People v. Duz-Mor Diagnostic Laboratory, Inc.

68 Cal. App. 4th 654, 80 Cal. Rptr. 2d 419, 98 Daily Journal DAR 12683, 98 Cal. Daily Op. Serv. 9082, 1998 Cal. App. LEXIS 1028
CourtCalifornia Court of Appeal
DecidedDecember 11, 1998
DocketNo. B113282
StatusPublished
Cited by29 cases

This text of 68 Cal. App. 4th 654 (People v. Duz-Mor Diagnostic Laboratory, Inc.) 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
People v. Duz-Mor Diagnostic Laboratory, Inc., 68 Cal. App. 4th 654, 80 Cal. Rptr. 2d 419, 98 Daily Journal DAR 12683, 98 Cal. Daily Op. Serv. 9082, 1998 Cal. App. LEXIS 1028 (Cal. Ct. App. 1998).

Opinion

Opinion

ARMSTRONG, J.

This case concerns the marketing and billing practices and procedures of clinical laboratories which perform services for Medi-Cal beneficiaries. The Attorney General, acting on behalf of the People of the State of California, appellant here, alleged that one such laboratory, Duz-Mor Diagnostic Laboratory, Inc., violated the Unfair Competition Act1 (the Act) by charging discounted fees to certain patients, by paying commissions to an independent marketing contractor, and by “unbundling” Medi-Cal billing, so that certain tests which should have been billed together were [658]*658billed separately. Appellant also alleged that the use of unbundled billing violated the False Claims Act, Government Code section 12651. The trial court found that none of the practices were unfair and that none violated any law, and thus that appellant had not proved a violation of the Act or the False Claims Act. We agree with many of the trial court’s conclusions, but do find that with regard to one of the factual allegations, concerning commissions paid to an independent contractor for marketing services, appellant proved a violation of law, and thus of the Act. We therefore reverse the judgment.

Summary

Under the Act, “unfair competition” means “any unlawful, unfair or fraudulent business act or practice . . . .” (Bus. & Prof. Code, § 17200.) A business practice constitutes unfair competition if it is forbidden by any law, “be it civil or criminal, federal, state, or municipal, statutory, regulatory, or court-made” (Saunders v. Superior Court (1994) 27 Cal.App.4th 832, 838-839 [33 Cal.Rptr.2d 438]) or if it is unfair, that is, if it “ ‘ “offends an established public policy or . . .is immoral, unethical, oppressive, unscrupulous or substantially injurious to consumers.” . . .’” (Podolsky v. First Healthcare Corp. (1996) 50 Cal.App.4th 632, 647 [58 Cal.Rptr.2d 89], citations omitted.)

Here, appellant alleged that respondents Duz-Mor Diagnostic Laboratory, Inc., a licensed clinical laboratory, Duz-Mor owner and chief executive officer (CEO) Joe Morehead, and Duz-Mor controller Zaven Aghankani engaged in a number of unfair business practices relating to Medi-Cal. Appellant alleged that the offer of discounted prices to certain patients and the payment of commissions to an independent marketing contractor violated Welfare and Institutions Code section 14107.2, subdivision (b)2 and Business and Professions Code section 6503 and a number of administrative regulations, and that the use of “unbundled” billing for certain tests violated [659]*659Government Code section 12651, subdivision (a), the False Claims Act.* **4 Appellant also contended that all those practices were unfair as that term is used in the Act. Appellant sought civil penalties of not less than two million dollars, restitution of sums unlawfully obtained, and injunctions.

Judgment was entered in favor of respondents after court trial. In response to a timely request by appellant, the trial court issued a statement of decision.

The statement of decision specified that the ruling was based in part on a finding that two of the above cited statutes, Welfare and Institutions Code section 14107.2 and Business and Professions Code section 650, must be construed to require a specific intent to violate the law, in order to avoid those constitutional problems which fall under the heading of “void for vagueness.” In so finding, the court relied on case law interpreting the federal Medicare “anti-kickback” statute, on which Welfare and Institutions Code section 14107.2 is modeled. For reasons set forth later in this opinion, we cannot agree that the statutes can be so read.

After review of all the evidence and arguments, we find that appellant did prove a violation of the Act, since the payment of commissions to a marketing contractor violates Welfare and Institutions Code section 14107.2. [660]*660However, appellant did not prove that the practice of offering discounted payments to certain patients, or the “unbundled” billing, violated any law or administrative regulation, or was unfair as that term is defined in the Act.

Standard of Review

The facts of this case are in large part undisputed, and were the subject of findings of fact by the trial court. Where appellant does challenge the sufficiency of the evidence to support a finding we are bound by the substantial evidence rule, and must accept as true all evidence tending to establish the correctness of the finding as made. Every substantial conflict in the testimony is resolved in favor of the finding. (Jacoby v. Feldman (1978) 81 Cal.App.3d 432, 442 [146 Cal.Rptr. 334].)

Interpretation and application of statutes is a question of law, subject to our independent review. (Service Employees Internat. Union v. County of Los Angeles (1990) 225 Cal.App.3d 761, 774 [275 Cal.Rptr. 508].) The question of whether a practice is unfair under the Act is such a question, and we consider the issue de novo. (Olsen v. Breeze, Inc. (1996) 48 Cal.App.4th 608, 621 [55 Cal.Rptr.2d 818].)

Facts

In summarizing the facts, we rely on the trial court’s extensive findings of fact. We summarize only those facts necessary to a determination of the legal issues on appeal, and generally do so as part of our review of each legal issue. We begin, however, with the preliminary facts necessary to an understanding of the case.

Duz-Mor is a clinical laboratory licensed by the state’s Department of Health Services (the Department) to perform diagnostic testing of human blood, urine, and other specimens. Duz-Mor is also a Medi-Cal provider. The Medi-Cal program is administered by the Department, and in order to become a provider, a laboratory must apply to the Department and be accepted by that agency.

Clinical laboratories such as Duz-Mor may perform tests only when tests are ordered by a physician. Where patients will pay for their own tests, and for patients with insurance, physicians may bill the patient or third party payor. The physician may not mark up the laboratory charge. (Bus. & Prof. Code, § 655.5.) Pursuant to Medi-Cal requirements, Duz-Mor billed MediCal directly for tests performed for Medi-Cal beneficiaries.

Between 65 and 70 percent of Duz-Mor’s business involved Medi-Cal billing and an additional 10 to 15 percent involved Medicare billing. Duz-Mor also had private-pay patients, HMO (health maintenance organization) patients, and business which involved direct billing to patients.

[661]*661The rules for Medi-Cal billing are found in Medi-Cal regulations and manuals. Medi-Cal reimburses laboratories such as Duz-Mor at fixed rates which are substantially less than retail rates. Under a regulation promulgated by the Department, Medi-Cal reimburses for laboratory tests at the least of four prices: the amount billed, the charge to the general public, Medicare’s maximum allowance, or the amount set out in the regulation. (Cal. Code Regs., tit. 22, § 51529, subd. (a)(2).) On average, Medi-Cal reimbursement rates are 60 percent of the charges on Duz-Mor’s schedule of fees.

The Department conducts routine audits of the amounts paid to providers like Duz-Mor for services to Medi-Cal beneficiaries, and may seek the return of any overpayment. (Welf. & Inst.

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68 Cal. App. 4th 654, 80 Cal. Rptr. 2d 419, 98 Daily Journal DAR 12683, 98 Cal. Daily Op. Serv. 9082, 1998 Cal. App. LEXIS 1028, Counsel Stack Legal Research, https://law.counselstack.com/opinion/people-v-duz-mor-diagnostic-laboratory-inc-calctapp-1998.