Bass, Berry & Sims attorney John Eason authored an article for Compliance Today that provides a clear framework for healthcare providers handling internal complaints related to the False Claims Act (FCA). With the healthcare industry a primary focus of FCA enforcement efforts, it is important that providers have a plan in place to address complaints or run the risk of significant issues.
John points out “For most healthcare providers, it is a matter of when—not if—an FCA-related complaint will arise. Take proactive steps now to establish investigation protocols to ensure a quick and thorough response when such a complaint does arrive.”
John explained that creating a detailed investigative plan helps clarify objectives, identify key witnesses and establish timelines. He also noted that investigations often evolve as new information emerges, requiring flexibility to adjust the scope to include broader practices or narrow the focus where appropriate.
Effective communication with the complainant is essential. John advised that healthcare providers acknowledge complaints quickly and keep the reporting employee informed throughout lengthy investigations. At the same time, providers must protect confidentiality and coordinate carefully with legal, compliance and human resources teams to avoid waiving privilege or exposing themselves to retaliation claims.
John emphasized the need for swift corrective action when potential violations are uncovered. This may involve stopping illegal conduct, disciplining responsible parties, revising training, and deciding whether to self-disclose misconduct to government agencies or repay overpayments.
“Every internal allegation of FCA violations should be treated with the utmost seriousness and initially viewed with an open mind,” said John. Healthcare providers should take every complaint seriously, recognizing that even seemingly minor concerns could signal larger compliance risks that warrant thorough investigation.
The full article, “False Claims Act: Preparing For and Navigating Internal Complaints,” was published on July 1 by Compliance Today and is available online.