Question & Answer

By June 11, 2019Legal, PBM

Q: Is it permissible for the Compliance Officer to report to General Counsel or the Legal Department? 

A: While some Plans and PBMs do this, it is not ideal or recommended.  There are potential conflict of interest concerns that have to be addressed.  Additionally, this type of structure can lead to situations in which one might have to recuse themselves from review of a compliance issue, human resources concern, or issue in areas where the “function” of either compliance or legal representation for the company may be unclear.  These issues are especially of concern when the General Counsel for the organization is also the Compliance Officer (same person vs. a reporting relationship).  In fact, Section 50.2.1 of Chapter 21 of the Medicare Managed Care Manual states that the Compliance Officer should not also serve as the General Counsel for the organization.  It also requires that the Compliance Officer provide compliance reports directly to the organization’s senior most leader, rather than routing such reports through operational management, like the General Counsel.