Firm News

January 1, 2010

Tully and Oppenheim Author ACO Article for ABA

Bradley Tully and Charles Oppenheim recently authored Health Care Reform: For “Accountable Care Organizations” to Work, Fraud and Abuse Laws Must Evolve. The article appears in the December 2009 issue of the American Bar Association’s Health E-Source Publication. The article may be accessed via the following link: http://www.abanet.org/health/esource/Volume6/04/Tully.html.

January 1, 2010

HLB Attorneys Recognized for Outstanding Service

Hooper, Lundy & Bookman is proud to announce recognition for the following firm attorneys:

Linda Randlett Kollar has become a Fellow in the prestigious Litigation Counsel of America (LCA). LCA is a highly selective, invitation-only trial lawyer honorary society composed of less than one-half of one percent of American Lawyers. According to LCA, fellows are selected based upon effectiveness and accomplishment in litigation, both at the trial and appellate levels, and superior ethical reputation.
Patric Hooper has been named Los Angeles Health Care Lawyer of the Year by Los Angeles Times. His selection was made through a polling process conducted by Law & Politics
Patric Hooper, Robert Lundy, Lloyd Bookman and Bradley Tully have been named in the Best Healthcare Lawyers, Southern California by the Los Angeles Times. Attorneys are selected through a polling process conducted by Law & Politics.
Stephen Phillips has been named an Outstanding Health IT Attorney by Nightingale’s Healthcare News.

January 1, 2010

Keville Named Principal

Hooper, Lundy & Bookman is pleased to announce that Jordan B. Keville has been named a principal of the firm, effective January 1, 2010.

Mr. Keville received his B.A. from the University of California at Santa Barbara in 1998, graduating with highest academic honors. He received his J.D. from Loyola Law School in Los Angeles in 2001, being elected to the Order of the Coif upon graduation.

Mr. Keville worked as a summer clerk for Hooper, Lundy and Bookman in 2000. He returned to the firm upon his graduation from law school in 2001 to commence his legal career and has remained there since.

Mr. Keville is a regulatory principal with more than 8 years experience in advising health care clients on a wide range of regulatory and reimbursement issues. He specializes in complex litigation challenging Medicare and Medicaid reimbursement policies on behalf of providers. With respect to his work in this area, Mr. Keville offers an extensive knowledge of substantive Medicare coverage and payment policies, as well as expertise in administrative law and federal and state court jurisdiction. Mr. Keville’s litigation practice has included extensive appellate work before the California Courts of Appeal and the United States Court of Appeals for the Ninth Circuit. In addition, Mr. Keville also represents health care providers in smaller scale litigation matters, both in state and federal courts and before various administrative tribunals, including the Provider Reimbursement Review Board.

Mr. Keville additionally represents clients in other areas and has provided advice and assistance on a variety of subjects, including, among other things, the Federal False Claims Act, mental health services provided under the Medicare and Medicaid programs and the Clinical Laboratory Improvements Act (CLIA). Mr. Keville also has assisted clients with issues related to enrollment and certification in the Medicare and Medicaid programs.
Mr. Keville’s clients include hospitals, adult day health care centers, physicians and physicians groups, pharmacies, medical transportation companies and ancillary providers such as physical therapists and independent diagnostic testing facilities.

Mr. Keville has a distinguished record of successful outcomes, including numerous published opinions. For example, Mr. Keville was instrumental in obtaining favorable results in the following cases:

Independent Living Center of Southern California v. Maxwell-Jolly, 543 F.3d 644 (9th Cir. 2009) affirming, in part, trial court’s granting of a preliminary injunction to stop statutorily mandated ten percent reduction in Medicaid payment rates for several classes of services.

California Pharmacists Ass’n v. Maxwell-Jolly, 563 F.3d 847 (9th Cir. 2009) issuing an emergency stay of statutorily mandated rate reductions in Medicaid payment rates for hospital services after the trial court declined to enjoin those rate reduction

Mission Community Hosp. Med. Ctr. v. Shewry, 168 Cal. App.4th 460 (Cal. App. 2008) reversing trial court decision and invalidating a statutorily mandated freeze on Medi-Cal payment rates for inpatient services rendered by hospitals that do not have a contract with the California Department of Health Care Services

Sharp Healthcare, et al. v. Leavitt, No. 08-cv-0170, 2008 WL 962628 (S.D. Cal. 2008) enjoining implementation of a competitive bidding demonstration project for payment for clinical laboratory services under the Medicare program in an action brought by several clinical laboratories who otherwise would have been subject to the project.

