Significant Cases

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In addition to the cases cited below, Hooper, Lundy & Bookman has successfully prosecuted and defended numerous high profile cases at the trial and arbitration level, which do not result in published citations, but which represent significant expertise in these types of proceedings. Cases may be located under the following categories: MedicareMedicaidFalse Claims Act, Managed Care, Post-Acute/Long-Term Care, and Miscellaneous Litigation

Medicare Cases

Agendia, Inc. v. Azar, 2019 U.S. Dist. LEXIS 191877 (C.D. Cal., 2019).  The decision holds that a Medicare Local Coverage Determination disallowing coverage for various molecular diagnostic laboratory tests was not enforceable because the LCD was not enacted as a Medicare regulation.  The decision is supported by the June 2019 decision of the Supreme Court in Allina v. Azar

Plott Nursing Home v. Burwell (9th Cir., 2015) HLB Submitted Amicus Brief on behalf of CAHF. Ninth Circuit reversed the Secretary’s determination that the nursing home violated the quality of care for urinary tract infection, and held that the nursing home was entitled to administrative review of all cited deficiencies and a remand with directions to review or dismiss the violations that were not reviewed by the agency. 

Gentiva v. Sebelius, 773 F.3d 292 (DC  Cir. 2013)

Peak Medical of Okla. No. 5, Inc. v. Sebelius, 2010 WL 4809319 (N.D. Okla., 2010) Court grants plaintiffs interim relief under the APA, pending the outcome of its administrative appeal of CMS’s decision to terminate a SNF's Medicare participation.

Sharp Healthcare v. Leavitt, 2009 WL 790113 (S.D. Cal., 2009)

Sharp Healthcare v. Leavitt, 555 F.Supp.2d 1121 (S.D. Cal., 2008) Court grants plaintiffs Preliminary injunction to halt Medicare lab demonstration project.

Foothill Hosp. – Morris L. Johnson Memorial v. Leavitt, 558 F.Supp.2d 1 (D.D.C., May 30, 2008) Court rules that presumption of collectability violates Medicare bad debt moratorium.

Labotest, Inc. v. Bonta, 297 F.3d 892 (9th Cir., 2002). Court holds that plaintiffs are prevailing parties and, thus, entitled to attorneys’ fees under the Civil Rights Act based on favorable Court approved settlement.

Alhambra Hospital v. Thompson, 259 F.3d 1071 (9th Cir., 2001). Ninth Circuit holds that the Medicare program improperly restricted the count of Medicaid subacute patient days in the calculation of hospitals’ Medicare disproportionate share hospital payments.

Monmouth Medical Center/Staten Island University Hospital v. Thompson, 257 F.3d 807 (D.C. Cir. 2001).  Court ruled that reopening prohibition in HCFA Ruling 97-2, which prevented the plaintiff hospitals from having their disproportionate share hospital (DSH) payment recalculated, was unlawful and that the court had mandamus jurisdiction to hear the hospitals’ challenge.  As a result of this decision, 253 lawsuits involving more than 600 hospitals were brought in the U.S. District Court for the District of Columbia and consolidated under the umbrella case name In Re: Medicare Reimbursement Litigation.  Settlement of more than $665 million negotiated to resolve the pending lawsuits.

United States v. Mackby, 243 F.3d 1159 (9th Cir., 2001). Ninth Circuit holds that per claim penalties and treble damages provisions of the federal False Claims Act are subject to review under the Excessive Fines Clause of the Eighth Amendment.

County of Los Angeles v. Shalala, 192 F.3d 1005 (D.C. Cir., 1999). Court holds that Medicare Act does not require a minimum annual amount of outlier payments, but holds that the Secretary of Health and Human Services did not state sufficient reasons for her methodology for setting outlier thresholds for 1985 and 1986.

Alvarado Community Hospital v. Shalala, 155 F.3d 1115 (9th Cir., 1998). Court holds that Medicare under-paid hospitals for outlier patients in 1985 and 1986 and orders retroactive payments in a case involving 140 hospitals.

United States ex. rel.Thompson v. Columbia/HCA Healthcare Corporation, 125 F.3d 899 (5th Cir., 1997). Circuit Court reverses District Court holding that qui tam action alleging Medicare false claims for services rendered in violation of the anti-kickback statute and self-referral statute did not state valid claim.

Hanlester Network v. Shalala, 51 F.3d 1390 (9th Cir., 1995). Court holds, inter alia, that, in order to find violation of anti-kickback statute, court must find that defendant knowingly and willfully engaged in prohibited conduct with specific intent to disobey law.

Athens Community Hospital, Inc. v. Shalala, 21 F.3d 1176 (D.C. Cir., 1994). Court invalidates Medicare regulation which prohibited hospitals from being geographically reclassified under the Prospective Payment System unless the county in which the hospital was located was adjacent to the Metropolitan Statistical Area or rural area to which reclassification was sought.

