Maryland Statutes
Part V - Contracts With Pharmacies and Pharmacists; Audits
Section 15-1631 - Retroactive Denial or Modification of Reimbursement for Approved Claim

Except for an overpayment as defined in § 15–1629(h) of this subtitle, if a claim has been approved by a pharmacy benefits manager through adjudication, the pharmacy benefits manager may not retroactively deny or modify reimbursement to a pharmacy or pharmacist for the approved claim unless:
        (1)    the claim was fraudulent;
        (2)    the pharmacy or pharmacist had been reimbursed for the claim previously; or
        (3)    the services reimbursed were not rendered by the pharmacy or pharmacist.

Structure Maryland Statutes