CEO 95-20 -- August 31, 1995

CONFLICT OF INTEREST

FORMER AHCA EMPLOYEE EMPLOYED BY HEALTH MANAGEMENT

COMPANY CONTRACTING WITH PREPAID MEDICAID HEALTH PLAN

PROVIDER CONTRACTING WITH AHCA

To: (Name withheld at the person's request.)

SUMMARY:

The Code of Ethics permitted a Medical/Health Care Program Analyst for the Agency for Health Care Administration to leave that position for employment with a health management company which contracts with a health maintenance organization contracting with the State to provide managed care services for Medicaid recipients. The former employee is not employed by a business entity contracting with his former agency; instead, he is employed by a business entity contracting with a separate business entity which contracted with the Agency for Health Care Administration. Thus, Section 112.3185, Florida Statutes, does not prohibit his subsequent employment with that health management company.

QUESTION:

Was the Code of Ethics for Public Officers and Employees violated where you, formerly employed as a Medical/Health Care Program Analyst by the Agency for Health Care Administration, subsequently became employed by a health management company which contracts with a health maintenance organization contracting with the Agency for Health Care Administration to provide prepaid health care services for Medicaid recipients?

Your question is answered in the negative.

Through your letter of inquiry and subsequent correspondence with our staff, we are advised that you were employed from July 1, 1993 to June 24, 1994 by the Agency for Health Care Administration (AHCA) as a Medical/Health Care Program Analyst. In that position, you were responsible for reviewing documents submitted by applicants seeking to become prepaid Medicaid health plans, wherein you determined whether legally required phrases were included by comparing the application documents against a preestablished check-list. Later, your responsibilities were expanded to include responding to inquiries about AHCA's contracting process. You relate that an application ranking system was used to prioritize which applications were selected for development into contracts, and during your tenure with AHCA, you participated in the partial review of approximately eight application documents.

We are further advised that contracts to become a prepaid Medicaid provider are not awarded through a competitive request for proposal process. Instead, Florida law establishes that any applicant meeting the minimum requirements may receive a contract with AHCA. You had no role in determining which applications you were to review, you advise, and your role was to assist applicants until their documentation achieved or surpassed minimum requirements. This created a process whereby materials were reviewed and edited, and then returned to the applicant for upgrading. New and rewritten materials were then resubmitted, thereby creating a new editing cycle.

You relate that as an agency employee, you had no contractual binding authority, no budgetary authority, and no direct or indirect supervisory authority over any agency employee. Further, you state that you had no contract management authority or responsibilities and did not ever perform monitoring, auditing, or training for a contract provider. You subsequently left AHCA employment for a position with a health management company. That company, you relate, contracts with a company who contracts with AHCA to provide Medicaid managed health care services to eligible persons. You question whether your subsequent employment violates the Code of Ethics for Public Officers and Employees.

The Code of Ethics for Public Officers and Employees provides:

No agency employee shall, after retirement or termination, have or hold any employment or contractual relationship with any business entity other than an agency in connection with any contract in which the agency employee participated personally and substantially through decision, approval, disapproval, recommendation, rendering of advice, or investigation while an officer or employee. [Section 112.3185(3), Florida Statutes (1993).]

No agency employee shall, within 2 years of retirement or termination, have or hold any employment or contractual relationship with any business entity other than an agency in connection with any contract for contractual services which was within his responsibility while an employee. [Section 112.3185(4), Florida Statutes (1993).]

Generally, Section 112.3185(3) prohibits a former State employee from private employment in connection with any contract with which he was involved while a public employee. Section 112.3185(4) would be violated if the former employee worked in a non-agency capacity during the two-year period following his public employment in connection with a contract that was within his responsibility as a public employee.

We are of the view that neither of these provisions were violated by your subsequent employment with the health management company. Since your employer is not contracting with the Agency for Health Care Administration, you obviously did not participate in the procurement of a contract with your employer while you were an AHCA employee. Nor could your subsequent employment have been in connection with a contract for contractual services that was within your responsibility while an AHCA employee, since your employer is not contracting with the Agency. In CEO 84-23, we recognized that neither Section 112.3185(3) nor 112.3185(4) were violated where a former H.R.S. employee engaged in respite caregiver services, since her business was not contracting with the Department.

Accordingly, we find that no prohibited conflict of interest was created by your subsequent employment with a health management company contracting with a managed health care services company which contracted with the Agency for Health Care Administration to provide services to Medicaid recipients.

ORDERED by the State of Florida Commission on Ethics meeting in public session on August 31, 1995, and RENDERED this _____ day of September, 1995.

__________________________

William J. Rish

Chairman