Tips and Pointers on Initiating Internal Investigations

An organization may call upon a variety of individuals to respond to a complaint or concern raised by an employee. However, only a few of these complaints rise to a level requiring investigation. How an organization labels their response to an issue is important and conveys meaning.

In an interview on initiating internal investigations, two leading experts provided useful tips, advice, and suggestions. James Cottos is a former HHS OIG Chief Inspector who trained and taught at the Federal Law Enforcement Training Center. Al Bassett is a former FBI Executive and Deputy Inspector General who trained and taught at the FBI Academy. Both worked for over thirty years as a Federal Special Agent and have extensive health care compliance consulting experience.

Cottos and Bassett both emphasized the importance of defining an investigation. Cottos noted that labeling something as an investigation uses an “emotionally charged term” that suggests a violation of law and impending enforcement action. He believes this has an impact on how individuals will respond when questioned about a situation or issue. Cottos stated “when people hear about an ‘investigation,’ their imagination may infer more regarding the circumstances than is factually correct.” Further, he believes that just hearing the term “investigation” may affect the way interviewees respond to questioning.

Bassett added that “someone announcing they are conducting an investigation generally has the effect of making people more defensive and cautious in responding to questions.” Further, Basset stated that many interviewees “develop a very cautious attitude if they believe they are being asked about something that may result in an enforcement action.” Both Cottos and Bassett offered the following:

What is an Investigation?

• A search to uncover facts and seek the truth about an issue (who, what, when, where, why, how)
• A thorough and systematic inquiry into an issue
• A detailed inquiry or systematic examination to gather facts and information to solve a problem, or resolve an issue
• An inquiry into unfamiliar or questionable activities

Other Activities Meet the Investigation Definition

Looking at the above descriptions of an investigation, the experts make it clear that there are a number of other activities that could meet these definitions including conducting an audit, evaluation, internal inquiry, or internal review. However, characterizing an activity using these other terms does not evoke the same emotional response as using the term “investigation.” Since these other activities also involve a detailed examination of facts, both Cottos and Bassett believe it is advisable to use neutral terminology wherever possible to avoid unnecessarily raising concerns or evoking speculation among employees.

Most Issues are Resolved Without an Investigation

Cottos and Bassett have reviewed thousands of complaints received via hotlines or through other means. They make it abundantly clear that the vast majority of these complaints can be resolve fairly quickly within a day or two and without a formal investigation. Many complaints, allegations, and concerns are routine in nature and may be resolved through normal management procedures or through human resources management (HRM). Those matters which do implicate a violation of law or regulation are normally directed to compliance officers or legal counsel. More complex cases may require a significant commitment of resources over a protracted period. In any case, the elements of any investigation or inquiry will include one or more interviews, gathering documents, and a case file.

Being Properly Prepared to Conduct Investigations

Some complaints do become cases which require an investigation. When confronted with this, the key to resolution is conducting an effective investigation. This necessitates having properly trained individuals to conduct the investigation. Investigators of the caliber of Cottos and Bassett cannot be expected to be available to conduct an internal investigation.

However, certain basic principles of investigation can be learned and implemented by anyone conducting an investigation regardless of whether their primary role is within a compliance office, HRM, legal counsel, or a privacy office. These include understanding how to plan an investigation, conduct proper interviews, organize evidence, prepare written reports, and document management. It is advisable to have individuals undergo this basic training by experts. This can be accomplished by sending individuals to a training conference, or by havingexperts provide training on site. If the latter, it is prudent to have all those who might be called upon to conduct an investigation participate (i.e. Compliance Officer, HRM, Privacy/Security Officer, and Legal Counsel). It is worthy to note that just because someone has a law degree does not mean they are equipped or trained to conduct investigations.

Triaging Complaints and Initiating Investigation

Bassett noted that it is the standard practice of professional investigators to “triage” all matters that may require an investigation similarly to how medical staff operate when patients arrive at a hospital emergency room. This involves an analysis of the complaint and any allegations to determine who is best equipped to resolve the issues at hand. Depending on this analysis, multiple functions may be required and an investigative plan can be developed. In conducting an internal investigation, it is important that investigators are properly empowered in the scope of the effort. This may require involvement from legal counsel, compliance officers, HRM, or members of senior management.

For more information on this subject, see “Conducting Internal Investigations in Health Care Organizations.”