Ch. 376                                     1993 LAWS OF MARYLAND

(C)     EVERY GROUP OR INDIVIDUAL POLICY ISSUED FOR DELIVERY IN THE
STATE WHICH PROVIDES COVERAGE FOR 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 INSURER 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 INSURER HAS KNOWLEDGE OF THAT PATTERN.

(E)     (1) NOTWITHSTANDING THE PROVISIONS OF THIS SECTION, AN
INSURER 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.

(2) ANY AUDIT OR INVESTIGATION OF 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 ARE
NOT GROUNDS TO DELAY PAYMENT OR WAIVE THE PROVISIONS OF § 477AA OF THIS
ARTICLE. '

(F)     FOR ANY CLAIM, BILL, OR REQUEST FOR PAYMENT THAT IS PAID AND
SUBSEQUENTLY DETERMINED TO BE THE RESULT OF A PROHIBITED REFERRAL, AN
INSURER MAY SEEK A REFUND OF THAT PAYMENT IN ACCORDANCE WITH THE
PROVISIONS OF § 1-305 OF THE HEALTH OCCUPATIONS ARTICLE.

SECTION 3. AND BE IT FURTHER ENACTED, That notwithstanding the
provisions of § 1-302 of the Health Occupations Article, a health care practitioner who
has established a beneficial interest in or compensation arrangement with a health care
entity prior to after January 1, 1993 to which the practitioner makes referrals that are
prohibited by Section 1 2 of this Act shall have 1 year from the effective date of this Act
to dispose of that beneficial interest or terminate the compensation arrangement if the
health care practitioner plans to continue to make patient referrals to that health care
entity after October 1, 1994. A health care practitioner who makes referrals under this section
between October 1, 1993 and October 1, 1994 shall comply with the disclosure provisions of §
1-303(b) and the penalty provisions of § 1-303(d) of the Health Occupations Article.

SECTION 4. AND BE IT FURTHER ENACTED, That the provisions of § 1-302
of the Health Occupations Article do not apply to:

(a) A neurology group practice that contains three or more full time radiologists
who are partners in a group practice with neurologists which was in existence on or before
December 30, 1988 provided that the neurology group practice does not expand its
facilities beyond the number of locations in existence in the State on January 1, 1993; or

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