EXPERIENCED GUIDANCE ON INTERNAL HEALTH CARE INVESTIGATIONS

Missteps in the health care industry can lead to serious sanctions. Wrongdoing may expose the organization to costly regulatory penalties and civil liability. Those involved may even face criminal charges. The first step toward avoiding – or mitigating – these consequences is to conduct an internal investigation.

At Marcilliat & Mills PLLC, we advise health care clients on when and how to conduct these investigations. As seasoned attorneys with strong backgrounds in criminal defense as well as prosecution, we know how to conduct detailed and thorough investigations – and how to apply those findings so clients can make informed decisions on how to proceed.

Our lawyers serve clinics, hospitals, medical suppliers, pharmacies, group practices for all kinds of health care providers and other health care organizations across North Carolina. We’re available to assist small local practices that may not have in-house legal counsel. Additionally, we can serve as outside counsel for larger organizations seeking an objective, independent and diligent investigation.

When Is An Internal Investigation Warranted?

Internal investigations might be required by organizational policies, federal or state law, or both. They are often triggered by:

• Internal reports of wrongdoing (such as fraud, data breaches, HIPAA violations, off-label marketing and Stark Law/anti-kickback violations)
• External complaints of misconduct
• Whistleblowing or False Claims Act investigations
• Government investigations
• Investigatory actions by state or federal agencies
• Grand jury proceedings
• External audits or reviews
• Determinations by internal compliance officers

By conducting an internal investigation, our lawyers can help you determine the best course of action on how to proceed. We can also help shape the scope of any resulting probe – whether a specific incident investigation or large-scale inquiry – sparing you the costs, resources and administrative burdens of an unnecessary (or overly broad) investigation.

The Value Of A Well-Executed Investigation

When done right, an internal healthcare investigation is a valuable tool for addressing and correcting compliance problems. Even if not strictly required, it may nonetheless be a wise decision – a way to get to the bottom of what happened and get out ahead of potentially damaging allegations.

Conducted within the confines of powerful safeguards such as attorney-client privilege and work-product protection, these investigations help organizations:

• Determine who was responsible
• Take appropriate employment and disciplinary action
• Identify witnesses
• Preserve evidence
• Determine whether reporting requirements apply
• Decide whether to pursue voluntary disclosure
• Decide whether (and to what extent) to cooperate with authorities
• Develop an action plan to remedy the problem and prevent its recurrence
• Provide recommendations on employee training
• Avoid or mitigate enforcement actions, whether regulatory/civil sanctions or formal charges

In weighing whether to press charges for health care violations, federal prosecutors in the U.S. Department of Justice (and prosecutors in state law enforcement agencies) frequently consider the organization’s response to wrongdoing. Voluntarily addressing and correcting the problem can position you more favorably when it comes to serious criminal investigations.

Contact Our Team

To discuss how our attorneys can help with an internal investigation, call 919-838-6643 or contact us online. We would be happy to meet with you at your office or at one of ours.