Conflict of Interest
This section contains information regarding cases where there may be a conflict of interest.
Policy
Division of Benefits and Medical Eligibility (DBME) employees, contractors, and volunteers cannot have involvement in a case where there may be a conflict of interest.
FAA avoids fraudulent activity by ensuring employees, contractors, and volunteers do not work on cases that may be considered a conflict of interest.
A case is considered a conflict of interest for an employee, contractor, or volunteer when any of the following occurs:
●The results of any case involvement may affect their own personal, professional, or financial interest.
●Personal involvement indicates there may be favoritism, improper behavior, or fraud.
This conflict could occur when an employee, contractor, or volunteer interacts with a case that belongs to, and is not limited to, any of the following:
●Themself
●Relative
●Roommate
●Neighbor
●Friend
●Business associate
●Co-worker or relative of a co-worker
●Significant other
●Parent of a common child
Employees, contractors, and volunteers are not allowed to request information from co-workers regarding cases with which they have a conflict of interest unless they are an authorized representative for the participant’s case.
Procedures
All AZTECS, HEAplus, and OnBase(g) inquiries are recorded. Actions that display on a case in which there is a conflict of interest could be considered suspicious or potentially fraudulent activity.
All employees, contractors, and volunteers with access to cases are required to report cases in which there may be a conflict of interest. (See Conflict of Interest – Reporting Responsibilities for additional information.)
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Conflict of Interest – Reporting Responsibilities
All employees, contractors, or volunteers with access to cases are required to report cases in which there may be a conflict of interest. (See Conflict of Interest – Reporting Responsibilities for additional information.)
The FAA supervisor must review any possible conflicts of interest with employees, contractors and volunteers on an annual basis. (See Supervisor Responsibilities for Conflict of Interest for additional instructions.) The supervisor must document the acknowledgement that conflict of interest policy, procedures, and forms were reviewed.
Arizona Revised Statute §41-1959 makes the release of confidential information a Class 2 Misdemeanor. Disciplinary action is to be taken when it is found that an employee, contractor, or volunteer has misused or inappropriately released case information. Disciplinary action may include suspension, dismissal, and prosecution.All inquiries regarding a participant’s medical provider or health plan must be referred to AHCCCS(g).
A Conflict of Interest/Confidentiality Statement (FAA-1446A) form and the Conflict of Interest Case Information (FAA-1447A) form must be completed at any of the following times:
●Upon hire
●When the employee, contractor, or volunteer becomes aware of any new case where a conflict of interest may exist
●During the opening of the new rating period when the previously completed forms are not available
List the information for all cases that may have a conflict of interest on the FAA-1447A form. Additional FAA-1447A forms may be used when additional space is required.
NOTE When the employee, contractor, or volunteer states that they do not know of any cases with a conflict of interest, the appropriate section must be completed on the FAA-1446A form.
When unsure whether there is a conflict of interest, the situation must be reviewed with FAA management. When management determines that a conflict of interest exists, document the case information on the FAA-1447A form.
Every year, the previously completed conflict of interest forms must be reviewed by the staff and management during the annual rating period planner. When reporting a change to the forms or the previous forms are not available, complete and submit new conflict of interest forms. Do not upload the completed forms to the appraisal system.
NOTE When an additional case with a conflict of interest is discovered, the employee, contractor, or volunteer must immediately complete and submit a new FAA-1446A form along with a new FAA-1447A form to their supervisor. Do not wait until the annual employee evaluation. Do not view case information to complete these forms.
Supervisor Responsibilities for Conflict of Interest
Supervisors must immediately report to HR Business Partners when any of the following occur:
●An employee, contractor, or volunteer reports accidental viewing of case information with a conflict of interest.
●Management suspects a potential violation has occurred.
At least once per year, during the annual employee rating period, supervisors must complete all of the following:
●Review the conflict of interest policy and procedures with each employee, contractor, or volunteer.
●Request written approval from the Region Program Manager (RPM) when an employee, contractor, or volunteer is to act as an authorized representative for a participant’s case.
●Review the previously completed Conflict of Interest/Confidentiality Statement (FAA-1446A) form and the Conflict of Interest Case Information (FAA-1447A) form.
●When there are changes or the previous forms are not available, have the employee, contractor, or volunteer complete and submit new conflict of interest forms.
●Ensure that any cases with a conflict of interest, discovered during the year, are included on the forms.
●Retain a copy of each form in the employee’s file.
●Provide the employee with a signed copy of each form.
●Forward the originals to HR. See, DBME HR Operations for appropriate routing.
●Destroy copies of the previously completed FAA-1446A and FAA-1447A forms.
●Document the annual rating period planner that conflict of interest policy, procedures, and forms have been reviewed. Do not upload the completed forms to the appraisal system.
