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Responding to Government Inquiries

General Policy Statement

[PROVIDER] cooperates fully with all government inquiries.

Suggested Elements

Providers may want to include the following suggested elements as part of their compliance policy in order to ensure appropriate and consistent responses to contact by government auditors and investigators:

GENERAL GUIDELINES FOR ALL TYPES OF INQUIRIES

  • All [PROVIDER] employees should be respectful and courteous to government investigators.
  • As soon as the investigators arrive, immediately notify the [Administrator,  Regional Vice President, etc.].  If those individuals are unavailable, then contact the most senior management person in your area. If a senior manager is not on the premises, the investigators should be asked to wait momentarily in an unused office or an area where no company business is being conducted. Wait with the investigators, but do not discuss anything related to business with the investigators while waiting until a senior manager arrives.
  • The senior manager should request identification from all investigators, including business cared for each investigator. Enforcement agents should be asked to show their badges.
  • The senior manager should ask the investigators the purpose of their visit and what information they are seeking.
  • Upon receiving this information, the senior manager should immediately contact someone who can provide legal guidance.
  • If the visit occurs outside of normal business hours in the Eastern time zone, please call [Administrator, Regional Vice President, etc.].

GUIDELINES FOR SPECIFIC TYPES OF INQUIRIES

  • Routine periodic surveys should be handled in the normal course of business. However, the [ADMINISTRATOR, LEGAL COUNSEL] should be contacted in the event there is an unscheduled visit by state the survey team, or agents other than usual state surveyors in attendance [OIG, FBI or STATE MEDICAID FRAUD CONTROL UNIT].
  • If  the inspectors are conducting an OIG Audit:
    • Notify the [ADMINISTRATOR, LEGAL COUNSEL]
    • [ADMINISTRATOR, LEGAL COUNSEL] should be designated to receive all requests for information or documentation. The investigators should be requested to make all requests for information through this designated individual. A list should be made of all information and documents requested.
    • Original documents should not be given to the investigators. Two copies of all documents taken by the investigators should be made; one copy for the investigators; one for the [ADMINISTRATOR, LEGAL COUNSEL].
  • If the investigators arrive with a search warrant:
    • The senior manager on site should request a copy of the warrant and any accompanying exhibits or attachments. The affidavit in support of the warrant should be specifically requested and then immediately contact the [ADMINISTRATOR, LEGAL COUNSEL] and forward on a copy of the warrant.
    • The investigators will have the authority to seize original documents—the senior manager should politely request permission to make copies of important documents before they are seized. If permission is not granted, a careful list of documents seized, by category and location should be made to the extent possible.
    • All employees should be directed to not interfere with investigators conducting a seizure pursuant to a search warrant. Employees perceived by the investigators to be interfering with the investigation may risk criminal sanctions, including but not limited to obstruction of justice.

EMPLOYEE RIGHTS AND OBLIGATIONS

  • Employees should be advised that they may be contacted individually at home
    or at work by investigators. Individuals should be made aware of the following
    rights in the event they are contacted by government agents.
  • Employees have the right to refuse to talk to investigators or to refuse to be interviewed unless they have an attorney to represent them. It is not an indication of guilt to request an attorney, but a common sense decision to have the assistance of someone who understands the context of government investigations and how to protect individual rights. [PROVIDER] will provide  counsel to represent the Employee in appropriate circumstances.
  • Employees have the right to refuse to speak to the investigators. Employees must be advised that making a false statement to a government investigator may subject the Employee to criminal sanctions.  Once employees become aware of  an ongoing government investigation, no documents in any way related to the  investigation should be destroyed or discarded, which may subject the Employee to criminal sanctions.
  • After an investigation has begun, Employees should be instructed (1) not to speculate about the nature of the investigation; and (2) not create memoranda, letters, emails or other electronic or paper documents related to  the investigation.
  • If contacted by government investigators, Employees should notify [PROVIDER Administrator or Legal Counsel].  Employees may not offer to provide access to [PROVIDER’S] documents. All requests for information and documents by government investigators should be processed through the [ADMINISTRATOR, LEGAL COUNSEL]. 
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