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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND ST. MARY'S HOSPITAL v. CAREFIRST OF MARYLAND, INC. : : : : : MEMORANDUM Before the Court is Defendant's Motion for Partial Summary Judgment (Paper No. 11). is ripe for decision. The motion has been fully briefed and

Civil Action WMN-01-1260

Upon review of the pleadings and

applicable case law, the Court determines that no hearing is necessary (Local Rule 105.6) and that the motion will be granted. I. BACKGROUND Plaintiff is a hospital incorporated and licensed in Maryland. Defendant is a Blue Cross Blue Shield health insurance In 1986 and 1995, Plaintiff

company operating in Maryland.

entered into written agreements with Defendant, whereby Plaintiff would provide medical services to eligible subscribers of Defendant's health benefit plans, in return for payment from Defendant. In this lawsuit, Plaintiff alleges that Defendant

breached the 1995 agreement by not providing full payment for services rendered by Plaintiff to 24 CareFirst subscribers during 1999 and 2000. Specifically, Plaintiff claims that Defendant

wrongfully denied payment for a portion of the hospital services received by each patient, on the ground that the duration of services had been longer than medically necessary. Opp. at 6. See, Pl.'s

Plaintiff asserts that the services were medically

necessary, and that Defendant's failure to pay for them in full constitutes a breach. The instant motion relates only to 7 of the 24 hospital patients. Those 7 patients were enrollees in a nationwide

government health plan for federal employees, called the Service Benefit Plan ("SBP" or "the Plan"). The SBP was created pursuant

to the Federal Employees Health Benefits Act (FEHBA), which authorizes the United States Office of Personnel Management (OPM) to contract with insurers (referred to as "carriers") to provide health benefits for federal employees. 5 U.S.C.

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Maryland Law