The changing world of HMO liability under ERISA

Journal of Legal Medicine

Volumn 22, Issue 1, 2001, Pages 77-106

  McAuliffe, Billee Elliott ^a  

^a SOUTHERN ILLINOIS UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; LAW; MANAGED CARE; PENSION;

EMPLOYEE RETIREMENT INCOME SECURITY ACT; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; INSURANCE BENEFITS; LIABILITY, LEGAL; MALPRACTICE; PATIENT ADVOCACY; UNITED STATES;

EID: 0035050759     PISSN: 01947648     EISSN: None     Source Type: Journal    
DOI: 10.1080/019476401750171151     Document Type: Article

References (282)

1. 1 120 S. Ct. 2143 (2000).
2. 2 Judith Nemes, Jury Is Still Out on HMO Liability: More Lawsuits Against Insurers Might Raise Costs, 23 CRAIN'S CHI. BUS. 33, at SR14 (2000), available at 2000 WL 8129348; Mark A. Hofmann, HMO Cost Control Rewards Upheld, 34 BUS. INS. 25, at 1 (2000), available at 2000 WL 8171299.
3. 2 Judith Nemes, Jury Is Still Out on HMO Liability: More Lawsuits Against Insurers Might Raise Costs, 23 CRAIN'S CHI. BUS. 33, at SR14 (2000), available at 2000 WL 8129348; Mark A. Hofmann, HMO Cost Control Rewards Upheld, 34 BUS. INS. 25, at 1 (2000), available at 2000 WL 8171299.
4. 3 Managed care is a system of health care management. There are a number of different forms of managed care systems. As a group, the systems are called integrated delivery systems. The health care industry is continuing to undergo epic consolidation and reorganization. The driving force of these extraordinary market changes has been to manage health care or "managed care." Managed care seeks to drive down the escalatory cost of care and increase access to care, while maintaining and improving the quality of care through the development of numerous types of health care delivery systems which incorporate a variety of cost efficiencies, all with the goal of an integrated comprehensive system. These health care systems combine the financing of services with the delivery of care into one enterprise. The application of managed care systems has not only driven the commercial market, but has crossed over to government regulated health care, resulting in Medicare risk contracting and Medicaid managed care through Federally Qualified Health Maintenance Organizations, health maintenance organizations ("HMOs") and other prepaid health plans. Because the concept of managed care is so broad, it is important to establish a base of understanding upon which an examination of the relevant regulations and attendant risks can be understood. Embodied within managed care are a variety of integrated health care delivery systems which attempt to be responsive to today's economic realities. An integrated delivery system ("IDS") is a vehicle in which an enumerated list of health care services are provided to enrollees while implementing cost and quality control mechanisms designed to create efficiencies. IDSs are formed for a variety of reasons: (1) to create a contracting force in the marketplace; (2) to increase market leverage and access for both the provider and IDS; (3) to maintain a level of autonomy and control where the IDS is provider owned; (4) to boost profit margins by controlling access and cost; and (5) to apportion or otherwise control risks associated with the delivery of health care. The overall purpose of any IDS is to provide high quality, medically necessary health care services in a cost efficient manner. This is the essence of managed care .... Examples of the more common IDSs are HMOs, Preferred Provider Organizations ("PPOs"), Exclusive Provider Organizations ("EPOs"), Point of Service Plans ("POS"), Physician Hospital Organizations ("PHOs"), Individual or Independent Practice Associations ("IPAs") and Management Organizations ("MSOs"). Delilah Brummet Flaum & Diane J. Romza-Kutz. An Overview of Managed Care Organizations: Sorting Out the Alphabet Soup (visited Apr. 18, 2000) . This commentary deals only with HMOs (as representative of all managed care organizations) because they are the most common and the most discussed in the media today.
5. 4 29 U.S.C. §§ 1001-1461 (1994).
6. 5 Pegram. 120 S. Ct. at 2145.
7. 6 See Nemes, supra note 2.
8. 7 See Hofmann, supra note 2 (quoting Henry Saveth. an attorney with William M. Mercer, Inc. in New York).
9. 8 "Past" in this context means pre-1995, before the transitional case, Dukes v. U.S. Healthcare, 57 F.3d 350 (3d Cir. 1995).
