BALTIMORE — The University of Maryland Medical System (UMMS) is suing a state Medicaid program for over $15 million in unpaid hospital bills.
Maryland Care, Inc., also known as Maryland Physicians Care (MPC), is accused of denying more than 15,000 patient claims for treatment sought at the emergency room.
"MPC denies payment for medical services, particularly [emergency department] 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 are enrolled in Medicaid programs.
As one of Maryland's nine Medicaid Managed Organizations, MPC reportedly receives over $1 billion in taxpayer dollars annually.
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 MPC allegedly declining coverage, a few of which are described below.
- "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."
In 2024 Maryland spent approximately $60.3 million treating 3,549 patients for firearm related injuries, according to recent court filings from the Maryland Attorney General's Office.
This lawsuit also comes on the heels of a legislative audit that accused Maryland's Department of Health of mishandling millions of dollars in questionable Medicaid claims.
The Department said they're not a party in this latest matter and therefore have no comment.
Ascension Saint Agnes did not respond to our request for a statement.
A copy of the lawsuit can be read below.
