<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".01" citation="COMAR 10.67.12.01" title_num="10" subtitle_num="67" chapter_num="12" heading="General.">
  <paragraph num="A.">
    <text>An MCO shall establish a corrective managed care plan that, at minimum, provides for:</text>
    <paragraph num="(1)">
      <text>The identification of an enrollee that has abused MCO pharmacy benefits; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The enrollment of an enrollee that has been determined to have abused MCO pharmacy benefits in the MCO’s corrective managed care plan.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Enrollee abuse exists when an enrollee:</text>
    <paragraph num="(1)">
      <text>Has engaged in behaviors identified in COMAR 10.09.24.14-1; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Engages in Medicaid fraud as defined under COMAR 10.09.24.14.</text>
    </paragraph>
  </paragraph>
</regulation>