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2011 SESSION
11102787DBe it enacted by the General Assembly of Virginia:
1. That §§ 32.1-310 and 32.1-320 of the Code of Virginia are amended and reenacted and that the Code of Virginia is amended by adding in Article 1 of Chapter 9 of Title 32.1 a section numbered 32.1-321.01 as follows:
§ 32.1-310. Declaration of purpose; authority to audit records; authority to review complaints of abuse or neglect.
The General Assembly finds and declares it to be in the public interest and for the protection of the health and welfare of the residents of the Commonwealth that a proper regulatory and inspection program be instituted in connection with the providing of medical, dental and other health services to recipients of medical assistance. In order to effectively accomplish such purpose and to assure that the recipient receives such services as are paid for by the Commonwealth, the acceptance by the recipient of such services and the acceptance by practitioners of reimbursement for performing such services shall authorize the Attorney General or his authorized representative to inspect and audit all records in connection with the providing of such services.
The General Assembly further finds and declares it to be in the public interest and for the protection of the health and welfare of the residents of the Commonwealth that, in conducting such regulatory and inspection program, the Attorney General or his authorized representatives shall review complaints alleging abuse or neglect of persons in the care or custody of others who receive payments for providing health care services under the state plan for medical assistance.
§ 32.1-320. Duties of Attorney General; medical services providers audit and investigation unit.
A. There shall be established within the Office of the Attorney General a unit to audit and investigate providers of services furnished under the State Medical Assistance Plan. The Department of Medical Assistance Services shall cooperate with the Office of the Attorney General in conducting such audits and investigations and shall provide such information for these purposes as may be requested by the Attorney General or his authorized representative.
B. The Attorney General or his authorized representative shall have the authority to:
1. Conduct audits and investigations of providers of medical
and other services furnished under medical assistance. Such investigations shall include
investigation of complaints
alleging abuse or neglect of persons in the care or custody
of others who receive payments for providing health care services under
the state plan for medical assistance,
regardless of whether the patient who is the subject of the complaint is a
recipient of medical assistance.
The relevant board within the Department of Health Professions shall serve in
an advisory capacity to the Attorney General in the conduct of audits or
investigations of health care providers licensed by the respective regulatory
boards. In the conduct of such audits or investigations, the Attorney General
may examine only(i) those records or portions
thereof, including patient records, for which services were rendered by a health
care provider and reimbursed by the Department of Medical Assistance Services
under the Plan for Medical Assistance, and (ii) in
cases involving a complaint alleging abuse or neglect of a person
in the care or custody of others who receive payments for
medical assistance, those records or
portions thereof, including patient records, which are relevant
to the investigation of the
complaint,
notwithstanding the provisions of Chapter 38 (§ 2.2-3800 et seq.) of Title 2.2
or of any other statute which may make or purport to make such records
privileged or confidential. No original patient records shall be removed from
the premises of the health care provider, except in accordance with Rule 4:9 of
the Rules of the Supreme Court of Virginia. The disclosure of any records or
information by the Attorney General is prohibited, unless such disclosure is
directly connected to the official purpose for which the records or information
was obtained. The disclosure of patient information as required under this
section shall not subject any physician or other health services provider to
any liability for breach of any confidential relationship between the provider
and the patient, but no evidence resulting from such disclosure may be used in
any civil, administrative or criminal proceeding against the patient unless a
waiver of the applicable evidentiary privilege is obtained. The Attorney
General shall cause all copies of patient medical records in his possession or
that of his designee to be destroyed upon completion of the audit,
investigation or proceedings, including appeals;
2. Issue subpoenas, compel the attendance of witnesses, administer oaths, certify to official acts, take depositions within and without the Commonwealth as now provided by law, and compel the production of pertinent books, payrolls, accounts, papers, records, documents and testimony relevant to such investigation. If a person in attendance before the Attorney General or his authorized representative refuses, without reasonable cause, to be examined or to answer a legal and pertinent question, or to produce a book or paper or other evidence when ordered to do so by the Attorney General or his authorized representative, the Attorney General or his authorized representative may apply to the judge of the circuit court of the jurisdiction where such person is in attendance, upon affidavit, for an order returnable in not less than two nor more than five days, directing such person to show cause why he should not produce such records. Upon the hearing of such order, if the court shall determine that such person, without reasonable cause, has refused to be examined or to answer a legal or pertinent question, or to produce a book or paper which he was ordered to bring or produce, he may forthwith assess all costs and reasonable attorney's fees against such person. If the motion for an order is granted and the person thereafter fails to comply with the order, the court may make such orders as are provided for in the Rules of the Supreme Court of Virginia. Subpoenas shall be served and witness fees and mileage paid as allowed in civil cases in the circuit courts of this Commonwealth.
§ 32.1-321.01. Exemptions from disclosure.
Records or information provided to the Office of the Attorney General pursuant to this article shall be exempt from disclosure under the Virginia Freedom of Information Act (§ 2.2-3700et seq.).