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Claims That Senior Did Not Receive All Benefits
California Supreme Court Tosses Out State Law Claims
Landmark Opinion On Express Preemption
The California Supreme Court recently unanimously ruled that the Medicare Act expressly preempted state common-law and statutory claims against a health maintenance organization and a healthcare plan administrator for allegedly failing to provide a senior with the care to which he was entitled under his Medicare Advantage Plan. The case is Quishenberry v. UnitedHealthcare, Inc., No. S271501, 2023 WL 4511572 (Cal. July 13, 2023) (to be published).[1] In the underlying complaint in the case, plaintiff alleged that his elderly parent was enrolled in a Medicare Advantage plan offered by an HMO and administered by the HMO’s contract administrator. After receiving treatment under the plan, plaintiff’s parent passed away, leading the plaintiff to bring multiple state-law claims against the HMO and the administrator, including common-law claims for negligence and wrongful death and a statutory claim for Elder Abuse. Id. at *2. The core allegation was that the patient did not receive the care to which he was entitled under his Medicare Advantage plan. Id. at *7.
The California Supreme Court held in a seven-to-zero opinion that the Medicare Act expressly preempted all of the plaintiff’s claims. The Medicare Act includes a particularly strong preemption provision that preempts any state law affecting Medicare Act plans. Here it is verbatim:
The standards established under this part shall supersede any State law or regulation (other than State licensing laws or State laws relating to plan solvency) with respect to MA [Medicare Advantage] plans which are offered by MA organizations under this part.
Id. at *3 (citing 42 U.S.C. § 1395w-26(b)(3)). First, note that this part of the Medicare Act supersedes “any State law or regulation” with respect to Medicare Advantage plans, with only two specific carve outs.
Second, the Medicare Act’s preemption provision is not limited to claims under state statutes and regulations, excepting common-law claims. The statute says “any,” and it includes only two exceptions—“state licensing laws” and “state laws related to plan insolvency.” The statutory language does not support creating a new exception for common-law claims. Id. at *5. As the California Supreme Court held, “The Medicare Act contains no equivalent savings clause or any other affirmative indication that Congress intended to preserve common-law duties.” Id. at 6.
Third, the Act’s preemption provision is likewise not limited to state-law regulations that specifically refer to and target Medicare Advantage plans. Again, despite the plaintiff’s urging, the California Supreme Court did not find an exception for laws of general applicability. The provision preempts any state-law standard “with respect to” Medicare Advantage plans. Which means that the Act’s standards preempt “even those duties set out in generally applicable statutes, but only as they apply to” Medicare Advantage plans. Id. at *6.
The California Supreme Court concluded as follows:
In sum, contrary to [the plaintiff’s] contentions, Congress did not categorically carve out and save from preemption state-law claims based on duties that duplicate federal standards, common law actions, or statutes of general applicability. Instead, it intended the standards established under Part C to supersede any state-law duty with respect to MA plans, regardless of whether that duty is grounded in statutory or common law, and even when the state-law duty is not inconsistent with and instead is based on and duplicates standards established under Part C. Id.
From there it was a short step to hold that federal law preempted the plaintiff’s claims. Despite efforts to recast his claims, the plaintiff’s lawsuit alleged that his late parent did not receive all the treatment to which he was entitled under his Medicare Advantage plan. Those allegations invoked standards under the Medicare Act Part C, and therefore were preempted. Id. at *7-*8.
Contact Us
Ingrid M. Evans has years of experience in representing seniors and their families against abusers of any kind, including in-home caregivers. You can reach us at (415) 441-8669, or by email at info@evanslaw.com. Our toll-free number is 1-888-50EVANS (888-503-8267).
[1] Evans Law Firm, Inc. was not involved in the case in any way.
