INSIDE - Health Care Compliance Association

PAYOR MANAGED CARE CFG...continued from page 11
tolerate other forms of inappropriate
conflict disclosure process, at least
conduct that can further erode the
for boards of directors and officers.
company’s reputation and result in
■ Educate employees about the com-
additional legal exposure.
pany’s policies and procedures.
Finally, conflicts of interest undermine
internal credibility. Imagine the effect
widespread self-dealing or favoritism
has on employee loyalty and trust. The
result likely would be either sharp alienation
from the company’s goals or a
sense that “anything goes.”
Conflicts of interest should be
addressed in any code of ethics or
compliance handbook and, as indicated
above, merits a stand-alone
policy. Reminders can be included
in employee newsletters or other
compliance communications, and
the issue should at a minimum be
VICKIE MCCORMICK
How to deal with conflicts of interest
Payor organizations should establish a
process to address conflicts of interest.
The process will help protect both the
company and individuals from the risks
associated with conflicts of interest.
Any program to address conflicts of
interest should include the following
elements:
■ Adopt corporate-wide policy on
conflicts of interest. The content of
the policy can be as strict as the
organization feels is appropriate, but
should clearly spell out the company’s
position and should alert
employees at all levels to their respective
obligations. The policy should
address high-risk areas such as gifts,
nepotism, and funding from pharmaceutical
manufacturers and device
makers.
■ Adopt reasonably detailed procedures
for handling conflicts of
interest. These procedures should
detail what situations need to be dis-
included in overall compliance training.
Organizations should consider
delivering specific training on conflicts
topics–whether by way of a
stand-up presentation, on-line
course, or custom-made or off-theshelf
video–particularly if there is
doubt as to the depth of employees’
understanding of the issues.
Whatever the format, education
should give concrete examples of
conflicts and how they should be
handled.
■ Document the process by which
situations are evaluated, resolved,
and communicated to employees.
Although conflicts can come in a
dizzying variety, documentation will
help payors strive for consistency,
and will enable them to demonstrate
that they have taken serious steps to
address the risk.
There are many other questions to consider
in designing a compliance program
to deal with conflicts of interest.
These include:
■ Should disclosure of conflicts or
potential conflicts be made part of
the vendor selection process? Some
firms include questions about known
conflicts in their RFP boilerplate to
elicit information from vendors at
the earliest possible time.
■ What types of information need be
disclosed? Typical questions include
outside employment, employment of
spouses, board memberships, and
financial interests. Should disclosure
forms ask about significant charitable
or political activities? With regard to
financial interests, disclosure obligations
should be phrased in terms of
both percent of ownership and
absolute value. For example, a policy
could ask the employee for information
about any investment that is
equal to or greater than 10% ownership
of the other firm or valued at
more than $50,000.
■ How much information should be
requested concerning family and
friends? One rule is to seek equivalent
information (i.e., employment,
closed, to whom disclosures should
■ Who should complete periodic dis-
board membership, substantial finan-
be made and in what fashion, and
closures? It is common practice to
cial interests) about all relatives with-
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what process will be followed for
evaluating disclosures. Serious consideration
should be given to mandating
a periodic (typically annual)
require officers and directors to complete
disclosure forms, but should the
process be extended to senior management,
or to the entire company?
in “one degree of consanguinity” -
that is, parents, spouses, and children.
What about siblings?
■ Should disclosure forms be com-