Who Filed That Compliant Against Me?

Who complained?

That might seem like a totally reasonable question. But it’s something that compliance officers might want to discourage from being asked. 

The issue was driven home for me recently when a client in the desert Southwest had an unpleasant interaction with a representative from the local licensing board. The board was investigating a situation that had occurred years earlier, when a physician was accused of some anger-management issues. The physician called the board to get details about the inquiry (it might have been best for the physician to have someone make the call on his behalf, but that is a topic for another article). 

Recounting that conversation, the physician explained that the agent was very friendly in the beginning, freely offering information about the nature of the investigation. The physician asked several clarifying questions before asking who filed the complaint. The investigator refused to tell him. The physician said that by the end of the call, the agent seemed far more reserved and less friendly. That worried him. He was at a loss to understand her change in tone. 

I am not. I am willing to bet that the agent was bothered by the fact that the physician wanted to know who made the complaint. She assumed, rightly or not, that the physician wanted to identify the individual so he could take some sort of retaliatory action. I know this physician rather well, and I’m confident that his true motivation was to be able to address the specifics of the complaint. He assumed that without knowing who raised the issue, he would be unable to talk about the situation and explain his side of the story. When I offered my theory as to the change in the agent’s tone, he was flabbergasted. He assumed he had a right to confront his accuser, if not literally, but certainly by knowing all of the specifics about the complaint. I totally understand his perspective. The Sixth Amendment to the constitution gives every American the right to confront his or her accuser in a criminal case. That shapes our view of what is fair. People expect to be able to discover who made an allegation so they can question the person’s sincerity.

In the compliance world, and in the eyes of most regulators, the Sixth Amendment becomes relevant only when a case goes to trial. The compliance world places a premium on protecting accusers from this sort of confrontation. 

There are two separate points I would like to make in this article. First, it is important to remember that there is a reason the Sixth Amendment exists. When individuals can make anonymous accusations, there is a risk that they will use the anonymity to put forth dishonest claims. I think that most compliance professionals are already acutely aware of this reality, but it is worth a reminder. 

The second point may be less obvious. When someone who is the subject of an allegation pushes aggressively for the identity of the accuser, most investigators will look askance at the accused. Therefore, it is worth including in the compliance training process a suggestion that people who learn of an investigation refrain from asking questions about the accuser. My physician-client would have been better off had he not asked the board about the complainant’s identity.

Take the time to educate people that while it may seem reasonable to ask who is bringing an accusation, government agents will interpret this inquiry negatively. They will think, “the question isn’t who made the claim, the question is whether it is true.” When the allegation relates to personal interactions (as it did in this case), the accused needs enough details about the situation to be able to respond, but if there were multiple people present, it is unnecessary to know which individuals raised concerns.

It is relatively common to have whistleblowers complain that they faced retaliation for raising an issue. Preserving the individual’s anonymity doesn’t eliminate the risk of a retaliation claim, but it lowers it. Perhaps more importantly, evidence about an inquiry into who made the complaint makes it easier for the whistleblower to claim that there was interest in retaliation, because they can argue that the focus on their identity implies a desire to retaliate.

A good compliance process prepares employees for possible interactions with the government (I recommend providing employees with extensive training on this point. As part of that education, I include a laminated card with tips for interacting with government investigators. If you would like one or more of these cards, please send me an email that includes your postal address). 

As part of that training, it is worth explaining that with any interaction with the government, or with internal compliance professionals, there is a real benefit to suspending your curiosity to ask about the identity of people making complaints.  

Facebook
Twitter
LinkedIn

David M. Glaser, Esq.

David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Decoding 2025 OPPS Charge Capture and Coding Complexities: Strategies for Success

Decoding 2025 OPPS Charge Capture and Coding Complexities: Strategies for Success

Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.

January 29, 2025
Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.

November 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Outpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

September 5, 2024

Trending News

Featured Webcasts

Navigating the 2025 Medicare Physician Fee Schedule: Key Changes and Strategies for Success

Navigating the 2025 Medicare Physician Fee Schedule: Key Changes and Strategies for Success

The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.

January 21, 2025
Patient Notifications and Rights: What You Need to Know

Patient Notifications and Rights: What You Need to Know

Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.

December 5, 2024
Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks.  Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.

November 19, 2024
Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.

October 24, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24