1. A. An MCO, its subcontractors, and its subcontractor’s subcontractors shall permit the following organizations or their designees to inspect, evaluate, or audit books, records, contracts, computer or other electronic systems, premises, and facilities that pertain to the MCO’s Medicaid enrollees, and any aspect of services and activities performed, or determination of amounts payable under, the MCO’s contract with the Department:

   1. (1) The Department and its agents;
   2. (2) The Medicaid Fraud Control Unit of the Office of the Attorney General;
   3. (3) The Insurance Fraud Division of the Maryland Insurance Administration;
   4. (4) The Centers for Medicare and Medicaid Services;
   5. (5) The Inspector General of the Department of Health and Human Services;
   6. (6) The Comptroller General; and
   7. (7) Other authorized State or federal agencies.
2. B. The right to inspect, audit, and evaluate shall exist for 10 years from the final date of the contract period or from the completion of any audit, whichever is later, except, if the Department, Centers for Medicare and Medicaid Services, or the Department of Health and Human Services Inspector General determines that there is a reasonable possibility of fraud, or similar risk, those agencies may inspect, audit, and evaluate at any time.
3. C. Notwithstanding §B of this regulation, the Department has the right to inspect the accuracy, truthfulness, and completeness of the encounter data submitted by, or on behalf of, the MCO.

Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland

Effective date: February 26, 2018 (45:4 Md. R. 205)

Regulation .01L amended effective December 31, 2018 (45:26 Md. R. 1244)

Regulation .01N adopted effective December 31, 2018 (45:26 Md. R. 1244)

Chapter transferred from COMAR 10.09.68 effective November 1, 2019 (46:22 Md. R. 977)