Mr. Keville brings a wide variety of litigation and regulatory expertise to the firm. He is a talented advocate for health care providers of all types and the firm looks forward to his continued contributions to the health care law industry.

July 30, 2009

Hooper, Lundy & Bookman Challenges Blue Cross’ Payments for Hospital Non-Contracted Claims

(Los Angeles)—Health law firm Hooper, Lundy & Bookman, Inc. (HLB) today filed complaints in state and federal court charging that Blue Cross of California and Anthem Blue Cross Life & Health Insurance used faulty data and systems to calculate inadequate reimbursement rates to Methodist Hospital of Southern California for out-of-network emergency care, authorized post-stabilization care and other medical services provided to Blue Cross’ HMO, PPO, and Blue Card members, and to beneficiaries of self-insured plans. (Case # CV09-5612-JSC (U.S. District Court); BC418873 (Los Angeles Superior Court).

“Blue Cross has repeatedly underpaid Methodist Hospital for emergency and post-stabilization claims submitted after Methodist’s contract terminated in December 2007,” said Methodist Co-Counsel Daron Tooch. “We believe these underpayments are in great part the result of flawed internal data and payment systems Blue Cross uses to determine out-of-network reimbursement rates.”

Because of the low payment rates and onerous terms in proposed hospital contracts, hospitals are increasingly deciding that they cannot afford to renew their contracts with health plans. Hospitals are nevertheless required to provide emergency care to patients, regardless of the patients’ ability to pay. After patients’ emergency condition was stabilized, Blue Cross often chose not to transfer the patients to in-network facilities, yet paid Methodist Hospital’s claims as though the patients chose to have their care at a non-contracted facility.

“If Blue Cross wanted to pay lower contracted rates for health care services provided to its stabilized members, then it should have transferred them to in-network facilities for their post-stabilization care,” said Methodist Co-counsel Glenn Solomon. “Having voluntarily opted to have its members receive their post-stabilization care at Methodist Hospital, Blue Cross has an obligation to pay the bills rather than leaving that burden with its members.”

The California suit filed today charges Blue Cross with failure to adequately compensate Methodist Hospital for non-contracted emergency, post-stabilization, and continuity of care services, by using flawed data and/or improperly manipulating the data.

The federal complaint makes similar allegations with respect to Blue Card and self-insured plans, and includes charges that the defendants have violated ERISA and the Racketeer Influenced and Corrupt Organizations Act (RICO).

“Blue Cross’ failure to adequately reimburse California hospitals for vital services has resulted in great financial stress for California hospitals and the patients they serve,” said Mr. Tooch. “Blue Cross should not be permitted to manipulate reimbursement rates that result in inadequate payment to providers.”

About Hooper, Lundy & Bookman: Founded in 1987, Hooper, Lundy & Bookman is the largest full service law practice in the country dedicated solely to the representation of healthcare providers. With offices in Los Angeles, San Francisco and San Diego, and clients in 49 states, we meet the business, litigation and regulatory needs of a broad array of healthcare providers--ranging from the largest national healthcare organizations to community hospitals and individual physician practices.

Relevant Documents

Complaint #1
Complaint #2

July 27, 2009

Hooper, Lundy & Bookman Files Nationwide Class Action Against Ingenix: Challenges Database Used To Pay ASC Non-Contracted Claims

(Los Angeles)—On behalf of Ambulatory Surgery Centers (ASCs) across the country, Hooper, Lundy and Bookman, Inc. (HLB) today filed a national class action complaint, challenging UnitedHealth Group, Inc. and other health plans’ misuse of the Ingenix, Inc. database, to knowingly underpay ASCs by millions of dollars over the years (Case No. CV09-0547-GW (PLA)).

“For many years, United and other payors have systematically underpaid ASCs. We believe that the flawed data in the Ingenix database, and the payors’ improper manipulations of that data, are major causes of the unreasonably low amounts of reimbursement to ASCs,” said Plaintiff Co-counsel Daron Tooch.

