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Oklahoma Administrative Code (Last Updated: March 11, 2021) |
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TITLE 310. Oklahoma State Department of Health |
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Chapter 659. Health Maintenance Organizations |
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Subchapter 3. Examinations |
SECTION 310:659-3-4. Conflict of interest
Latest version.
- (a) An independent quality examiner contracted by an HMO or a qualified person contracted by the Department pursuant to 36 O.S. Section 6929 shall:(1) Have knowledge and expertise in the area they are contracted to review; and(2) Have no history of disciplinary action or sanctions related to quality of care, fraud, or other criminal activity.(b) No contracted examiner or qualified person shall have any material, professional, familial or financial conflict of interest with:(1) The HMO;(2) Any officer, director, or management employee of the HMO;(3) Any provider contracted with the HMO; or(4) Any other HMO in the service area.(c) A potential reviewer or qualified person shall disclose information regarding potential conflicts of interest to all parties to the review.