HARRY HUGHES, Governor

2555

CHAPTER 669

(House Bill 1111)

AN ACT concerning

Health Insurance - Fraudulent Claims

FOR the purpose of permitting nonprofit health service plans
to recover costs and expenses reasonably incurred in a
successful action against a health care provider who
makes false claims as to services rendered or amounts
charged with the purpose of defrauding nonprofit health
service plans; permitting a health care provider to
recover costs and expenses reasonably incurred m
defending such an action if the nonprofit health
service plan is denied relief; providing that this Act
does not limit certain other rights; and defining a
certain term.

BY adding to

Article 48A - Insurance Code

Section 361D

Annotated Code of Maryland

(1979 Replacement Volume and 1980 Supplement)

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That section(s) of the Annotated Code of Maryland
be repealed, amended, or enacted to read as follows:

Article 48A - Insurance Code

361D.

(A) (1) IN THIS SUBTITLE "HEALTH CARE PROVIDER" MEANS
A PERSON ENTITLED TO PROVIDE HEALTH CARE IN THE STATE OF
MARYLAND.

(2) "HEALTH CARE PROVIDER" INCLUDES SURGEONS,
PHYSICIANS, DENTISTS, NURSES, OPTICIANS, OPTOMETRISTS, AND
CHIROPODISTS.

(B)  A NONPROFIT HEALTH SERVICE PLAN MAY RECOVER THE
COSTS AND EXPENSES REASONABLY INCURRED BY IT IN A SUCCESSFUL
ACTION AGAINST A HEALTH CARE PROVIDER IF THE NONPROFIT
HEALTH SERVICE PLAN SHOWS THAT THE PROVIDER, KNOWINGLY OR
WILLFULLY, MADE OR CAUSED TO BE MADE:

(1) A FALSE STATEMENT OR REPRESENTATION OF A
MATERIAL FACT IN ANY APPLICATION FOR ANY BENEFIT OR PAYMENT
UNDER THIS TITLE FROM A NONPROFIT HEALTH SERVICE PLAN;