§ 19-712.4. Prohibited referral services, payment
West's Annotated Code of MarylandHealth--General
MD Code, Health - General, § 19-712.4
§ 19-712.4. Prohibited referral services, payment
(a) In this section the terms “health care practitioner”, “health care entity”, and “health care service” have the same meanings as provided in § 1-301 of the Health Occupations Article.
(b) A health maintenance organization may seek repayment from a health care practitioner of any money paid for any claim, bill, or other demand or request for payment for the health care services that were determined by the appropriate regulatory licensing board to be furnished as a result of a referral prohibited by § 1-302 of the Health Occupations Article.
(c) Every contract between a health maintenance organization and its subscribers or a group of subscribers for the provision of health care services shall include a provision excluding payment of any claim, bill, or other demand or request for payment for health care services determined to be furnished as a result of a referral prohibited by § 1-302 of the Health Occupations Article.
(d) A health maintenance organization subject to the provisions of this section shall report to the Commissioner and the appropriate regulatory board any pattern of claims, bills or other demands or requests for payment submitted for a health care service provided as a result of a referral prohibited by § 1-302 of the Health Occupations Article within 30 days after that health maintenance organization has knowledge of that pattern.
(e)(1) Notwithstanding the provisions of this section, a health maintenance organization reimbursing for health care services is not required to audit or investigate any claim, bill, or other demand or request for payment for the purpose of determining whether those services were the result of a prohibited referral.
Credits
Added by Acts 1993, c. 376, § 2, eff. Oct. 1, 1993. Amended by Acts 1994, c. 3, § 1, eff. Feb. 28, 1994; Acts 2000, c. 61, § 1, eff. April 25, 2000.
MD Code, Health - General, § 19-712.4, MD HEALTH GEN § 19-712.4
Current through legislation effective through July 1, 2024, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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