Business Law Health Law Committee

The Department of Health Services (DHS) administers California’s Medi-Cal program and reimburses Medi-Cal hospital service providers for allowable costs. The Center for Medicare and Medicaid Services issues the Medicare Provider Reimbursement Manual, which governs what payments are owed. Read more

Section 1557 of the Patient Protection and Affordable Care Act (ACA) prohibits discrimination in the healthcare system by incorporating four nondiscrimination statutes—including the Rehabilitation Act, which prohibits certain types of disability discrimination. Andrea Schmitt, who has a severe hearing loss disability, filed a class action against Kaiser Foundation Health Plan, alleging that it unlawfully discriminated against her and other hearing-disabled plan members by excluding all hearing loss treatments except cochlear implants. Read more

Ben-E-Lect, a third party insurance claim administrator, developed a “wrapping” strategy for reducing employer health insurance costs by bundling low-premium, high-deductible health insurance with self-funded accounts to pay employee healthcare expenses within the annual deductible and any co-pay requirements. Ben-E-Lect sold its wrapping services through insurance brokers and agents to the small-employer market. Read more

After a surgical sponge was inadvertently left inside a patient, the State Department of Public Health fined Saint Francis Memorial Hospital for failing to develop and implement a sponge count procedure and a policy for properly training its staff. Saint Francis sought administrative review. Read more

Matthew Wicks went to Antelope Valley Hospital’s emergency room for stomach, chest, and neck pain. Hospital nurses and two independent contractor ER doctors evaluated him. He was then discharged with instructions to see a cardiologist the next day, but he died eight hours later from an acute aorta dissection. Read more

Ruth Goros sued Kindred Healthcare, which operated the nursing home where she lived, for failing to provide timely treatment after she suffered a stroke. Goros argued that Kindred’s negligence caused her “permanent and irreversible [and eventually fatal] brain damage.” Kindred moved for summary judgment as to causation, supporting its motion with a neurologist’s declaration that Kindred’s conduct was unrelated to Goros’s injuries. Read more

Agreeing with its sister circuits in a case of first impression, the Ninth Circuit Court of Appeals held that the terms of a contract alone cannot require a court to grant equitable relief where there is an adequate monetary remedy at law. Barranco v. 3D Systems Corporation, 2020 WL 1179728 (9th Cir. 3/12/20). Read more

Skyline Wesleyan Church filed suit against the California Department of Managed Health Care and its Director (collectively, the “DMHC”) after the DMHC issued letters to seven health insurers mandating that their insurance plans include coverage for legal abortions. Until the DMHC’s directive, Skyline had obtained DMHC-approved health insurance for its employees that restricted abortion coverage consistent with Skyline’s belief that abortion is impermissible except possibly when the life of a pregnant woman is at risk. Read more

Doctor Suzanne Yang sued a Tenet hospital and members of its medical staff for defamation based on alleged statements they made about her qualifications, competence, and medical ethics. The statements were made both to the public and the medical community. Defendants’ alleged statements denigrated Dr. Yang’s ethics and her standard of care; they also directed other physicians not to refer patients to her. Read more

Under Medicare, hospitals that serve a disproportionate number of low-income patients receive a reimbursement for the higher costs incurred in providing those services. See 42 U.S.C. § 1395ww(d)(5)(F)(vi). Whether a hospital receives a reimbursement—and, if so, how much—depends on the hospital’s “disproportionate patient percentage,” which captures the number of Medicare- and Medicaid-eligible patient days for which the hospital provides services. Read more