What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You...
Transcript of What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You...
![Page 1: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/1.jpg)
37 Offices in 18 Countries
What Keeps You Up atNight?
Issues of Fraud and Abuse ComplianceSeries
Keeping In House Out of theDoghouse – Invoking the Attorney-Client Privilege
![Page 2: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/2.jpg)
2
Keeping In House Out of the Doghouse– Invoking the Attorney-Client Privilege
![Page 3: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/3.jpg)
3
Today’s Host
David W. GrauerChair, Squire Sanders Healthcare PracticeT +1 614 365 [email protected]
![Page 4: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/4.jpg)
4
Today’s Speakers
Thomas E. ZenoT +1 513 361 [email protected]
Emily E. RootT +1 614 365 [email protected]
Elizabeth E. TrendeT +1 614 365 [email protected]
![Page 5: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/5.jpg)
5
Importance of the Attorney-Client Privilege
![Page 6: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/6.jpg)
6
Scenario #1
A medical director sends an email to a hospitalemployee negotiating physician compensation, with acopy to in-house counsel who is not involved in thenegotiations. The email says that because thephysician refers lots of patients to the hospital, themedical director thinks the hospital should pay thephysician more than the current proposal. The emailsubject says “Attorney-Client Privilege.”
Can the hospital claim the email is covered by theattorney-client privilege?
![Page 7: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/7.jpg)
7
Caveat!
The attorney-client privilege is a complex andevolving doctrine.
• Detailed analysis
• Fact-specific
• Differs across jurisdictions
![Page 8: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/8.jpg)
8
What Is Covered by Attorney-ClientPrivilege?
1. Communication
2. Attorney
3. Client
4. Providing Legal Advice
5. Expectation of Confidentiality
![Page 9: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/9.jpg)
9
What is Protected by the Work ProductDoctrine?
1. Documents
2. Prepared by or for an attorney
3. In anticipation of litigation
![Page 10: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/10.jpg)
10
Don’t Lose It!
Practice Tip
• Don’t forward attorney emails outside theorganization
• Don’t forward attorney emails toemployees with no need to know
• Make Board presentations in executivesession
• Enforce social media and publicstatement policies
![Page 11: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/11.jpg)
11
Copying In House Counsel on Emails
Copying in house counsel on an email or letter doesnot, by itself, make the email privileged.
• Reference on-going legal matter in the email (Foryour review of the contract…)
• Only include attorneys who are handling the legalmatter
Practice Tip:
• Include explicitrequest for legaladvice (Can wepay thephysician morebecause…?)
![Page 12: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/12.jpg)
12
When In House Counsel Also Has aBusiness Role
Many in house counsel also have a businessrole (Vice President, Chief Operating Officer,etc.)
Key issue is whether thecommunication:
• Seeks legal adviceOR
• Relates to thebusiness role
![Page 13: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/13.jpg)
13
Privilege and the Compliance Officer
Not automatically privileged
Practice Tip:
• Chief Compliance Officer is
Part of the General Counsel office OR
Acting under the direction of counsel
• Explicit reference to legal purposes, rather
than business purposes
![Page 14: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/14.jpg)
14
The Privilege and Consultants
Not automatically privileged
Practice Tip:• Counsel retains the
consultant• Document that the
purpose of theconsultant’s work is toanalyze data regardingidentified legal issues
![Page 15: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/15.jpg)
15
The “Attorney-Client Privilege” Label
Is a best practice because it is evidence ofconfidentiality and seeking legal advice
Also assists in identifying privilegeddocuments in subsequent review ofdocuments that may be produced
BUT it does not make a documentprivileged that doesn’t meet the criteria
![Page 16: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/16.jpg)
16
Scenario #2
During an internal investigation into alleged improperMedicare billing by a provider group, in house andoutside counsel jointly conduct an interview with thephysician in charge of coding and billing. In theinterview, the physician states that the group hasidentified problems with physician coding in the past buthas not taken any action.
The group waives the attorney-client privilege andsettles with the government. The government thenprosecutes the physician.
Can the statement during the interview be usedagainst the physician?
![Page 17: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/17.jpg)
17
Who Can Waive the Privilege
The “Client” owns (and canwaive) the privilege
In internal investigations,the company is the “client”– not the individual beinginterviewed
• Individual cannot waive the company’sprivilege (generally)
• Company can waive the privilege, even ifthe waiver exposes the individual
![Page 18: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/18.jpg)
18
“Upjohn” Warnings
Practice Tip:
• Provide (read) complete Upjohnwarnings to an employee beforeinterviewing the employeeduring an internal investigation.
• Have an associate with you totake notes of the interview.
• Document Upjohn warnings andanswers in interviewer notesand interview summary.
Upjohn warnings should be given beforeinterviews in furtherance of internalinvestigations
![Page 19: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/19.jpg)
19
Sample “Upjohn” Warnings
• I am a lawyer with the Company. I and my associaterepresent the Company. We represent only the Company.We do not represent you personally.
• We are conducting this interview to gather facts in order toprovide legal advice to the Company. This interview is partof an investigation to determine the facts andcircumstances about _________.
• Your communications with us are protected by the attorneyclient privilege. But the attorney client privilege belongssolely to the Company, not to you. That means theCompany alone may decide to waive the attorney clientprivilege and reveal our discussion to third parties. Thecompany alone may decide to waive the privilege anddisclose our discussion to third parties such as federal orstate agencies, without your permission or notice.
