Conflicts of Interest of SA Employees

4008 - Conflicts of Interest of SA Employees (Rev. 1, 05-21-04) (Also see §7202) Conflicts of interest may arise within the Medicare/Medicaid certification program when public employees utilize their position for private gain or to secure unfair advantages for outside associates. The gain involved may or may not be monetary. Abuses of privileged information, abuses of influence, and other abuses of trust are included, regardless of whether a monetary advantage is gained or sought. Almost all States have laws or regulations prohibiting, and providing punishment for, overt specific violations of public trust. It is not possible to list all situations which could be construed as potential conflicts of interest in the certification process, but many would be among the examples in subsection A, below. SA administrators should require employees to make a declaration of any such outside interests and update this declaration periodically. The SA should evaluate the need for preventive measures to protect the integrity of the certification program. In cases where certification work is performed by agencies other than the designated SA, the SA administrators and the subagency administrators have a shared responsibility for such surveillance. It is not necessary for the SA to inform the RO of all potential and apparent conflict situations. However, if an overt abuse requires corrective action, the SA should inform the RO as described in subsection B, below. 4008A - Examples of Potential Conflicts of Interest (Rev. 1, 05-21-04) The following are typical situations that may raise a question of possible conflicts of interest on the part of an agency employee representing the Medicare/Medicaid survey and certification program: • Participation in ownership of a health facility located within the employing State; • Service as a director or trustee of a health facility; • Service on a UR committee; • Private acceptance of fees or payments from a health facility, group of health facilities, or association of health facility officers for personal appearances, personal services, consultant services, contract services, referral services, or for furnishing supplies to a health facility; • Participation in a news service disseminating trade information to a segment of the health industry; and/or • Having members of one’s immediate family engaged in any of the above activities, other than non-managerial employees of health facilities. 4008B - Report and Investigation of Improper Acts (Rev. 1, 05-21-04) State codes should provide judicial or administrative remedies for abuses of influence, privileged information, or trust arising through conflicts of interest. Any acts of employees in violation of State laws or regulations should be handled in accordance with applicable State procedures. When there appears to be Medicare/Medicaid program involvement, the SA immediately reports this to CMS and keeps it advised of corrective actions. Also, the SA requests assistance or advice on any case of an impropriety involving conflicts of interest that cannot be handled immediately under an applicable State procedure. The regional OIG, along with the RO, will work in close cooperation with the responsible State officials to resolve the matter.