Mt. Diablo Medical Center v. Bowen, 860 F.2d 951 (9th Cir., 1988). Court invalidates Medicare policy prohibiting payment of TEFRA bonuses until final settlement.

National Medical Enterprises. v. Bowen, 662 F. Supp. 476 (C.D. Cal., 1987); aff’d, 851 F.2d 291 (9th Cir. 1988). Court holds that Medicare policy excluding return on equity capital earned during a current period from a provider’s ending equity capital calculation is inconsistent with the Medicare regulations.

Tallahassee Regional Medical Center v. Bowen, 815 F.2d 1435 (11th Cir., 1987), aff’g Parkway Regional Medical Center v. Bowen, 614 F. Supp. 564 (S.D. Fla. 1985). Court holds that Medicare program’s 1979 Malpractice Rule is invalid and that 1986 Malpractice Rule may not be given retroactive effect.

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Medicaid Cases

Bronx-Lebanon Hosp. Ctr. v. Daines956 N.Y.S.2d 660 (N.Y. App. Div. 2012). Court grants inpatient hospital reversal of a statute-of-limitations dismissal of the hospital’s Medicaid reimbursement challenge.

California Hospital Association v. Maxwell-Jolly, 776 F. Supp.2d 1129 (E.D. Cal., 2011). Court rules that attempted Medi-Cal rate rollback was unconstitutional under the contracts clause because it impaired the state’s obligations under its contracts with hospitals. 

Cleanmaster Industries v. Shewry, 491 F. Supp.2d 937, 948-49 (C.D. Cal., 2007). Court rules that section 14043.65(b) of the Welfare and Institutions Code was unconstitutional on due process ground because it penalized providers for appealing Medi-Cal sanctions.

Simonyan v. Connell, 2000 WL 562861 (C.D. Cal., 2000). Court enjoins State Controller from investigating Medi-Cal claims and enjoins Department of Health Services from basing a Medi-Cal withhold on a Controller audit.

Fountain Valley Regional Hospital and Medical Center v. Bonta, 75 Cal. App. 4th 316 (1999). Court holds that burden of proof on issue of laches shifts to Department of Health Services, when Department assesses alleged Medi-Cal overpayments after analogous statute of limitations period has expired.

Doctor’s Medical Laboratory, Inc. v. Connell 69 Cal. App. 4th 891 (1999). Court holds that federal Medic-aid law barred Department of Health Services from delegating to the State Controller the discretionary authority to audit Medi-Cal claims and to withhold alleged overpayments.

People v. Duz-Mor Diagnostic Laboratory, Inc. 68 Cal. App. 4th 654 (1998). Court holds that clinical laboratory, which provides services to Medi-Cal patients, did not violate unfair competition law by charging discounted fees to physicians’ private-pay patients.

Exeter Memorial Hospital Association v. Belshé, 145 F.3d 1106 (9th Cir., 1998). Court holds that State may not implement changes in Medicaid rate methodology prior to federal approval of State Plan amendment.

Beverly Community Hosp.Ass’n v. Belshé, 132 F. 3d 1259 (9th Cir., 1997). Reversal of District Court decision requiring State to pay Medicare deductibles and co-insurance for persons receiving both Medicare and Medicaid, after Congress retroactively amended statute governing states’ obligation.

Orthopaedic Hospital v. Belshé, 103 F.3d 1491 (9th Cir., 1997). Court holds that Medi-Cal hospital outpatient rates must bear a reasonable relationship to hospital costs.

Missouri Department of Social Services v. Great Plains Hospital, 930 S.W. 2d 429 (Mo. Ct. App., 1996). Court invalidates Missouri’s cap on Medicaid reimbursement for psychiatric services.

Physicians and Surgeons Laboratories, Inc. v. Department of Health Services, (6 Cal. App. 4th 968, 1992). Challenge by independent clinical laboratory to a Medicaid regulation prohibiting discriminatory billing practices.

AMISub (PSL), Inc. v. Colorado Dept. of Social Services, 789 F.2d 291 (10th Cir., 1989). Court invalidates Colorado Medicaid payment rate for inpatient hospital services due to use of budget factor which violated federal law.

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False Claims Act Cases

U.S. ex rel. Martinez v. Orange County Global Med. Center, Case No. 15-CV-01521, (C.D. Cal., Sept. 14, 2017)  Court grants motion to dismiss complaint on grounds that relator did not plausibly plead that the government’s disbursements to a Medicare managed care plan were affected by provider’s allegedly false billing.  

U.S. v. Executive Health Resources, Inc. 196 F. Supp. 3d 477 (E.D. Pa. 2016),Court holds that relator did not sufficiently plead involvement by defendant hospital with particularity in vendor’s fraudulent scheme.

