Liability of Program Integrity Contractor Employees

4.2.2.4 - Liability of Program Integrity Contractor Employees (Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21) This section applies to UPICs. Under the terms of their contracts (refer to 42 CFR §421.316(a)), UPICs, their employees, and professional consultants are protected from criminal or civil liability as a result of the activities they perform under their contracts as long as they use due care. If a UPIC or any of its employees or consultants is named as defendants in a lawsuit, CMS will determine, on a case-by-case basis, whether to request that the U.S. Attorney’s office offer legal representation. If the U.S. Attorney’s office does not provide legal representation, the UPIC will be reimbursed for the reasonable cost of legal expenses it incurs in connection with defense of the lawsuit, as long as funds are available and the expenses are otherwise allowable under the terms of the contract. If a UPIC is served with a complaint, the UPIC shall immediately contact its chief legal counsel and the COR. The UPIC shall forward the complaint to the HHS Office of the Regional Chief Counsel (the CMS regional attorney) who, in turn, will notify the U.S. Attorney’s office. The HHS Office of the Regional Chief Counsel and/or the COR will notify the UPIC whether legal representation will be sought from the U.S. Attorney’s office prior to the deadline for filing an answer to the complaint.