A. The Superintendent or a designee may
examine an administrator who directly or indirectly transfers funds, manages
funds, adjusts claims, or asserts control over the transfer of funds for the
purpose of payment of provider services for compliance with the requirements of
B. Any administrator being
examined shall provide to the examiner convenient and free access, at all
reasonable hours at its offices, to all books, records, documents, and other
papers relating to its business affairs. The examiner shall not have access to
beneficiary medical records that are protected by state statute.
C. The examiners designated by the
Superintendent pursuant to this Section may make reports to the Superintendent.
Any report alleging substantive violations of this Rule, or any applicable
provisions of the Maine Insurance Code, shall be in writing and be based upon
facts obtained by the examiners. The report shall be verified by the
D. If a report is
made, the Superintendent shall either deliver a duplicate thereof to the
administrator being examined or send such duplicate by certified or registered
mail to the administrator's address specified in the records of the Bureau. The
Superintendent shall afford the administrator an opportunity to request a
hearing to object to the report. As a result of the findings of the report, the
Superintendent may initiate a hearing concerning revocation or suspension of
registration if the findings of the report so indicate.