ASCs are health care facilities that provide outpatient surgical procedures such as orthopedic, podiatry, endoscopy, ophthalmology and oral surgery. Insurers and health plans throughout the country use the Ingenix database to determine the usual and customary rate (UCR) to pay ASCs that are not part of their network. This case specifically targets Ingenix’s flawed reimbursement calculations for ASCs that do not have contracts with health plans.

“The misuse of the Ingenix database to pay physician claims has been the subject of investigations by Congress. We believe that the conflict of interest issues and problems with the database identified in those investigations apply equally to the calculation and payment of ASC claims,” said Plaintiff Co-counsel Glenn Solomon.

The class action complaint specifically charges that Ingenix and UnitedHealth have:

Violated the Employee Retirement Income Security Act (ERISA) through their failure and refusal to fairly and appropriately compensate ASCs for their services.
Violated the Racketeer Influenced and Corrupt Organizations Act (RICO) in that they have committed mail fraud and wire fraud by sending false and misleading information in connection with their scheme to underpay ASCs.
Violated the Sherman Act by price-fixing with regard to the reasonable and customary rates of nonparticipating ASCs.
Violated California’s Business and Professions Code by engaging in unfair, unlawful and fraudulent business acts and practices.

The class action complaint outlines numerous flaws in the Ingenix Database. A sample of the errors in database calculations include:

Using data that is not representative of ASC charges within a geographic area;
Improperly “scrubbing” of data so that the true rates charged by ASCs are reduced;
Reporting of charges that are systematically skewed downward;
Using incorrect and inaccurate methodologies to calculate UCRs;
Lack of quality control to ensure the validity and authenticity of data submitted.

For more information about this case, or if you are aware of any information that might be relevant to this case, please contact Mr. Tooch or Mr. Solomon by phone or e-mail, as noted above.

Relevant Documents

Complaint

June 17, 2009

HLB Ranks in Top Tier of Leading Law Firms in Latest Chambers Review

Hooper, Lundy & Bookman, Inc., has once again been named one of the top three
health care law firms in California and one of the leading health care law firms in
the country, according to the latest edition of Chambers USA. The directory is published by the prestigious Chambers & Partners, which produces law firm directories of top-rated law firms throughout the United States and Europe, ranking law firms primarily based on outside interviews with General Counsel, high-profile entrepreneurs and other significant purchasers of legal services. In addition to the firm ranking, five HLB attorneys were recognized as top performers in the state for the third year in a row.

Following is the text of the firm’s profile, reprinted with permission of Chambers & Partners, USA. We thank all of our clients and friends who contributed to the Chambers review.

"A gold standard, and certainly a leading practice in the state," this California healthcare boutique has a notable profile in local counsel work for hospitals and associated corporate, regulatory and reimbursement matters. It worked on the Hoag Orthopedic project to create a regional orthopedic program in the western USA. Other clients include Sharp Healthcare. Name partner Lloyd Bookman is one of the first-class lawyers at the firm. Although his skills are wide, he has built a particularly good name in government reimbursement and regulatory work. Patric Hooper "forms the backbone" of the top healthcare litigation practice, particularly in Medicare reimbursement fraud and abuse and False Claims Act matters, up to the Ninth Circuit. Robert Lundy is a founding partner, whom sources praise as "a great business and transactional lawyer with a good head for structuring deals." Compliance expert Bradley Tully has "considerable skill and know-how" in the regulatory and Stark aspects of healthcare. John Hellow has developed a solid reputation in government reimbursement and Medicaid matters.

May 26, 2009

Hooper, Lundy & Bookman Negotiates Class Action Settlement with Health Net: California Hospitals to Receive at Least $1.95 million

Los Angeles - On behalf of the California Hospital Association and all California hospitals, Hooper, Lundy and Bookman, Inc. (HLB) has negotiated a class action settlement with Health Net of California and Health Net Life Insurance Company, relating to the rescission of patients’ policies. Under the settlement, Health Net has agreed to pay at least $1.95 million to settle claims with hospitals that did not receive payments following rescissions.

The settlement is the result of extensive negotiations that have been ongoing between HLB and Health Net since July 2008, and covers rescissions by Health Net that occurred between February 2004 and October 2007. (Case No. BC414389).

