General Counsels Decision Tree for Healthcare Related Internal Investigations

King & Spalding

Healthcare systems, hospital networks, and other healthcare providers regularly face challenges that may require an internal investigation to determine the root cause of an issue in order to evaluate how best to remediate and guard against future occurrences of a potentially harmful event. From industry-specific concerns, such as those related to federal and state healthcare program billing, False Claims Act matters, HIPAA protections, payor reimbursement, prescription drug compliance, or more general corporate concerns equally applicable to the healthcare industry, such as data breaches, environmental catastrophes, or human resource issues, there are more than enough landmines in today’s legal and regulatory environment to keep any general counsel up at night. While not all issues may be avoided, having a playbook in place for conducting an internal investigation that facilitates the identification and remediation of issues is an important step in feeling prepared for whatever may come.

When a developing situation requires an internal investigation, a healthcare system’s general counsel faces a series of decisions, sometimes in rapid succession. Beyond first protecting the integrity and quality of patient care and public health, many constituents must stay top of mind as the situation moves forward...

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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