256B.27 MEDICAL ASSISTANCE; COST REPORTS.
Subdivision 1. Reports and audits.
In the interests of efficient administration of the medical
assistance to the needy program and incident to the approval of rates and charges therefor, the
commissioner of human services may require any reports, information, and audits of medical
vendors which the commissioner deems necessary.
Subd. 2. Verification of report.
All reports as to the costs of operations or of medical care
provided which are submitted by vendors of medical care for use in determining their rates or
reimbursement shall be submitted under oath as to the truthfulness of their contents by the vendor
or an officer or authorized representative of the vendor.
Subd. 2a. Cost and statistical data audits.
The commissioner shall provide for an audit of
the cost and statistical data of nursing facilities participating as vendors of medical assistance.
The commissioner shall select for audit at least 15 percent of the nursing facilities' data reported
at random or using factors including, but not limited to: data reported to the public as criteria for
rating nursing facilities; data used to set limits for other medical assistance programs or vendors
of services to nursing facilities; change in ownership; frequent changes in administration in excess
of normal turnover rates; complaints to the commissioner of health about care, safety, or rights;
where previous inspections or reinspections under section
have resulted in correction
orders related to care, safety, or rights; or where persons involved in ownership or administration
of the facility have been indicted for alleged criminal activity.
The commissioner shall meet the 15 percent requirement by either conducting an audit
focused on an individual nursing facility, a group of facilities, or targeting specific data categories
in multiple nursing facilities. These audits may be conducted on site at the nursing facility,
at office space used by a nursing facility or a nursing facility's parent organization, or at the
commissioner's office. Data being audited may be collected electronically, in person, or by any
other means the commissioner finds acceptable.
Subd. 3. Access to medical records.
The commissioner of human services, with the written
consent of the recipient, on file with the local welfare agency, shall be allowed access to all
personal medical records of medical assistance recipients solely for the purposes of investigating
whether or not: (a) a vendor of medical care has submitted a claim for reimbursement, a cost report
or a rate application which is duplicative, erroneous, or false in whole or in part, or which results
in the vendor obtaining greater compensation than the vendor is legally entitled to; or (b) the
medical care was medically necessary. The vendor of medical care shall receive notification from
the commissioner at least 24 hours before the commissioner gains access to such records. The
determination of provision of services not medically necessary shall be made by the commissioner.
The commissioner may consult with an advisory task force of vendors the commissioner may
appoint, on the recommendation of appropriate professional organizations. The task force expires
as provided in section
15.059, subdivision 6
. Notwithstanding any other law to the contrary, a
vendor of medical care shall not be subject to any civil or criminal liability for providing access to
medical records to the commissioner of human services pursuant to this section.
Subd. 4. Authorization of commissioner to examine records.
A person determined to be
eligible for medical assistance shall be deemed to have authorized the commissioner of human
services in writing to examine, for the investigative purposes identified in subdivision 3, all
personal medical records developed while receiving medical assistance.
Subd. 5. Private data.
Medical records obtained by the commissioner of human services
pursuant to this section are private data, as defined in section
13.02, subdivision 12
History: 1971 c 961 s 24; 1976 c 188 s 3; 1977 c 326 s 11; 1980 c 349 s 7,8; 1981 c 311 s 39;
1982 c 476 s 1; 1982 c 545 s 24; 1982 c 640 s 8; 1983 c 312 art 5 s 25,26; 1984 c 654 art 5 s 58;
1986 c 444; 1987 c 370 art 1 s 5,6; 1988 c 629 s 53; 1995 c 207 art 11 s 6; 2007 c 147 art 6 s 40