In a case of first impression in the U.S. District Court for the Eastern District of Pennsylvania, a judge has ruled that a Medicare patient is barred from suing Aetna U.S. Healthcare — her Medicare HMO provider — for malpractice and breach of contract until she has exhausted all levels of administrative review before the U.S. Department of Health and Human Services.
In his 12-page opinion in Wilson v. Chestnut Hill Healthcare, et al., Chief U.S. District Judge James T. Giles found that because all of the claims against Aetna “arise under” the Medicare Act, the plaintiff was required to bring her claims under the law’s enforcement provision before going to court.
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