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Keywords

contractnegligenceregulationcommon law
negligenceappealregulationcommon lawrespondent

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Morrison v. Health Plan of Nev., 130 Nev. 517, 328 P.3d 1165, Med & Med GD (CCH) P 305,003, 130 Nev. Adv. Op. 55

Facts

Louis Morrison, a Medicare beneficiary, alleged that Health Plan of Nevada (HPN) failed to properly investigate a contracted medical provider, leading to his infection with hepatitis C. Morrison claimed that HPN was negligent in directing him to seek treatment at the Endoscopy Center of Southern Nevada, which he argued engaged in unsafe medical practices. The district court dismissed Morrison's complaint, ruling that his claims were preempted by the federal Medicare Act.

Morrison's second amended complaint alleged that HPN breached its duty to “use reasonable care to select its health care providers” and “to inquire into the medical practices at the clinic” and was negligent in directing him to seek treatment at the Clinic.

Issue

Whether a Medicare beneficiary's state common law negligence claim against his private health insurance company is preempted by the federal Medicare Act.

To resolve this appeal, we must determine whether state common law negligence claims against Medicare plan providers are preempted by the federal Medicare Act.

Rule

The Medicare Act contains an express preemption clause stating that the standards established under this part shall supersede any State law or regulation with respect to MA plans offered by MA organizations, except for state licensing laws or state laws relating to plan solvency.

The Medicare Act contains an express preemption clause which states that 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 plans which are offered by MA organizations under this part.

Analysis

The court determined that Morrison's state common law negligence claims were preempted by the Medicare Act because the Act establishes federal standards that regulate the conduct of MA organizations in their relationships with contracted providers. The court noted that allowing state law claims could impose additional requirements on the quality assurance regime regulated by the Centers for Medicare and Medicaid Services (CMS), which would conflict with the federal standards.

Thus, we conclude that even if the Medicare preemption provision applied only when express Medicare provisions exist, Morrison's state common law negligence claims would still be preempted.

Conclusion

The court affirmed the district court's order dismissing Morrison's state common law negligence action, concluding that his claims were expressly preempted by the Medicare Act.

Accordingly, for the reasons set forth in this opinion, we affirm the district court's order dismissing Morrison's state common law negligence action.

Who won?

Health Plan of Nevada, Inc. prevailed in the case because the court found that Morrison's claims were preempted by the federal Medicare Act, which establishes comprehensive standards for MA organizations.

Respondents Health Plan of Nevada, Inc.; Sierra Health Services, Inc.; Sierra Health and Life Insurance Company, Inc.; Sierra Health–Care Options, Inc.; United Healthcare Insurance Company; and United Healthcare Services, Inc. (collectively, HPN) are health insurance businesses that specialize in health maintenance and/or managed care.

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