§ 9.605. Department investigations.
(a) The Department may investigate plans as necessary to determine compliance with Act 68, the PPO Act, the HMO Act and this chapter
(b) Investigation may include onsite inspection of a plan’s facilities and records, and may include onsite inspection of the facilities and records of any IDS subcontractor.
(c) The Department or its agents will have free access to all books, records, papers and documents that relate to the business of the plan, other than financial business.
(d) The Department will have access to medical records of plan enrollees for the purpose of determining the quality of care, investigating complaints or grievances, enforcement, or other activities relating to ensuring compliance with Article XXI, this chapter or other laws of the Commonwealth.
(e) The Department may request submission by the plan of a special report detailing any aspect of its operations relating to the provision of health care services to enrollees, provider contracting or credentialing, operation of the enrollee complaint and grievance system, or quality assessment.
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