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Healthcare Reimbursement: HMO Arbitration Clause Enforced

Published online by Cambridge University Press:  01 January 2021

Carly Kelly
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Extract

In Pacificare Health Systems, Inc. v. Jefrey Book, the US. Supreme Court ruled that the mandatory arbitration clause in an HMO contract should be enforced to compel a physician to arbitrate his RICO charges against the health plan, even though the clause could be construed to limit the arbitrator’s authority to award full damages under the RICO statute. The ruling could prevent physicians with health plan arbitration agreements from taking future reimbursement claims against insurance companies directly to court, even when the allegations involve a potential statutory breach outside of the explicit scope of the provider contract.

Dr. Book’s arbitration claim was part of a larger class action lawsuit filed in August of 2000 by a group of physicians and patients seeking reimbursement from eight managed care companies for unpaid health insurance claims.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 31 , Issue 4 , Winter 2003 , pp. 731 - 734
Copyright
Copyright © American Society of Law, Medicine and Ethics 2003

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References

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