participation agreement
(2) Independence (A) In general Subject to subparagraph (B), each individual conducting a review in a case shall— (i) not be a related party (as defined in paragraph (5)); (ii) not have a material familial, financial, or professional relationship with such a party in the case under review; and (iii) not otherwise have a conflict of interest with such a party. (B) Exception Nothing in subparagraph (A) shall be construed to— (i) prohibit an individual, solely on the basis of a participation agreement with a fiscal intermediary, carrier, or other contractor, from serving as a reviewing professional if— (I) the individual is not involved in the provision of items or services in the case under review; (II) the fact of such an agreement is disclosed to the Secretary and the individual entitled to benefits under part A or enrolled under part B, or both, or such individual’s authorized representative, and neither party objects; and (III) the individual is not an employee of the intermediary, carrier, or contractor and does not provide services exclusively or primarily to or on behalf of such intermediary, carrier, or contractor; (ii) prohibit an individual who has staff privileges at the institution where the treatment involved takes place from serving as a reviewer merely on the basis of having such staff privileges if the existence of such privileges is disclosed to the Secretary and such individual (or authorized representative), and neither party objects; or (iii) prohibit receipt of compensation by a reviewing professional from a contractor if the compensation is provided consistent with paragraph (3). For purposes of this paragraph, the term “participation agreement” means an agreement relating to the provision of health care services by the individual and does not include the provision of services as a reviewer under this subsection.