“We are very pleased to have come to an agreement with Health Net that results in hospitals receiving substantial payments for the previously unreimbursed services that they provided to Health Net members who were rescinded,” said HLB partner and co-lead counsel, Glenn Solomon. "We believe that Health Net did the right thing here and appreciate its cooperation in reaching a mutually acceptable settlement."

Under terms of the Settlement Agreement that was preliminarily approved by the court today, Health Net will establish a Facility Compensation Fund and mechanisms to reimburse hospitals for the services they provided to rescinded members. In addition, Health Net will provide each affected hospital with a list of the patients whose policies were rescinded so that the hospitals and the patients can receive closure regarding the rescissions.

“The practice of rescinding patients’ policies after the patient has received medically necessary services has caused a great deal of financial stress to both the patients and the hospitals that provide those services. This settlement goes a long way towards compensating the hospitals for those services,” said HLB attorney and co-lead counsel, Daron Tooch.

For copies of the complaint and the settlement agreement see our website at www.health-law.com.

Relevant Documents

Settlement Agreement
Complaint

March 16, 2009

Charles Oppenheim Joins Hooper, Lundy & Bookman

Health Law Expert Expands Firm Expertise at Critical Time for Providers

Los Angeles - Hooper Lundy & Bookman, Inc. (HLB) is pleased to announce that Charles B. Oppenheim has joined the firm as a partner in the firm’s Los Angeles Office.

Most recently a partner at Foley & Lardner, LLP, where he co-chaired the Health Care Payments, Fraud & Abuse, and Compliance Work Group¸ Mr. Oppenheim brings with him more than 18 years of health law experience.

“We are pleased to have Charles Oppenheim join our team of health law experts specializing in the complexities of Stark Law and anti-kickback issues,” said HLB Managing Partner Robert Lundy.

Stark Law provisions govern physician self-referral for Medicare patients and anti-kickback laws are designed to prevent fraud and abuse of Medicare and Medicaid by curtailing the influence of money on healthcare decisions.

“Charles’ expertise is especially vital now, given the strong focus the Obama administration has signaled in the recently enacted federal stimulus package and federal budget proposal. It is more important than ever that healthcare providers understand the practical and legal implications of their business arrangements,” Mr. Lundy said.

A nationally-recognized expert on anti-kickback and Stark Law issues, Mr. Oppenheim wrote the 2008 American Health Lawyers Association monograph on Stark Law, the fourth edition of a treatise he first wrote in 1998. His practice includes transactional, operational and regulatory healthcare law. Mr. Oppenheim’s clients include many of the largest healthcare organizations in the United States.

In addition to counseling healthcare providers, Mr. Oppenheim has served as an expert on anti-kickback and Stark Law issues in arbitration and litigation, in both civil and criminal proceedings. He also has recognized expertise in the evolving field of healthcare gainsharing. In addition, he creates and implements compliance programs, investigates compliance issues, responds to government enforcement actions, and negotiates settlements for many types of healthcare providers. He also has substantial experience assisting managed care entities in a variety of transactional and regulatory matters.

Mr. Oppenheim may be contacted at coppenheim@health-law.com or 310.551.8110.

February 2, 2009

Hooper, Lundy & Bookman Sues California on Behalf of Medi-Cal Providers

Complaint Seeks to Halt Additional Medi-Cal Payment Cuts Slated for March 1

Hooper, Lundy & Bookman, Inc. (HLB), filed a complaint February 2, 2009 against the State of California on behalf of a coalition of major healthcare provider organizations seeking to halt implementation of Medi-Cal reimbursement cuts enacted as part of the 2008 -2009 budget and slated to go into effect March 1, 2009.

“Once again, the state has attempted to move forward with dangerous cuts to providers who serve our most vulnerable population,” said Plaintiff Attorney Craig Cannizzo of HLB. “And once again the state has attempted to implement these cuts in violation of federal and state laws that demand that the state ensure first and foremost that Medi-Cal patients will not be harmed and that providers will be able to afford to continue to treat these patients.”

The members of the plaintiff coalition include the California Pharmacist’s Association, the California Medical Association, the California Dental Association, the California Hospital Association, the California Association for Adult Day Services, Ross Valley Pharmacy, South Sacramento Pharmacy, Farmacia Remedios, Inc., Acacia Adult Day Services, Sharp Memorial Hospital, Grossmont Hospital Corporation, Sharp Chula Vista Medical Center and Sharp Coronado Hospital and Healthcare Center.

