§346-40  Maintenance and availability ofrecords; penalty.  (a)  To enable another provider to determine the propercourse of treatment in emergencies and in order to determine whether a provideris genuinely entitled to reimbursement and to protect the medicaid programagainst fraud and abuse, each provider of health care, service or suppliesunder the state medicaid program shall maintain, and keep for a period of threeyears, such records as are necessary to disclose fully the type and extent ofhealth care, service or supplies provided to medicaid recipients.  Thedepartment may identify the types of records necessary to be kept bypromulgation of appropriate rules.

(b)  No provider shall refuse or fail to makeavailable at the provider's place of business or appropriate location, duringnormal business hours, or, if the appropriate representative agrees, at themutual convenience of the parties, immediate access to all records required tobe maintained under this section or rules promulgated hereunder and alldiagnostic devices concerning or used for the provision of health care, serviceor supplies to a medicaid recipient to any duly authorized representative ofthe attorney general's office or the department of human services acting in thecourse and scope of the duly authorized representative's employment; suchdiagnostic devices may be examined and tested and such records may be retainedby said duly authorized representative for a reasonable period of time for thepurpose of examination, audit, copying, testing or photographing.  Thissubsection shall supersede any other provision of the Hawaii Revised Statutesto the contrary notwithstanding.

(c)  Whenever a provider without reasonablejustification fails to keep adequate supporting records as required by thissection or rules promulgated hereunder or fails to make them available asrequired by this section, the director of human services shall suspend theprovider during the period of noncompliance with this section, and no paymentmay be made to such provider with respect to any item or service furnished bysuch provider during the period of suspension.  A provider shall receive noticeand be provided an opportunity for a hearing in compliance with regulations ofthe department of human services for such suspension.

(d)  Wilful refusal or failure to make recordsavailable as provided in subsection (b) of this section is a misdemeanor. [L1978, c 105, §6; gen ch 1985; am L 1987, c 339, §4]

 

Revision Note

 

  Subsection designations "b", "c", and"d" substituted for "c", "d", and "e".

 

Cross References

 

  Medicaid fraud unit, see §28-91.

 

Case Notes

 

  State has compelling interest in ensuring that medicaidprogram is not being defrauded.  481 F. Supp. 1028.