Employee Reporting Case Participation
When a DBME employee, contractor, or volunteer is a current or past participant in any NA, CA, or MA case, they must report the information at all of the following times:
●At the New Employee Orientation
●Within three workdays(g) of becoming an employee, contractor, or volunteer of DBME
●Within three workdays of submitting a paper or electronic application for benefits
●Any time there is a change in case participation
Reporting case participation can be submitted in any of the following ways:
●Via email, phone, or completion and submission of a Change Report (FAA-0412A) to the Employee Benefits Unit (EBU)
●By completing and submitting both of the following forms to the employee’s supervisor:
Conflict of Interest/Confidentiality Statement (FAA-1446A)
Conflict of Interest Case Information (FAA-1447A)
Employee Case Access
The Employee Benefits Unit (EBU) maintains all current employee program case files(g). This includes employees, contractors, and volunteers of any of the following administrations:
●Disability Determination Service Administration (DDSA)
●Family Assistance Administration (FAA)
●Quality Management Administration (QMA)
An active or inactive FAA program case file of a current DBME employee is locked and can only be accessed by any of the following:
●Staff designated by DBME Administration
●Human Resources
●FAA Systems Helpdesk
The EBU staff completes all eligibility actions on locked case files. This includes, and is not limited to, any of the following:
●Completing the application process (new and renewal)
●Processing all changes, including NA Mid Approval Contacts
●Responding to inquiries from employees, contractors, and volunteers
●Completing reports of potential overpayments
●Writing overpayments
●Accepting and processing appeal hearing requests
●Attending hearings for employees, contractors, or volunteers who request an appeal
Employees must complete the application process for their case and cases in which they are an authorized representative during nonwork time(g).
Designated break time is considered state work time. DBME employees, contractors, and volunteers are not permitted to complete any of the following during break time:
●Submit verification or complete other activities for their benefit case
●Submit verification or complete other activities for cases in which they are the authorized representative
DBME employees, contractors, and volunteers must not have any case involvement with their case or any case that may result in a conflict of interest. For information on case involvement, see Conflict of Interest – Reporting Responsibilities and Employee Reporting Case Participation.
Employees, contractors, and volunteers may contact the EBU for information on their own case.
When information is needed on their case file or a case in which they are an authorized representative, employees, contractors, and volunteers may consider accessing any of the following personal accounts during nonwork time:
●MyFamilyBenefits account
●HEAplus account using the customer portal
DBME employees, contractors, and volunteers must not be given special privileges and must be treated as all other program participants.
Handling Employee Cases
For additional policies and procedures regarding case handling of DBME employees, contractors, and volunteers, see all of the following:
Employee Case Involvement
Case files for DBME employees, contractors, and volunteers who are or have ever been FAA program participants must be locked.
DBME employees, contractors, and volunteers must not have any case involvement with their case or any case that may result in a conflict of interest. Case involvement(g) includes, and is not limited to, all of the following:
●Accessing and viewing or making changes to a case file
●Determining eligibility for benefits
●Registering applications
●Interviewing a participant
●Case-specific discussion with another DBME employee, contractor, or volunteer about the employee’s, contractor’s, or volunteer’s case
●Issuing EBT cards on an employee’s, contractor’s, or volunteer’s case
●Submitting verification on behalf of a participant with whom a conflict of interest exists
DBME employees, contractors, and volunteers must not be given special privileges and must be treated the same as all other program participants.
With permission from a direct supervisor or office manager, DBME employees, contractors, and volunteers can use the office resources that are available to participants to discuss or provide information for their case. This includes, and is not limited to, any of the following:
●Interoffice mail
●Office fax machines
●State telephones
●When available, FAA office lobby copiers and kiosks
Employee Interviews
Interviews for all Division of Benefits and Medical Eligibility (DBME) employees, contractors, and volunteers are conducted by telephone. Contact the Employee Benefits Unit (EBU) to complete an interview during nonwork time.
Do not call the Statewide Interview Line; staff do not have access to locked case files(g).
Employee Receipt of an EBT Card
Division of Benefits and Medical Eligibility (DBME) employees, contractors, and volunteers may order an EBT card via phone or request an over the counter (OTC) card.
DBME employees, contractors, and volunteers requesting an OTC card from their assigned office during normal business hours must do so only during their approved break or lunch period.
Employees, contractors, and volunteers may not go directly to another staff member within their own office to request an OTC EBT card. The employee, contractor, or volunteer must request the OTC from their office manager or direct supervisor. The office manager or supervisor must follow all established EBT policies, including documenting the case file with the type of identification that was used to verify the identity of the employee.
The office manager or supervisor must notify the Employee Benefits Unit (EBU) of the OTC EBT card issuance via email on the date of issuance.
Employees, contractors, and volunteers may go to another FAA office during nonwork time(g) and follow the normal process.
When employees feel that they cannot be fair about a case, the case must be given to management as a possible conflict of interest. The reasons for the impartiality must be explained in detail. Management decides whether the case should be reassigned.
Employee Relatives Cases
When a Division of Benefits and Medical Eligibility (DBME) employee’s, contractor’s, or volunteer’s relative (by blood or marriage) is an active or past participant in an FAA program, they must report this to their supervisor as a conflict of interest.
