MEDICARE HMOS: Court Rules Suits O.K. in Some Cases
The Fourth Appellate District Court in Santa Ana ruled yesterday that "Medicare recipients may sue their health maintenance organizations for punitive damages in state court for denying referrals, tests or certain treatments," the Los Angeles Times reports. It is the first "appellate decision on whether Medicare enrollees living in California could sue their HMOs in state court." A number of previous cases were "dismissed on the grounds that the federal Medicare law precluded complaints at the state level." The appellate court found that while federal law does apply "in many cases, consumers who wish to use the quicker state court process may do so in certain cases," such as when claimants "do not merely seek reimbursement for Medicare benefits." Plaintiffs' attorney Carol Jimezen said, "This is a fabulous victory for California's Medicare enrollees. It will open up the gates for people (to sue) when they are denied treatment." The case involved a Costa Mesa man who has since died from lung disease who alleged that PacifiCare Health Systems Inc. "denied him important treatment and repeatedly refused to refer him to a specialist for a transplant." PacifiCare had no comment on the decision (Maharaj/Bernstein, 8/18).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.