MEDICARE
Christus Health Gulf Coast v. Aetna, No. 14-03-01281-CV (Tex. Ct. App. Dec. 28, 2004)
The
Court of Appeals of Texas ruled that hospitals involved in a payment dispute
with an HMO were required to exhaust their administrative remedies under the
Medicare program prior to suing the HMO in state court. The HMO had entered
into a contract with another entity to administer its Medicare+Choice product.
When this entity became insolvent and failed to reimburse hospitals for services
provided, they sued the HMO. The court found that the hospitals' claims "arose under" the
Medicare Act, and that the hospitals were thus required to exhaust the administrative
procedures called for by the Act.