Texas Supreme Court Rules Against Medicare HMOs in Hospital Reimburse...(pInitially the trial court dismissed the...),Health

Date:8/31/2007

p>Initially, the trial court dismissed the lawsuit, finding that the dispute was governed exclusively by the federal Medicare Act. That ruling meant that the hospitals had no other remedy but to pursue their 6,000 individual claims through a lengthy federal administrative process. A Texas court of appeals affirmed the trial court decision.

However, the Texas Supreme Court found that "requiring Hospitals to exhaust administrative remedies before coverage decisions have been made would turn the administrative scheme on its head ... "

The Court reversed the court of appeals decision and remanded the case to the trial court to determine Aetna's contractual obligations to the hospitals.

The hospital systems are represented by Scott Clearman and Brian Walsh of McClanahan & Clearman, L.L.P., and David Warden and Eric Chenoweth of Yetter & Warden, L.L.P., in Houston.

For more information about this case, contact Scott Clearman of McClanahan & Clearman at 713-223-2005 or 713-304-9669 or Mike Androvett at 214-507-5456 or mike@legalpr.com.

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SOURCE McClanahan & Clearman Copyright©2007 PR Newswire. All rights reserved

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