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§ 14-105. Fraudulent health insurance claims

West's Annotated Code of MarylandInsurance

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 14. Entities that Act as Health Insurers
Subtitle 1. Nonprofit Health Service Plans (Refs & Annos)
Part I. Definitions; General Provisions
MD Code, Insurance, § 14-105
§ 14-105. Fraudulent health insurance claims
Currentness
Recovery of costs and expenses incurred by action
(a) If a nonprofit health service plan is successful in an action against a person authorized to provide health care in the State, the nonprofit health service plan may recover the costs and expenses reasonably incurred by it in the action if it shows that:
(1) the person knowingly or willfully made or caused to be made:
(i) a false statement or representation of a material fact in an application for a benefit or payment from a nonprofit health service plan under this subtitle or Title 15 of this article;
(ii) a false statement or representation of a material fact for use in determining rights to those benefits or payments; or
(iii) a false statement or representation about a procedure, operation, or service alleged to have been performed; or
(2) the person:
(i) engaged in gross, willful, and continued overcharging for a procedure, operation, or service; or
(ii) filed false statements for collection of fees for services that were not rendered.
Recovery of costs and expenses incurred in defense of action
(b) If a nonprofit health service plan is denied relief in an action under this section, the person against whom the action was brought may recover the costs and expenses reasonably incurred by the person in defending the action.
Additional rights or remedies
(c) This section does not limit any additional rights or remedies that a nonprofit health service plan may have at law or in equity.

Credits

Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997.
Formerly Art. 48A, § 361D.
MD Code, Insurance, § 14-105, MD INSURANCE § 14-105
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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