(a) It is a violation of this subtitle for a carrier to fail to fulfill the carrier’s obligations to provide or reimburse for health care services specified in the carrier’s policies or contracts with members. (b) If, in rendering a coverage decision or appeal decision, a carrier fails to fulfill the carrier’s policies or contracts with members, the Commissioner may: (1) issue an administrative order that requires the carrier to: (i) cease inappropriate conduct or practices by the carrier or any of the personnel employed or associated with the carrier; (ii) fulfill the carrier’s contractual obligations; (iii) provide a health care service or payment that has been denied improperly; or (iv) take appropriate steps to restore the carrier’s ability to provide a health care service or payment that is provided under a contract; or (2) impose any penalty or fine or take any action as authorized: (i) for an insurer, nonprofit health service plan, or dental plan organization, under this article; or (ii) for a health maintenance organization, under the Health - General Article or under this article.
Maryland Legal Code