Relatives include, and are not limited to, those within a third-degree relationship of any of the following:
●A spouse(g) (current and former)
●A child (natural, adopted, foster, stepchild, grandchild, great-grandchild)
●A parent
●A grandparent
●A great grandparent
●A sister or brother (including step)
●An aunt or uncle
●A niece or nephew
●A cousin
●An in-law
NOTE This includes past relationships due to former marriages.
DBME employees, contractors, and volunteers must not have any case involvement with their case or any case that may result in a conflict of interest. For information on case involvement, see Employee Case Involvement.
When a DBME employee, contractor, or volunteer is assigned a case belonging to their relative, all of the following must occur:
●The employee, contractor, or volunteer must immediately report this to their direct supervisor or office manager.
●The office manager or direct supervisor determines who the case should be transferred to and transfers the case.
When a DBME employee, contractor, or volunteer in a rural area is assigned a case belonging to their relative, have the participant call the Customer Care Center (CCC) for Health-e-Arizona Plus and FAA. To contact the CCC for Health-e-Arizona Plus (HEAplus) and FAA, call (855) HEA-PLUS or (855) 432-7587.
NOTE DBME employees, contractors, and volunteers are not allowed to request information from co-workers regarding their relatives’ case unless they are the authorized representative of the case.
Co-workers and Co-worker’s Relatives
There is a possible conflict of interest when a Division of Benefits and Medical Eligibility (DBME) employee, contractor, or volunteer works on the case of a co-worker or a case belonging to a co-worker’s relative (within a third-degree relationship). A co-worker is anyone that works in the employee’s, contractor’s, or volunteer’s current DBME office or any office in which they have worked in the past.
When a DBME employee, contractor, or volunteer is assigned a case with participants related to their supervisor, the case must be given to the FAA office manager or other management to be reassigned to another unit.
Employee Other Nonrelative
When a participant and a Division of Benefits and Medical Eligibility (DBME) employee, contractor, or volunteer spend time together outside of the office, the employee, contractor, or volunteer must report this to their supervisor as a possible conflict of interest.
This also includes any participant with whom the employee, contractor, or volunteer has had any of the following:
●A negative relationship
●A personal reason that they cannot act impartially
When an employee, contractor, or volunteer is not well known to or familiar with the neighbor, friend, or business associate, discuss the situation with a supervisor. The supervisor determines whether there is a conflict of interest and documents the conversation and decision in the participant’s case file.
Verification
Employee Case Submitting Verification
Division of Benefits and Medical Eligibility (DBME) employees, contractors, or volunteers may use state equipment during their lunch period and before or after their work hours. A member of management must be informed before using state equipment to submit verification on their case.
The employee, contractor, or volunteer may submit their verification in any of the following ways during nonwork time(g):
●Fax directly to the Employee Benefits Unit (EBU) using the Fax Cover Sheet (DES-1078A) form.
●Via email directly to the EBU.
●By taking their verification to their office manager or direct supervisor.
NOTE The office manager or direct supervisor must upload information on the same day of receipt. The verification is not to be put in a general location. A DBME employee, contractor, or volunteer may not upload their verification or ask someone in their own office, other than the office manager or a direct supervisor to upload their verification.
●By uploading verification to their HEAplus account using the customer portal in the same manner as all other participants.
Examples
1) Examples of unacceptable behavior that could be subject to disciplinary action including suspension, dismissal, and prosecution include, and are not limited to, any of the following:
●Processing your co-worker’s adult child’s benefit determination after the case was given to you by that co-worker.
●Checking your roommate’s AZTECS case because you know that the previous worker must have made a mistake. After all, your roommate makes much less than the income limit.
●When you go out to the lobby, pick up your cousin’s verification, and deliver it to your co-worker so that your cousin doesn’t need to stand in line.
●Calling a co-worker and asking them to put your mother’s case to the top of their cases to work today.
●Calling the local office using a number that is not available to the public to ask that they call your brother who cannot get through the telephone system.
●Your neighbor comes over to the house the night before to bring you their verification. You then bring it into the office the next morning and give it to your co-worker.
●Checking on the status of your friend’s case when they call because their worker is not calling them back.
●Printing a copy of your girlfriend’s birth certificate from OnBase for her because she cannot find her copy.
●Looking up the telephone number of your friend in AZTECS because the one that you have is no longer in service.
●Looking up your brother’s ex-wife’s case to find out how much child support your brother is paying her.
●Asking your co-worker to look up your brother’s ex-wife’s case to find out how much child support your brother is paying her.
●Looking up the address and phone number of your ex-boyfriend’s new girlfriend to tell her to stay away from your ex-boyfriend.
Legal Authorities
ARS 38-501 through ARS 38-511
ARS §41-165E
ARS §41-1959
7 CFR 273.2(a)(1)
last revised12/26/2023