Filed in U.S. Federal District Court - Central District, the suit seeks to block the scheduled reduction in Medi-Cal payments enacted on September 18, 2008 as part of budget trailer bill, AB 1183. If this legislation is permitted to go into effect, the following services will be affected:

A five percent rate reduction for Medi-Cal fee-for services benefits paid to certain hospitals, intermediate care facilities, distinct part nursing facilities, rural swing-bed facilities, subacute care units, pediatric subacute care units, and adult day health care centers
A five percent rate reduction in payments to pharmacies
A one percent rate reduction for all other Medi-Cal fee-for-service benefits, including physician and dental care.

“These cuts were clearly enacted illegally,” said Plaintiff Attorney Byron Gross of HLB. “As we pointed out in earlier litigation involving previous cuts, lawmakers failed to consider the likely impact of such cuts on Medi-Cal beneficiaries. “If these cuts are allowed to go into effect, the Medi-Cal program will be devastated as care to our most vulnerable population will be jeopardized.“

Federal and state law (42 C.F.R. Sect. 447.204) requires that Medi-Cal payments to providers “must be sufficient to enlist enough providers so that services under the [Medi-Cal] plan are available to recipients at least to the extent that those services are available to the general public.”

“If the new Medi-Cal cuts are implemented, providers will have no choice but to further limit participation in the program. This is true since current payment rates are shamefully low already, among the lowest in the nation, and provider participation in the program has been reduced to a point that jeopardizes the ability of many Medi-Cal patients to receive timely access to care. Furthermore, patients unable to receive timely care will be forced to seek care at already overburdened emergency departments," said Mr. Cannizzo.

Related Litigation
The complaint filed today follows previous attempted rate reductions under earlier legislation. Specifically, AB 5, enacted February 16, 2008, attempted to reduce payments to providers by 10 percent, effective July 1, 2008. (Independent Living Center of Southern California v. Shewry.) A preliminary injunction remains in effect with a hearing set before the Ninth Circuit Court of Appeal for February 18, 2009.

For more information, please contact Craig Cannizzo at ccannizzo@health-law.com or Byron Gross at bgross@health-law.com.

January 9, 2009

Hooper, Lundy & Bookman, Inc. is pleased to announce that Blake R. Jones has been promoted to principal

Hooper, Lundy & Bookman, Inc. is pleased to announce that Blake R. Jones has been promoted to principal. He is a talented litigator who has a distinguished record of successful outcomes, including numerous published opinions. He brings a wide variety of employment and litigation expertise to the firm.

Mr. Jones received his B.A. from the University of Missouri in 1996, graduating with academic honors. He received his J.D. from Tulane Law School in 2000, graduating magna cum laude.

Mr. Jones is a litigation principal with over 8 years experience in complex litigation, with an emphasis in employment law. Mr. Jones joined Hooper, Lundy & Bookman, Inc. in June 2004, with the opening of the San Diego office. Prior to that time, he was an attorney in the San Diego office of Luce, Forward, Hamilton & Scripps, LLP.

Mr. Jones litigates on behalf of healthcare and non-healthcare entities in all areas of employment law, including defending employers against claims for wage and hour violations, wrongful termination, discrimination/harassment, breach of employment contracts, and class actions. He is also involved in advising employers on disciplining and terminating employees, workplace investigations, trade secret protection, and non-competition/non-solicitation agreements.

Mr. Jones additionally represents clients in other areas, including medical staff/peer review proceedings, administrative law, medical board proceedings, unfair competition, defamation, officer and director liability, contractual disputes, and general business litigation. He has also done extensive appellate work before the California Courts of Appeal, the California Supreme Court, and the United States Court of Appeals for the Ninth Circuit.

Mr. Jones’ clients include hospitals, skilled nursing facilities, provider groups, ambulance operators, pharmacies, healthcare organizations, and medical device companies. He has also represented non-healthcare clients, including Fortune 500 companies and large national organizations.

