Supreme Court of California

State law claims against a health maintenance organization, arising out of its refusal to provide services under a Medicare-subsidized health plan, do not fall within the exclusive review provisions of the Medicare Act, 42 USC 1395 et seq., that require exhaustion of administrative remedies.

Appellate Information

• Decided 05/03/2001
• Published 05/03/2001

Judges

• WERDEGAR, J.

Court

• Supreme Court of California

Counsel

• For Appellant:
  
•  Houck & Balisok, Russell S. Balisok, Steven C. Wilheim, Los Angeles;  Law Office of Carol S. Jimenez and Carol S. Jiminez, Long Beach, for Plaintiff and Appellant., Sara Lenz Lock, Bruce Vignery, Michael Schuster, San Diego;  Gill Deford;  and Herbert Semmel, Los Angeles, for American Association of Retired Persons and Center for Medicare Advocacy as Amici Curiae on behalf of Plaintiff and Appellant.


• For Appellees:
  
• Konowiecki & Rank, Jon N. Manzanares, Keith A. Weaver, Jeffrey D. Olster;  Greines, Martin, Stein & Richland and Timothy T. Coates, for Defendants and Respondents PacifiCare of California, Inc. and PacifiCare Health Systems, Inc., Rosato & Samuels, Cary S. Samuels, Ellen Kamon, Pamela Sirkin, N. Hollywood;  Hemer, Barkus & Clark, Davis, Grass, Goldstein & Housouer, Upland, and Edward A. Stumpp, Santa Ana, for Defendant and Respondent Greater Newport Physicians, Inc., Bonne, Bridges, Mueller, O'Keefe & Nichols, Los Angeles, Nancy Flores, Los Angeles;  Greines, Martin, Stein & Richland, Robert A. Olson and Laura Boudreau, Beverly Hills, for Empire Physicians Medical Group as Amicus Curiae on behalf of Defendants and Respondents.