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Authority: AS 47.05.010 AS 47.07.030 AS 47.07.074

AS 47.05.200 AS 47.07.040 7 AAC 160.110. Fiscal audit. (a) The department or its designee shall conduct fiscal audits of Medicaid providers, their subcontractors, and their grantees. A provider that bills the department is responsible for ensuring that records related to the services billed are kept by employees, subcontractors, and grantees, are maintained in accordance with 7 AAC 105.230, and are made available when requested by the department. (b) For purposes of this section, a fiscal audit may include a desk audit, a field audit, or both, to determine the provider’s compliance with the requirements of 42 U.S.C. 1396, AS 47.05, AS 47.07, 42 C.F.R. Part 430 — 42 C.F.R. Part 498, and 7 AAC 105 — 7 AAC 160. (c) For purposes of conducting an audit under this section, the provider must allow the department or its designee, the federal government, or the Department of Law access to original financial, clinical, and other records documenting care provided to Medicaid recipients. (d) Except as provided in (e) of this section, the department or its designee will give a provider 30 days’ advance notice of an audit to be conducted under this section. The notice will

(1) advise the provider that the department or its designee intends to conduct an audit of the provider’s records;

(2) specify the place where the audit is to be conducted;

(3) specify the records that the provider must produce for purposes of the audit;

(4) specify the date by which the provider must produce the records and the address to which the records are to be delivered or inspected; and

(5) advise the provider that the provisions of 7 AAC 105.240 apply to the production of the records requested. (e) The department or its designee may request and receive immediate access to records and perform an audit of those records without advance notice if the department or its designee has reason to believe, based on credible evidence, that the provider is engaging in a course of conduct or performing an act in violation of the requirements specified in (b) of this section. Notwithstanding the provisions of 7 AAC 105.240, the provider shall produce the requested records for an immediate audit under this subsection at the provider’s place of business or other