How to Conduct an Investigation Interview

How to Conduct an Investigation Interview

Techniques for collecting forensic evidence in a healthcare audit.

When most people hear the word “forensic,” they think of a crime scene surrounded by yellow tape, with police scouring the area for clues. In healthcare, the crime scene may be a medical claim and, instead of fingerprints, the clues may be codes. Swap out the police for a forensic auditor and you have the makings of a formal compliance investigation for healthcare insurance fraud.

In a compliance investigation, trained professionals perform audits, collect forensic evidence, and conduct interviews, with the intention of turning their findings over to local or federal authorities.

What Is a Forensic Auditor? Forensic auditors perform audits, collect evidence, and conduct interviews as part of a formal compliance investigation. A forensic auditor must possess the ability to review financial records and advise or assist in the investigation of alleged fraud. A designation as a Certified Fraud Examiner (CFE) may be required. Experience with statistical sampling and knowledge of medical coding and auditing concepts are generally required.

The following is an outline of how to conduct a forensic investigation interview.

Start With a Plan

Conducting interviews in the proper order is important; the Internal Investigation Plan (the Plan) outlines the order. The Plan will contain:

  • A witness list, as well as the name of the subject of the investigation, if applicable;
  • Whether the interviewee is high risk and who needs to be present for the interview; and
  • An outline of topics to be covered with the interviewee.

Set the Stage

Conducting this type of interview is not easy for either party, but there are several things you can do to make the encounter go well. The important thing to remember is that you are not conducting an interrogation; you are conducting an interview, and nothing more.

Whether you are interviewing a possible witness or the subject of the investigation, plan out your interview. It’s best to interview in a neutral place to put the interviewee at ease; a relaxed interviewee will likely reveal more than intended. Also take into consideration privacy, noise, room size, and lighting. The fewer distractions, the better. Make sure the interview location is safe for you and the interviewee, as well. There should be a clear path to the exit should the interviewee become agitated.

Set up two chairs across from each other with no table in between. This will allow you to observe the interviewee’s body language.

First, Some Formalities

Start the interview by explaining the investigation in general terms; most people will be nervous, and knowing what to expect may help them relax. Never reveal more about the investigation than you need to, however.

Here is a general outline of next steps:

  • Verify the interviewee’s name, position, and contact information.
  • Without providing too much detail, explain why the interviewee is important to the investigation.
  • Explain that this is not a legal matter, but their cooperation is expected. If the interviewee refuses the interview or wishes to stop the interview in progress, remind them that they are required to submit to an interview as a condition of employment.
  • Explain that no assumption of wrongdoing has been made; the interview is a fact-finding mission.
  • Remind the interviewee that the company has a non-retaliation policy for anyone making a report of possible misconduct.
  • Tell the interviewee that if a question is unclear, they should ask for clarification.
  • Remind the interviewee that they should only relate what they know.
  • Give the interviewee your contact information so they may reach out to you with additional information they recall after the interview.

Begin the Questioning

Once the interviewee understands how the interview will evolve, move on to neutral questions; this will help you establish a rapport with the interviewee. This will also allow you to note baseline body habits when the interviewee is telling the truth.

Continue to watch the person’s body language as you question them using short, direct, and easy-to-understand “yes” or “no” questions, when applicable. Avoid asking open-ended questions at the beginning of the interview because they allow the interviewee to interject their personal bias.

Let the interviewee do most of the talking. Follow the 80/20 rule: The interviewee talks 80 percent of the time, and the interviewer talks 20 percent of the time.

While the interviewee is talking, you can take notes, but do not try to capture their every word. Detailed notetaking may cause you to miss something and will disrupt the flow of the interview.

What to Watch For

Another reason for the 80/20 rule is it allows you to observe how the interviewee responds to your questions. The interviewee’s verbal and physical reactions to your questions can be revealing.

Verbal signs of lying include:

  • Hesitating to answer
  • Going on the attack (without answering the question)
  • Making convincing statements instead of giving simple answers
  • Answering in complete sentences
  • Making inconsistent statements

Physical signs of deception include:

  • Swallowing before answering
  • Shifting weight
  • Fidgeting or body tics (such as an eye twitching)
  • Contradicting body movements such as shaking their head side to side but saying “Yes” or nodding their head but saying “No.”

Remember to pace the important questions; a few seconds pause can be a good tool to get the interviewee to fill the silence and say more than intended.

Ask follow-up questions based on the interviewee’s previous statements. This tactic will help you keep control of the interview and remind the interviewee that you’re in charge.

Recap the Interviewee’s Statement

Wrap up the interview with a recap of what the interviewee has related and ask if they want to clarify or add anything. A few prompting questions may help the interviewee recall some additional details. For example:

  • Is there anything else I should ask you that I haven’t?
  • Is there anything else I should know?
  • Is there anything else you think you should tell me?

Remind the interviewee that this is a fact-finding mission and their cooperation is important; should they recall anything, they should contact you.

Be Gracious and Professional

Always end the interview on a positive note; even if the interviewee was uncooperative or negative, remember that you are a professional. Thank them for participating and remind them that they have your contact information. As soon as possible, document the interview memo according to your employer’s protocol. Retain your handwritten notes in case clarification is needed later.

Norma Panther

2 Responses to “How to Conduct an Investigation Interview”

  1. MARIZA CUEVAS says:

    can 9007 and 93312 be billed together

  2. Renee Dustman says:

    Please check the NCCI code tables for bundling edits. https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits

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