10. 9 Thomas A. Moore & Matthew Gaier, HMO Liability - Part III: ERISA Preemption, 218 N.Y.L.J. 44, at 3 (1997).
11. 10 15 U.S.C. §§ 1011-1015.
12. 11 See 29 U.S.C. §§ 1001-1191 (c).
13. 12 Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 91 (1983).
14. 13 29 U.S.C. § 1001 (1994).
15. 14 See Moore & Gaier, supra note 9, at 3.
16. 15 Hansen v. Continental Ins. Co., 940 F.2d 971, 975-78 (5th Cir. 1991); Kanne v. Connecticut Gen. Life Ins. Co., 867 F.2d 489, 491-92 (9th Cir. 1988).
17. 16 Taggart Corp. v. Life & Health Benefits Admin., 617 F.2d 1208 (5th Cir. 1980).
18. 17 57 F.3d 350 (3rd Cir. 1995).
19. 18 Id. at 356.
20. 19 Id.
21. 20 Id.
22. 21 See Moore & Gaier, supra note 9, at 3.
23. 22 29 U.S.C. § 1144 (1994).
24. 23 Id. § 1144 (c).
25. 24 Id.
26. 25 Shaw v. Delta Air Lines, Inc., 463 U.S. 85 (1983).
27. 26 Id.
28. 27 Nealy v. U.S. Healthcare HMO, 844 F. Supp. 966 (S.D.N.Y. 1994).
29. 28 Id.
30. 29 Id. at 973.
31. 30 Id.
32. 31 28 U.S.C. § 1441 (1994).
33. 32 See Moore & Gaier, supra note 9, at 3.
34. 33 28 U.S.C. § 1441 (1994).
35. 34 Id.
36. 35 29 U.S.C. § 1132(a)(1)(A)-(B) (1994).
37. 36 Kearney v. U.S. Healthcare, Inc., 859 F. Supp. 182 (S.D.N.Y. 1994).
38. 37 481 U.S. 58 (1987).
39. 38 Dukes v. U.S. Healthcare, Inc., 57 F.3d 350, 354 (3rd Cir. 1995) (citing Metropolitan Life v. Taylor, 481 U.S. 58 (1987)).
40. 39 See generally Lister v. Stark, 890 F.2d 941,943-44 (7th Cir. 1989) (plaintiff's state law claim challenging the calculation of his time of "uninterrupted service" for the purposes of calculating his pension benefits held removable); Smith v. Dunham-Bush, Inc., 959 F.2d 6, 8-12 (2d Cir. 1992) (common-law claim for breach of an oral promise to pay pension-related benefits properly removed to federal court); Sofo v. Pan-American Life Ins. Co., 13 F.3d 239, 240-41 (7th Cir. 1994) (plaintiff's state court rescission claim against a group insurance policy for the policy's refusal to reimburse plaintiff for medical treatment received was properly removed because plaintiff's claim was for a denial of benefits); Anderson v. Electronic Data Sys. Corp., 11 F.3d 1311, 1314 (5th Cir. 1994) (removal was proper because state law claim alleging that plan fiduciary was demoted and terminated for refusing to violate ERISA fell within § 502(a)(2) & (3)).
41. 40 See Moore & Gaier, supra note 9, at 1.
42. 41 Metropolitan Life, 481 U.S. at 63-64.
43. 42 In re U.S, Healthcare, Inc., 193 F.3d 151, 160 (1999).
44. 43 29 U.S.C. § 1132(a).
45. 44 Metropolitan Life, 481 U.S. at 63-64.
46. 45 29 U.S.C. § 1132(a)(1)(B).
47. 46 Caterpillar, Inc. v. Williams, 482 U.S. 386, 398-99 (1987).
48. 47 Id.
49. 48 Rice v. Panchal, 65 F.3d 637, 639 (7th Cir. 1995).
50. 49 See infra section III, subsection A.
51. 50 Dukes, 57 F.3d at 355.
52. 51 29 U.S.C. § 1144(a). ERISA "shall supersede any and all State law insofar as they may now or hereafter relate to any employee benefit plan."
53. 52 U.S. Healthcare, 193 F.3d at 160.
