Hopkins files suit against Carefirst

March 08, 1991|By Raymond L. Sanchez | Raymond L. Sanchez,Evening Sun Staff

Johns Hopkins University has filed a lawsuit charging CareFirst and the Health Corporation of America, with failing to pay nearly $500,000 in doctors' fees.

The suit was filed Monday in Baltimore Circuit Court. It came 10 days after the Insurance Division of the state Department of Licensing and Regulation froze the assets of Carefirst to protect the 118,000 members of the financially troubled health-maintenance organization.

The assets of CareFirst were frozen after regulators discovered that they had fallen below state net-worth requirements. The HealthCare Corp. of America is a CareFirst Inc. subsidiary.

Frederick G. Savage, the university's associate general counsel, said the suit was prompted by a breakdown in talks between Hopkins and CareFirst, and the appointment of Maryland Insurance Commissioner John A. Donaho as conservator for CareFirst.

"We were hopeful of resolving this without having to go to litigation," Savage said yesterday. "We want to make sure that our claims are on the record."

A spokeswoman for the CareFirst HMO declined to comment on details of the law suit.

"Our lawyers are reviewing it," the spokeswoman said.

The suit, citing breach of contract and negligent misrepresentation, alleges that CareFirst, one of the state's largest HMOs, and two physicians' groups under contract to CareFirst failed to pay $497,632 for medical services administered by the physicians, who are faculty members of the university.

The two physicians' groups named in the lawsuit are Maryland Health Physicians Associates and Berdann & Krieger.

The suit said Maryland Health Physicians Associates owes the Hopkins' physicians $474,362. The physicians' group was referring patients to the Hopkins' doctors as recently as last summer, according to Savage.

Berdann & Krieger owes Hopkins $23,270, according to the suit. Savage said the group last referred patients to Hopkins a year and half ago.

Last week, Blue Cross and Blue Shield of Maryland agreed to buy the CareFirst system in a deal expected to pull the financially troubled company from under state control.

The sale is expected to be completed by next week, according to company officials.

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