§ 15–10C-04
Statutes in effect as of October 1, 2026.
Md. Code Ann., Ins. § 15-10C-04 (2026)
Title 15. Health Insurance
Subtitle 10C. Medical Directors
§ 15–10C-04LinkCopy Citation
(a)
Subject to the hearing procedures in §§ 2-210 through 2-214 of this article, the Commissioner may suspend, revoke, or refuse to renew a certificate of a medical director if the Commissioner finds a pattern that the utilization management procedures and policies used by the medical director in making utilization review decisions or used by a private review agent employed by or under contract with the health maintenance organization over whose utilization review decisions the medical director has responsibility are not:
(1)
objective;
(2)
clinically valid;
(3)
compatible with established principles of health care; or
(4)
flexible enough to allow deviations from the norms when justified on a case by case basis.
(b)
The Commissioner may consult with an independent review organization or medical expert that meets the requirements of § 15-10A-05 of this title, the Department, the Board, or any other appropriate entity for purposes of taking an action described under subsection (a) of this section.