Conflict of Interest Questionnaire for Employees
(Healthcare Organization)

Summary

This template is a questionnaire that may be used by healthcare organizations to identify potential conflicts of interest of certain high level and key employees. This template includes practical guidance and drafting notes. Healthcare organizations may require key employees to disclose any relationship that may pose a potential conflict of interest with that individual's role in the organization. Such employees may be asked to complete this short conflict of interest questionnaire. For more on healthcare generally, see First Year Associate Resource Kit: Healthcare, Healthcare Fundamentals Resource Kit, and Healthcare Fraud and Abuse Compliance Resource Kit. For a related conflict of interest policy, see Conflict of Interest Policy for Medical Staff (Healthcare Organization). For a conflict of interest questionnaire and policy specifically for directors and officers, see Conflict of Interest Questionnaire for Directors and Officers (Healthcare Organization) and Conflict of Interest Policy for Directors and Officers (Healthcare Organization). For additional resources on building effective healthcare compliance plans, see Compliance Programs for Healthcare Providers, Healthcare Compliance Plan Elements, and Implementing a Healthcare Compliance Plan. To compare state and federal healthcare fraud and abuse laws, see the Healthcare State Law Comparison Tool.