Article
General Counsel’s Decision Tree for Internal Investigations for the Healthcare Industry
November 9, 2023

Healthcare systems, physician practices, post-acute providers, pharmacies, laboratories 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. These range from industry-specific concerns, such as those related to federal and state healthcare program billing, False Claims Act (FCA), Stark Law and Antikickback Statute, Health Insurance Portability and Accountability (HIPAA) protections, payor reimbursement, quality of care and adverse patient outcomes– to more general concerns equally applicable to the healthcare industry, including compliance with bribery and corruption statutes such as the Foreign Corrupt Practices Act (FCPA), data breaches, environmental catastrophes, accounting concerns, whistleblower complaints, risks introduced by the use of third parties and human resources issues. While having a robust compliance program can help avoid many issues, not all issues can be foreseen or avoided. The GC Decision Tree has been designed to assist with the identification and remediation of issues and is an important complement to a well-designed and functioning compliance program. It also will facilitate the in-house team’s communications with outside counsel, who have a range of experience guiding companies through these precarious situations. In addition, adherence to a well-crafted playbook helps companies meet the expectations of enforcement authorities, such as the Department of Justice (DOJ), the Securities and Exchange Commission (SEC) and state attorneys general (as well as others), which can materially mitigate potential enforcement efforts and sanctions. 

Authors
Stephanie F. Johnson
Partner
Government Matters & Regulation
Aaron W. Lipson
Partner
Special Matters & Government Investigations
Michael E. Paulhus (Mike)
Partner
Government Matters & Regulation
Adam Baker
Partner
Special Matters & Government Investigations
James W. Boswell III (Jim)
Partner
Government Matters & Regulation
Sara Brinkmann
Partner
Government Matters & Regulation
Christopher C. Burris (Chris)
Partner
Special Matters & Government Investigations
Craig Carpenito
Partner
Special Matters & Government Investigations
Daniel F. Donovan (Dan)
Partner
Special Matters & Government Investigations
Zachary Fardon
Partner
Special Matters & Government Investigations
Ehren Halse
Partner
Special Matters & Government Investigations
Amy Schuller Hitchcock
Partner
Special Matters & Government Investigations
Mark A. Jensen
Partner
Special Matters & Government Investigations
Brandt Leibe
Partner
Special Matters & Government Investigations
Amelia R Medina
Partner
Special Matters & Government Investigations
Paul B. Murphy
Partner
Special Matters & Government Investigations
Grant W. Nichols
Partner
Special Matters & Government Investigations
Alicia C. O'Brien
Partner
Special Matters & Government Investigations
Michael R. Pauze
Partner
Special Matters & Government Investigations
Mark D. Polston
Partner
Government Matters & Regulation
John C. Richter
Partner
Special Matters & Government Investigations
Adam Robison
Partner
Government Matters & Regulation
McGregor Scott (Greg)
Partner
Special Matters & Government Investigations
Peter A. Strotz
Partner
Product Liability & Mass Torts
Daron Tooch
Partner
Government Matters & Regulation
David K. Willingham
Partner
Business Litigation
Sally Q. Yates
Partner
Special Matters & Government Investigations
Desi Hamilton
Senior Associate
Special Matters & Government Investigations
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