Managed Care

Possible Conflict of Interest

  • 1.  Possible Conflict of Interest

    Posted 01-23-2015 04:26 PM
    This message has been cross posted to the following eGroups: Managed Care and Chief Compliance and Ethics Officer Health Care .
    I'm posting the following question on behalf of a member who would like to remain anonymous - any feedback for them is greatly appreciated!

    I would appreciate any feedback and suggestions on how others would address the following hypothetical scenario.  A Managed Care Organization (MCO) contracts with a service provider organization who has a long standing contract with legal counsel.  Legal counsel's spouse works for the provider organization, but the spouse did not have any direct responsibilities for this contract.  This spouse is then promoted to the CEO position of the organization and continues with the same legal counsel (their spouse). Thoughts?  Recommendations for the CO of the MCO?

    Stephanie Gallagher
    Social Media Manager
    2020 HCCA Managed Care

  • 2.  RE:Possible Conflict of Interest

    Posted 01-24-2015 09:09 AM
    I guess I'm slightly confused by the wording here and may require further clarification.

    Are we saying that the MCO also has the same legal counsel?

    These are the thoughts that immediately popped into my and questions I would ask:

    Is this a for profit or non for profit provider organization? If non for profit, did the Board of Directors review and approve this potential conflict?

    What does the organization's conflict of interest policy state in terms of defining what constitutes a conflict and what actions are listed as a result?

    Also, what is the reporting structure of the provider organization, in terms of Corporate Compliance? Does the provider organization's Compliance Officer report directly to the Board and therefore a check and balance may exist, doses the Compliance Officer utilize separate counsel than the CEO's spouse?

    It's one of those situations that doesn't sit well with me but I'd want to know the type if organization and review their internal policies before revealing my thoughts about this. And if I did find that this structure violated regulatory or organizational standards, any recommendations I would provide would be carefully worded to ensure that long standing or new relationships weren't trampled in the process.

    Amethyst Jumbo Other
    Manager Corporate Compliance and Risk Management
    SCO Family of Services
    New York

    2020 HCCA Managed Care