Legislation
SECTION 4913
Conflict of interest
Public Health (PBH) CHAPTER 45, ARTICLE 49, TITLE 2
§ 4913. Conflict of interest. 1. No external appeal agent or officer,
director, or management employee thereof; or clinical peer reviewer
employed or engaged thereby to conduct any external appeal pursuant to
this title, shall have any material professional affiliation, material
familial affiliation, material financial affiliation, or other
affiliation prescribed pursuant to regulation, with any of the
following:
(a) the health care plan;
(b) any officer, director, or management employee of the health care
plan;
(c) any health care provider, physician's medical group, independent
practice association, or provider of pharmaceutical products or services
or durable medical equipment, proposing to provide or supply the health
service;
(d) the facility at which the health service would be provided;
(e) the developer or manufacturer of the principal health service
which is the subject of the appeal; or
(f) the enrollee whose health care service is the subject of the
appeal, or the enrollee's designee.
2. Notwithstanding the provisions of subdivision one of this section,
the commissioner shall promulgate regulations to minimize any conflict
of interest where such conflict may be unavoidable.
director, or management employee thereof; or clinical peer reviewer
employed or engaged thereby to conduct any external appeal pursuant to
this title, shall have any material professional affiliation, material
familial affiliation, material financial affiliation, or other
affiliation prescribed pursuant to regulation, with any of the
following:
(a) the health care plan;
(b) any officer, director, or management employee of the health care
plan;
(c) any health care provider, physician's medical group, independent
practice association, or provider of pharmaceutical products or services
or durable medical equipment, proposing to provide or supply the health
service;
(d) the facility at which the health service would be provided;
(e) the developer or manufacturer of the principal health service
which is the subject of the appeal; or
(f) the enrollee whose health care service is the subject of the
appeal, or the enrollee's designee.
2. Notwithstanding the provisions of subdivision one of this section,
the commissioner shall promulgate regulations to minimize any conflict
of interest where such conflict may be unavoidable.