United Behavioral Health, a California Corporation and Its Subsidiary Pacificare Behavioral Health, Inc. v. Maricopa…

Summary

The court held that Medicare-related coverage disputes between Medicare Advantage organizations and contract providers are subject to the Medicare Act's mandatory administrative review process, which preempts otherwise applicable arbitration agreements. Because the providers' claims challenged whether continued inpatient treatment was medically necessary and covered, they were inextricably intertwined with claims for Medicare benefits, and the providers had administrative appeal rights. The court vacated the court of appeals' decision concerning ERISA-related claims and remanded for an arbitrability determination that assumes a viable claim without deciding standing or other defenses.