Ama Policy

Conflict of Interest in Care Review H-320.955

U.R. Criteria

AMA policy is that utilization review organizations make every effort to avoid potential conflicts of interest for physician reviewers by not assigning cases to a physician reviewer who (1) is an associate or competitor of the physician under review, (2) actively practices in the same hospital as the physician under review when feasible, (3) participated in the development or execution of the patient’s treatment plan, or (4) is a member of the patient’s family.

Policy Timeline

Res. 701, A-95Reaffirmed: CMS Rep. 7, A-05Reaffirmed: CMS Rep. 1, A-15