Conflict of Interest, Insurance Law, Etc

[scagnt83]

Hypothetically, if a "Benefits programs Coordinator" basically the head of HR, at a big hospital was to create an agency and run the hospitals benefits through their agency; would this violate any laws?


Obviously there are ethical issues here, and I am sure the board of directors would love to hear about it; but what about from a pure legal aspect?

 

[leevena]

Hypothetically, if a "Benefits programs Coordinator" basically the head of HR, at a big hospital was to create an agency and run the hospitals benefits through their agency; would this violate any laws?


Obviously there are ethical issues here, and I am sure the board of directors would love to hear about it; but what about from a pure legal aspect?

No, not necessarily. Many entities have their own agency inside to do such things. Where there might be something unusual is if the person did so outside of the entity and then did not disclose it. Don't know if that violates any laws (check your state) but it would begin to sound like an ethical problem.

 

[scagnt83]

No, not necessarily. Many entities have their own agency inside to do such things. Where there might be something unusual is if the person did so outside of the entity and then did not disclose it. Don't know if that violates any laws (check your state) but it would begin to sound like an ethical problem.

This agency is separate from the entity; and the entity at hand is not the only client they have.

I dont exactly know what the level of disclosure is within the entity, but I know that its not as much as it should be.

And the agency is owned by the individual, not by the entity.

 

[leevena]

This agency is separate from the entity; and the entity at hand is not the only client they have.

I dont exactly know what the level of disclosure is within the entity, but I know that its not as much as it should be.

And the agency is owned by the individual, not by the entity.

I am not an attorney, but based on what you have outlined so far, it does not appear to be a legal problem. You may have an ethical issue, but hard to say because you indicate there is some level of disclosure...just not enough.

Sounds like you are an agent and you may be losing business to this outside entity that has a person on the inside. Thats one of the perils of our business.

And hello to a fellow Palmetto resident. Just saw your flag.

 

[arnguy]

Contact PrePaidLegal. Even if he doesn't have the answer, he can send them a scarry (sic) letter!

 

[somarco]

I have seen these situations before where the company was aware of the relationship and had no issue.

I also have worked with folks in the past that were dealing under the table. When the employer found out it did not go well for the person involved.

 

[scagnt83]

Thanks for the replies guys.

I was thinking that there might be a HIPPA reg or something that would prohibit a director of a company from funneling GHI commissions for the company through themselves.... it seems like the situation would be ripe for abuse...


While HIPPA might come into play, I am fairly sure that ERISA will when it comes to the 401K....
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Sounds like you are an agent and you may be losing business to this outside entity that has a person on the inside. Thats one of the perils of our business.

Actually I might gain biz from this.... but Im very weary of the situation...
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And hello to a fellow Palmetto resident. Just saw your flag.

Hello to you too.

Go to the User CP link at the header of the page and you can change your flag.

 

[somarco]

I was thinking that there might be a HIPPA reg or something that would prohibit a director of a company from funneling GHI commissions for the company through themselves

Based on what?

fairly sure that ERISA will when it comes to the 401K.

Maybe, but not necessarily.

I have worked with ERISA plans off and on for over 30 years. It has been a while since I dealt with retirement plans, and can't say I know of a case where someone on the inside was benefiting from fees or commissions on a retirement plan, but I have seen it on some large insurance plans.

UPS has an offshore captive to handle reinsurance on their packages. Other companies have done likewise using offshore and domestic captive companies to handle some of their risks.

If this person is doing this under the table that is one thing, but AFAIK there is nothing in HIPAA or ERISA that prohibits inside dealing.

 

[ABC]

I do not think it violates any laws.

I lost a group that bought an agency to handel their PC and group health benefits.

 

[b61mack]

if they have other clients it is ok....you just can't have one big client.... it isn't worth gettting worked up over. next