Mercy Medical Center, Inc. v. United Healthcare of Mid-Atlantic, Inc.

815 A.2d 886, 149 Md. App. 336, 2003 Md. App. LEXIS 3
CourtCourt of Special Appeals of Maryland
DecidedJanuary 30, 2003
Docket1495, Sept. Term, 2001
StatusPublished
Cited by13 cases

This text of 815 A.2d 886 (Mercy Medical Center, Inc. v. United Healthcare of Mid-Atlantic, Inc.) is published on Counsel Stack Legal Research, covering Court of Special Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mercy Medical Center, Inc. v. United Healthcare of Mid-Atlantic, Inc., 815 A.2d 886, 149 Md. App. 336, 2003 Md. App. LEXIS 3 (Md. Ct. App. 2003).

Opinion

KRAUSER, J.

Appellant, Mercy Medical Center, Inc. (“Mercy”), guaranteed a medical services contract between Maryland Personal Physicians, Inc. (“MPPI”), a physicians’ network created by Mercy, and appellee, United Healthcare of the Mid-Atlantic, Inc. (“United”), a health maintenance organization (“HMO”). 1 Specifically, Mercy guaranteed the payments MPPI was to make, under that contract, to medical service providers for services rendered by those providers to United’s members. When MPPI was unable to make those payments, United turned to Mercy.

*344 Invoking Mercy’s guarantee, United demanded that Mercy pay the outstanding medical fees and costs that MPPI had promised to cover. Mercy demurred, insisting that the guarantee had expired and that, even if it had not, Mercy owed substantially less than the total amount claimed by United. Its payment demand rejected, United turned to the Circuit Court for Baltimore City for assistance. That court ordered Mercy to fund a bank account in the amount of $5,108,476.00, from which United could pay outstanding medical service claims but denied United’s request for pre-judgment interest on that amount. Cross-appeals followed.

Mercy maintains that the circuit court erred in concluding that it had agreed to guarantee payment of over five million dollars of MPPI’s unpaid obligations, and presents the following issues for our review, which, although re-ordered, have been set forth below as they appear in Mercy’s brief. They are:

I. Whether the court erred when it ignored the express termination of the April 1998 amendment, which served as the document pursuant to which Mercy’s guarantee was given.
II. Whether the court erred when it found that [Mjercy impliedly consented to the drastic modifications to the IPA agreement in October 1998.
III. Whether the court erred when it determined that the language of attachment Q and the guarantee do not limit Mercy’s liability to a maximum amount of $1.1 Million.

On cross-appeal, United presents the following question:

Did the circuit court err in denying United’s demand for pre-judgment interest for Mercy’s breach of its Guarantee?

For the reasons that follow, we shall affirm the judgment of the circuit court.

BACKGROUND

Mercy is a hospital located in Baltimore City. Sometime *345 between 1994 and 1996, 2 Mercy formed MPPI. According to MPPI’s 1997 Annual Report, it was “an integrated network of primary care and specialist physicians in Central Maryland” created for the purpose of “negotiat[ing] service contracts and provid[ing] practice management services.” Mercy capitalized MPPI with a $14,000,000.00 investment.

At the outset, Mercy held about 90% of the stock in MPPI, and remained a majority stockholder in 1997 and 1998, with 57% of the stock. Although MPPI had a separate corporate identity from Mercy, Mercy’s chief executive officer and chief financial officer sat on MPPPs board of directors and on its Joint Policy Committee in 1997 and 1998. In addition, Mercy provided funding to MPPI, including a $4,000,000.00 line of credit, from which MPPI drew throughout 1997.

Mercy created MPPI to establish a geographically-dispersed network of physicians. That network, Mercy hoped, would send patients to Mercy for treatment. Once MPPI was formed, MPPI entered into “full risk capitated contracts” with health maintenance organizations like United; they, in turn, were to send their members to MPPI and Mercy for medical services. A “full-risk capitated contract” is one in which an “individual practice association”(“IPA”), such as MPPI, accepts a fixed monthly payment from an HMO, such as United, for each HMO member who chooses or is assigned to the individual practice association. In consideration for the fixed monthly payment, the individual practice association agrees to accept full responsibility for the medical treatment of each HMO member, even if the cost of that medical treatment exceeds the fixed amount paid to the individual practice association by the HMO.

In the spring of 1997, after months of negotiations, MPPI entered into a contract with United that commenced on April 1, 1997 (“IPA Agreement”). During those negotiations, MPPI and Mercy were represented by Mercy Ventures, Inc., a *346 Maryland Corporation that was formed by Mercy. Mercy Ventures was created by Mercy to provide medical practice management services to physicians, physician groups, and hospitals. One such service was to review and negotiate managed care contracts on behalf of such clients as MPPI and Mercy.

Under the IPA Agreement, United was to compensate MPPI on a “monthly fee for service” basis for each of United’s commercial members. But with respect to each Medicaid and Medicare member, United was to pay MPPI a “monthly capitation payment.” 3 “[I]n consideration of said capitation payments,” MPPI agreed to “provide or arrange for all those physician services [ ] required in [the] Agreement and [to] assume the responsibility for the costs of said services.” Some of those services were provided by “External Providers.” An “External Provider” is defined by the IPA Agreement as “any physician, health professional, or other health care provider, including [MPPI] Physicians, health service contractors, and Health Centers contracted with [MPPI] to provide Covered Services to all Members of [United].”

To comply with the Health Maintenance Organization Act, Maryland Code (2002), § 19-713.2(d)(3) of the Health-General Article (“HMO Act”), the parties added “Attachment Q” to the 1997 IPA Agreement. Section 19-713.2(d)(3) of the HMO Act provides that an HMO cannot enter into an administrative services contract 4 unless the HMO files a plan with the Insurance Commissioner that:

*347 (3) Require[s] the health maintenance organization to establish and maintain a segregated fund, in a form and an amount approved by the Commissioner, which may include withheld funds, escrow accounts, letters of credit, or similar arrangements, or require the availability of other resources that are sufficient to satisfy the contracting provider’s obligations to external providers.

Accordingly, Attachment Q states that

[plursuant to Maryland Health-General 19-713.2, [MPPI] shall provide [United] with reasonable acceptable collateral to secure an amount equal to the immediately preceding sixty (60) days of IPA capitation. The purpose of such Reserve is to ensure that sufficient funds are on hand to reimburse [United] for any payments made to External Providers, as required by law, if [MPPI] fails to make any such payments. [United] agrees that a Letter of Guarantee from Mercy Medical Center shall be deemed reasonably acceptable collateral for such purpose. Such Letter of Guarantee shall be delivered prior to contract signature and will be made part of this Agreement.

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815 A.2d 886, 149 Md. App. 336, 2003 Md. App. LEXIS 3, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mercy-medical-center-inc-v-united-healthcare-of-mid-atlantic-inc-mdctspecapp-2003.