January 5, 2009

Keys to Winning RAC Appeals are Regulatory Expertise, Clinical Acumen and Efficient Internal Processes, Hooper, Lundy & Bookman Attorney Tells Lawyers

Los Angeles - As the Recovery Audit Contractor (RAC) demonstration project ends and the federal government prepares to launch the RAC program nationally, there is much hospitals can do to prepare for RAC audits and substantially increase their chances of prevailing, Hooper, Lundy & Bookman, Inc. (HLB) Attorney Lloyd Bookman told a group of healthcare lawyers meeting in California recently.

“Setting up efficient internal processes that include a vital communication network between the business and clinical departments is key,” said Mr. Bookman, who has been the lead attorney for the firm in winning 100 percent of the more than 550 RAC audit appeals handled by HLB to date.

Mr. Bookman noted that if hospitals establish efficient internal operations for handling the varied and complex requests and deadlines of RAC contractors, they can often effectively handle Level 1 and Level 2 RAC appeals in-house, needing outside counsel only to help with the establishment of effective internal systems. His initial suggestions to hospitals included:

Establish lines of communication between the business and clinical departments
Establish and maintain a good calendaring system
Keep copies of every document filed
Ensure that clinical arguments are specific to the particular patient
Respond to reasons for denial as specifically as possible and explain why the service in question was medically necessary.

It is rare that a Hospital wins a Level 1 appeal, said Mr. Bookman, making efficient record keeping vital for the next stage. Hospitals occasionally win Level 2 appeals, he noted, but many appeals must go to Level 3 – Administrative Law Judge (ALJ) review.

“Once an appeal hits the judicial review stage, it is generally imperative that a hospital engage outside counsel for representation,” Mr. Bookman said. “At this stage, it is the integration of legal regulatory experience and clinical legal experience that provides the hospital with the greatest chance of prevailing.”

To that end, HLB’s RAC team includes experienced Medicare regulatory and nurse attorneys to cover the spectrum of issues at stake – including preparing physicians for testimony, he noted.

Mr. Bookman suggested that hospitals considering hiring outside counsel to handle their RAC appeals, ascertain the following when selecting a candidate law firm:

Years of experience and measurable success in handling Medicare and Medicaid hearings;
Clinical legal experience of the attorneys handling the case;
Number of RAC appeals handled and won on behalf of clients

“You cannot underestimate the need for internal organization, Medicare hearing experience and clinical expertise in prevailing in these appeals,” Mr. Bookman said.

December 15, 2008

Byron Gross Receives California Lawyer Angel Award

HLB Partner Byron Gross has been named as a recipient of California Lawyer Magazine’s third annual Angel Awards.

Angel Award recipients were selected based on their “deep commitment to pro bono work,” according to the magazine. Lawyers cannot apply for the award. Winners are selected based on California Lawyer’s own reporting and from nominations submitted by nonprofit organizations statewide.

Mr. Gross was selected as a result of nearly 20 years of pro bono work he has done for the HIV and AIDS Legal Services Alliance (HALSA), pursuing health care access and federal disability-benefit appeals. He has personally represented more than 20 clients living with HIV and AIDS. Mr. Gross's pro bono work has included settling an HIV-discrimination case in which the client had been denied medical treatment, and litigating an ERISA complaint for a client whose insurance carrier had denied long-term disability benefits.

As an example, when a HALSA client had his Supplemental Security Income payments and Medi-Cal coverage suspended last year without explanation--and then was charged $16,500 for an overpayment—Mr. Gross took the case and discovered that the Social Security Administration had erred. After several months of advocacy, the SSA waived the $16,500 overcharge. Gross also got the client's health care benefits reinstated.

November 19, 2008

Hooper, Lundy & Bookman Announces Court Decision Invalidating Medicaid Payment Rate Freeze

(Los Angeles)—In a case of national significance, a California appellate court has invalidated a Medicaid payment freeze on the grounds that, in adopting the freeze, the California Legislature failed to follow federal Medicaid notice and comment requirements.
Hooper, Lundy & Bookman, Inc. (HLB) represents 100 California hospitals in the case.

Click here for a copy of the court decision.

“We believe this to be the first case in the nation invalidating a Medicaid rate provision under federal notice and comment requirements,” said HLB Partner Byron Gross, who argued the case before the appellate court. “For these 100 hospitals alone, this case represents approximately $50 million in reimbursement. Further, this case is also important for other cases in which we are challenging Medi-Cal rate cuts on behalf of our clients.”

