Articles Posted in Public Benefits

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Plaintiff was a Medicare beneficiary who received his Medicare benefits through a plan offered by Respondents, health insurance businesses that specialize in health maintenance and/or managed care and are engaged in the joint venture of providing insurance. As a result of his treatment at a clinic, which was a contracted provider for Respondents, Plaintiff became infected with hepatitis C. Plaintiff subsequently sued Respondents alleging negligence in selecting their health care providers. The district court dismissed the complaint, concluding that Plaintiff’s claim was preempted by the federal Medicare Act. The Supreme Court affirmed, holding that state common law negligence claims regarding the retention and investigation of contracted Medicare providers are expressly preempted by the Medicare Act. View "Morrison v. Health Plan of Nev., Inc." on Justia Law

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From 2007 to 2008, Dorothy Rogers received Medicare benefits through Pacificare's federally-approved Medicare Advantage Plan, Secure Horizons. Rogers and Pacificare entered into separate contracts each year providing the terms and conditions of coverage. After receiving treatment from the Endoscopy Center of Southern Nevada (ECSN), a facility approved by Pacificare for use by its Secure Horizons plan members, Rogers tested positive for hepatitis C. Rogers sued Pacificare, alleging that Pacificare should be held responsible for her injuries because it failed to adopt and implement an appropriate quality assurance program. Pacificare moved to dismiss her claims and compel arbitration based on a provision in the parties' 2007 contract. The district court determined that the 2007 contract governed, but held that the arbitration provision was unconscionable and, thus, unenforceable. The Supreme Court reversed, holding (1) because the parties in this case did not expressly rescind the arbitration provision at issue, the provision survived the 2007 contract's expiration and was properly invoked; and (2) as the Medicare Act expressly preempts any state laws or regulations with respect to the Medicare plan at issue in this case, Nevada's unconscionability doctrine was preempted to the extent that it would regulate federally-approved Medicare plans. View "Pacificare of Nevada v. Rogers" on Justia Law