2013 Maryland Code
INSURANCE
§ 15-10C-04 - Suspension or revocation by Commissioner of certificate of Medical Director


MD Ins Code § 15-10C-04 (2013) What's This?

(a) Refusing to renew a certificate. -- 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) Independent experts. -- 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.

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