At issue was a freeze adopted as part of the 2004 California budget. Over a three-day period, the legislature proposed and enacted a freeze on the rates the state would use to reimburse certain hospitals that provided services to Medicaid beneficiaries during the state’s 2004-2005 fiscal year.

HLB represented the many hospitals that initially filed suit, claiming that the state’s legislative action violated federal Medicaid notice and comment requirements, as well as other federal Medicaid mandates for revising rates and rate methodologies. The trial court disagreed with the hospitals, except to the extent the freeze affected services rendered prior to the freeze’s enactment.

In today’s ruling, the appellate court reversed the trial court’s ruling. The court concluded that the federal statute requiring notice and comment procedures applied to action taken by the state legislature, and that the legislature’s process did not satisfy the federal statute.

“A significant aspect of this ruling is that the court, in essence, is telling the state what it must do to comply with federal Medicaid laws,” noted HLB Partner Lloyd Bookman, who represented the hospitals along with Mr. Gross.

About Hooper, Lundy & Bookman, Inc.: Hooper, Lundy & Bookman’s litigation lawyers are regularly engaged in complex litigation involving hospitals and health systems, as well as other health care providers. The firm’s litigation department regularly assists provider clients with litigation, arbitration and mediation services that have resulted in numerous favorable judgments and new case law. With clients in 47 states and offices in Los Angeles, San Francisco and San Diego, the firm is the largest law firm in the country dedicated solely to the representation of health care providers. For more information, visit the firm’s website at www.health-law.com.

September 24, 2008

St. Helena v. Leavitt; Rural Floor Budget Neutrality Case

(Los Angeles)—Hooper, Lundy & Bookman is representing 377 hospitals nationwide in a challenge to the way CMS computed a component of inpatient hospital PPS rates. Click here to view the Rural Floor Budget Neutrality case: St. Helena v. Leavitt.

July 7, 2008

Hooper, Lundy & Bookman Negotiates 11.8 Million Settlement for California Hospitals in Blue Cross Rescission Class Action

(Los Angeles)—On behalf of the California Hospital Association and all California hospitals, Hooper, Lundy and Bookman, Inc. has negotiated a landmark $11.8 million settlement with Blue Cross of California, Blue Cross Life and Health and their parent company, Wellpoint, Inc., in a class action relating to rescission of patients’ policies. The lawsuit, filed in October, 2006, alleges that Blue Cross illegally rescinded patients’ health care insurance policies after the patients received services at California hospitals. (Case No. BC360235 (CCW)).

“We are very pleased to have come to an agreement with Blue Cross that fairly reimburses hospitals for the services they provided to Blue Cross members and protects the patients from being liable to pay for those services,” said Hooper, Lundy & Bookman attorney and co-plaintiff counsel, Daron Tooch.

Under terms of the Memorandum of Understanding approved by the court today:

Blue Cross will establish a Facility Compensation Fund to reimburse hospitals for the services they provided to rescinded members.
Blue Cross will establish a Patient Reimbursement Fund to reimburse patients for payments they made to hospitals after their policies were rescinded.
Hospitals will cease collection activities against rescinded Blue Cross members for claims that were not paid by Blue Cross due to policy rescissions.

“The practice of rescinding patients’ policies after the patient has received medically necessary services causes a great deal of financial stress to both the patients and the hospitals who provide those services. This settlement goes a long way towards compensating the hospitals for those services and providing closure to the patients for these debts,” said Hooper, Lundy & Bookman attorney and co-plaintiff counsel, Glenn Solomon.

Background
Hooper, Lundy & Bookman, Inc. filed a class action complaint against Blue Cross in October, 2006, seeking to establish protection of hospitals statewide from the practice by Blue Cross of California, Blue Cross Life and Health, and their parent company, Wellpoint, Inc., of retroactively rescinding insurance policy coverage for numerous patients after the health care services have been provided by the hospitals. The complaint explained that California law prohibits Blue Cross from retroactively denying payment after the services have been provided in good faith.

Blue Cross has been the subject of dozens of lawsuits by patients alleging that Blue Cross routinely looks for after-the-fact reasons to cancel policies by reviewing previously approved applications. But the rescissions also directly impacted the hospitals, because they were the ones not being paid for their services, and instead were being directed and forced by Blue Cross to try to collect from their patients.

