1997 Minnesota Statutes

     62D.14 Examinations. 

    Subdivision 1.  The commissioner of health may make an 
 examination of the affairs of any health maintenance 
 organization and its contracts, agreements, or other 
 arrangements with any participating entity as often as the 
 commissioner of health deems necessary for the protection of the 
 interests of the people of this state, but not less frequently 
 than once every three years.  Examinations of participating 
 entities pursuant to this subdivision shall be limited to their 
 dealings with the health maintenance organization and its 
 enrollees, except that examinations of major participating 
 entities may include inspection of the entity's financial 
 statements kept in the ordinary course of business.  The 
 commissioner may require major participating entities to submit 
 the financial statements directly to the commissioner.  
 Financial statements of major participating entities are subject 
 to the provisions of section 13.37, subdivision 1, clause (b), 
 upon request of the major participating entity or the health 
 maintenance organization with which it contracts. 

    Subd. 2.  The commissioner will notify the organization and 
 any involved participating entity in writing when an examination 
 has been initiated.  The commissioner will include in this 
 notice a full statement of the pertinent facts and of the 
 matters being examined, and may include a statement that the 
 organization or participating entity must submit to the 
 commissioner within 30 days from the date of the notice a 
 complete written report concerning those matters. 

    Subd. 3.  In order to accomplish the duties under this 
 section with respect to the dealings of the participating 
 entities with the health maintenance organization, the 
 commissioner of health shall have the right to: 

    (a) inspect or otherwise evaluate the quality, 
 appropriateness, and timeliness of services performed; 

    (b) audit and inspect any books and records of a health 
 maintenance organization and a participating entity which 
 pertain to services performed and determinations of amounts 
 payable under such contract; 

    (c) require persons or organizations under examination to 
 be deposed and to answer interrogatories, regardless of whether 
 an administrative hearing or other civil proceeding has been or 
 will be initiated; and 

    (d) employ site visits, public hearings, or any other 
 procedures considered appropriate to obtain the information 
 necessary to determine the issues.  

    Subd. 4.  Any data or information pertaining to the 
 diagnosis, treatment, or health of any enrollee, or any 
 application obtained from any person, shall be private as 
 defined in chapter 13 and shall not be disclosed to any person 
 except (a) to the extent necessary to carry out the purposes of 
 sections 62D.01 to 62D.30, the commissioner and a designee shall 
 have access to the above data or information but the data 
 removed from the health maintenance organization or 
 participating entity shall not identify any particular patient 
 or client by name or contain any other unique personal 
 identifier; (b) upon the express consent of the enrollee or 
 applicant; (c) pursuant to statute or court order for the 
 production of evidence or the discovery thereof; or (d) in the 
 event of claim or litigation between such person and the 
 provider or health maintenance organization wherein such data or 
 information is pertinent.  In any case involving a suspected 
 violation of a law applicable to health maintenance 
 organizations in which access to health data maintained by the 
 health maintenance organization or participating entity is 
 necessary, the commissioner and agents, while maintaining the 
 privacy rights of individuals and families, shall be permitted 
 to obtain data that identifies any particular patient or client 
 by name.  A health maintenance organization shall be entitled to 
 claim any statutory privileges against such disclosure which the 
 provider who furnished such information to the health 
 maintenance organization is entitled to claim. 

    Subd. 5.  The commissioner of health shall have the power 
 to administer oaths to and examine witnesses, and to issue 
 subpoenas. 

    Subd. 6.  Reasonable expenses of examinations under this 
 section shall be assessed by the commissioner of health against 
 the organization being examined, and shall be remitted to the 
 commissioner of health for deposit in the general fund of the 
 state treasury. 

    Subd. 7.  Failure to provide relevant information necessary 
 for conducting examinations pursuant to this section shall be 
 subject to the levy of a fine up to $200 for each day the 
 information is not provided.  A fine levied under this 
 subdivision shall be subject to the contested case and judicial 
 review provisions of chapter 14.  In the event a timely request 
 for review is made, accrual of a fine levied shall be stayed 
 pending completion of the contested case and judicial review 
 proceeding.  

    HIST: 1973 c 670 s 14; 1977 c 305 s 45; 1984 c 464 s 37; 1986 
 c 444; 1987 c 384 art 2 s 1; 1988 c 612 s 22