UMMS Sues Medicaid Provider for $15M Over Denied Patient Care Claims
University of Maryland Medical System Sues Medicaid Contractor For $15M Over Denied Patient Care
The University of Maryland Medical System (UMMS) has filed a lawsuit in Baltimore City Circuit Court against Maryland Physicians Care (MPC), a private Medicaid managed care organization, alleging it wrongfully denied more than $15 million in payments for medical services provided to low-income patients.
The dispute centers on care given to approximately 15,000 Medicaid recipients at UMMS’s 11 hospitals across the state. Many of the bills stemmed from emergency room visits, treatment for COVID-19, and critical care for premature infants in neonatal intensive care units.
UMMS President and CEO Dr. Mohan Suntha said in a statement that the health system delivered care for “premature babies with special needs and patients recovering from heart attacks, gunshot wounds, strokes and other life-threatening conditions,” but that MPC repeatedly refused to pay for those services.
Founded in 1996, Maryland Physicians Care is jointly owned by several hospital systems in the state, including Ascension Saint Agnes, Holy Cross Health, Meritus Health, and UPMC Western Maryland. The company has not yet publicly responded to the lawsuit.
UMMS alleges in the suit that MPC violated both state and federal laws, as well as its contractual obligations, by systematically and deliberately denying valid claims, especially those involving emergency care. According to the lawsuit, MPC denied 99% of complex emergency claims, 79% of emergency behavioral health claims, and 70% of COVID-related claims from UMMS since it joined the MPC network in 2018.
Unlike many cases where hospitals pursue payment directly from patients, this suit targets the insurer, marking a notable shift in Maryland, where hospitals have faced increasing restrictions on billing low-income patients. State laws now provide more protections, including mandates for free or reduced-cost care and even refunds for patients who were wrongly charged.
Though the $15 million at stake represents a small portion of UMMS’s overall revenue, its hospitals deliver roughly 25% of all hospital care in Maryland—the lawsuit argues that MPC has unjustly profited by withholding taxpayer-funded payments.
UMMS is asking the court to compel MPC to pay the denied claims and revise its reimbursement practices. The suit contends that MPC’s actions not only harm hospitals financially but also undermine the integrity of the Medicaid system, which is designed to support the state’s most vulnerable residents.
