Suspension or revocation by Commissioner of certificate of medical director

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    (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:

        (1)    objective;

        (2)    clinically valid;

        (3)    compatible with established principles of health care; or

        (4)    flexible enough to allow deviations from the norms when justified on a case by case basis.

    (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.


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