![Page 20: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/20.jpg)
20
Sample “Upjohn” Warnings
• In order for this discussion to be protected, itmust be kept in confidence. It is the Company’sdecision whether it will waive the privilege. Inother words, with the exception of your ownattorney, you may not disclose the substance ofthis interview to any third party, including otheremployees or anyone outside of the Company.You may discuss the facts of what happened,but you may not discuss this discussion.
• Do you have any questions?
(Record answer (No) in memo)
• Are you willing to proceed?
(Record answer (Yes) in memo)
![Page 21: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/21.jpg)
21
Scenario #3
Following preliminary results of a peer reviewcommittee meeting that indicates a physician isperforming medically unnecessary procedures, inhouse counsel conducts an additional investigationand hires an outside consultant to review a sampleof charts. The hospital concludes that self-disclosure is necessary.
What parts of the investigation process, if any,are privileged?
![Page 22: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/22.jpg)
22
In House Counsel and Investigations
Investigations undertaken in theordinary course of business aregenerally not privileged.
Practice Tip:Document privilege elements(requesting legal advice, identityof counsel, identity of employeesacting for the company, etc.)
![Page 23: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/23.jpg)
23
In House or Outside Counsel?
Retain Outside Counsel When Appropriate
• Allegations about senior executives or general
counsel’s office
• Particularly serious or complex matters
• Unique skill sets or experience needed
• Matters where business role of general counsel
could make privilege arguments complicated
Practice Tip:
Full support of outside counsel by general counseland key executives is necessary to get the bestadvice and limit costs
![Page 24: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/24.jpg)
24
The Golden Rule
Practice Tip:
ALWAYS write like the government (andeveryone else) is looking over yourshoulder
![Page 25: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/25.jpg)
25
Public Statements
Practice Tip:
• Get Legal Dept.to review publicstatements inadvance
• Have designatedspokespersonson sensitiveissues, andinformemployees ofthe protocol
![Page 26: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/26.jpg)
26
Government Investigations
Asserting the Privilege in GovernmentInvestigations
Since the McNulty Memo in December 2006, DOJhas shown greater respect for the privilege.
The DOJ generally will not:• Request waiver of the attorney-
client privilege or attorney workproduct protections.
• Hold against a company thedecision to assert the attorney-client privilege when decidingwhether to prosecute.
![Page 27: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/27.jpg)
27
The Disclosure
Delicate balance between adequatedisclosure and maintaining privilege.
• Purpose of disclosure
• Level of knowledge
• Type of activity to disclose (settlement,litigation, government investigation,internal investigation, etc.)
• Other public statements
![Page 28: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/28.jpg)
28
Scenario #4
An employee forwards to the legal department
some emails between human resources
individuals, which the employee considers to be
evidence of employment discrimination.
The emails are later requested through the
discovery process in subsequent litigation.
Does the company have to produce the
emails?
![Page 29: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/29.jpg)
29
The Privilege and Pre-Existing Documents
• Cannot protect documents from discovery
just by giving them to an attorney
• Documents (letters, emails, notes, etc.) that
were not created as communications with an
attorney or under the direction of an attorney
Practice Tip:To avoid confusion,explicitly state in adocument if it isprepared for or bycounsel
![Page 30: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/30.jpg)
30
Scenario #5
The Board of Directors, of which General Counsel
is a member and Secretary, receives a
presentation regarding the hospital’s financial
performance for the year, a proposal to make
certain improvements to retain market share, and
an update on an internal investigation by the
compliance officer. The General Counsel also
makes a presentation regarding on-going
litigation, where the hospital is represented
primarily by outside counsel.
Are all or part of the minutes of the meeting
privileged?
![Page 31: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/31.jpg)
31
Attorney as Board Member
Key Issue – What communications were made to
seek or obtain legal advice and which were made
for a business purpose?
Practice Tip:
If the GC is a voting member of the Board or a
committee, they may be more likely to be viewed as
acting in their business capacity.
![Page 32: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/32.jpg)
32
Steps Organizations CanTake to Protect Themselves
![Page 33: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/33.jpg)
33
Training
• Training for individuals who are likely to beseeking legal advice
• Legaldepartmentshould teachbest practicesas they interactwith otheremployees
![Page 34: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/34.jpg)
34
Best Practices – Highlights
Invoke the privilege early and often
Write carefully – never count on the privilege
Explicitly ask for legal advice or reference on-going legal issues when making sensitivecommunications
Designate privileged emails or memos as“Attorney-Client Privilege”
Send documents to only those people who needto see them
Hire consultants for legal issues through counsel
![Page 35: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/35.jpg)
35
Questions?
![Page 36: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/36.jpg)
36
Thank You for Joining Our Webinar
Join Us for Future Calls in This Series …
• Addressing Enterprise Risk After the AffordableCare Act – November 15, 2012
• Corporate Integrity Agreements and CorporateCompliance Programs – January, 2013
• Proper Recordkeeping in a HeightenedEnforcement Environment – March, 2013
![Page 37: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/37.jpg)
37
Thank You for Joining Our Webinar
Contact us with other topics, questions or issues:
• Tom Zeno: [email protected]
• Emily Root: [email protected]
• Emy Trende: [email protected]
![Page 38: What Keeps You Up at Night? - Squire Patton Boggs/media/files/insights/events/... · What Keeps You Up at Night? Issues of Fraud and Abuse Compliance ... Sample “Upjohn” Warnings](https://reader030.fdocuments.in/reader030/viewer/2022021610/5b30af107f8b9ae16e8e6a57/html5/thumbnails/38.jpg)
37 Offices in 18 Countries
What Keeps You Up atNight?
Issues of Fraud and Abuse ComplianceSeries