I took a bioethics class in college and I remember the professor being very vocal about being against capital punishment. “Those with the capital, don’t get the punishment” was a quote I remember him using during our discussions. Later in the class, a student asked the professor how he would feel if he or his family were victims of some potentially capital crime. “Someone stole my lawnmower last month,” the prof told us. “If they caught the guy that took my mower, and I was the guy to dispense justice, capital punishment wouldn’t be enough and couldn’t be done fast enough. That’s why our society uses judges and jury for these things—I’d have a ‘conflict of interest’ and couldn’t render a fair decision.”

We hear the term conflict of interest in legal terms, during school, in business, even in sports and just about every other aspect of our lives. It’s an important concept to understand and avoiding conflicts of interest are integral to having a career, running a business, or even living a life known for integrity, honesty, and “doing the right things”.

Conflicts of interest happen when an individual’s personal interests conflict or interfere with their professional responsibilities and decision making. The simplest definition of conflict of interest is “a situation in which a person has a potential to be unable to make a fair decision because they are affected by the result of that decision”. A person can think of numerous examples of conflict of interest in our personal and professional lives:

• A judge recuses (removes) them self from a case when a family member or close friend is involved.
• In boxing, a referee would stand down if they have a close personal relationship with one of the boxers.
• A manager would typically not make a hiring decision in competitive situations where their spouse or other close family member was vying for the job.
• In selecting who gets a government contract, decision-makers that know the potential contractor should remove themselves from the decision.
• A college admissions officer should never be involved in deciding if their child gets into a college or receives a scholarship.
• A coach or baseball (or football or basketball) player should not be placing bets on games that they are participating in.

Now, apply the concept to business and specifically our industry, the DME industry. All manner of human resource management, billing and reimbursement issues, and ethical decisions about what patient/customers to admit to service present potential conflicts of interest. Our industry encounters potential conflicts of interest all the time. How they handle these potential conflicts is important and that handling of conflicts is governed by accreditation standards and sometimes law and regulation as well.

HQAA has a specific standard addressing conflict of interest:

CONFLICT OF INTEREST

Standard ORG 6

The company must identify and define in a policy any potential for professional conflicts of interest by its employees or customers and ensure they are reviewed and addressed as required by law and regulation in a timely manner.

Evidence of Compliance:

Evidence of compliance with this standard would be a policy that addresses the organization’s view of conflict of interest. The policy clearly describes what action should be taken if a potential conflict exists. Additional areas addressed in policy should include:

• Definition of conflict of interest
• Employee awareness
• Reporting procedure
• Leadership review of any submitted reports

How HQAA evaluates your organization’s ability to meet the standard starts in the application process. Applying organizations are asked to submit their policy on conflict of interest. A coach will evaluate the policy to ensure it meets the various requirements listed above. It continues during the survey process. Staff ranging from customer service and other boots on the ground employees all the way up to owners and managers are expected to understand the policy. Surveyors may ask about any potential conflicts of interest and how staff would handle the conflict. They are expecting that the staff can describe a process similar to what the company’s policy actually says they do.

It’s typical for organizations to have new employees sign off on the conflict of interest policy and state that they have no conflicts. There is often a place for them to list potential conflicts. If a new employee’s spouse is a referring physician, or a family member works for a competitor, or the employee has a pending lawsuit with a major vendor for the company, it should be disclosed. Disclosure doesn’t necessarily mean the employee would not be hired. But the disclosure should trigger a series of events/evaluations by the organization to ensure the potential conflict of interest is not detrimental to the organization and also (perhaps, more importantly) that the organization is compliant with law and regulation.

The accreditation standard outlines what needs to be included in the policy. In addition to a policy that meets the standard, the organization should train all staff at orientation on what constitutes conflict of interest and how to report conflicts. During survey, the surveyor will certainly ask about conflicts and expect all staff to understand how the process works when a conflict arises.

Years ago, in a DME organization I was surveying, I asked the owner how he dealt with conflicts of interest. This was in the very early 2000’s and fraud and abuse were a bit more prevalent than they are today. The organization was geographically located in an area that was a hotbed of fraudulent activity (that shall go unnamed). It was obvious from his answer that I’d touched a nerve with him and he was passionate as he described how his staff was instructed to maintain the highest level of ethical standards, which to him, included avoiding any semblance of conflict of interest. “I teach my staff what conflicts of interest are and how important it is to avoid them. I also tell my staff to report conflicts or potential conflicts immediately and ‘when in doubt, ask’. There’s no harm in asking, but a lot of potential for harm in not asking and assuming.” His passion and that quote synthesizes the spirit of avoiding conflicts of interest perfectly.

Avoiding conflicts of interest is considered doing the right thing in the eyes of the law, the government, and any accreditation agency. It is ethical and fair and thus something for all businesses to do right. Make sure the philosophy as well as the actual policy/procedure is firmly ingrained in all employees and all aspects of your company.