Texas Supreme Court Rules that Hospitals May Pursue their Lawsuit Against a Medicare Advantage Organization without First Exhausting Medicare Administrative Remedies


In Christus Health Gulf Coast et al v. Aetna Inc. et al., No. 05-0710 (Tex. Sup. Ct. 8/31/07), the Texas Supreme Court addressed an issue involving a payment dispute over Medicare reimbursements to hospitals. More specifically, the issue was whether the Medicare Act requires healthcare providers, like hospitals, that do not have a contract with a managed-care insurer, like Aetna, to exhaust the Medicare administrative appeals process on coverage questions before suing to recover from the insurer.

Excerpted from Health Law Litigation, American Bar Association Section of Litigation, Vol. 7, Issue 2, Winter 2008. To read the full article, click here (member sign-in required).

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