American Journal of Law & Medicine

Medicaid & Medicare: California Medicare HMO patients may seek damages in state court for injuries resulting from denial of benefits.

Medicaid & Medicare: California Medicare HMO Patients May Seek Damages in State Court for Injuries Resulting from Denial of Benefits--McCall v. PacifiCare of California(1)--A California Court of Appeals held that: (1) a Medicare patient could sue his heath maintenance organization (HMO) in state court for damages resulting from that provider's denial of critical treatment; and (2) a physician provider group can be vicariously liable for the negligence of one of its physician members.(2)

Appellant George McCall suffered from progressive lung disease and was a patient of Pacificare, a Medicare HMO provider. Pacificare contracted with Greater Newport Physicians, Inc. (GNP), a physician group provider, which in turn employed Lakshmi Shukla, McCall's primary care physician. …

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