Kaiser Found. Health Plan, Inc. v. Superior Court of L. A. Cnty.

*1129 INTRODUCTION

Prime Healthcare La Palma, LLC and affiliated hospitals (collectively, Prime) 1 sued Kaiser Foundation Health Plan, Inc. (Kaiser) 2 in superior court *1130 under California law, alleging that Kaiser failed to reimburse Prime for emergency medical services Prime provided to Kaiser members. A portion of Prime's claims relate to emergency medical services Prime provided to enrollees in a Medicare Advantage plan administered by Kaiser pursuant to Part C of the Medicare Act ( 42 U.S.C. § 1395w-21 et seq. ) (the Medicare Advantage claims).

After a rather convoluted multi-year path, the parties agreed to arbitration in lieu of the superior court litigation. After Prime filed an arbitration demand, Kaiser moved in the arbitration proceedings to dismiss Prime's Medicare Advantage claims on the ground that they are preempted by the Medicare Act and subject to that Act's requirement that claimants exhaust administrative remedies before resorting to litigation or arbitration. The arbitration panel denied Kaiser's motion and memorialized its ruling in what it labeled as a "Partial Final Award Re Medicare Advantage Claims" (the partial final award). Kaiser petitioned the…