Those of you who have very good relationships with your regulators may be more inclined to be cooperative and not demand a subpoena that a subpoena be issued for every document or information request. Go through this expert long term care training article and know more.
By having that kind of an attitude, it can help preserve a harmonious relationship. It can have the effect that you might be able to narrow the issues or you might be able to resolve these surveyors or the regulators’ concerns simply by having a conversation with them without them having to dig through files and talk to people.
Our expert suggested in the long term care conference that, certainly, cooperative approach can be less stressful. Although in reality, any staff member who's being spoken to by a surveyor or auditor, investigator or regulator, they're going to be nervous about it regardless of the context.
The other advantage to cooperation though is it may be a mitigating factor if you're facing penalties down the road. But some disadvantages are that sometimes you're led down the primrose path and you let your guard down. You think, “Hah, you know, we're working this out.” The next thing you know you're looking at an indictment or you're looking at some kind of demand for return of property or, you know, refund of reimbursement monies.
So you have to be mindful that, you know, the old adage, you know, “We're from the government. We're here to help” may not be entirely correct. And there can be serious implications if you let your guard down and get too casual about it.
Get more online long term care training at our healthcare conferences page
Also there could be very serious implications for staff members who may be under suspicion. And frankly, they may not know that at the beginning of an investigation. Many investigations more for take on different focuses as they begin and as the investigators get more information. And then they originally thought about a matter.
Now they're thinking in a different direction or taking the case in a different direction, so a staff member who may have been really casual, “Hey, I have no involvement in this” and was just kind of you know, glib in their responses may themselves to be a target and understand suspicion.
So that's a downside of a more casual or cooperative approach. And of course, you have to be very mindful of waiving your privileges, your attorney client privilege, your work product privilege when you're dealing with investigators.
If you have your lawyers involved and you're doing an investigation where you're putting your investigators sue their paces and making them justify their request and issue you proper process to get documents, that’s going to be less of an issue because your attorneys are going to make sure you don’t waive your privileges. And they're going to protect you in that regard as per the long term guidelines. But that's a downside risk of a cooperative approach where you're just giving documents and handing things over without really talking it through.
What should you do if you are faced with an investigation kind of outside of your normal survey process, either the Medicaid fraud control unit is looking at you or another type of investigation is going on. This is not a promotion for a continuous employment of lawyers but you should retain your facility counsel and bring them into the loop ASAP.
That can often benefit you because perhaps a call from an attorney can streamline some of these issues. The attorney can also figure out what the heck is going on. Why are they looking at this behavior? Why are they seeking this information? What information do they have, that the government have that they believe something wrongful might have occurred in the facility? They can get some information that you otherwise may not be able to get mainly because they may have relationships with these investigators as well.
There's also the issue of advising as to whether to get separate counsel for employees. And that's a facility by facility decision or an owner by owner decision. Some facilities have the view that, you know, if you're our employee, we're not going to hang out to drive. We'll provide you with counsel.
Most facilities look at it on a case by case basis. And frankly, if they have the staff member who has really acted outside of the bounds of appropriate conduct, they may not want to align themselves with that staff member and they may advise the staff member to get their own counsel.
For more coding, billing and healthcare compliance information, visit our Health system conference page.