U.S., et al. v. Kaiser Found. Health Plan, Inc. (Summary)

FALSE CLAIMS ACT

U.S., et al. v. Kaiser Found. Health Plan, Inc., No. 12-cv-03896-WHO (N.D. Cal. Aug. 28, 2013)

An ambulance company claimed that Kaiser Health Plan’s refusal to pay an ambulance service for transporting Kaiser ESRD patients to and from dialysis treatments and instead required the ambulance company to seek reimbursement from Medi-Cal violated the False Claims Act.  The ambulance service also alleged that after its representative complained to Kaiser about this practice, Kaiser retaliated against the transport service by refusing to pay for services rendered and by excluding the ambulance company from bidding to provide future services.

The United States District Court for the Northern District of California granted in part and denied in part Kaiser’s motion to dismiss and motion to strike.  The district court dismissed the False Claims Act claim, holding that the medical transport services provider inadequately pled the FCA claim by failing to identify the law, rule or regulation the health plan undertook to comply with that “is implicated in submitting a claim for payment.”  The medical transport services provider also failed to identify what claims the health plan submitted that were “impliedly” false.  However, the ambulance company was given the opportunity to amend its complaint.

The court dismissed with prejudice the ambulance company’s state health and safety code claim finding that the law covers only patients and employees, whereas the provider is an entity, not “any other health care worker.”  Kaiser’s motion to dismiss the ambulance company’s unfair competition law claims was granted in part and denied in part and the court will also permit the ambulance company the opportunity to amend its state unfair competition law count.