Individuals Involved in Internal Investigations in Healthcare

Safe Harbor 3-2
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Identify the individuals typically involved in conducting an organization-initiated internal investigation of a compliance violation, and explain their purpose in the investigation. Contrast with those individuals who conduct an agency-driven investigation.
The current areas of human operations, including healthcare, are sophisticated. Amidst such sophistication, there is increasingly high scrutiny and concerns from various quarters, including employees, media, and government. Thus, organizations are on a high alert and can often initiate investigations in which issues are raised either using internal or external resources. Corporates are increasingly exposed to whistleblower allegations, shareholder demands, internal and external audits, subpoenas, adverse media reporting, and inquiries advanced by government or civil litigants. Organizations have to implement an internally based investigation or conduct an investigation using external agencies to prepare and respond to such issues. The U.S healthcare system is grappling with many problems, including fraud, misuse, and non-compliance in federal healthcare programs such as Medicare. Healthcare providers are subject to internal and external investigation, inquiries, or reviews.
In many health organizations, allegations of fraud and non-compliance related activities can be investigated and reviewed by external organizations such as the U.S. Department of Justice (DOJ), the U.S. Department of Health & Human Services (HHS), and the HHS Office of Inspector General (OIG), amongst others! (Wolfson, Smith, & Proper, 2018). On the other hand, internal investigations are conducted by healthcare providers to assess their extent of compliance to laws, policies, and agreements such as corporate integrity agreements (CIA). Parties actively engaged in internal investigations in most health organizations comprise health executives, facility heads, department managers, and quality health managers.
Internal investigations aim to uncover the truth about the alleged misconduct, non-compliances and raised concerns within the organization. Typically, the internal investigation involves collecting and examining written or recorded evidence, interviews with suspects and witnesses, and computer and network forensics. The individuals who often participate in internal organizational...