Haw. Code R. § 17-1736-17 - Record keeping requirements for providers

(a) In order to determine the correct amount of medicaid program payments due to any provider, and to protect the medicaid program from fraud and abuse, the DHS's representative, agent, investigative and recovery service, the fiscal agent, and the medicaid fraud control unit of the attorney general's office shall have the right to examine, inspect, copy, and if necessary, seize all records of a provider pertaining to medicaid patients which are necessary to fully disclose the type and extent of health care services or supplies provided to eligible medicaid recipients. The provider, for a period of three calendar years, shall maintain thorough records of medicaid patients, including but not limited to the following:

(1) Billings and account ledgers;

(2) Records of patient appointments;

(3) Patient history forms, medical records, diagnosis, and orders prescribed and treatment plans;

(4) Records of requests for and results of tests and examinations ordered or furnished;

(5) Records of prescriptions, medications, assistive devices, or appliances prescribed, ordered, or furnished; and

(6) All records which are necessary to justify the amount of claims for payment which are determined by cost reimbursement or a similar basis, including billing documents showing the cost of services or supplies provided to the recipient.

(b) A provider shall make these records available to any duly authorized DHS representative or agent, including the DHS investigative and recovery service, a representative of the fiscal agent, and any representative of the medicaid fraud control unit. These records shall be made available at the provider's place of business during normal business hours or upon agreement of the provider and appropriate representatives of the state at any other mutually convenient time or place.

(c) In addition to those records required to be maintained in accordance with subsection (b), institutional providers shall also make available to the agencies specified in subsection (b) records of receipts and disbursements of patient trust funds by the provider, including ledger accounts reflecting credits, debits and balances for each recipient.

(d) The records described in subsections (a) and (b) shall be maintained for a period not less than three calendar years. For purposes of this section, a record shall not be counted as three calendar years old until the last entry made in that record is three years old.

(e) All records obtained by the state agency, the investigative and recovery service, the fiscal agent or the medicaid fraud control unit, pursuant to this section, shall be maintained in safe keeping and may be used for auditing, scientific examination and writing analysis, photocopying, or testing in any other way, so long as that test does not significantly alter, damage, or destroy the record taken. Records which are not undergoing examination or testing as defined in this subsection and are not intended to be used as evidence in a judicial or administrative hearing by the State shall be immediately returned to the provider.

(f) Cost report files of an institutional provider shall contain the following information:

(1) Reimbursable cost;

(2) Cost finding schedules; and

(3) Other financial and statistical data to support reimbursable cost, including:

(A) Employment records;

(B) Work shift and schedules; and

(C) Payroll records of all institutional personnel, owners, and corporate officers.

Notes

Haw. Code R. § 17-1736-17

[Eff 08/01/94] (Auth: HRS § 346-14) (Imp: HRS § 346-40)