U.S. v Reliance, 2014 WL 5761113 (C.D. Cal., 2014) Government charges numerous violations of the False Claims Act involving spinal surgeries,  against Physician Owned Distributorship (open case). 

Zeman ex rel. U.S. v. USC University Hospital, 2013 WL2456863 (C.D. Cal., 2013) Court holds that plaintiff failed to provide evidence of improper billing. 

U.S. ex rel. Jamison v. McKesson Corp., 900 F.Supp2d 683 (N.D. Miss.,2012). Court holds that government failed to carry a burden of proof that McKesson violated the Anti-kickback Statute or the False Claims Act.      

U.S. ex rel. Jamison v. McKesson Corp., 784 F. Supp. 2d 664 (N.D. Miss., 2011).  Court holds that Enteral supplier reasonably relied on Medicare contractor’s determination of compliance with applicable Medicare requirements and thus its Medicare claims were not objectively false.

United States ex rel. Colucci v. Beth Israel Med. Ctr.785 F. Supp. 2d 303 (S.D.N.Y. 2011), mot. to reopen denied, No. 1:06-cv-05033, 2012 WL 3577995 (S.D.N.Y. Aug. 16, 2012), aff’d, No. 12-3694-cv, 2013 WL 4516407 (2d Cir. Aug. 27, 2013).

U.S. ex rel. Serrano v. Oaks Diagnostics, Inc., 568 F.Supp.2d 1136 (C.D. Cal., 2008) Court finds that complaint fails to allege the allegedly false claims submitted with sufficient particularity to satisfy pleading standard. 

U.S. v. Borseau, 531 F. 3d 1159 (9th Cir. 2008), Court discusses materiality requirement of the False Claims Act and rules confirms that award of treble damages violates Excessive Fines Clause if it is grossly disproportional to gravity of defendant’s offense.  

U.S. ex rel. Ernst v. Tenet Healthcare Corp., 2005 WL 474244 (N.D. Cal., 2005). Court dismisses complaint because relator did not adequately allege that he was the original source of publicly disclosed information.                               

U.S. ex rel. Lee v. Horizon West, Inc., 2006 WL 305966, N.D. Cal (2006) Court grants defendant's request to lift the seal of the contents of the case.                            

U.S. ex rel. Swan v. Covenant Care, Inc., 279 F.Supp.2d 1212, E.D. Cal (2002) Court holds that regulatory violations and other “quality of care” concerns cannot give rise to false claims liability as to skilled nursing facilities participating in the Medicare program.

U.S. v. Mackby, 243 F.3d 1159 (9th  Cir., 2001) Ninth Circuit holds that per claim penalties and treble damages provisions of the Federal False Claims Act are subject to review under the Excessive Fines Clause of the Eighth Amendment.                                                            

People v. DuzMor Diagnostic Laboratory, Inc. 68 Cal.App. 4th 654 (1999) Court holds that clinical laboratory, which provides services to Medi-Cal patients, did not violate unfair competition law by charging discounted fees to physicians’ private-pay patients.                    

United States ex. rel.Thompson v. Columbia/HCA Healthcare Corporation, 125 F.3d 899 (5th Cir., 1997). Circuit Court reverses District Court holding that qui tam action alleging Medicare false claims for services rendered in violation of the anti-kickback statute and self-referral statute did not state valid claim.Court dismisses claims of billing for unnecessary services.

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Managed Care Cases

Connecticut General Life Ins. Co. v. La Peer Surgery Center LLC 2 2014 WL 961806 (C.D. Cal., 2014)

Children's Hospital Central California v. Blue Cross of California, 226 Cal.App.4th 1260 (2014). Represented hospital against health plan in dispute in which appeals court held that California's quantum meruit standard for services permits the parties to present evidence to the jury to consider a variety of material, which can include the hospital's charges, contracted rates and government rates, among other things, but does not include the costs to render the services at issue.

Aetna Life Ins. Co. v. Bay Area Surgical Management, LLC 2013 WL 685375 (N.D. Cal., 2013)

Promise Hospital of East Los Angeles, L.P. v. Cigna Corp. 2013 WL 5590236 Cal. App. 2nd (2013)

Children’s Hospital Central California v. Blue Cross of California, Case No. MCV 048512 (Madera County Sup. Ct.) (2012). Jjury verdict determining plan was liable for post-stabilization services rendered by hospital when plan failed to transfer Medi-Cal managed care beneficiaries to alternative providers; jury rejected health plan's argument that hospital had not received authorization or been deemed authored to provide the services.

Scripps Health v. Schaller Anderson, LLC 2012 WL 2390760 (S.D. Cal, 2012)   

Scripps Health v. Food Employers & Bakery & Confectionery Workers Ben. Fund of Southern California  2012 WL 1430955 (S.D. Cal., 2012).  

