(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
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(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.