(2) The authority may retain appraisers, independent actuaries, independent certified public accountants or other professionals and specialists in conducting an examination, as needed. The coordinated care organization that is the subject of the examination is responsible for the cost of retaining the professionals and specialists.
(3) Upon an examination or investigation of a coordinated care organization, the Oregon Health Authority may examine under oath all persons who may have material information regarding the property or business of the coordinated care organization being examined or investigated.
(4) Every person being examined or investigated shall produce all books, records, accounts, papers, documents and computer and other recordings in its possession or control relating to the matter under examination or investigation, including, in the case of an examination, the property, assets, business and affairs of the person.
(5) With regard to an examination, the officers, directors and agents of the coordinated care organization being examined shall provide timely, convenient and free access at all reasonable hours at the offices of the coordinated care organization being examined to all books, records, accounts, papers, documents and computer and other recordings. The officers, directors, employees and agents of the person must facilitate the examination.
(6) In an investigation or examination of a coordinated care organization’s financial condition, the authority may order a coordinated care organization to produce information the coordinated care organization does not possess but to which the coordinated care organization might have access by reason of a contractual relationship or a statutory obligation or by other means. If the coordinated care organization cannot obtain the information the authority requires, the coordinated care organization shall provide the authority with a detailed explanation of the reason the coordinated care organization cannot obtain the information and shall identify the person that possesses the information. If the authority finds that the coordinated care organization’s explanation is without merit, the authority may impose a civil penalty on the coordinated care organization as provided in rules adopted pursuant to ORS 415.011 (2)(g) or may suspend or revoke the coordinated care organization’s contract. [2019 c.478 §9]
Structure 2021 Oregon Revised Statutes
Volume : 11 - Juvenile Code, Human Services
Chapter 415 - Regulation of Health Care Entities
Section 415.001 - Reinsurance program for coordinated care organizations (CCOs).
Section 415.012 - Definitions for ORS 415.012 to 415.430.
Section 415.013 - Powers and authority to enforce ORS 415.012 to 415.430 and 415.501.
Section 415.019 - Right to contested case hearing.
Section 415.056 - Confidentiality of reports regarding certain financial information.
Section 415.057 - Authorized use of confidential reports regarding financial information.
Section 415.061 - Definitions for 415.061 to 415.067.
Section 415.064 - Waiver of privilege; permitted disclosures.
Section 415.066 - Exceptions to privilege of compliance self-evaluative audit document.
Section 415.105 - Investigations authorized.
Section 415.109 - Conduct of examination; access to records; civil penalty.
Section 415.111 - Report of examination; opportunity to respond.
Section 415.115 - Annual audits; rules.
Section 415.203 - Opportunity to cure impairment of required capitalization.
Section 415.204 - Grounds for order of supervision; right to hearing to contest order.
Section 415.205 - Period of supervision; cause of action for violation of order of supervision.
Section 415.251 - Jurisdiction of delinquency proceedings.
Section 415.252 - Exclusive remedy.
Section 415.261 - Petition for delinquency proceeding.
Section 415.280 - Petition for order for rehabilitation or liquidation of CCO.
Section 415.281 - Court order for rehabilitation or liquidation proceeding against CCO.
Section 415.300 - Rehabilitation proceeding.
Section 415.330 - Grounds for order to liquidate.
Section 415.333 - Powers of Oregon Health Authority in liquidation proceeding.
Section 415.335 - Order to liquidate.
Section 415.341 - Immunity from civil liability for receivers.
Section 415.400 - Filing proof of claim against CCO declared by court to be insolvent.
Section 415.401 - Requirements for proof of claim.
Section 415.402 - Preference of claims.
Section 415.404 - Contingent claims.
Section 415.405 - Priority of special deposit claims.
Section 415.422 - Voidable transfers or liens.
Section 415.430 - Liability of member of CCO to pay provider for cost of care.
Section 415.500 - Definitions.
Section 415.501 - Procedures for review of material change transactions; rules.
Section 415.505 - Conflicts of interest prohibited.
Section 415.510 - Quadrennial study of impact of health care consolidation.