54. 53 Bartholet v. Reishauer A.G., 953 F.2d 1073, 1075 (7th Cir. 1992).
55. 54 See infra section II, subsection A.
56. 55 Robert Pear, Judges Deplore Law that Shields HMOs, J. REC., July 15, 1998, available at 1998 WL 11953346.
57. 56 29 U.S.C. § 1144(a) (1994).
58. 57 Id. § 1144(b)(2)(A).
59. 58 Id. § 1144(b)(2)(B).
60. 59 Id. § 1144(b)(2)(A).
61. 60 471 U.S. 724 (1985).
62. 61 Id. at 758.
63. 62 Id. at 743.
64. 63 Id. at 743-44.
65. 64 29 U.S.C. § 1144(b)(2)(B).
66. 65 Id.
67. 66 SEC v. National Sec., Inc., 393 U.S. 453, 459-60 (1969).
68. 67 Group Life & Health Ins. Co. v. Royal Drug Co., Inc., 440 U.S. 205, 212-14 (1979).
69. 68 Id. at 217.
70. 69 Union Labor Life Ins. Co v. Pierno, 458 U.S. 119 (1982).
71. 70 See generally Sylvia A. Law & Barry Ensminger, Negotiating Physicians' Fees: Individual Patients or Society?, 61 N.Y.U.L. REV. 1, 80-81 (1986).
72. 71 BARRY FURROW ET AL., HEALTH LAW: CASES, MATERIALS AND PROBLEMS 781 (3d ed. 1997).
73. 72 Laura Meckler, Aetna Video Called "Smoking Gun" by Right-to-Sue HMO Advocates, 219 LEGAL INTELL. 4 (1998).
74. 73 FURROW ET AL., supra note 71.
75. 74 William Sage, "Health Law 2000": The Legal System and the Changing Health Care Market, 15 HEALTH AFF. 9 (Fall 1996).
76. 75 29 U.S.C. § 1132.
77. 76 Id. § 1132(a)(1)(B).
78. 77 Id. § 1132(a)(3).
79. 78 Pear, supra note 55.
80. 79 How the inclusion of health care plans was a last minute adjustment is discussed herein at section II, subsection B.
81. 80 946 F.2d 401 (5th Cir. 1991).
82. 81 Id. at 405.
83. 82 Id.
84. 83 Id.
85. 84 29 U.S.C. § 1133(1).
86. 85 Id. § 1133(1).
87. 86 Id. § 1133(2).
88. 87 Id. § 1109.
89. 88 Id. § 1002(21).
90. 89 Id. § 1104(a)(1).
91. 90 Id. § 1132(a).
92. 91 Id. § 1132(g).
93. 92 Id. § 1132(l).
94. 93 Id. § 1132(e).
95. 94 Id. § 1132(g)(1).
96. 95 The discussion below regarding the statutory history of ERISA, at section II, subsection B, considers the method behind this formulation and how Congress probably did not envision the "related to" preemption clause to be so broad. If the vision of the Act was narrower, then these restrictions on recovery seem more reasonable.
97. 96 FURROW ET AL., supra note 71, at 816.
98. 97 Id.
99. 98 Id.
100. 99 Id.
101. 100 Id.
102. 101 Id.
103. 102 Id.
104. 103 Carol Marie Cropper, Congressional Eye upon Texas as They Ponder Patients' Rights, J. REC., Sept. 16, 1998 (no page numbers).
105. 104 Id.
106. 105 Id.
107. 106 Id.
108. 107 Id.
109. 108 Id. This case is considered to be the impetus for Texas State Senator David Sibley to push through the Texas statute that allows malpractice suits against HMOs and other insurers. TEX. CIV. PRAC. & REM. CODE ANN. § 88.002 (West 1999).
110. 109 Arizona, California, Connecticut, Florida, Maryland, Missouri, New Jersey, New York, Rhode Island, Tennessee, Virginia, and Illinois are examples of states that have debated and/or enacted Patients Bill of Rights statutes.
111. 110 HMO Liability in the Post-Pegram World: Temporary Relief, Not Total Relaxation, MANAGED CARE WEEK, June 26, 2000, at 1, available at 2000 WL 10659624.
