§346-40  Maintenance and availability of
records; penalty.  (a)  To enable another provider to determine the proper
course of treatment in emergencies and in order to determine whether a provider
is genuinely entitled to reimbursement and to protect the medicaid program
against fraud and abuse, each provider of health care, service or supplies
under the state medicaid program shall maintain, and keep for a period of three
years, such records as are necessary to disclose fully the type and extent of
health care, service or supplies provided to medicaid recipients.  The
department may identify the types of records necessary to be kept by
promulgation of appropriate rules.



(b)  No provider shall refuse or fail to make
available at the provider's place of business or appropriate location, during
normal business hours, or, if the appropriate representative agrees, at the
mutual convenience of the parties, immediate access to all records required to
be maintained under this section or rules promulgated hereunder and all
diagnostic devices concerning or used for the provision of health care, service
or supplies to a medicaid recipient to any duly authorized representative of
the attorney general's office or the department of human services acting in the
course and scope of the duly authorized representative's employment; such
diagnostic devices may be examined and tested and such records may be retained
by said duly authorized representative for a reasonable period of time for the
purpose of examination, audit, copying, testing or photographing.  This
subsection shall supersede any other provision of the Hawaii Revised Statutes
to the contrary notwithstanding.



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



(d)  Wilful refusal or failure to make records
available as provided in subsection (b) of this section is a misdemeanor. [L
1978, 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 medicaid
program is not being defrauded.  481 F. Supp. 1028.