Florida Statutes 641.515 – Investigation by the agency
Current as of: 2023 | Check for updates
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Terms Used In Florida Statutes 641.515
- Agency: means the Agency for Health Care Administration. See Florida Statutes 641.47
- Organization: means any health maintenance organization as defined in…. See Florida Statutes 641.47
- Subscriber: means an individual who has contracted, or on whose behalf a contract has been entered into, with a health maintenance organization for health care services. See Florida Statutes 641.47
(1) The agency shall investigate further any quality of care issue contained in recommendations and reports submitted pursuant to s. 641.511. The agency shall also investigate further any information that indicates that the organization does not meet accreditation standards or the standards of the review organization performing the external quality assurance assessment pursuant to reports submitted under s. 641.512. Every organization shall submit its books and records and take other appropriate action as may be necessary to facilitate an examination. The agency shall have access to the organization’s medical records of individuals and records of employed and contracted physicians, with the consent of the subscriber or by court order, as necessary to administer this part.
(2) The reports and the records prepared or obtained under this section or s. 641.512 by the agency or by an outside source may be used by the agency in enforcing the requirements of this part and in disciplinary proceedings. Except as otherwise provided in this section, any patient-identifying information contained in these records and reports is confidential and exempt from s. 119.07(1).
(3) If the agency, through its examination or through any investigation, has a reasonable belief that conduct by a staff member or any other employee of an organization may constitute grounds for disciplinary action by the appropriate regulatory board, the agency shall report this fact to such regulatory board.
(4) The agency shall promulgate rules imposing upon physicians and hospitals performing services for a health maintenance organization standards of care generally applicable to physicians and hospitals.