1. The Commissioner shall make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements or other arrangements pursuant to its health care plan as often as the Commissioner deems it necessary for the protection of the interests of the people of this State, but not less frequently than once every 3 years.
2. The Commissioner shall make an examination concerning any compliance program used by a health maintenance organization and any report, as determined to be appropriate by the Commissioner, regarding the health maintenance organization produced by an organization which examines best practices in the insurance industry. The Commissioner shall make such an examination as often as the Commissioner deems it necessary for the protection of the interests of the people of this State, but not less frequently than once every 3 years.
3. In making an examination pursuant to subsection 1 or 2, the Commissioner:
(a) Shall determine whether the health maintenance organization is in compliance with this Code, including, without limitation, whether any relationship or transaction between the health maintenance organization and any other health maintenance organization is in compliance with this Code; and
(b) May examine any account, record, document or transaction of any health maintenance organization or any provider which relates to:
(1) Compliance with this Code by the health maintenance organization which is the subject of the examination;
(2) Any relationship or transaction between the health maintenance organization which is the subject of the examination and any other health maintenance organization; or
(3) Any relationship or transaction between the health maintenance organization which is the subject of the examination and any provider.
4. Except as otherwise provided in this subsection, for the purposes of an examination pursuant to subsection 1 or 2, each health maintenance organization and provider shall, upon the request of the Commissioner or an examiner designated by the Commissioner, submit its books and records relating to any applicable health care plan to the Commissioner or the examiner, as applicable. Medical records of natural persons and records of physicians providing service pursuant to a contract with a health maintenance organization are not subject to such examination, although the records, except privileged medical information, are subject to subpoena upon a showing of good cause. For the purpose of examinations, the Commissioner may administer oaths to and examine the officers and agents of a health maintenance organization and the principals of providers concerning their business.
5. The expenses of examinations pursuant to this section must be assessed, billed and paid in accordance with the provisions of NRS 679B.290.
6. In lieu of an examination pursuant to this section, the Commissioner may accept the report of an examination made by the insurance commissioner of another state or an applicable regulatory agency of another state.
(Added to NRS by 1973, 1255; A 1991, 2036; 2013, 3647; 2017, 2395; 2019, 1719)