False Claims Act cases often begin with a whistleblower, and worse, one who had reported the issue to management and nothing was done about it, at least not that the whistleblower knew.
David Schumacher (LinkedIn), a partner at the law firm Hooper, Lundy & Bookman and author of the Chapter “Government Investigations” in the new HCCA book False Claims in Healthcare is not surprised. As he explains in this podcast, compliance teams are often completely overwhelmed, making it difficult to determine what call is routine and what possibly raises a real and substantial issue.
Another complicating factor: many calls get triaged and sent to teams outside of compliance. These teams may not follow up adequately, or at all.
To reduce these risks he recommends remembering that whistleblowers very much want to be heard. As a result, it’s important to respond, document responses to them and ensure that the issues that they raised are followed up on.
Once the investigation begins it’s important, he points out, that compliance stay deeply involved, even if legal is running point. The compliance team can assist the investigation, likely has a strong grip on the facts and will play a driving role in any subsequent remedial actions.
Once the government gets involved it’s important to realize the potential for disruption, and even paralysis, within then organization. As a result, an aura of calm needs to be projected.
Also essential: gathering the documentation and data to demonstrate to the government the effectiveness of the compliance program. That includes information such as the size of the compliance program, its scope of responsibilities, how many audits have been completed, what is on the workplan for next year, how many complaints have been fielded in the last several months (or years), and the number of educational events conducts, just to name a few.
And don’t wait to pull these documents together only once an investigation starts. Documenting as you go is much more advisable.
Listen in to learn more about how to manage False Claims Act investigations, including what the current focus of the government is.