The University of Maryland Medical System (UMMS) is taking legal action against Maryland Physicians Care MCO (MPC), a company tasked with managing Medicaid claims for the state, in a battle over $15 million worth of denied health service claims. UMMS claims that MPC denied payment for medical services provided to 15,000 lower-income patients, affecting those with serious conditions such as COVID-19 and infants in neonatal intensive care units (NICU), as CBS News Baltimore reported.
Highlighting the severity of the alleged denials, UMMS mentioned cases where MPC reportedly refuted the necessity for continued hospital care for patients dealing with the aftermath of a cardiac arrest and a gunshot wound also a patient suffering from multiple medical conditions at once, and a premature infant exposed to drugs in utero with a diagnosis including extreme respiratory distress and severe feeding intolerance. These instances were described as "not just inappropriate—they were cruel," by UMMS, as stated in the lawsuit cited by CBS News Baltimore.
On the defense, MPC insists upon its adherence to the highest standards, contesting UMMS's portrayal of its actions. "Maryland Physicians Care, a Medicaid Managed Care Organization, is committed to the highest standards of integrity and compliance in administering health benefits since 1997 on behalf of our partner, the Maryland Department of Health. We strictly adhere to all state and federal rules and guidelines," MPC told CBS News Baltimore, emphasizing its record of compliance and regulatory satisfaction. Nonetheless, UMMS is demanding that the court force the payment of the claims and overhaul MPC's reimbursement practices.
The situation pinpoints a significant dispute between UMMS, which operates 11 hospital facilities serving as vital healthcare resources for the vulnerable, and MPC, owned by other hospital systems including Ascension Saint Agnes and Holy Cross Health, moreover, UMMS alleges that post-MPC's network join in 2018, the company has denied 99% of complex emergency claims and 70% of COVID-related claims, which is a focus of UMMS's legal complaint for $15 million in denied claims as reported by WYPR.
