2006 Code of Virginia § 32.1-137.4 - Examination, review or investigation

32.1-137.4. Examination, review or investigation.

A. The Commissioner shall cause each managed care health insurance planlicensee subject to certification under this article to be examined orreviewed for each new application and to be periodically examined or reviewedat reasonable times thereafter, including both for complaint investigationand for renewal compliance. Such examinations or reviews shall consider thecompliance of the managed care health insurance plan licensee with theregulations promulgated under 32.1-137.3.

In lieu of or in addition to making his own examination of the managed carehealth insurance plan licensee, the Commissioner may accept the report of anexamination of the licensee under similar laws of another state, similarregulatory agency, state health commissioner, or accreditation entity.

B. Any examiner authorized by the Commissioner shall, so far as necessary forthe purposes of the examination or review, have access during regularbusiness hours to the premises and to any books, records, files, or propertyof the licensee as far as they directly relate to the quality of careprovided by the licensee. All material copied or recorded or received shallbe privileged and confidential and shall not be subject to subpoena.

C. Every person from whom information is sought, in an investigation of acomplaint pursuant to this article against a managed care health insuranceplan licensee, shall cooperate in producing or allowing reasonable accessduring regular business hours to the books, records, files, accounts, papers,documents, and any or all computer or other recordings of the licensee beingexamined or those of any person delivering health care services undercontract, affiliation, delegation or other arrangement directly relevant tothe investigation. Such information shall be limited to that which isrelevant to the investigation in question, as specified in regulationspromulgated pursuant to this article. All material copied or recorded orreceived shall be privileged and confidential, and shall not be subject tosubpoena.

D. The refusal of any licensee, by its officers, directors, employees oragents, to submit to examination or review or to comply with any reasonablewritten request of the examiners shall be grounds for suspension, revocation,denial, or nonrenewal of any certificate of quality assurance held by thelicensee. Any such proceedings for suspension, revocation, denial ornonrenewal of any certificate shall be conducted pursuant to 32.1-137.5.

(1998, c. 891.)