Section 4913. Conflict of interest  


Latest version.
  • 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.