Kaiser Foundation Health Plan v. Super. Ct.

CourtCalifornia Court of Appeal
DecidedJuly 31, 2017
DocketB272284
StatusPublished

This text of Kaiser Foundation Health Plan v. Super. Ct. (Kaiser Foundation Health Plan v. Super. Ct.) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kaiser Foundation Health Plan v. Super. Ct., (Cal. Ct. App. 2017).

Opinion

Filed 7/31/17 CERTIFIED FOR PUBLICATION

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

SECOND APPELLATE DISTRICT

DIVISION SEVEN

KAISER FOUNDATION HEALTH B272284 PLAN, INC., et al., (Los Angeles County Petitioners, Super. Ct. No. BS158615)

v.

THE SUPERIOR COURT OF LOS ANGELES COUNTY,

Respondent;

PRIME HEALTHCARE LA PALMA, LLC, et al.,

Real Parties in Interest.

ORIGINAL PROCEEDINGS in mandate. Jane L. Johnson, Judge. Petition granted to direct that judgment be vacated for lack of jurisdiction. Manatt, Phelps & Phillips, Gregory N. Pimstone and Joanna S. McCallum for Petitioners. No appearance for Respondent. King & Spalding, Marcia Augsburger and W. Scott Cameron for Real Parties in Interest.

________________________

INTRODUCTION

Prime Healthcare La Palma, LLC and affiliated hospitals (collectively, Prime)1 sued Kaiser Foundation Health Plan, Inc. (Kaiser)2 in superior court under California law, alleging that Kaiser failed to reimburse Prime for emergency medical services Prime provided to Kaiser members. A portion of Prime‘s claims relate to emergency medical services Prime provided to enrollees in a Medicare Advantage plan administered by Kaiser pursuant to Part C of the Medicare Act (42 U.S.C. § 1395w-21 et seq.) (the Medicare Advantage claims). After a rather convoluted multi-year path, the parties agreed to arbitration in lieu of the superior court litigation. After

1 The other hospitals in the group are Alvarado Hospital, LLC; Prime Healthcare Centinela, LLC; Veritas Health Services, Inc.; Desert Valley Hospital, Inc.; Prime Healthcare Services– Garden Grove, LLC; Prime Healthcare Paradise Valley, LLC; Prime Healthcare Services–San Dimas, LLC; Prime Healthcare Anaheim, LLC; Prime Healthcare Services-Encino, LLC; Prime Healthcare Huntington Beach, LLC; Prime Healthcare Services– Montclair, LLC; and Prime Healthcare Services-Sherman Oaks, LLC. Each of these hospitals was, at relevant times, owned and operated by Prime Healthcare, Inc. or an affiliated entity. 2 Two other Kaiser entities were named as defendants: Kaiser Foundation Hospitals and Southern California Permanente Medical Group.

2 Prime filed an arbitration demand, Kaiser moved in the arbitration proceedings to dismiss Prime‘s Medicare Advantage claims on the ground that they are preempted by the Medicare Act and subject to that Act‘s requirement that claimants exhaust administrative remedies before resorting to litigation or arbitration. The arbitration panel denied Kaiser‘s motion and memorialized its ruling in what it labeled as a ―Partial Final Award Re Medicare Advantage Claims‖ (the partial final award). Kaiser petitioned the trial court to vacate the award. The court denied the petition and entered a judgment confirming the award. The case is before us on Kaiser‘s appeal from that judgment. Kaiser contends that the panel‘s ruling on the Medicare Act preemption and exhaustion issues memorialized in the partial final award was wrong as a matter of law and that the court thus erred in entering a judgment confirming the award. Prime defends the legal basis of the rulings by the panel and the court on those issues. Prior to oral argument, we asked the parties to address whether the judgment was appealable, and, if not, whether we could review the judgment by treating Kaiser‘s appeal as a petition for writ of mandate. At oral argument and in supplemental briefs, Kaiser and Prime joined forces and answered yes to both questions. We have concluded otherwise, however. The merits of the confirmation of the panel‘s award on the Medicare Act preemption and exhaustion issues are not reviewable, either by appeal or by writ.

