The University of Maryland Medical System (UMMS) filed a lawsuit against Physicians Care MCO, accusing the company of denying $15 million in claims for health services.

Physicians Care MCO is one of four companies that manage Medicaid claims for the state.

Lawsuit alleges claims denied for lower-income patients 

According to the lawsuit, the company denied the claims of 15,000 lower-income patients who use Medicaid. The patients included individuals who were infected with COVID-19 and premature babies who were treated in neonatal intensive care units (NICU). 

The lawsuit alleges that Physicians Care MCO's denial of the claims violated federal and state laws and its contract with UMMS. 

UMMS said the company engaged in a "longstanding, ongoing, deliberate, and systematic practice of denying timely and complete payment."

UMMS calls denial of claims "cruel"

The lawsuit included multiple examples of what UMMS said was unlawful denial of coverage.

According to the lawsuit, Physicians Care MCO 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 the company 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, UMMS said the company declined coverage to a premature infant who 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," UMMS wrote.

Maryland Physicians Care disputes UMMC's claims

In a statement to WJZ, MPC said it strictly follows state and federal guidelines.

"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 as our policies and procedures are regularly reviewed by the MD Department of Health as well as national accrediting bodies. The rigorous reviews consistently confirm that we meet regulatory requirements," MPC said. 

MPC added that it "strongly disputes the University of Maryland Medical System's unfounded characterizations."