112. 111 H.R. CONF. REP. No. 93-1280 (1973), reprinted in 1974 U.S.C.C.A.N. 4639-5166.
113. 112 H.R. CONF. REP. No. 93-1280 (1974), reprinted in 1974 U.S.C.C.A.N. 5038-165.
114. 113 Laura Harshbarger, ERISA Preemption Meets the Age of Managed Care: Toward a Comprehensive Social Policy, 47 SYR. L. REV. 191, 218 (1996-97).
115. 114 Id.
116. 115 S. REP. No. 93-127 (1973), reprinted in 1974 U.S.C.C.A.N. 4838-88.
117. 116 H.R. REP. No. 93-533 (1973), reprinted in 1974 U.S.C.C.A.N. 4639-70 (Education & Labor Committee); H.R. REP. No. 93-807 (1974), reprinted in 1974 U.S.C.C.A.N. 4670-837 (Ways & Means Committee); S. REP. No. 93-127 (1973), reprinted in 1974 U.S.C.C.A.N. 4838-89 (Labor & Public Welfare Committee); S.REP. No. 93-383 (1973), reprinted in 1974 U.S.C.C.A.N. 4890-5037 (Finance Committee); H.R. CONF. REP. No. 93-1280 (1973), reprinted in 1974 U.S.C.C.A.N. 5038-166.
118. 117 S. Rep. No. 93-127 (1973), reprinted in 1974 U.S.C.C.A.N. at 4839.
119. 118 Id. at 4871.
120. 119 Id.
121. 120 Id.
122. 121 David L. Truman, HMO Liability: Narrowing the ERISA Preemption, 222 N.Y.L.J. 1 (1999).
123. 122 Id.
124. 123 844 F. Supp. 906 (S.D.N.Y. 1994).
125. 124 Id. at 970-75.
126. 125 Id.
127. 126 Id. at 972.
128. 127 See, e.g., Pomeroy v. Johns Hopkins Med. Serv., Inc., 868 F. Supp. 110 (D. Md. 1994) (state law-based claims of medical malpractice, direct and vicarious negligence, and intentional infliction of emotional distress were all held to be preempted by ERISA); Smith v. Dunham-Bush, Inc., 959 F.2d 6 (2d Cir. 1992) (employee's common-law claims of breach of oral promise and negligent misrepresentation were preempted by ERISA); Sandler v. New York News, Inc., 721 F. Supp. 506 (S.D.N.Y. 1989) (breach of contract claim preempted by ERISA, but negligent representation not preempted by ERISA because plaintiff was an employee suing his employer and resolution of the claim would have had no direct effect on administration of benefits under the plan); Fortune v. Medical Ass'n of Woodhull, P.C., 803 F. Supp. 636 (E.D.N.Y. 1992) (ERISA-preempted claim of breach of contract, negligent or reckless disregard of defendant's obligations to plaintiff, and intentional misrepresentation preempted by ERISA).
129. 128 Nealy, 844 F. Supp. at 966.
130. 129 Silva v. Kaiser Permanente, 59 F. Supp. 2d 597 (N.D. Tex. 1999).
131. 130 Danca v. Private Health Care Sys., Inc., 185 F.3d 1 (1st Cir. 1999).
132. 131 Corcoran v. United Healthcare, Inc., 965 F.2d 1321 (5th Cir. 1992); Kuhl v. Lincoln Nat'l Health Plan of Kansas City, Inc., 999 F.2d 298 (8th Cir. 1993); Turner v. Fallon Comm. Health Plan, Inc., 127 F.3d 196 (1st Cir. 1997).
133. 132 28 F.3d 269 (2d Cir. 1994). This technique is used and expanded in the later cases as a way of getting around ERISA and to protect patients injured because of HMO decisions.
134. 133 Id. at 270-71.
135. 134 Id. at 271.
136. 135 Id.
137. 136 Id.
138. 137 Id.
139. 138 Id.
140. 139 Id. at 274.
141. 140 Id. at 272.
142. 141 Id. (quoting Taylor v. Anderson, 234 U.S. 74, 75-76 (1914)).
143. 142 481 U.S. 58 (1987).
144. 143 Lupo, 28 F.3d at 272.
145. 144 Id. at 272-74.
146. 145 Id. at 274.
