State of Cal. v. Encino Hospital Medical Center

CourtCalifornia Court of Appeal
DecidedJanuary 20, 2023
DocketB302426
StatusPublished

This text of State of Cal. v. Encino Hospital Medical Center (State of Cal. v. Encino Hospital Medical Center) 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
State of Cal. v. Encino Hospital Medical Center, (Cal. Ct. App. 2023).

Opinion

Filed 12/21/22; Modified and Certified for Pub. 1/20/23 (order attached)

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA SECOND APPELLATE DISTRICT DIVISION ONE

STATE OF CALIFORNIA ex rel. B302426, B303196 MARY LYNN RAPIER et al., (Los Angeles County Plaintiffs and Appellants, Super. Ct. No. BC641254) v. ENCINO HOSPITAL MEDICAL CENTER et al., Defendants and Respondents.

APPEALS from a judgment and post-judgment order of the Superior Court of Los Angeles County, William F. Fahey, Judge. Affirmed. California Department of Insurance, J. Scott McNamara, Assistant Chief Counsel, Nicholas G. Campins and Sara Kim Danielson, Trial Attorneys, for Plaintiff and Appellant State of California. Waters Kraus & Paul, Gary M. Paul, Michael L. Armitage, Charles S. Siegel, Kay Gunderson Reeves; Bartlett Barrow, Brian P. Barrow and Jennifer L. Bartlett for Plaintiff and Appellant Mary Lynn Rapier. Knox Ricksen, Thomas E. Fraysse and Taylor T. Steele for Anti-Fraud Alliance as Amicus Curiae on behalf of Plaintiffs and Appellants. Katten Muchin Rosenman, Ryan M. Fawaz and Christopher B. Maciel for The Coalition Against Insurance Fraud as Amicus Curiae on behalf of Plaintiffs and Appellants. Jacklyn DeMar; Goldberg Kohn, Roger A. Lewis, W. Kyle Walther; Rukin Hyland & Riggin and Valerie Brender for Taxpayers Against Fraud Education Fund as Amicus Curiae on behalf of Plaintiffs and Appellants. King & Spalding, Peter A. Strotz, Paul R. Johnson, James W. Boswell and Michael E. Paulhus for Defendants and Respondents. _______________

This proceeding arises out of a qui tam action against Prime Healthcare Services—Encino Hospital, LLC (Encino Hospital) and others to impose civil penalties for violation of the Insurance Fraud Prevention Act (IFPA), Insurance Code section 1871 et seq. The State of California and relator Mary Lynn Rapier appeal from a judgment entered after a bench trial in which the court found insufficient evidence supported their allegations that defendants engaged in insurance fraud by billing insurers for services performed in a detox center for which they had no appropriate license, and by employing a referral agency to steer patients to the center. We affirm the judgment.

2 BACKGROUND Encino Hospital was licensed by the Department of Public Health (sometimes CDPH) as a general acute care hospital (sometimes GACH). SRCC Associates, LLC was formed to operate a long-term detox facility. Through a management services agreement, Encino Hospital engaged SRCC Associates to manage and operate Serenity Recovery Center (Serenity) at the hospital, under the hospital’s direction and control, to provide acute (i.e., short-term) drug and alcohol detoxification services. Serenity operated at Encino Hospital from November 3, 2015, to January 31, 2019. The program provided no long-term or outpatient services.

A. Complaint On November 18, 2016, Mary Lynn Rapier filed this qui tam action 1 on behalf of the People of the State of California, alleging employment-related claims and various violations of the Insurance Code against 10 defendants. Rapier filed the complaint in the name of the State of California, under seal, as required by statute (Ins. Code, § 1871.7, subd. (e)), but the superior court unsealed it on February 5, 2018, when the California Department of Insurance (CDI) elected to intervene.

1“ ‘Qui tam is short for the Latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, which means “who pursues this action on our Lord the King’s behalf as well as his own.” ’ ” (San Francisco Unified School Dist. ex rel. Contreras v. Laidlaw Transit, Inc. (2010) 182 Cal.App.4th 438, 442, fn. 2; Vermont Agency of Natural Resources v. U.S. ex rel. Stevens (2000) 529 U.S. 765, 768, fn. 1.)

3 (We will refer to the CDI and the State of California interchangeably.) From that point forward, CDI had “the primary responsibility for prosecuting the action.” (Ins. Code, § 1871.7, subd. (f)(l).) 2 On May 2, 2018, the CDI filed a first amended complaint alleging employment and insurance fraud claims against 17 defendants. The trial court ordered arbitration as to the employment claims but stayed arbitration pending the outcome at trial of the insurance fraud claims. On November 9, 2018, CDI filed the operative second amended complaint, which was eventually pared down to allege a cause of action for “illegal patient steering,” in violation of subdivision (a) of section 1871.7, and a cause of action for “submission of false claims” in violation of subdivision (b) of that section. CDI alleged the causes of action against six defendants: Encino Hospital, Prime Healthcare Services, Inc., and Prime Healthcare Foundation, Inc. (collectively Prime); and SRCC Associates, its principal, Jonathan Lasko, and JNL Management, LLC (collectively SRCC). Of note in this paring down process, the trial court ruled that no triable issue of material fact existed as to whether Encino Hospital was properly licensed by the California Department of Public Health as a general acute care hospital. The CDI alleged that although Encino Hospital was properly licensed as a general acute care hospital, it could not legally operate a medical detoxification facility because it had no separate license as a chemical dependency recovery hospital (sometimes CDRH). The CDI alleged that in billing for detox

2Undesignated Statutory references will be to the Insurance Code.

4 services for which they had no proper license, defendants knowingly submitted at least 1,858 fraudulent insurance claims, requiring an award of damages of at least $57,678,436 before trebling. CDI further alleged that Serenity employed a referring party to funnel patients to its program in exchange for Serenity discharging acute-care patients to chronic-care facilities affiliated with the referring party. The parties engaged in some law and motion proceedings which we will describe in the discussion portion of this opinion as they become pertinent. B. Trial A bench trial commenced on June 19, 2019, at which CDI presented the testimony of multiple witnesses and introduced about 50 exhibits. Jonathan Lasko, SRCC Associates’ principal, testified that in 2014 he became involved in the medical detoxification business in Florida. He came to California in 2015, formed SRCC Associates, and entered into a management services agreement with Encino Hospital. Lasko testified the management services agreement was a lengthy and detailed contract that “went back and forth” between the lawyers. Lasko deferred to his lawyers regarding all licensing issues. Lasko testified that SRCC Associates set up Serenity’s detox program on the third floor of Encino Hospital, and began operations in November 2015. The hospital made 28 beds available for the program. In 2016, Lasko hired Rapier as the director of Serenity’s clinical services. Serenity obtained patients through an in-house marketing program and through referrals from such entities as Aid in

5 Recovery, LLC (AIR), a call center. There was no written agreement between Serenity and AIR, and Serenity did not pay for referrals. Serenity’s patients, who were admitted only with a doctor’s approval, were provided 24-hour inpatient care, usually staying for three to seven days. Serenity was not a lock-down facility; its patients could leave at any time. Most patients preplanned their transfer to a long-term residential treatment facility after their stay at Serenity. Lasko testified that a predetermined discharge plan was sometimes necessary because patients undergoing acute detoxification were unable to make sensible long-term decisions. The patients’ medical expenses were covered by insurance companies or other providers, whom Encino Hospital billed.

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Bluebook (online)
State of Cal. v. Encino Hospital Medical Center, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-of-cal-v-encino-hospital-medical-center-calctapp-2023.