# Insurance (GIN)

## Title 15. Health Insurance

### Subtitle 10C. Medical Directors

#### Section 15-10C-04

(a) Subject to the hearing procedures in Sec.Sec. 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 Sec. 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.

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Md. Code Ann., Ins. (as displayed at mgaleg.maryland.gov, October 16, 2026)