147. 146 For cases holding ERISA preempts medical malpractice claims against HMOs based on vicarious liability, see Pomeroy, 868 F. Supp. at 110; Visconti v. U.S. Health Care, 857 F. Supp. 1097 (E.D. Pa. 1994); Dukes v. U.S. Health Care Sys. of Pa., Inc., 848 F. Supp. 39 (E.D. Pa. 1994). For cases holding ERISA does not preempt medical malpractice claims against the HMO based on a vicarious liability or ostensible agency theory, see Haas v. Group Health Plan, Inc., 875 F. Supp. 544 (S.D. Ill. 1994); Dearmas v. Av-Med, Inc., 865 F. Supp. 816 (S.D. Fla. 1994); Kearney v. U.S. Healthcare, Inc., 859 F. Supp. 182 (E.D. Pa. 1994); Burke v. SmithKline Bio-Science Labs., 858 F. Supp. 1181 (M.D. Fla. 1994).
148. 147 Pacificare of Okla., Inc. v. Burrage, 59 F.3d 151 (10th Cir. 1995).
149. 148 957 F.2d 1555 (10th Cir. 1992).
150. 149 59 F.3d at 154 (quoting National Elevator Indus., Inc. v. Calhoon, 957 F.2d 1355 (10th Cir. 1992)).
151. 150 Id. at 154.
152. 151 Id. (quoting Airparts Co., 28 F.3d at 1065 (citing National Elevator, 957 F.2d at 1559)).
153. 152 Id. at 154-55.
154. 153 Id. at 155.
155. 154 57 F.3d 350 (3d Cir. 1995).
156. 155 Case 1: The Dukes case involved the wife of a man who was having trouble with his ears and received surgery. At that time, blood was drawn and was sent for testing. The medical center where the blood was sent for testing refused to test it. The next day, Mr. Dukes sought treatment from another physician, who again drew blood. This time it was tested. Nevertheless, Mr. Dukes' condition worsened and he died. His blood sugar was extremely high at the time of his death. Allegedly, if the testing had been done originally, then the condition could have been treated. Case 2: The Visconti case is brought by the parents of Serena Visconti who was stillborn. While in her third trimester, Mrs. Visconti developed symptoms of preeclampsia and her physician ignored her symptoms. As a result, the Viscontis claimed that the child was stillborn. Visconti, 57 F.3d at 355-57.
157. 156 Id. at 350.
158. 157 Id. at 355-57.
159. 158 Id.
160. 159 Id.
161. 160 Id.
162. 161 Id. at 356-57.
163. 162 Id. at 357.
164. 163 Id.
165. 164 65 F.3d 637 (7th Cir. 1995).
166. 165 Id. at 638-39.
167. 166 Id. at 640-41.
168. 167 Id. at 641.
169. 168 Id.
170. 169 481 U.S. 58 (1987).
171. 170 Rice, 65 F.3d at 641.
172. 171 Id.
173. 172 Id. at 642.
174. 173 Id.
175. 174 Id.
176. 175 29 U.S.C. § 185(a) (1994). This is the specific section of the LMRA that was used.
177. 176 Metropolitan Life, 481 U.S. at 64-66.
178. 177 Rice, 65 F.3d at 644-45.
179. 178 Id. at 644.
180. 179 Id. at 644-45 (citing Lingle v. Norge Div. of Magic Chef, Inc., 486 U.S. 399, 407 (1988)).
181. 180 463 U.S. 1 (1983).
182. 181 Rice, 65 F.3d at 646.
183. 182 Id. at 646 (citing Caterpillar v. Williams, 482 U.S. 386, 399 (1987)).
184. 183 Id.
185. 184 29 U.S.C. § 1001 (1994).
186. 185 193 F.3d 151 (3rd Cir. 1999).
187. 186 Id. at 164-65.
188. 187 Id. at 155.
189. 188 Id.
190. 189 Id. at 156.
191. 190 Id.
192. 191 Id.
193. 192 Id.
