Commonwealth v. Samaritan Alliance, LLC

439 S.W.3d 757, 2014 WL 685479, 2014 Ky. App. LEXIS 27
CourtCourt of Appeals of Kentucky
DecidedFebruary 21, 2014
DocketNo. 2012-CA-000745-MR
StatusPublished
Cited by7 cases

This text of 439 S.W.3d 757 (Commonwealth v. Samaritan Alliance, LLC) is published on Counsel Stack Legal Research, covering Court of Appeals of Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Commonwealth v. Samaritan Alliance, LLC, 439 S.W.3d 757, 2014 WL 685479, 2014 Ky. App. LEXIS 27 (Ky. Ct. App. 2014).

Opinion

[759]*759 OPINION

MAZE, Judge:

The Cabinet for Health and Family Services and the Cabinet’s Secretary (collectively, “the Cabinet”) bring this interlocutory appeal from an order of the Franklin Circuit Court denying its motion to dismiss the breach of contract and fraud claims brought against it by Samaritan Alliance LLC, d/b/a Samaritan Hospital (“Samaritan”). The Cabinet argues that Samaritan’s claims for breach of contract and fraud are barred by the doctrine of sovereign or governmental immunity. We conclude that the legislature has waived the Cabinet’s immunity from the breach of contract claim by operation of Kentucky Revised Statutes (KRS) 45A.245. We further find that KRS 13B.150 allows Samaritan to present evidence of extrinsic fraud as part of its statutory appeal from the Cabinet’s Final Order, but Samaritan cannot assert an independent claim for damages arising out of that alleged fraud. Finally, we conclude that the substantive matters regarding the validity of Samaritan’s statutory appeal are not properly raised in this interlocutory appeal. Hence, we affirm in part, reverse in part, and remand for additional proceedings.

During the periods relevant to this action, Samaritan owned and operated Samaritan Hospital, a 366-bed acute care hospital in Fayette County. The Cabinet administers the Kentucky Medical Assistance Program (KMAP), which provides for implementation of the Federal Medicaid Program in Kentucky. Samaritan entered into a Medicaid Provider Agreement with the Cabinet. The Agreement provided that the Cabinet would reimburse Samaritan for Medicaid services provided at rates governed by state and federal statutes and regulations.

Samaritan alleges that, beginning in 2003, the Cabinet misapplied the regulations governing reimbursement for certain outpatient services. Samaritan states that the Cabinet’s actions resulted in a substantial underpayment of Medicaid reimbursements. When Samaritan received notice of its Medicaid rates for the year beginning July 1, 2004, it filed a request for a Dispute Resolution Meeting (DRM). The Cabinet held the DRM on May 25, 2005, but has never issued a decision on the matter. Samaritan filed requests for DRMs regarding its reimbursements for the years beginning July 1, 2005, and 2006, respectively. Samaritan states that the Cabinet has not responded to those appeals.

On April 11, 2007, the Cabinet sent a letter stating that it had overpaid Medicaid reimbursements to Samaritan in the amount of $241,687 and that it was seeking reimbursement of that amount. Five days later, Samaritan filed for bankruptcy. On May 25, 2007, Samaritan responded to the Cabinet’s April 11, 2007 letter. Samaritan stated that it was objecting to the Cabinet’s claim for reimbursement. Samaritan also reminded the Cabinet of its pending appeals in the other matters and requested that any attempted recoupment be stayed pending resolution of those claims.

After conducting an evidentiary hearing,, the Cabinet’s hearing officer issued a recommended order dismissing Samaritan’s appeal as untimely. On January 18, 2008, the Secretary of the Cabinet issued a Final Order which adopted the hearing officer’s recommended order and dismissed the appeal.

Thereafter, on February 15, 2008, Samaritan filed this action asserting a number of claims for relief, including a claim for breach of contract, challenges to the Secretary’s Final Order dismissing the appeal, to the Cabinet’s method of calculating Medicaid reimbursements, and to the [760]*760Cabinet’s failure to rule on Samaritan’s previous appeals. During the course of discovery in the action, Samaritan obtained internal Cabinet e-mails indicating that the Cabinet was aware that it had underpaid Medicaid providers at the time it sent the April 11, 2007 letter claiming an overpayment. Based upon this information, Samaritan filed an amended complaint asserting a claim for fraud against the Cabinet.

On January 24, 2012, the Cabinet moved to dismiss Samaritan’s claims for breach of contract and fraud based upon sovereign immunity, and also argued that Samaritan’s other claims should be dismissed based upon untimeliness and failure to exhaust administrative remedies. On February 6, the trial court overruled the Cabinet’s motion, holding that there were factual and legal issues concerning the effect of Samaritan’s 2007 bankruptcy filing. After additional discovery, the Cabinet renewed its motion to dismiss based upon Samaritan’s failure to file a timely appeal and sovereign immunity. On the former issue, the trial court found that there were factual issues regarding whether the Cabinet had acted arbitrarily or capriciously. On the latter issue, the trial court determined that the Cabinet waived any sovereign immunity from the tort and breach of contract claims by entering into a Medicaid Service Provider Agreement with Samaritan. The Cabinet then brought this interlocutory appeal

Generally, under Kentucky Rules of Civil Procedure (CR) 56.03, the denial of a motion for summary judgment is not appealable. However, sovereign immunity entitles its possessor to be free from the burdens of not only liability, but also of defending the action. Rowan County v. Sloas, 201 S.W.3d 469, 474 (Ky.2006). See also Lexington—Fayette Urban County Government v. Smolcic, 142 S.W.3d 128, 135 (Ky.2004). Therefore, an order denying a claim of sovereign immunity is immediately appealable. Breathitt County Bd. of Educ. v. Prater, 292 S.W.3d 883 (Ky.2009). Furthermore, we review the case on a de novo basis because it presents a question of law. See Sloas, 201 S.W.3d at 475; Northern Kentucky Area Planning Commission v. Cloyd, 332 S.W.3d 91, 93 (Ky.App.2010).

As a preliminary matter, however, Samaritan moves to dismiss the Cabinet’s appeal as falling outside the rule allowing interlocutory appeals. Samaritan concedes that the denial of a substantial claim of absolute immunity is immediately ap-pealable before final judgment. Prater, 292 S.W.3d at 887, citing Mitchell v. Forsyth, 472 U.S. 511, 105 S.Ct. 2806, 86 L.Ed.2d 411 (1985). But Samaritan contends that the Cabinet’s claim of immunity is neither substantial nor absolute because it seeks review of the trial court’s decision denying its motion to dismiss the fraud and breach of contract claims.

We agree with Samaritan to the extent that the Cabinet is attempting to raise issues which are not related to its claim of sovereign immunity. Although a party can immediately appeal from the denial of a motion to dismiss based upon absolute immunity, most other substantive defenses must wait for adjudication by a final order. In this case, the trial court found that Samaritan has a statutory right to appeal from the Cabinet’s administrative decisions or its failures to render administrative decisions.

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Cite This Page — Counsel Stack

Bluebook (online)
439 S.W.3d 757, 2014 WL 685479, 2014 Ky. App. LEXIS 27, Counsel Stack Legal Research, https://law.counselstack.com/opinion/commonwealth-v-samaritan-alliance-llc-kyctapp-2014.