Jeannine LeCompte, Publishing and Research Coordinator
Most long-term care facilities are aware of the legal demand to conduct investigations in the event of specific complaints reported via hotlines or other methods of communication. A similar duty of care must be followed in the case of issues which are classified as “internal” or “non-hotline” incidents.
The difference between the two types of issues is simply that the first arises from a directly-reported complaint or tip, and the second usually occurs due to ongoing internal observation and monitoring, or from advisories from staff or outside instances.
An internal investigation is based primarily on a factual review of potential problems or issues. It is usually conducted by the facility’s compliance officer, internal audit department, or outside counsel.
Issues raised by a review could include, but are not limited to, noted medicinal shortages, an increase in patient incidents such as falls, bed sores, etc., or any similar trend which emerges from a regular review of facility operating statistics. Any notable deviation from the norm could be an indication that a problem exists somewhere in the facility logistics, staffing, or management.
An internal investigation could also be launched if management is notified of a potential violation by employees or third parties. These third parties can include residents, their family members, the Office of the Inspector General (OIG), or any other regulatory body.
The primary focus of an internal investigation is to determine if there has been any wrongdoing—either by accident or design. No matter what the outcome of such a determination, management is under a legal obligation to immediately take steps to halt any wrongdoing and implement corrective action.
During the investigation, information should be gathered and used to develop appropriate responses to any potential queries from regulatory authorities, to determine where and why the problem might have arisen, and to minimize any potential criminal or civil liabilities.
Finally, an internal investigation should highlight any failures or lapses which may be present in the facility’s organizational structure.
