This California Supreme Court case concerns a Medicare Advantage (MA) enrollee who died after being discharged from a skilled nursing facility. The enrollee’s son, Larry Quishenberry, sued the MA health maintenance organization (HMO) plan and a healthcare services administrator that managed his father’s MA benefits. Quishenberry pled state-law claims for negligence, wrongful death, and elder abuse based on allegations that the HMO and healthcare services administrator breached a duty to ensure his father received skilled nursing benefits to which he was entitled under his MA plan.
The HMO and healthcare services administrator asserted that Quishenberry’s claims are expressly preempted by Medicare Part C’s preemption provision, which provides that the “standards established under” Part C “shall supersede any State law or regulation” concerning MA plans. (42 U.S.C. § 1395w26(b)(3)).
In affirming the Court of Appeal, The Court held that as Quishenberry’s state-law claims are based on allegations that his father’s HMO plan and healthcare services administrator breached state-law duties that incorporate and duplicate standards established under Part C, Quishenberry’s claims are thus expressly preempted by Medicare Part C.