GOVERNMENTSupreme Court rejects challenge to Medicare HMO rulingThe U.S. high court's decision means that a California medical negligence case against PacifiCare can go forward.By Tanya Albert, amednews staff. Nov. 5, 2001. A legal challenge of California Medicare beneficiaries' ability to sue health plans they believe denied them necessary care has ended. Without comment, the U.S. Supreme Court in October said it would not hear the challenge of a California Supreme Court ruling allowing such lawsuits. The decision by the nation's highest court ended the appeal process. "It was the right decision," said Los Alamitos, Calif., attorney Carol Jimenez, who represented the family suing the HMO in question, PacifiCare of California Inc. "People who are denying care based on a financial reason need to stand up and take notice and realize that they are accountable." In its ruling earlier this year, the California Supreme Court acknowledged that Medicare regulations establish an administrative review process designed to hear appeals. But it said that process does not stop lawsuits under state laws. The federal courts already have granted similar rights to patients enrolled in Medicare HMOs. Health plans say the ruling will create havoc, leaving decisions in the hands of individual judges and juries, who will apply different standards. In a statement, PacifiCare said it was disappointed that the U.S. Supreme Court wouldn't hear the case. "We continue to believe this is a significant issue that must be resolved at the federal level," the statement read. "The Medicare review process is a vital and important part of the Medicare program and serves patients well. It allows patients to have medical or benefits decisions quickly reviewed by a neutral third-party expert, and the health plan must abide by that decision."
[...]
Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2001 American Medical Association. All rights reserved.
|
Feature articlesHealth reform review The Massachusetts experience Litigation stress Being sued is personal as well as professional Comprehensive coverage
Most-viewedNov. 23 issueAMA meeting: Delegate vote refines AMA stance on system reform Liability premiums stay stable, but insurers warn this might not last Columns and series
From the vault: 5 years agoState tort reform ballot wins set stage for further battles Nov. 22, 2004 
|
SHARE
