Providence Health & Services-Oregon v. Mancuso

524 P.3d 973, 323 Or. App. 573
CourtCourt of Appeals of Oregon
DecidedJanuary 5, 2023
DocketA173949
StatusPublished

This text of 524 P.3d 973 (Providence Health & Services-Oregon v. Mancuso) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Providence Health & Services-Oregon v. Mancuso, 524 P.3d 973, 323 Or. App. 573 (Or. Ct. App. 2023).

Opinion

Argued and submitted December 7, 2021, reversed in part and remanded January 5, 2023

PROVIDENCE HEALTH & SERVICES–OREGON, an Oregon nonprofit corporation, dba Providence Portland Medical Center, Plaintiff-Appellant, v. Sanjana Pahalad MANCUSO, Personal Representative of the Estate of Rattan Kumar Pahalad, in her official and personal capacities, Defendant, and ELAP SERVICES, LLC, a Delaware limited liability company, Defendant-Respondent. Multnomah County Circuit Court 16CV38474; A173949 524 P3d 973

Plaintiff appeals from a judgment denying plaintiff’s claims after the trial court granted defendant’s motion for summary judgment. Plaintiff assigns error to the trial court’s rulings (1) that there was no evidence that defendant made the alleged misrepresentations that constituted plaintiff’s Unlawful Trade Practices Act (UTPA) claim; (2) that a portion of the UTPA claim was preempted by ERISA; and (3) that the trial court lacked jurisdiction to adjudicate whether defendant acted wrongfully in violating the Oregon Rules of Professional Conduct for attor- neys, as a basis for plaintiff’s tortious interference with economic relations claim. Defendant argues the trial court did not err, and alternatively argues for affir- mance on the basis that plaintiff was not a consumer and thus not a person who could bring a UTPA claim, and that plaintiff had not alleged any ascertainable loss as contemplated by the UTPA. Held: The trial court erred in granting defen- dant’s motion for summary judgment. There was a genuine issue of material fact regarding whether defendant made the alleged misrepresentations that consti- tuted the UTPA claim. The trial court’s order was overly inclusive with respect to ERISA preemption. The trial court erred in concluding it did not have jurisdic- tion to adjudicate plaintiff’s theory of tortious interference based on a violation of the Oregon Rules of Professional Conduct. Defendant’s additional arguments do not provide an alternative basis for affirming the grant of summary judgment because a nonconsumer may bring an action under the UTPA and attorney fees incurred in litigation against a third party may qualify as an ascertainable loss for purposes of a UTPA claim. Reversed in part and remanded. 574 Providence Health & Services-Oregon v. Mancuso

Eric J. Bloch, Judge. J. Aaron Landau argued the cause for appellant. Also on the opening brief was Harrang Long Gary Rudnick P. C. Also on the reply brief were Susan Marmaduke, Arden J. Olson, and Harrang Long Gary Rudnick P. C. Kristopher R. Alderman argued the cause for respon- dent. Also on the brief were Mary-Anne Rayburn, Robert W. Kirsher, and Gordon & Polscer, L.L.C. and Thomas E. Lavender, III, and FisherBroyles, LLP. Before Ortega, Presiding Judge, and Shorr, Judge, and Powers, Judge. SHORR, J. Reversed in part and remanded. Cite as 323 Or App 573 (2023) 575

