CHA News

CHA Successfully Encourages Supreme Court Review of Decision on Liability for ED Reimbursement Claims

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On Aug. 9, the California Supreme Court agreed to review the Court of Appeal’s published decision in County of Santa Clara v. Superior Court after CHA submitted a “friend of the court” letter brief encouraging the Supreme Court to review (and hopefully overturn) this decision.   

The challenged decision arose out of a lawsuit by two hospitals that had provided emergency medical services to members of Santa Clara County’s health plan. When the plan reimbursed the hospitals less than 20% of the amount of the hospitals’ claims, the hospitals sued the plan for the reasonable value of the emergency medical services they had provided.  

The county challenged the lawsuit on the ground, among others, that it was immune from liability under the Government Claims Act (Gov. Code §810 et seq.) While the trial court rejected the plan’s arguments, the Court of Appeal reversed the trial court’s decision, holding that because the hospitals’ action was tortious rather contractual in nature, the county plan was immune from liability under the Government Claims Act. The hospitals then petitioned the Supreme Court to review this decision. 

In its letter brief supporting the hospitals’ petition, CHA argued that the Court of Appeal’s decision misinterprets the Knox-Keene Act and, moreover, will undermine the delivery and availability of emergency medical services by allowing publicly owned commercial health plans to unilaterally decide to underpay for those services by exempting them from enforcement lawsuits by hospitals and other providers.    

In granting review, the Supreme Court specified that the issue to be briefed and argued is limited to the following: Is Santa Clara County immune under the Government Claims Act (Gov. Code, § 810 et seq.) from an action seeking reimbursement for emergency medical care provided to persons covered by the county’s health care service plan?  

CHA plans to submit an amicus brief in support of the hospitals’ position that county health plans have no such immunity and thus are subject to lawsuits by providers when plans underpay them.