Md. Code Ann., Ins. § 15-1631 – Retroactive denial or modification of reimbursement of claims prohibited

(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.

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:

Added by Acts 2012, c. 318, § 1, eff. Oct. 1, 2012; Acts 2012, c. 319, § 1, eff. Oct. 1, 2012. Amended by Acts 2019, c. 400, § 1, eff. May 13, 2019.