194. 193 Strep is the common name for streptococcal infections. Streptococcal infections are caused by gram-positive bacteria called streptococci....Group B streptococci most commonly cause dangerous infections in newborns (neonatal sepsis) and infections in the joints (septic arthritis) and heart (endocarditis)....Infections with certain types of streptococci can cause an autoimmune reaction in which the body attacks its own tissues. Such reactions may occur after an infection such as strep throat and may lead to rheumatic fever, chorea, and kidney damage (glomerulonephritis). MERCK RESEARCH LABORATORIES, THE MERCK MANUAL OF MEDICAL INFORMATION 875 (Home ed. 1997) (emphasis in original).
195. 194 Id. Meningitis is "an inflammation of the lining covering the brain and spinal cord [that] is usually caused by a bacterial or viral infection." Id. at 372.
196. 195 In re U.S. Healthcare, 193 F.3d at 156.
197. 196 Id. at 165.
198. 197 Id. at 162-64.
199. 198 Count 1 alleged that U.S. Healthcare policy encouraged, pressured, and/or directly or indirectly required 24-hour precertified discharge of mothers and their newborn children. Count 2 alleged that the newborn child Michelina did not receive timely diagnosis and treatment for the infection that caused her death. Count 5 alleged that U.S. Healthcare adopted utilization policies that discouraged physicians from readmitting newborn infants to the hospital when problems arose after discharge. Id.
200. 199 Id. at 162.
201. 200 Id. at 163 (emphasis added).
202. 201 Id.
203. 202 Id. at 162-64.
204. 203 Id. at 165.
205. 204 93 F. Supp. 2d 585 (E.D. Pa. 2000).
206. 205 Id. at 586. "Emphysema is an enlargement of the tiny air sacs of the lungs (alveoli) and the destruction of their walls." MERCK MANUAL, supra note 193, at 177.
207. 206 Alpha 1-Antitrypsin Deficiency is a hereditary decificency in alpha 1-antitrypsin and causes lung and liver disease. Alpha 1-antitrypsin, an enzyme produced by the liver, is present in saliva, duodenal fluid, lung secretions, tears, nasal secretions, and cerebrospinal fluid. This enzyme inhibits the action of other enzymes that break down proteins. A lack of alpha 1-antitrypsin allows the other enzymes to damage tissue in the lungs. The deficiency in blood represents a failure of the liver to secrete the enzyme. Its retention inside liver cells may cause damage, fibrosis (scarring), and cirrhosis. MERCK MANUAL, supra note 193, at 570.
208. 207 Tiemann, 93 F. Supp. 2d at 587.
209. 208 Id. at 588.
210. 209 Id.
211. 210 Id.
212. 211 Id. at 591.
213. 212 Id. (emphasis in original).
214. 213 Id.
215. 214 514 U.S. 645 (1995).
216. 215 724 A.2d 889 (Pa. 1998).
217. 216 Tiemann, 93 F. Supp. 2d at 594.
218. 217 Id.
219. 218 120 S. Ct. 2143 (2000).
220. 219 Id. at 2154.
221. 220 Id. at 2147.
222. 221 An ultrasound is a diagnostic tool. "Sound waves of a frequency higher than the range audible to the human ear...are propagated at a speed determined by the physical properties of the medium through which they travel [and are] used in medicine for diagnostic purposes." ATTORNEY'S ILLUSTRATED MEDICAL DICTIONARY U2 (West 1997).
223. 222 Pegram, 120 S. Ct. at 2147.
224. 223 Id. Peritonitis is inflammation usually caused by an infection of the lining of the abdominal cavity (peritoneum). The peritoneum is a thin, clear membrane that normally covers all abdominal organs and the inside walls of the abdomen. Peritonitis is usually caused by an infection spreading from an infected organ in the abdomen. Common sources are perforations of the stomach, intestine, gallbladder, or appendix. The peritoneum is remarkably resistant to infection. Unless contamination continues, peritonitis doesn't develop, and the peritoneum tends to heal with treatment. MERCK MANUAL, supra note 193, at 548.
225. 224 Pegram, 120 S. Ct. at 2147.
226. 225 Id.
227. 226 Id.
228. 227 Id.
229. 228 Id. at 2148.
230. 229 Id.
231. 230 Id. at 2147.
232. 231 Id. at 2154.
233. 232 Id.
234. 233 Id.
235. 234 Id. at 2150 (citing 29 U.S.C. § 1002(21)(A)(i)-(iii) (1994)).
