Maintenance of Financial Records

Participating providers agree that the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), the Comptroller General, or their designees have the right to audit, evaluate and inspect any books, contracts, and computers or other electronic systems, including medical records and documentation related to the plan's Medicare Advantage contracts with CMS. This right exists through 10 years from the final date of the calendar year (the plan's contract year with CMS) in which services are provided.

Maintenance of Records

The plan and its participating providers must maintain books, records, documents, and other evidence of accounting procedures and practices for 10 years. Records must include:

• ownership and operation of the financial, medical and other record keeping systems
• financial statements for the current contract period and 10 prior periods
• federal income tax or informational returns for the current contract period and 10 prior periods
• asset acquisition, lease, sale, or other action
• agreements, contracts and subcontracts
• franchise, marketing and management agreements
• schedules of charges for the Medicare Advantage (MA) organization's fee-for-service patients
• matters pertaining to costs of operations
• amounts of income received by source and payment
• cash flow statements
• any financial reports filed with other federal programs or state authorities

The plan and participating providers must agree to allow access to facilities and records to Department of Health and Human Services (HHS), the Comptroller General or their designees, through inspection, audit or other means.