South Peninsula Hospital v. Xerox State Healthcare LLC

223 F. Supp. 3d 929, 2016 U.S. Dist. LEXIS 188165, 2016 WL 8290121
District Court, D. Alaska·Decided September 30, 2016·No. Case No. 3:15-cv-00177-TMB·Published·Cited by 3 cases

Opinion

ORDER RE: DEFENDANT’S MOTION TO DISMISS

TIMOTHY M. BURGESS, UNITED STATES DISTRICT JUDGE

I. INTRODUCTION

This matter is now before the Court on Defendant Xerox State Healthcare, LLC’s (“Xerox”) Motion to Dismiss Plaintiffs First Amended Complaint. The Court heard oral argument on Xerox’s motion on June 29, 2016.1 Based on the arguments presented in the parties’ briefs and at oral argument, and for the reasons that follow, the Court DENIES Xerox’s motion to dismiss at docket 35.

II. BACKGROUND

a. Procedural History

Plaintiffs South Peninsula Hospital (“South Peninsula”), Alaska Speech and Language Clinic, Inc. (“Alaska Speech”), and Kenai Vision Center, LLC (“Kenai Vision”) initiated this action on September 24, 2015, on behalf of themselves and all others similarly situated.2 On January 15, 2016, Plaintiffs filed their First Amended Complaint (“FAC”), alleging violations of the Alaska Unfair Trade Practice and Consumer Protection Act (Count One) and negligence and/or reckless indifference (Count Two).3 In relief, Plaintiffs seek monetary damages to compensate them[933]*933selves and other Medicaid providers for financial injuries they suffered due to delayed reimbursements caused by defects in the State of Alaska’s Medicaid payment system, which Xerox designed, developed, and implemented.4

Xerox moved to dismiss the FAC pursuant to Fed. R. Civ. P. 12(b)(1) and Fed. R. Civ. P. 12(b)(6) on February 8, 2016.5 Plaintiffs filed their opposition on March 3, 2016.6 and Xerox replied on March 21, 2016.7 In addition to their briefing, Xerox submitted several affidavits and exhibits in support of its position regarding the exhaustion of administrative remedies and this Court’s subject matter jurisdiction over the claims in this action.

b. Factual Background

Among other things, the FAC alleges that:

The parties. Plaintiffs are all healthcare providers enrolled in Medicaid who submitted claims for reimbursement for Medicaid services from October 1, 2013 to present using the State of Alaska’s Medicaid Management Information System (“MMIS”).8 The current version of Alaska’s MMIS is called “Healthcare Enterprise.” 9

Xerox is a limited liability company based in Atlanta, Georgia and with an office in Anchorage, Alaska.10 As the successor to Affiliated Computer Services State Healthcare, LLC (“ACS”), Xerox was responsible for the design, development, and implementation of Healthcare Enterprise.11

Health Enterprise. Alaska’s Medicaid program is administered by the Alaska Department of Health and Social Services (“DHSS”).12 The Alaska Medicaid system serves more than 140,000 low-income or disabled Alaskans.13 Through this system, DHSS pays out approximately $1.5 billion annually in state and federal money to Medicaid providers.14

Alaska’s original MMIS was established in 1987 to process and pay Medicaid claims.15 In November 2006, DHSS issued a Request for Proposals (“RFP”) to replace the original MMIS.16 Among other things, the RFP required that the new MMIS meet all federal Medicaid requirements and state healthcare mandates; permit timely processing of Medicaid claims from health care providers, whether those claims were submitted electronically or on federally approved paper forms; and provide prompt payment of authorized claims.17

DHSS’ contract for the new MMIS contemplated three phases: (1) design, devel[934]*934opment, and implementation of the new MMIS; (2) operation of the MMIS, including its data warehouse and decision support system; and (3) turnover of the MMIS to DHSS or its contractor upon completion of performance.18 In 2007, DHSS awarded the MMIS contract to ACS.19 Section A.13 of the contract expressly states that ACS is an independent contractor for the State.20 Section A.22 states that the contract “is for the sole benefit of the parties hereto and not for the benefit of any third party.”21 Xerox became ACS’ successor-in-interest to the contract when it acquired ACS.22

“Go-live" crisis. After a series of delays, Health Enterprise went live on October 1, 2013.23 As of the “go-live” date, electronic and paper claims could be submitted by Medicaid providers only through Health Enterprise and not through the old MMIS.24 Plaintiffs allege that DHSS agreed to the “go-live” date based on its reasonable reliance on misrepresentations made by Xerox about the readiness of Health Enterprise to process healthcare providers’ Medicaid claims, including that Xerox had performed extensive “system testing” on the MMIS to confirm that the system met the essential requirements necessary to “go live.”25

Almost immediately after Health Enterprise went live, it became clear that the system was not able to perform the functions required of it under the MMIS contract.26 The system, for example, was unable to process many properly submitted claims, erroneously denied authorized claims, and failed to pay certain entire categories of claims.27 Because of these and other material system defects about which Plaintiffs allege Xerox knew or should have known, Medicaid providers were prevented from receiving timely reimbursements on properly submitted, valid claims.28

Those delayed reimbursements resulted in financial harms to Medicaid providers, including loss of the time value of money, increased operational costs expended to recover backlogged payments, business injury due to interruption of cash flow, and even going out of business.29

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South Peninsula Hospital v. Xerox State Healthcare LLC, 223 F. Supp. 3d 929, 2016 U.S. Dist. LEXIS 188165, 2016 WL 8290121 (D. Alaska 2016).

223 F. Supp. 3d 929 (South Peninsula Hospital v. Xerox State Healthcare LLC) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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