BALTIMORE — The University of Maryland Medical System (UMMS) is suing a state Medicaid program over more than $15 million in unpaid medical bills.
According to the lawsuit filed in Baltimore City Circuit Court, Maryland Care, Inc., also known as Maryland Physicians Care (MPC) allegedly denied claims of more than 15,000 patients who sought emergency treatment for conditions like COVID-19 or premature child birth.
"MPC denies payment for medical services, particularly ED services, provided to its members by UMMS at alarmingly high rates that exceed the denial rates of other payors, including other Medicaid Managed Care Organizations (MCOs)," the lawsuit alleges.
Approximately one in four Maryland residents receive health coverage through Medicaid programs.
MPC is one of Maryland's nine Medicaid MCOs, receiving over $1 billion in taxpayer dollars each year. They're owned by Ascension Saint Agnes, Holy Cross Health, Meritus Health, and UPMC Western Maryland.
"MPC has abused the State’s trust and violated its obligations by improperly denying millions of claims and pocketing the money to bolster its own profits," the lawsuit states.
Court documents reveal several examples of cases in which MPC is accused of declining coverage. Here's a few highlighted by UMMS.
- "In one case, MPC consistently disputed and denied coverage for care for an infant born three months prematurely, weighing barely more than a pound who required continuous ventilatory support, nutrition support, and round-the-clock NICU monitoring for months. This neonate had been exposed to fentanyl and cocaine in utero."
- "MPC denied coverage for a patient with multiple complex and active conditions—including a recent stroke, HIV, COVID-19, and sepsis—while that patient was still fighting to stabilize. That patient was hospitalized for more than three months and underwent several invasive procedures, including repairing a broken leg."
- "MPC denied the necessity of continued hospital care for an MPCMember who had just survived cardiac arrest and a gunshot wound on the grounds that the member was no longer in enough pain to justify hospitalization."
It should be noted Maryland spent approximately $60.3 million treating 3,549 patients with firearm related injuries.
The Maryland Department of Health said they were not a party in the matter and therefore had no comment.
We've also reached out to Ascension Saint Agnes, and are awaiting to hear back.
A copy of the lawsuit can be read below.