3 Code of Civil Procedure3 section 1294, subdivision (d) (section 1294(d)), authorizes appeals from judgments confirming arbitration awards. To be appealable under section 1294(d), however, a judgment confirming an arbitration award must be final—that is, it must embody a final determination of the parties‘ rights, just like an appealable judgment in a civil case that did not go to arbitration (§§ 577, 904, 1287.4). The judgment confirming the partial final award here does not meet that standard. The judgment is final only as to the determination that the Medicare Advantage claims are neither preempted by the Medicare Act nor subject to exhaustion under that Act. It resolved nothing more than that. Whether Kaiser is liable to Prime on the Medicare Advantage claims remains to be resolved in the arbitration and then in subsequent proceedings in the trial court. The same is true of all of Prime‘s other claims (the Medicare Advantage claims constitute just one piece of Prime‘s claims), as well as cross-claims that Kaiser has submitted to arbitration. Because the judgment is not a final judgment, it is nonappealable. Our ability to review by writ the merits of the judgment confirming the partial final award on the Medicare Act preemption and exhaustion issues depends on whether the trial court had jurisdiction to confirm the award in the first place. The court lacked jurisdiction if the ―award‖ did not meet the section 1283.4 standards for an award. To qualify under section 1283.4, an award must ―include a determination of all the questions submitted to the arbitrators the decision of which is necessary in

3 All undesignated statutory references are to the Code of Civil Procedure.

4 order to determine the controversy‖ (§ 1283.4). Based on the reasoning of our decision in Judge v. Nijjar Realty, Inc. (2014) 232 Cal.App.4th 619 (Judge), the partial final award the court confirmed fails to satisfy that requirement because it determined only the questions of Medicare Act preemption and exhaustion. It left unresolved all of the other questions the arbitrators will have to decide in order to determine the parties‘ controversy. Because the ―award‖ is not an award, we cannot review by writ the merits of the confirmation of the panel‘s Medicare Act preemption and exhaustion rulings. We are, however, treating Kaiser‘s appeal as a petition for writ of mandate for the purpose of directing the trial court to vacate its judgment confirming the partial final award and enter a new order dismissing Kaiser‘s petition to vacate the award. We do so on the ground that the failure of the partial final award to qualify as an ―award‖ under section 1283.4 deprived the court of jurisdiction to confirm or vacate it. Parties generally have broad leeway to structure an arbitration as they see fit, free from statutory constraints. They may, for example, conduct the arbitration in phases and ask the arbitrators, as Kaiser and Prime did here, to issue phase-specific, interim awards. Parties‘ requests for judicial approval or disapproval of arbitration awards are, however, subject to statutory constraints that limit when and under what circumstances courts may review arbitrators‘ rulings. Those restrictions deprive trial courts of jurisdiction to review an award that does not qualify as an award under section 1283.4, and appellate courts of jurisdiction to review on appeal a judgment that does not qualify as a final judgment under section 1294(d).

5 The request of Kaiser and Prime for judicial intervention into their arbitration at this stage founders on these shoals.

FACTUAL AND PROCEDURAL BACKGROUND

A. The State Court Litigation In January 2008, Prime filed five separate state court actions against Kaiser in different counties throughout California. Prime‘s claims arose from its provision of emergency medical services to Kaiser members, including to enrollees in Kaiser‘s Medicare Advantage plan.4

4 By way of background, Congress established the Medicare Advantage program in 1997 as Part C of the Medicare Act. (42 U.S.C.

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Kaiser Foundation Health Plan v. Super. Ct., Counsel Stack Legal Research, https://law.counselstack.com/opinion/kaiser-foundation-health-plan-v-super-ct-calctapp-2017.