before memories fade and the intrusion of intervening events.

4. Always Remain Fair and Impartial. The process of conducting the investigation must consist of a fair and impartial review of all relevant facts. Any demeanor by the investigator contrary to that principle will severely damage the value of the work performed.

5. Include Management Views. It is important to include management’s views as part of the report and not rely solely upon representations of staff.

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6. Exercise Discretion. It is very important for the investigator to remain “low key” in the approach and to be discreet in gathering pertinent facts. In a confined work environment, it is easy to “telegraph” information about the investigation that could easily undermine its effectiveness.

7. Avoid Using Original Documents. In conducting reviews and other investigative steps use copies, not original documents. Original documents should remain under lock and key.

8. Maintain Chain of Custody. All evidence obtained during an investigation must be tracked so that it is never outside of the control of the investigation. This is referred to as maintaining “chain of custody”. Failure to maintain the chain of custody may cause evidence to be excluded in a formal adjudicative process.

9. Remain Focused. It is easy to be distracted by secondary issues. Investigators must never lose sight of the purpose and objective of the investigation. This means staying focused on factors relating to the complaint and avoiding distractions such as extraneous information.

10. Be Flexible. Although it is critical to stay focused, investigators should not be inflexible to changing fact patterns, directions, or conditions during the investigation. This is not meant to conflict with the previous point but to recognize that under certain circumstances that deviating from the guidelines and investigative plan may be necessary. Remaining too narrowly focused may result in missing even more significant issues than those that predicated the original investigation. In many cases, the investigation may identify related problems to the original complaint or allegation.

11. Be Comprehensive. For most investigations, there is only one chance and it is important that everything is done right the first time. The investigation must be comprehensive enough to answer all the questions raised in the predication, as well as sufficient enough to identify any pervasive or systematic problems that may have caused the problem. Having to redo any or all the investigation is not a valuable use of resources and can call into question the investigation’s findings.

12. Take Steps to Prevent Retaliation. One of the worst outcomes of an investigation is if retaliation or retribution against the original complainant or witnesses occurs. This issue is specifically addressed in the OIG Compliance Guidance. It is also something that can create serious legal liability. As such, care needs to be taken to prevent information from flowing away from the investigation until all matters have been resolved.

It is advisable to have some level of investigative training and access to experts should the need arise for a full internal investigation. The material noted herein is drawn in large measure from Conducting Internal Investigations in Health Care Organizations, AIS, 2011, (ISBN 979-1-936230-60-8). It contains 17 chapters and is a “how to” manual on the subject.