Iowa Admin. Code r. 481-73.5

Current through Regsiter Vol. 46, No. 26, June 12, 2024

Rule 481-73.5 - Access to records

In addition to the authority maintained by investigators with the unit pursuant to Iowa Code section 10A.403, the unit is established as a health oversight agency, as defined by 45 CFR 164.501, exempt from the privacy regulations of the federal Health Insurance Portability and Accountability Act (HIPAA) and authorized to engage in health oversight activities in accordance with 45 CFR 164.512.

(1) Unit personnel shall have the authority to request, review, and retain any medical, clinical, financial, or personnel records maintained by a Medicaid provider in order for unit personnel to investigate allegations of incidents that fall within MFCU's investigative authority as established in rule 481-73.2 (10A).

(2) For Medicaid provider fraud investigations, unit personnel shall have access to any records pertaining to Medicaid and non-Medicaid recipients of health care goods and services to verify that:

a. Medicaid claims for goods and services have been accurately paid.

b. Medicaid recipients actually received the goods and services claimed by the Medicaid provider.

c. Medicaid providers have retained supporting documentation to substantiate claims.

(3) For abuse or neglect investigations, unit personnel shall have access to any records pertaining to any Medicaid patients or residents identified during the course of an investigation who are receiving health care services in a health care facility that receives Medicaid funds or in a board and care facility. Unit personnel may obtain access via subpoena or other legal methods to any records pertaining to any non-Medicaid patients or residents identified during the course of an investigation.

Iowa Admin. Code r. 481-73.5

Amended by IAB May 9, 2018/Volume XL, Number 23, effective 6/13/2018