Supreme Court of the United States · Official docket →
Atlanta Medical Center, Inc., fka Tenet Healthsystem GB, Inc., et al. v. Care Improvement Plus South Central Insurance Company
Paid petition · United States Court of Appeals for the Eleventh Circuit, No. 16-11176 · judgment August 18, 2017
Before the decision, modestly above the 4.1% base rate. The model weighted this up for a circuit split argued in the petition, a dissent in the court below (flagged in the petition), and an Eleventh Circuit decision below, and down for a business respondent.
Question presented
Medicare Advantage provides Medicare benefits through private insurers known as Medicare Advantage Organizations. Under the relevant regulations, enrollees have a right to “organization determinations” whenever they believe they are entitled to benefits under their Medicare Advantage plans. A multi-step administrative appellate process follows, culminating in judicial review. The Department of Health and Human Services, whose regulations govern the Medicare appeals process, has twice explained in amicus briefs that healthcare providers need not exhaust this Medicare appeals process before suing a Medicare Advantage organization over a refusal to pay the provider when the enrollee no longer has any interest in the outcome. The question presented is as follows: Whether healthcare providers must exhaust the Medicare appeals process before challenging a Medicare Advantage Organization’s refusal to pay for medical care when the enrollee no longer has any interest in the outcome.
Counsel of record
For petitioner
Jonathan Lentine Williams
Jonathan L. Williams, P.A.
For respondent
Charles D. Austin
Crowell & Moring LLP
Proceedings
- Oct 01 2018Petition DENIED.
- Jul 11 2018DISTRIBUTED for Conference of 9/24/2018.
- Jul 10 2018Reply of petitioners Atlanta Medical Center, Inc., et al. filed.
- Jun 22 2018Brief of respondent Care Improvement Plus South Central Insurance Co. in opposition filed.
- May 07 2018Motion to extend the time to file a response is granted and the time is extended to and including June 22, 2018.
- May 03 2018Motion to extend the time to file a response from May 24, 2018 to June 22, 2018, submitted to The Clerk.
- Apr 24 2018Response Requested. (Due May 24, 2018)
- Apr 11 2018DISTRIBUTED for Conference of 4/27/2018.
- Mar 29 2018Waiver of right of respondent Care Improvement Plus South Central Insurance Co. to respond filed.
- Mar 09 2018Petition for a writ of certiorari filed. (Response due April 12, 2018)
- Jan 19 2018Application (17A755) granted by Justice Thomas extending the time to file until March 9, 2018.
- Jan 12 2018Application (17A755) to extend the time to file a petition for a writ of certiorari from January 24, 2018 to March 9, 2018, submitted to Justice Thomas.