Relevant Documents

Court's Preliminary Approval Order
Notice of Class Action Settlement (Sent by Blue
Cross to Class Members 7/14/2008)
Settlement Agreement
Stipulation and Order re Class Action Settlement
CHA Memorandum
Judgment on Class Action Settlement
Notice of Ruling Approving Final Settlement
Stipulation and Order re Uncashed Settlement Checks

June 16, 2008

HLB Ranks in Top Tier of Latest Chambers Review of Leading Health Law Firms

Following is the text of the firm’s profile, reprinted with permission of Chambers & Partners, USA. We thank all of our clients and friends who contributed to the Chambers review.

The Firm: “Hooper Lundy & Bookman has a real depth of experience, understanding and expertise across the complete range of healthcare matters, in particular with regard to complex Medicare and Medicaid reimbursement issues,” clients say of this boutique healthcare firm. From its three California offices in San Diego, San Francisco and Los Angeles, the group devotes its time to advising healthcare providers in 46 states. The team covers all matters of concern across the healthcare industry, from business transactions to regulatory and litigation matters. On the regulatory side, a highlight was the team’s representation of the California Hospital Association and a number of member hospitals in appealing the Medicare Reimbursement Audit Contractor reviews for inpatient rehabilitation services.

The Lawyers: The “exceptional” Lloyd Bookman represents healthcare providers in transactional matters and is described as “a mastermind in Medicaid and Medicare reimbursement,” as well as representing clients in compliance matters. Clients praised him for “being on top of all the legal issues.” Top-ranked Patric Hooper brings long-standing experience to the table and is a recognized leader in the healthcare field. He has particular expertise in reimbursement matters and is “a respected litigator in California.” He also represents clients in fraud and abuse matters, and is described as “an amazingly knowledgeable and focused individual.” The “excellent and conscientious” Robert Lundy concentrates his practice on all matters related to healthcare business transactions. Clients praise “his intelligent and focused approach to his work.” Bradley Tully advises clients on regulatory matters and business transactions in the healthcare sector. Interviewees note that “with two decades of experience, he really knows what he is talking about,” adding that “he has a deep knowledge of the healthcare sector and its associated issues.” John Hellow continues to impress clients and peers for his Medicare and Medicaid reimbursement work, “in which he is experienced and respected.”

Clients/Work Highlights: The group represents the California Hospital Association and the California Medical Association in a class action complaint against Blue Cross California. On the transactional side, the firm represented a number of the purchasers in several transactions following Tenet Healthcare’s recent divestiture of many of its hospitals across California.

May 5, 2008

Hooper, Lundy & Bookman Sues California on Behalf of Medi-Cal Providers Suit Seeks to Halt 10 Percent Payment Cut

(Los Angeles)—Hooper, Lundy & Bookman, Inc., today filed a class action complaint against the State of California on behalf of a coalition of seven major health care provider organizations seeking to halt a 10 percent cut in Medi-Cal and Denti-Cal reimbursement rates scheduled to take effect July 1, 2008.

Filed in Los Angeles County Superior Court, the suit seeks an immediate injunction to block the scheduled reduction in Medi-Cal payments. The seven members of the plaintiff coalition include the California Medical Association, the California Hospital Association, the California Dental Association, the California Association for Adult Day Services, the American College of Emergency Physicians State Chapter of California, the California Pharmacists Association, and the California Association of Public Hospitals and Health Systems.

“The cuts agreed to by the Legislature and signed into law by the governor in February were invoked illegally, as lawmakers failed to consider the likely impact of such cuts on Medi-Cal beneficiaries,” said lead Plaintiff Counsel Craig Cannizzo of Hooper, Lundy & Bookman. “If allowed to go into effect, these cuts will devastate the Medi-Cal program as care to our most vulnerable population will be jeopardized.”

State and federal law (42 C.F.R. Sect. 447.204) requires that Medi-Cal payments to providers “must be sufficient to enlist enough providers so that services under the [Medi-Cal] plan are available to recipients at least to the extent that those services are available to the general public.”

“If the 10 percent cut is implemented, this mandate will not be met,” said co-Plaintiff Counsel Lloyd Bookman. “Providers will not be able to pay vendors, and in some cases, employees. Furthermore, patients unable to receive timely care will be forced to seek care at already overburdened emergency departments.”

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