Forest Ambulatory Surgical Associates, L.P. v. United Healthcare Ins. Co. 2012 WL 1094651 (N.D. Cal., 2012)

South Gate Ambulatory Surgery Center LLC v. Int'l Longshore & Warehouse Union-Pacific Maritime Ass'n Coastwise 2011 WL 672539 (C.D. Cal. 2011)

Scripps Health v. Blue Cross & Blue Shield of Kansas, Inc. 2011 WL 292142 (SD Cal.,  2011)  

Coast Plaza Doctors Hosp. v. Arkansas Blue Cross and Blue Shield 2011 WL 3756052 (C.D. Cal., 2011)

Forest Ambulatory Surgical Associates, L.P. v. United HealthCare Ins. Co. 2011 WL 2748724 (N.D. Cal., 2011)

Scripps Health v. Blue Cross & Blue Shield of Kansas, Inc. 2010 WL 4929085 (SD Cal., 2010)

American Medical Association v. United Healthcare Corp., No. 00 Civ. 2800 (S.D.N.Y. August 16, 2010). Successfully represented the California Hospital Association, along with a national provider of dialysis services, and a putative class of all ambulatory surgery centers in the country, in obtaining court order that class action settlement agreement regarding United’s reimbursement practices to non-contracted physicians does not bar facilities from pursuing underpayment claims for facility services.

C/HCA, Inc. v. Regence Blue Cross Blue Shield of Utah, No. 2L09-CV-1100 TC (D. Utah, Central Division, January 4, 2010) (successfully represented hospitals in obtaining preliminary injunction against health plan from marketing the hospitals as being in-network providers for new tiered network product that was not contemplated by the parties’ contract).

Coast Plaza Doctors Hosp. v. Blue Cross of California, 173 Cal.App.4th 1179 (2009). Successfully represented hospital in appeals court decision that providers are not preempted from pursuing direct state law claims against non-self-funded ERISA health plans, and can sue such plans in their own right, rather than as assignees of the patient’s ERISA benefits.

People v. CHCM, Inc., No. BC411400 (Los Angeles Sup. Ct. 2009). Represented hospital in complex negotiations with the city of Los Angeles for a pre-filing settlement and stipulated judgment to resolve allegations of improper psychiatric patient discharges.

Hailey v. California Physicians' Services (dba Blue Shield of California)158 Cal.App 4th 542 (2007). Represented California Medical Association in amicus briefing and at court of appeal oral argument in dispute by patient against health plan for denying payment based on post-claims underwriting.

California Pacific Medical Center v. Concentra Preferred Systems, Inc. 2004 WL 2331876 (N.D. Cal., 2004)

Mount Diablo Medical Center v. Health Net of California, Inc. 101 Cal.App.4th 711, Cal.App. 1st (2002). Court holds that Federal Arbitration Act does not preempt trial judge’s authority under California law to deny arbitration when choice of law provision in contract between hospital and health plan selected California law, and the contractual payment dispute overlapped with payment dispute with health plan’s delegated intermediary, who was not a party to the contract.

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Post-Acute & Long-Term Care Cases 

Lemaire v. Covenant Care California, LLC,  234 Cal. App. 4th 860  (2015)

Polomski v. SavaSeniorCare, LLC2014 WL 5018815, Mich. Ct. App. (2014). As lead appellate counsel to the corporate parent of a skilled nursing facility, succeeded in obtaining the complete reversal of a $500,000 attorney’s fee award after the appellate court rejected the logic of two previous decisions issued by previous panels of the same court that had affirmed such awards in similar cases under Michigan’s unique fee-shifting rule for tort cases.

Valley View Health Care, Inc. v. Chapman,  992 F.Supp.2d 1016, E.D. Cal. (2014)

Nevarrez v. San Marino Skilled Nursing and Wellness Centre, 221 Cal. App. 4th 102 (2013)  

Shuts v. Covenant Holdco LLC, 208 Cal. App. 4th 609 (2012)                                              

Peak Medical of Okla. No. 5, Inc. v. Sebelius
No. 4:10-cv-00597, 2010 WL 4809319 (N.D. Okla. Nov. 18, 2010) (represented a skilled nursing facility in its successful effort to obtain interim relief under the APA pending the outcome of its administrative appeal of CMS’s decision to terminate the facility’s Medicare participation);     

Ruiz v. Podolsky, 50 Cal.4th 838, Cal. Supreme Court (2010)

Hogan v. Country Villa Health Services, 148 Cal. App. 4th 259 (2007)

Covenant Care, Inc. v. Superior Court, 32 Cal.4th 771,  Cal. Supreme Ct. (2004)

Norman v. Life Care Centers of America, Inc., 107 Cal. App. 4th 1233 132 (2003)

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Miscellaneous Litigation 

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