Title 42
SECTION 513.430
513.430 Audits and record retention.
§ 513.430 Audits and record retention.(a) Right to audit. The Federal Government, including CMS, HHS, and the Comptroller General, or their designees, has the right to audit, inspect, investigate, and evaluate any documents and other evidence regarding implementation of the MFN Model.
(b) Access to records. MFN participants must maintain and give the Federal Government, including CMS, HHS, and the Comptroller General, or their designees, access to all such documents and other evidence sufficient to enable the audit, evaluation, inspection, or investigation of the implementation of the MFN Model, including without limitation, documents and other evidence regarding the following:
(1) The MFN participant's compliance with the terms of the MFN Model, including this subpart.
(2) Quality measure information and the quality of services performed under the terms of the MFN Model, including this subpart.
(3) Patient safety.
(4) The accuracy of model-specific payments made under the MFN Model.
(5) Utilization of items and services furnished under the MFN Model.
(6) Other program integrity issues.
(c) Record retention. The MFN participant must maintain the documents and other evidence described in paragraph (b) of this section and other evidence for a period of 6 years from the last payment received by the MFN participant under the MFN Model or from the date of completion of any audit, evaluation, inspection, or investigation, whichever is later, unless -
(1) CMS determines there is a special need to retain a particular record or group of records for a longer period and notifies the MFN participant at least 30 days before the normal disposition date; or
(2) There has been a termination, dispute, or allegation of fraud or similar fault against the MFN participant, in which case the records must be maintained for an additional 6 years from the date of any resulting final resolution of the termination, dispute, or allegation of fraud or similar fault.