| Advisory opinion request regarding whether Edward Fowler, a Medicaid Program Manager 2 with the Policy and Compliance Section under the Bureau of Health Services Financing with the Department of Health and Hospitals (DHH), within two years of the termination of his employment, may accept employment with AmeriHealth Caritas at a time when AmeriHealth Caritas has a contractual relationship with the Bureau of Health Services Financing. |
|
Edward Fowler was employed as a Medicaid Program Manager 2 with the Policy and Compliance Section under the Bureau of Health Services Financing with the Department of Health and Hospitals (DHH). Mr. Fowler resigned on February 10, 2015. According to Mr. Fowler, he stated his primary duties involved developing and distributing member materials for web and print; gathering data from a variety of sources and compile reports; and maintain the Intranet for Medicaid staff. According to Mr. Fowler's position job duties and responsibilities, he was part of the Eligibility Policy Section that was responsible for the development, issuance, implementation and administration of policies, procedures and protocols necessary to establish eligibility for Louisiana's Medicaid Program. His specific responsibilities included statewide administration of the Medicaid Eligibility Quality Control, Buy-in Program, eligibility program compliance, staff direction, orientation, training, consultation, evaluation, and reporting. As Program Manager, he oversaw the implementation and daily operation of these three programs, directs and manages staff, estimates associated costs, monitors and manages the budget, and performs other non-specific duties relative to the management of these programs statewide. Mr. Fowler supervised four employees.
AmeriHealth Caritas currently has a contract with the Bureau of Health Services Financing, a managed care organization, contracted to provide a broad range of services necessary for the delivery of healthcare services to Medicaid enrollees participating in the Bayou Health Program. The services provided include developing and maintaining an adequate provider network, access standards, utilization management, fraud and abuse monitoring and compliance, case management, chronic care management and account management.
Mr. Fowler has the position of "Member Engagement Director" with AmeriHealth Caritas. His job duties would include lead initiatives to improve member satisfaction with ACLA; develop strategies to improve member compliance with healthcare objectives; maintain policies and procedures; chair the Member Grievance and Appeals Committee; communicate with state representatives regarding member complaints and issues; chair the Member advisory Committee; and develop and distribute member materials for web and print.
|
|
|
This matter came before the Board at a previous meeting with Mr. Fowler making an appearance. During the appearance, it became known that Mr. Fowler was not asking for an opinion regarding outside employment, as described in his opinion request, but seeking an opinion on post employment since he had resigned his position at DHH. The matter was deferred to obtain additional information about his position at DHH.
|
|
|
La. R.S. 42:1121B provides no former public employee shall, for a period of two years following the termination of his public employment, assist another person, for compensation, in a transaction, or in an appearance in connection with a transaction in which such former public employee participated at any time during his public employment and involving the governmental entity by which he was formerly employed, or for a period of two years following the termination of his public employment, render, any service which such former public employee had rendered to the agency during the term of his public employment on a contractual basis, regardless of the parties to the contract, to, for, or on behalf of the agency with which he was formerly employed.
|
|
|
Adopt the proposed advisory opinion.
|
|
| Assigned Attorney: |
Tracy Barker |
|
|