Supreme Court Upholds Right to Sue Calif. M+C Plans
The U.S. Supreme Court yesterday declined to hear an appeal of a case giving California Medicare beneficiaries in HMOs the right-to-sue their health plans over denials of care, the Los Angeles Times reports. Without comment, the court upheld a May ruling by the California Supreme Court finding that Medicare+Choice beneficiaries can sue managed care companies for damages "if [the companies] are negligent or deceptive in caring for their patients." The decision came in the case of George McCall, a Costa Mesa, Calif., man who was "allegedly denied" coverage for a lung transplant by his Medicare HMO, PacifiCare of California, "until it was too late." After McCall died, his wife sued both PacifiCare and its medical group, Greater Newport Physicians, after discovering that her husband "could have received a transplant paid for by Medicare if he had not been enrolled in the HMO" (Savage, Los Angeles Times, 10/10). In its decision, the California Supreme Court ruled that Medicare+Choice members can "bypass" the traditional Medicare review process set forth under federal Medicare law (Holland, AP/Nando Times, 10/9). Tyler Mason, a spokesperson for PacifiCare, which had argued that allowing Medicare HMOs to be sued would prove "dangerous and disruptive," said the company was "disappointed" by the Supreme Court's decision. He added, "[W]e continue to believe there is a significant issue that must be resolved at the federal level." The Los Angeles Times reports that the McCall case will not affect the current prohibition against members of traditional HMOs suing their health plans; that issue is being discussed in the ongoing federal patients' rights debate (Los Angeles Times, 10/10).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.