SHORR, J. Plaintiff appeals from a judgment denying plain- tiff’s claims after the trial court granted defendant’s motion for summary judgment. Plaintiff assigns error to the court’s grant of summary judgment in favor of defendant on plain- tiff’s claims for violation of the Oregon Unlawful Trade Practices Act and tortious interference with economic rela- tions. For the reasons set out below, we reverse in part and remand for further proceedings. I. FACTUAL AND PROCEDURAL BACKGROUND In 2016, Rattan Kumar Pahalad sought care at the hospital Providence Portland Medical Center. Plaintiff Providence Health & Services-Oregon operates that hos- pital. Upon admission, Pahalad signed a Conditions of Admission form (the Agreement), agreeing to be financially responsible for payment for services provided by the hospi- tal at its Charge Master rates.1 Pahalad passed away after spending 12 days in plaintiff’s hospital and undergoing qua- druple bypass surgery. Plaintiff ultimately billed a total of $740,263.46 for the services provided. Prior to his death, Pahalad was covered by an employer-funded health care plan (the Plan). The Plan was administered by defendant ELAP Services,2 which func- tioned as the “Designated Decision Maker.” Defendant’s business model consists of auditing patients’ medical bills by reviewing publicly available data from health service pro- viders’ financial filings with the government and then set- ting reimbursement rates based on defendant’s assessment of the bills. Defendant will provide patients with legal rep- resentation to defend against medical providers’ attempts to recoup any unpaid balance. Based on defendant’s assess- ment, the Plan paid plaintiff $304,761.29 for the billed ser- vices, leaving $435,502.17 unpaid. 1 A hospital’s “Charge Master” is a comprehensive listing of billable items and the rates for those items. 2 Though the litigation below included Pahalad’s estate’s personal repre- sentative as a defendant, the dispute before us concerns only defendant ELAP Services. Therefore, use of “defendant” in this opinion will refer only to ELAP Services. 576 Providence Health & Services-Oregon v. Mancuso

Sanjana Pahalad Mancuso, Pahalad’s daughter, was appointed the personal representative of Pahalad’s estate. Plaintiff notified Mancuso of the unpaid balance under the Agreement and filed a claim against the estate. Mancuso conferred with her probate attorney and contacted defen- dant. Following its business model, defendant connected Mancuso with the law firm FisherBroyles to defend against plaintiff’s claim on the estate. Mancuso signed an Attorney-Client Representation Agreement with the firm on September 7, 2016.3 Mancuso subsequently filed a “Notice of Disallowance” on behalf of the estate on October 21, 2016, denying plaintiff’s claim and stating in part: “[Plaintiff] has already been paid fully and properly for the goods and services it provided to the decedent between March 23, 2016, and April 4, 2016. Through your claim, you seek to collect excessive, unreasonable charges that neither the decedent nor the estate ever agreed to pay. As you admitted, [plaintiff] has already been paid $304,761.29 for these goods and services. Medicare would have paid and [plaintiff] would have accepted just $184,179.25 for the same goods and services. Thus, [plaintiff] has already been paid 165% of the amount routinely paid and accepted for these services. In 2015, [plaintiff] collected only about half of its total charges. Accordingly, to [plaintiff’s] self-reported cost-to-charge ratios, the charges it seeks to collect from the estate are nearly three times its fully allocated costs to provide the goods and services to the decedent. [Plaintiff’s] charges are grossly in excess of both the amounts typically paid for such goods and services and the costs incurred to provide them. The estate is not liable to pay such exces- sive, unreasonable charges. [Plaintiff] has already been paid properly for the goods and services provided to the decedent.”

Plaintiff subsequently filed suit against Mancuso, claiming she breached a contract and her fiduciary duties as the representative of the estate by both failing to pay the outstanding hospital bill and denying plaintiff’s resulting

3 The Attorney-Client Representation Agreement stated that if she chose to pursue an appeal of the payment determination under the Plan, the law firm did not represent her in that matter. She filed a pro se appeal of the payment deter- mination on October 19, 2016. Cite as 323 Or App 573 (2023) 577

claim against the estate.4 Plaintiff also named defendant in the litigation, alleging that defendant provided Mancuso with false information that led Mancuso to wrongly deny plaintiff’s claim against the estate. The trial court bifurcated the proceedings.

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Bluebook (online)
524 P.3d 973, 323 Or. App. 573, Counsel Stack Legal Research, https://law.counselstack.com/opinion/providence-health-services-oregon-v-mancuso-orctapp-2023.