236. 235 Id. at 2151-52.
237. 236 Id. at 2154.
238. 137 Id. at 2154-55.
239. 238 Id. at 2152.
240. 239 Id.
241. 240 Id. at 2155.
242. 241 Id. at 2148.
243. 242 Id. at 2149.
244. 243 Id.
245. 244 Id. at 2150.
246. 245 Id.
247. 246 Id. at 2156.
248. 247 Id.
249. 243 Id.
250. 249 221 F.3d 472 (3d Cir. 2000).
251. 250 Id. at 488.
252. 251 Id. at 499.
253. 252 Id.
254. 253 Pegram, 120 S. Ct. at 2157.
255. 254 High Court Decision on HMO Suits put Focus on Congress, States, 8 INSIDE HEALTH CARE REFORM 3, available at 2000 WL 11695453.
256. 255 See, e.g., 29 U.S.C. §§ 1002, 1058, 1081, 1103.
257. 256 Pegram, 120 S. Ct. at 2151.
258. 257 Id.
259. 258 Id.
260. 259 See generally Cigna Healthplan of La., Inc. v. Louisiana, 82 F.3d 642, 646-47 (5th Cir. 1996).
261. 260 See, e.g., Lupo, 28 F.3d at 269; Pacificare, 59 F.3d at 151.
262. 262 Pegram, 120 S. Ct. at 2158.
263. 263 Craig Winslow, Things May Not Be as They Appear, 47 FED. LAW 4, 4 (Aug. 2000).
264. 264 Pegram, 120 S. Ct. at 2158.
265. 265 Id.
266. 266 Stephanie Levy, Treatment Decisions Made by HMO Physician-Owners Are Not Fiduciary Acts Under ERISA, 36 TRIAL 81 (Aug. 2000), available at 2000 WL 15000435; Jill Weschler & John Jesitus, Supreme Court Tosses HMO Reform Ball to Congress, 10 MANAGED HEALTHCARE 14 (2000), available at 2000 WL 16435666.
267. 266 Stephanie Levy, Treatment Decisions Made by HMO Physician-Owners Are Not Fiduciary Acts Under ERISA, 36 TRIAL 81 (Aug. 2000), available at 2000 WL 15000435; Jill Weschler & John Jesitus, Supreme Court Tosses HMO Reform Ball to Congress, 10 MANAGED HEALTHCARE 14 (2000), available at 2000 WL 16435666.
268. 267 See Nemes, supra note 2; Hofmann, supra note 2.
269. 268 See Winslow, supra note 263, at 4.
270. 269 Id.
271. 270 Nemes, supra note 2; Hofmann, supra note 2; Joan Rose, US Supreme Court "Sees No Evil" in Incentives to Ration Care, 77 MED. ECON. 2829 (2000).
272. 271 Tracey Walker, New Round of Protections Predicted for Managed Care, 10 MANAGED HEALTHCARE 12 (2000), available at 2000 WL 16435680; Hofmann, supra note 2.
273. 272 See Winslow, supra note 263, at 4.
274. 273 Diana Bearden & Bryan Maedgen, Emerging Theories of Liability in the Managed Health Care Industry, 47 BAYLOR L. REV. 285, 288-356 (1995).
275. 274 Editorial, "Why We All Hate HMOs," 158 N.J.L.J. 390 (1999).
276. 275 Id.
277. 276 Id.
278. 277 Paul A. Pautler & Michael G. Vita, Hospital Market Structure, Hospital Competition, and Consumer Welfare: What Can the Evidence Tell Us?, 10 J. CONTEMP. HEALTH L. & POL'Y 117 (1994), reprinted in A HEALTH LAW READER: AN INTERDISCIPLINARY APPROACH 614 (John H. Robinson et al. eds. 1999).
279. 278 Thomas Bodenheimer, The HMO Backlash - Righteous or Reactionary?, 335 NEW ENG. J. MED. 1601 (1996).
280. 279 A HEALTH LAW READER, supra note 277, at 644.
281. 280 Karen Lee, Patients' Rights Dealt Double Blow, EMPLOYEE BENS. NEWS, July 1, 2000, available at 2000 WL 10182704.
282. 281 Id.