The importance of delivering independent, conflict-free services to citizens
A conflict of interest may exist when a contractor has an interest, financial or otherwise, in the outcome of its services or a relationship with an individual or contractor that could influence the outcome of its services. Conflicts of interest, whether real or perceived, can undermine the effectiveness of government programs as well as public confidence and trust in the programs’ integrity.
Maximus is firmly committed to offering conflict-free services to government, which is critical for our work as the largest independent administrative services organization, supporting 70 percent of all Medicaid and CHIP beneficiaries in the country and as the largest Qualified Independent Contractor of Medicare appeals.
Which regulations require conflict-free services?
Government Rule | Requirement |
Balanced Budget Act of 1997 | Covers state Medicaid managed care enrollment brokers |
42 Code Federal Regulations § 438.810 | Requires independence of state Medicaid managed care enrollment brokers |
Federal Acquisition Regulation Subpart 9.5 | Medicare Compliance Program Guide for Medicare Fee-for-Service Contractors that prevents the existence of conflicting roles that might bias a contractor’s judgment and precludes unfair competitive advantage |
The Sarbanes-Oxley Act of 2002 | Strengthens financial oversight of corporations by ensuring that corporations accurately certify their financial reporting and adhere to key provisions on disclosures, controls and improper influence |
LTSS Regulation of March 2014 | Requires separation of assessment and care planning from direct service delivery |
Medicaid and CHIP Managed Care Rule (June 2016) | Contains definitions and codifies COI in the assessment and care planning process for LTSS |
State “Sunshine Laws” | Encourage transparency by requiring full and open disclosure of services procured by governments |
Balanced Budget Act of 1997 | Covers state Medicaid managed care enrollment brokers |