The secretary of the
department of social and health services or his authorized
representative shall have the authority to:
(1) Conduct audits and investigations of providers of medical
and other services furnished pursuant to this chapter, except that
the Washington state medical quality assurance commission shall
generally serve in an advisory capacity to the secretary in the
conduct of audits or investigations of physicians. Any overpayment
discovered as a result of an audit of a provider under this
authority shall be offset by any underpayments discovered in that
same audit sample. In order to determine the provider's actual,
usual, customary, or prevailing charges, the secretary may examine
such random representative records as necessary to show accounts
billed and accounts received except that in the conduct of such
examinations, patient names, other than public assistance
applicants or recipients, shall not be noted, copied, or otherwise
made available to the department. In order to verify costs
incurred by the department for treatment of public assistance
applicants or recipients, the secretary may examine patient records
or portions thereof in connection with services to such applicants
or recipients rendered by a health care provider, notwithstanding
the provisions of RCW 5.60.060, 18.53.200, 18.83.110, or any other
statute which may make or purport to make such records privileged
or confidential: PROVIDED, That no original patient records shall
be removed from the premises of the health care provider, and that
the disclosure of any records or information by the department of
social and health services is prohibited and shall be punishable as
a class C felony according to chapter 9A.20 RCW, unless such
disclosure is directly connected to the official purpose for which
the records or information were obtained: PROVIDED FURTHER, That
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:
PROVIDED FURTHER, That the secretary shall destroy all copies of
patient medical records in their possession upon completion of the
audit, investigation or proceedings;
(2) Approve or deny applications to participate as a provider
of services furnished pursuant to this chapter;
(3) Terminate or suspend eligibility to participate as a
provider of services furnished pursuant to this chapter; and
(4) Adopt, promulgate, amend, and repeal administrative rules,
in accordance with the Administrative Procedure Act, chapter 34.05 RCW, to carry out the policies and purposes of RCW 74.09.200
through 74.09.290.
[1994 sp.s. c 9 § 749; 1990 c 100 § 5; 1983 1st ex.s. c 41 § 23; 1979 ex.s. c 152 § 10.]
NOTES:
Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
Severability -- 1983 1st ex.s. c 41: See note following RCW 26.09.060.