Subdivision 1. Examination authority.
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
, clause (b), upon request of the major participating entity or the health maintenance
organization with which it contracts.
Subd. 2. Notice of examination.
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. Commissioner's authority.
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
(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Subd. 4.[Repealed, 2000 c 468 s 33
Subd. 4a. Classification of data.
Any data or information obtained by the commissioner
under this section or section
shall be classified as private data on individuals as defined
in chapter 13. Such data shall be protected and may be released consistent with the provisions
60A.03, subdivision 9
Subd. 5. Oaths; witnesses; subpoenas.
The commissioner of health shall have the power to
administer oaths to and examine witnesses, and to issue subpoenas.
Subd. 6. Examination expenses.
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. Penalty.
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.
History: 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; 2000 c 468 s 18