Interviewing a Healthcare Worker Suspected of Diversion

I have sat across the table from a lot of healthcare workers suspected of diversion over the years. Nurses. Pharmacists. Anesthesiologists. Technicians. People at every stage of their careers, in every kind of facility, with every possible relationship to what the evidence showed.

And what I can tell you, without qualification, is that the interview is the hardest part.

Not because the evidence is usually ambiguous by the time you get to the subject interview — in most cases, if the investigation has been conducted properly, the data pattern is clear enough to support the conversation. It is hard because of what the conversation requires of the interviewer. The ability to remain calm and professional while presenting evidence of something deeply serious. The discipline to follow a structure when every instinct is telling you to react to what is happening in the room. The skill to create conditions where the truth can emerge without coercion. And the emotional resilience to sit with the full weight of what this moment means for the person across the table — and for the patients whose care may have been affected.

Most of the people conducting these interviews in healthcare facilities have never been trained to do it. They are pharmacy directors, HR professionals, compliance officers, and nurse managers who are doing something genuinely difficult with no preparation and no framework.

The consequences of that gap are significant — not just for the outcome of the investigation, but for the legal and regulatory exposure of the facility that conducts it.

If the people responsible for conducting subject interviews in your facility have never received formal investigative interview training, that is a gap worth closing before the next investigation requires it. Schedule a free 30-minute assessment with Rxpert Solutions — interview coaching is one of the core services we provide.

Why the subject interview is different from other interviews

The subject interview in a diversion investigation is categorically different from the witness interviews that precede it — and from almost any other difficult conversation a healthcare leader is likely to have.

In a witness interview, the goal is to gather information. The emotional stakes are relatively contained. The person being interviewed is not the focus of the investigation, and the conversation — while potentially uncomfortable — does not carry the same weight of consequence.

In a subject interview, the person across the table knows, or strongly suspects, why they are there. The emotional dynamics are intense and unpredictable. The legal stakes are significant. And the interviewer is navigating a conversation that needs to be both thorough enough to produce a defensible outcome and fair enough to withstand later scrutiny.

The difference between a well-conducted subject interview and a poorly conducted one is not just a matter of whether a confession is obtained. It is a matter of whether the interview itself becomes a liability — through an improperly obtained admission, through documentation that contradicts the facility’s position, through a process that creates grounds for a wrongful termination claim, or through a conversation that was so poorly managed that the subject’s attorney successfully challenges everything that followed.

Getting the subject interview right requires preparation, structure, and skill that most healthcare facilities do not have in-house. Book a complimentary 30-minute consultation with RXpert Solutions — we have conducted these interviews and we can help you build the competency to do them right.

What preparation actually looks like

The most common interview failure I see is not a failure of skill in the room. It is a failure of preparation before the room.

An interviewer who does not have full command of the evidence before the subject interview begins is an interviewer who cannot effectively respond to what the subject says. When the subject offers an explanation — and they almost always do — the interviewer needs to know immediately whether that explanation is consistent with the data, whether it has already been considered and ruled out, and what the next question should be in response.

Without that preparation, the interview becomes reactive rather than structured. The subject controls the narrative. Explanations that are implausible go unchallenged. The conversation drifts away from the evidence and into territory that is harder to document and less useful to the investigation.

Preparation means knowing the evidence thoroughly — every transaction, every anomaly, every discrepancy, every witness account that is relevant to the conversation. It means anticipating the explanations the subject is likely to offer and knowing how to respond to each one. It means having a clear objective for the interview — what outcome are you trying to reach, and what does the path to that outcome look like — before you enter the room.

The structure of an effective subject interview

Effective investigative interviews are not conversations that unfold organically. They follow a deliberate structure — a sequence of phases that create the conditions for honest disclosure while maintaining the professionalism and legal defensibility the situation requires.

That structure typically begins with establishing rapport — not in a manipulative sense, but in the genuine sense of creating an environment where the subject feels heard and treated with dignity. People who feel respected are more likely to engage honestly than people who feel accused from the moment they sit down.

From there, the interview moves through the evidence — presenting what the investigation has found in a way that is clear, non-accusatory, and impossible to simply deny without engaging with the specifics. Theme development — the technique of providing the subject with a framework that minimizes the psychological barrier to admission — is one of the most important skills an investigative interviewer can develop. It is not manipulation. It is the recognition that people disclose the truth more readily when they are given a face-saving way to do so.

Documentation throughout — and a precise written record immediately after — is not optional. What was said in that room is part of the evidentiary record. It needs to be captured accurately, completely, and in a way that reflects what actually happened rather than what the interviewer wishes had happened.

What happens after the interview

The subject interview is not the end of the investigation. It is a data point — a significant one, but one that needs to be evaluated in the context of everything else the investigation has produced.

An admission changes the trajectory of what follows significantly. It shapes the termination decision, the regulatory reporting obligation, the patient notification consideration, and the documentation that needs to accompany all of those. A denial — even an implausible one — does not end the investigation. It becomes part of the record alongside the evidence that contradicts it.

And sometimes the interview produces something in between — a partial disclosure, an admission to something less serious than the evidence supports, or an account that raises new questions the investigation needs to answer. Each of those outcomes has its own implications, and navigating them well requires both investigative experience and legal awareness.

At RXpert Solutions, interview coaching and direct investigation support are among the most important services we provide to healthcare organizations — because the subject interview is where investigations succeed or fail, and most facilities are navigating it without the preparation they need.

If your team is facing a situation that requires a subject interview, or if you want to build the investigative competency to handle these situations before the next one arrives, let’s talk. Your first 30 minutes with Rxpert Solutions are free — and that conversation could make all the difference in how the next investigation goes.

— Terri Vidals B.S.Pharm
Founder, RXpert Solutions | Host, Drug Diversion Insights

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