{"data":{"id":"us-md/md.-code-insurance-15-10c-04","jurisdiction":"us-md","citation":"Md. Code, Insurance § 15–10C–04","heading":"","body":"(a) 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:\n(1) objective;\n(2) clinically valid;\n(3) compatible with established principles of health care; or\n(4) flexible enough to allow deviations from the norms when justified on a case by case basis.\n(b) 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.","path":["Article - Insurance"],"source_url":"https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin\u0026section=15-10C-04","current_through":"2026-01-01","vintage":"","retrieved_at":"2026-09-14T19:59:28Z","sha256":"d03cf13ae7b89546c676bb9f3cfe58798d60497edf2c901c3f7530f552f588d9","source_id":"us-md","stale":false,"prev":"us-md/md.-code-insurance-15-10c-03","next":"us-md/md.-code-insurance-15-10d-01"},"notice":"GroundRules: Original legal text. Not legal advice."}