Ralph Yeomans v. California Physicians Service

I. BACKGROUND

According to the complaint, Plaintiff is a 96-year-old World War II veteran. (Compl. 6, ECF No. 1-2.) He is “visually impaired, physically disabled, homebound, and struggles to move around his house.” (/d. 47.) Blue Shield is a Medicare Advantage Organization (“MAO”), meaning it contracts with the Centers for Medicare and Medicaid Services (“CMS”) to “provide Medicare benefits to Unqualified references to Defendant in this Order pertain to the movant and not codefendant Allied Pacific of California IPA (“Allied Pacific”). Page 1 of 11 CIVIL MINUTES — GENERAL Initials of Deputy Clerk SMO

persons enrolled in Blue Shield’s” Medicare Advantage health plans. (Notice of Removal ¶¶ 2, 4, 5.) Medicare Advantage is also known as “Part C” coverage. (Id. ¶ 12.) Coverage under Blue Shield’s Medicare Advantage plans, including for home health agency care, is determined through CMS regulations, national and local coverage determinations, and guidelines included in Medicare manuals and instructions. (Id. ¶¶ 14, 16.) CMS pays Blue Shield a fixed amount each month for each plan enrollee. (Id. ¶ 5.)

Plaintiff receives…