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Frequently Asked Questions

Compliance

Ethics/Compliance Hotline:

The University maintains a toll-free ethics hotline at 888-206-6025 and allows individuals to submit ethics concerns through the Internet at www.ethicspoint.com. You can also report health care compliance concerns directly to the Billing Compliance Office at 801-213-3948. You should also report your concerns to your direct line supervisor unless you believe that person is part of the activity about which you are concerned. (Last reviewed on Dec. 1, 2011)

Conflict of Interest Policies:

Both Utah law and University policy are designed to promote the public interest, strengthen the confidence of the people in Utah in the integrity of their government, and ensure that actions do not interfere with the full and faithful discharge of the duties of public employees.

a. Public Employees Ethics Act

The Public Employees' Ethics Act (the "Act") generally prohibits a University employee from accepting a gift that (1) would tend to improperly influence the employee in their official duties; (2) is given to reward employee for "official action taken," or (3) is given in close proximity to a University transaction. Utah Code Ann. § 67-16-1 et seq. These prohibitions generally do not apply to occasional, non-pecuniary gifts having a value of less than $50. An employee may accept a gift exceeding the $50 limit if she satisfies the Act's fairly extensive disclosure requirements. An employee who knowingly violates the Act is subject to dismissal from employment and charged with a misdemeanor or felony depending on the value of the gift.

b. University Conflicts of Interest Policy

University Policy 1-006 requires reporting of conflicts. Some conflicts are prohibited, and most must be managed. The Policy requires employees to report "significant financial or other conflicts of interest" such as those relating to research or scholarly activity, purchasing, or intellectual property. Some common examples of reportable financial relationships include situations where an employee receives external compensation or serves as a director, officer, employee, or agent of an outside organization. Reports of conflicts are electronically submitted to the University's Conflict of Interest Committee, which is comprised of a broad faculty representation. The Committee develops management plans for reported conflicts and also investigates violations of Policy 1-006.

c. University of Utah Hospitals & Clinics’ Conflict of Interest Policy

The University of Utah Hospitals & Clinics’ (“UUHC”) conflict of interest policy requires UUHC employees who are manager level or above to make an annual disclosure of “financial interests” such as compensation from a business entity, equity interests in a business entity, intellectual property rights, or holding a position as an officer, director, agent, or employee of a business entity.  The policy also requires individuals for whom purchasing is a major part of their responsibilities, as well as those who are members of committees that make purchasing decisions, to make an annual disclosure of financial interests.  If an individual reports a financial interest in an entity that conducts business at or with UUHC, he or she cannot participate in purchasing decisions related to that entity, and his or her recusal must be noted in the minutes of the relevant committee meeting.  Finally, the policy requires employees who advocate to a UUHC purchasing committee for a particular product or service to report to the committee any financial interest held in the company offering the product or service.

d. University of Utah Hospitals & Clinics’ Vendor Gifts Policy

The University of Utah Hospitals & Clinics' ("UUHC") vendor policy is more restrictive than state law or general University policy and prohibits vendors from providing any gifts to UUHC departments and employees.  The vendor policy implements other measures to secure public trust and limit industry influence on patient care and patient education.  Key elements of the policy are vendor orientations and vendor letter agreements, vendor ID badges, a prohibition on cold calls and access to patient areas, a strict product purchasing process, and general prohibitions on vendor-supplied drug samples and patient education materials.  

e. School of Medicine Industry Relations Policy

The School of Medicine ("SOM") Industry Relations Policy also prohibits gifts from vendors. It permits industry-sponsored scholarships and educational funding but requires the funding to meet certain defined expectations. The policy provides guidance to faculty regarding appropriate consulting, research support, and other industry financial relations while discouraging participation on speakers' bureaus and prohibiting ghost writing. Like the UUHC policy, the SOM policy prohibits cold calls and access to patient areas, requires ID badges, and includes general prohibitions on vendor-supplied drug samples and patient education materials. The SOM Dean's Office has implemented an annual reporting process for faculty. (Last reviewed on August 1, 2015)

Discounted or Free Medical Services:

Free and discounted services can raise concerns under the anti-kickback statute, which prohibits payments (in cash or in-kind) to another to induce the referral of items or services reimbursable by a Federal payor. Issues to consider are whether referrals to the University may arise from the arrangement and whether participants will receive any direct/indirect benefits from the services.

In terms of approving the arrangement, first contact the department chair for approval. Then contact the Office of General Counsel to discuss the regulatory issues and properly document the arrangement. (Last reviewed on Dec. 1, 2011)

Stark/Anti-kickback:

The Stark and Anti-kickback laws are federal laws intended to prohibit the payment of any remuneration in exchange for referrals of items or services paid for under a federal health care program. These are two separate but related laws, with relatively complex regulatory schemes and compliance requirements. In summary, all "financial" arrangements with any non-University healthcare entity should be based on a written contract. A financial arrangement may include the payment of money or other remuneration, including providing of goods or services. All payments should be based on the fair market value of goods or services provided. Under no circumstances should any portion of the payment be based on the volume or value of referrals between the parties. When entering into business transactions which may implicate these laws, please consult with the Office of General Counsel. (Last reviewed on Dec. 1, 2011)