Case Study in Nevada: The Allegedly Unsafe Medical Provider and ERISA Preemption

more+
less-

In Cervantes v. Health Plan of Nevada, 263 P.3d 261 (Nov. 2011), the plaintiff commenced an action against a managed care organization (MCO) alleging it violated Nevada's quality assurance laws and regulations when MCO allegedly referred her to a "blatantly unsafe medical provider" where she alleges she contracted hepatitis C. The plaintiff received health care benefits through her union's self-funded benefit plan governed by the Employee Retirement Income and Security Act of 1974, 29 U.S.C. §1001, et seq. (ERISA). The ERISA plan had retained the MCO to negotiate contracts for discounted fees with selected providers, who were then denominated as in-network providers.

The MCO moved for summary judgment, arguing that the plaintiff's claims were preempted by ERISA §514(a) because they have an impermissible connection with an ERISA plan; the district court granted the motion. The Supreme Court of Nevada affirmed, holding a claim predicated upon Nevada's quality assurance laws and regulations may be preempted if the MCO merely acts as an administrator or agent of the ERISA plan because Nevada's law would directly regulate the ERISA plan's benefit structure – i.e., ERISA plans would have a duty to monitor their service providers and, in turn, provide as a plan benefit a quality assurance program due to Nevada law. The court held that such a requirement clearly undermined Congress' objective of the uniform administration of ERISA benefits because administrative decisions would be subjected to individual state laws.

Please see full article below for more information.

LOADING PDF: If there are any problems, click here to download the file.

Written by:

Published In:

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Sedgwick LLP | Attorney Advertising

Don't miss a thing! Build a custom news brief:

Read fresh new writing on compliance, cybersecurity, Dodd-Frank, whistleblowers, social media, hiring & firing, patent reform, the NLRB, Obamacare, the SEC…

…or whatever matters the most to you. Follow authors, firms, and topics on JD Supra.

Create your news brief now - it's free and easy »

All the intelligence you need, in one easy email:

Great! Your first step to building an email digest of JD Supra authors and topics. Log in with LinkedIn so we can start sending your digest...

Sign up for your custom alerts now, using LinkedIn ›

* With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name.
×
Loading...
×
×