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PARRIS N. GLENDENING, Governor
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Ch. 123
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delivered by a provider who is a participating or nonparticipating provider in the
preferred provider organization or employee assistance program network.
(b) A private review agent or any individual who is either affiliated with,
under contract with, or acting on behalf of a private review agent may not:
(1) refer a patient who has undergone utilization review by the private
review agent to:
(i) a health care facility in which the private review agent owns a
significant beneficial interest; or
(ii) the private review agent's own health care practice;
(2) pay or agree to pay any sum to, or accept or agree to accept any sum
from, any person for bringing or referring a patient to the private review agent; or
(3) provide for different insurance coverage or benefits based on
receiving the service from a health care facility or health care provider in which the
private review agent owns a significant beneficial interest.
(c) A private review agent or any individual who is either affiliated with,
under contract with, or acting on behalf of a private review agent may refer a patient
who has undergone utilization review by the private review agent to another health
care provider regulated under the Health Occupations Article if:
(1) (i) the patient or provider requests the private review agent to
provide the patient with the name of a health care provider appropriate to meet the
health care needs of the patient; or
(ii) the patient has no attending physician; and
(2) the private review agent provides the patient with the names of at
least 2 health care providers appropriate to meet the health care needs of the
patient.]
15-10B-16.
THE COMMISSIONER MAY ESTABLISH REPORTING REQUIREMENTS TO:
(1) EVALUATE THE EFFECTIVENESS OF PRIVATE REVIEW AGENTS; AND
(2) DETERMINE IF THE UTILIZATION REVIEW PROGRAMS ARE IN
COMPLIANCE WITH THE PROVISIONS OF THIS SECTION AND APPLICABLE
REGULATIONS.
[15-10B-17.
(a) A person who violates any provision of this subtitle or any regulation
adopted under this subtitle is guilty of a misdemeanor and on conviction is subject to
a penalty not exceeding $1,000. Each day a violation is continued after the first
conviction is a separate offense.
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- 765 -
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