The University of Maryland Medical System in Baltimore has sued Maryland Physicians Care — a Medicaid managed care organization — seeking to recover more than $15 million for services allegedly provided to over 15,000 patients.
UMMS alleges that MPC improperly and repeatedly denied payments for a wide range of medically necessary services — including emergency department care, treatment for COVID-19, and neonatal care for prematurely born infants.
“Payment was denied for essential care that UMMS provided to more than 15,000 people, including premature babies with special needs and patients recovering from heart attacks, gunshot wounds, strokes and other life-threatening conditions,” UMMS President and CEO Mohan Suntha, MD, said in a June 16 news release.
Dr. Suntha emphasized the system’s role in caring for underserved populations, noting that one in four people in Maryland receive coverage through Medicaid programs like MPC.
“It is inexplicable and inexcusable for UMMS to not have been compensated for providing this care by an organization with a contractual and statutory responsibility to manage its members’ health outcomes,” he said
According to the complaint, MPC’s denial rates for medical services — particularly emergency care — far exceed those of other payers, including peer Medicaid MCOs in Maryland.
UMMS is a nonprofit system comprising 11 hospitals and accounts for over 25% of hospital-based care statewide, according to the health system. In 2018, it entered into a health provider agreement with MPC to provide care to MPC’s Medicaid members under Maryland’s HealthChoice program — the state’s mandatory managed care model.
MPC is one of nine Medicaid managed care organizations in the state and receives capitated payments from the Maryland Department of Health to cover care and administrative costs for its enrollees.
The lawsuit argues that UMMS’s broad geographic footprint and network of facilities — from regional hospitals to its flagship R Adams Cowley Shock Trauma Center — make its inclusion critical to MPC’s network adequacy compliance and member recruitment. Excluding UMMS from its network would significantly diminish MPC’s attractiveness to Medicaid beneficiaries, the suit contends.
MPC strongly disputes the UMMS’ allegations and argues that rigorous reviews confirm that it consistently meets regulatory requirements and guidelines.
“As a managed care organization owned by four non-profit, Maryland-based hospital systems, we deeply value the vital role that hospitals play in providing care for our communities,” MPC CEO Jason Rothman said in a statement shared with Becker’s. “We have worked in good faith to address these concerns with the University of Maryland Medical System and have engaged in dialogue to seek resolution.”
