Operators of Prince George's Hospital Center have asked the District for $5.2 million to cover the cost of treating uninsured District residents since D.C. General, the city's public hospital, stopped providing inpatient care three years ago.

Dimensions Healthcare System, the nonprofit group that runs Prince George's Hospital Center and five other county health care facilities, sent a letter to District officials last month seeking payment for care provided to nearly 5,400 uninsured patients since July 2001.

Bob Howell, a Dimensions spokesman, said officials have been monitoring the flow of patients from the District for years. They recently analyzed the numbers and "noticed that it was adding up to significant dollars."

D.C. officials said yesterday that it is highly unlikely that Prince George's will ever see the money.

Tony Bullock, a spokesman for Mayor Anthony A. Williams (D), said the mayor would be willing to meet with county officials to discuss the issue. But he said Prince George's Hospital Center's experience is comparable to that of other hospitals across the country, including many in the District.

"Everybody knows uncompensated care is a permanent part of the landscape of running a hospital in the 21st century," Bullock said. "A significant number of Maryland and Virginia residents who have no means to pay come to D.C. hospitals all the time. . . . We had a huge problem at D.C. General with non-D.C. residents seeking care. The vast majority were from Prince George's County. We never attempted to send Prince George's a bill because we knew we wouldn't get very far."

A spokeswoman for the city's Department of Health said the D.C. Healthcare Alliance, created in July 2001 to pay for the care of uninsured residents, is not responsible for services rendered by providers not in the alliance. Six hospitals, about 60 clinics and 800 practitioners, all in the District, participate in the alliance.

"The D.C. Healthcare Alliance does not have a contractual relationship with hospitals or facilities located outside the District," Leila Abrar, a spokeswoman for the city's Health Department.

Robert Murray, executive director of the state Health Services Cost Review Commission, which sets rates for Maryland hospitals, said the commission bases a hospital's rates in part on the uncompensated care it is expected to provide. Prince George's Hospital Center's rates were increased in recent years to help compensate for care provided to uninsured residents, he said.

Some uninsured D.C. residents received care at Laurel Regional Hospital and Bowie Health Center, also Dimensions facilities. But most of the patients in question, more than 4,500, went to Prince George's Hospital Center, which treats three-fourths of the county's uninsured patients and is the only trauma center serving Southern Maryland. About $1.3 million is sought from the District for treatment of city residents in the Cheverly hospital's emergency room.

The hospital has been buckling under the cost of caring for indigent patients for decades. Last year, Dimensions came close to financial collapse after the state rate-setting panel denied an increase in rates. The state and county government later brokered a deal to pump $45 million into the Dimensions system over five years.

In the letter to city health officials, K. Singh Taneja, a senior vice president at Dimensions, said the hospital only wants to be treated fairly. If Prince George's is providing care to residents who otherwise would have been treated at D.C. General, it should be compensated, Taneja argues in the letter.

Bullock said that he sympathizes with Prince George's Hospital Center but that the argument doesn't hold up.

"If I were uninsured from Milwaukee and I was visiting a relative in Bowie and took ill and they took me to Prince George's Hospital, the city of Milwaukee is not required to pay my bill," Bullock said.