This conflict of interest form is designed for transparency regarding the perspectives of appointed ad hoc experts who serve as volunteers for the Commission. We recognize that most experts are employed in a field related to the topic under consideration or have personal beliefs which will influence their testimony. This form allows the Commission and the public to better understand each expert’s perspective and the incentives they may be experiencing. The presence of real or potential conflicts of interest does not necessarily prevent someone from being appointed as an expert. We encourage full responses and explanations.
Before filling out this form, you may wish to review your records on CMS Open Payments and Dollars for Docs, as staff routinely searches these sources as part of due diligence. This survey contains a place to explain any errors or to provide contextual information.
Information provided on this form will not be published routinely, but is subject to public records law and may become public. A brief verbal summary of your conflicts of interest will be offered at each public meeting you attend as expert.
