Nondisclosure_Agreement_NDA.pdf

Attachment #2

Non-Disclosure Agreement between Department of Health & Human Services and

Contractor Employee or Other External Entity Granting Conditional Access to Sensitive but Unclassified Information

Contract Number:

Prime Contractor:

Employer (if different):

I, ,hereby consent to this agreement in consideration for my being granted conditional access to certain United States Government documents or materials containing sensitive but unclassified information. I understand and agree to the following terms and conditions:

1. Sensitive but unclassified information is any information, the loss, misuse, or unauthorized modification of which could adversely affect the national interest, the conduct of Federal programs, or the privacy to which individuals are entitled under Title 5 U.S.C. paragraph 552a, but which has not been specifically authorized to be kept secret in the interest of national defense or foreign policy.

2. Upon the execution of this agreement, I may be granted conditional access to sensitive but unclassified information concerning patient charts and their health conditions and making a determination if these patients required extensive diagnostic procedures. This information concerns the Department of Health and Human Services and other Governmental agencies.

Information may be in the form of system data, files and records, contract data, analyses, memos, meeting content, conversations, or any other form. The sole purpose of this access is to assist in the review, analyze, research and opine on patients’ health conditions and whether or not they needed the type and quantity of diagnostic procedures billed to Medicare and Medicaid. By reviewing the patient charts the expert will be able to determine what conditions and complaints the patients presented with, whether the numerous diagnostic procedures billed were performed or were medically necessary and whether or not the results of the numerous diagnostic procedures were reviewed and interpreted by the individual and used as a basis of on-going medical treatment.

3. I will not use, release, or disclose any sensitive but unclassified information or data, in any form whatsoever, to any person or entity except as is necessary to perform the duties under the above-cited contract or except as authorized by the Contracting Officer or the Contracting Officer’s Technical Representative. I will not take, alter, or convert such information to any use not specifically authorized under the contract or this agreement.

4. I will not seek access to non-public information beyond what is required for the performance of my duties under the above-cited contract.

5. I will ensure that my status as a contractor employee is known when seeking access to and receiving non-public information.

6. I will protect sensitive but unclassified information in accordance with the provisions of 18

U.S.C. 1905 (Trade Secrets Act); 5 U.S.C. 552 (Privacy Act of 1974); P.L. 104-294 (Economic Espionage Act of 1996), P.L. 103-339 (Counterintelligence and Security Enhancement Act of 1994); to the extent applicable, P.L. 104-191 (Health Information Portability and Accountability Act); and other pertinent laws and regulations governing the confidentiality of privileged information. If I become aware of any improper use, release or disclosure of non-public information, I will advise the Contracting Officer as soon as possible.

7. I will surrender any written or electronic non-public information given to me pursuant to this agreement, including my own notes, upon completion or termination of my duties under the above-cited contract, or upon the request of the Contracting Officer, Contacting Officer’s Technical Representative, or my supervisor.

8. Unless and until I am provided with a written release from this agreement, all conditions and obligations contained herein apply both during my period of conditional access and at all times thereafter.

9. I will submit any book, article, column or other written work for general publication that is based upon any knowledge that I obtained pursuant to this agreement to the Department of Health & Human Services for security review, prior to submission for publication, to ensure that no sensitive but unclassified information is disclosed.

10. I hereby assign to the United Stated Government all royalties and remuneration that have resulted or will result from any use, release or disclosure that is inconsistent with this agreement.

11. I understand that any unauthorized use, release or disclosure of non-public information in violation of this agreement may subject me and/or my employer to administrative, civil, or criminal remedies as may be authorized by law.

Signed:

(Contractor Employee) Date

Reviewed/Approved By:

(Authorized Government Official) Date