12 hours ago
University of Maryland Medical System files $15 million lawsuit over denied health service claims
The University of Maryland Medical System has filed a lawsuit against Physicians Care MCO, accusing the company of improperly denying $15 million in claims for health services.
Physicians Care MCO is one of four companies that manages Medicare claims for the state.
The UMMS says the company denied claims to 15,000 lower-income patients who use Medicaid. This group of patients includes individuals who were infected with COVID-19, and premature babies treated in neonatal intensive care units, according to the lawsuit.
According to the lawsuit, Physicians Care MCO denied claims in a way that violated federal and state laws, as well as its contract with the health system.
The UMMS said the company engaged in a "longstanding, ongoing, deliberate, and systematic practice of denying timely and complete payment."
Lawsuit details claims of wrongful denial of coverage
The lawsuit details multiple examples of what the UMMC says was unlawful denial of coverage.
According to the lawsuit, MPC decided that a patient no longer needed to stay in the hospital, despite having recently survived cardiac arrest and a gunshot wound, because their level of pain was deemed too low to warrant continued care.
In another case, the suit alleges that MPC denied coverage to a patient with multiple active medical conditions including a recent stroke, HIV, COVID-19, and sepsis - while that patient was still fighting to stabilize.
In one example the UMMC said the company declined coverage to a premature infant that was exposed to fentanyl and cocaine in utero. The infant was diagnosed with extreme respiratory distress, recurrent apnea, severe feeding intolerance, and numerous other comorbidities associated with extreme prematurity, according to the lawsuit.
"These denials were not just inappropriate—they were cruel. They demonstrate that MPC's corporate profit motives override the medical needs of the sickest and smallest patients in the State," the UMMS wrote.
The Baltimore Banner reached out to Physicians Care MCO, but a response has not yet been received.
