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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE XXII CORPORATIONS
  • CHAPTER 176G HEALTH MAINTENANCE ORGANIZATIONS
  • Section 10 Reports; audits, examinations or inspections; confidentiality

Section 10. Every health maintenance organization shall annually file with the commissioner, within 60 days of the close of its fiscal year, a report verified by at least 2 principal officers and covering its preceding fiscal year; provided that, if the commissioner determines that a threat of insolvency exists with respect to a health maintenance organization, he may require that such report be made available prior to the expiration of said 60 days. The report shall include:—

(1) financial statements of the health maintenance organization on the latest applicable form of annual statement approved by the National Association of Insurance Commissioners for health maintenance organizations, with any additional information the commissioner may require for the purpose of eliciting a complete and accurate exhibit of the condition and transactions of the health maintenance organization;

(2) statistics relating to the cost of operations and the pattern of utilization of services in the previous fiscal year; and

(3) such other information as the commissioner may reasonably require relating to the past performance of the organization.

All financial information reflected in the annual report shall be maintained and prepared in accordance with statutory accounting practices and procedures prescribed or permitted by the commissioner.

The commissioner shall require that the annual report be maintained and prepared in accordance with the Annual Statement Instructions and Accounting Practices and Procedures Manual adopted by the National Association of Insurance Commissioners unless further modified by the commissioner as deemed appropriate.

The commissioner may make an examination of the affairs of a health maintenance organization when the commissioner deems prudent but, in any event, not less frequently than once every 5 years. Health maintenance organizations shall be examined in all respects as companies subject to and pursuant to section 4 of chapter 175.

Notwithstanding any other provisions of the General Laws, including clause Twenty-sixth of section 7 of chapter 4, chapter 66, or section 4 of chapter 175, the records of any such audit, examination or other inspection and the information contained in the records, reports or books of a health maintenance organization examined pursuant to this section shall be confidential and open only to the inspection of the commissioner, his examiners and assistants. Access to the confidential material may be granted by the commissioner to the National Association of Insurance Commissioners, to the insurance department of any other state or country or to law enforcement officials of the commonwealth or any other state or agency of the federal government at any time, so long as the agency or office receiving the information agrees in writing to hold the material confidential. Nothing in this section shall be construed to prohibit the required production of such records, and information contained in the reports of such health maintenance organization, before any court of the commonwealth or any master or auditor appointed by any such court, in any criminal or civil proceeding, affecting such health maintenance organization, its officers, directors or employees.

The final report of any such audit, examination or other inspection by or on behalf of the division shall be a public record.