Title 33, Chapter 21, Section 17
( 33-21-17)
(a) Whenever the Commissioner of Insurance shall deem it expedient,
but not less than once every three years, he or his designee shall
visit and examine the transactions, accounts, financial records, and
documents of any health maintenance organization and of the
providers with whom such organization has contracts, agreements, or
other arrangements pursuant to its health benefits plan; and in
connection with such examination the Commissioner of Insurance shall
also have the authority to conduct an examination into the market
conduct of the health maintenance organization. (b) Whenever the commissioner of human resources shall deem it
expedient, but not less than once every five years, he or his
designee shall visit and examine all matters relating to the quality
of health care services of any health maintenance organization and
providers with whom the organization has contracts, agreements, or
other arrangements pursuant to its health benefits plan as often as
he deems it necessary for the protection of the interests of the
people of this state. (c) Every health maintenance organization, its officers, employees,
representatives, and providers shall produce and make freely
accessible to the Commissioner of Insurance or the commissioner of
human resources the accounts, records, documents, and files in its
possession or control relating to the subject of the examination.
The officers, employees, representatives, and providers shall
facilitate such examination and aid the examiners as far as it is in
their power in making the examination. (d) The Commissioner of Insurance or his designee shall make a full
written report of each examination made by him containing only facts
ascertained from the accounts, records, and documents examined and
from the sworn testimony of witness. (e) The report shall be certified by the Commissioner of Insurance
or by the examiner in charge of the examination and, when so
certified and after filing as provided in subsection (f) of this
Code section, shall be admissible in evidence in any proceeding
brought by the Commissioner against the health maintenance
organization examined or any officer or agent of the health
maintenance organization and shall be prima-facie evidence of the
facts stated in such report. (f) The Commissioner of Insurance shall furnish a copy of the
proposed report to the health maintenance organization examined not
less than 20 days prior to filing the report. If the health
maintenance organization so requests in writing within such 20 day
period or any longer period as the Commissioner may grant, the
Commissioner shall grant a hearing with respect to the report and
shall not file the report until after the hearing and such
modifications have been made in the report as the Commissioner may
deem proper. (g) The Commissioner of Insurance may withhold from public
inspection the report of any examination or investigation for so
long as he deems it to be in the public interest or necessary to
protect the health maintenance organization examined from
unwarranted injury.
(h) After the report has been filed, the Commissioner of Insurance
may publish the report or the results of such report in one or more
newspapers published in this state if he should deem it to be in the
public interest. (i) The health maintenance organization so examined shall pay, at
the direction of the Commissioner of Insurance, all the actual
travel and living expenses connected with the examination. When the
examination is made by an examiner who is not a regular employee of
the Insurance Department, the health maintenance organization
examined shall pay the proper charges for the services of the
examiner and his assistants in an amount approved by the
Commissioner. A consolidated account for the examination shall be
filed by the examiner with the Commissioner. No health maintenance
organization or other entity shall pay and no examiner shall accept
any additional emolument on account of any examination. When the
examination is conducted in whole or in part by regular salaried
employees of the department, payment for the services and proper
expenses shall be made by the health maintenance organization
examined to the Commissioner; and such payment shall be deposited
with the Office of Treasury and Fiscal Services. |