Tulare Local Healthcare District

United States Bankruptcy Court, E.D. California·Decided April 27, 2021·No. 17-13797·Unknown

Opinion

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF CALIFORNIA In re ) Case No. 17-13797-B-9 ) TULARE LOCAL HEALTHCARE ) DC No. GL-1 ) ) Debtor. ) ) ) )

MEMORANDUM DECISION ON CREDITOR DEPARTMENT OF HEALTH CARE SERVICES’ MOTION FOR LEAVE TO FILE AMENDED CLAIM 197 Before: René Lastreto II, Bankruptcy Judge __________________ Grant Lien, Deputy Attorney General of California, Sacramento, CA, for the Department of Health Care Services, Creditor. Riley C. Walter, WANGER JONES HELSLEY, PC, Fresno, CA, for Tulare Local Health Care District, dba Tulare Regional Medical Center, Debtor. _____________________ RENÉ LASTRETO II, Bankruptcy Judge: To receive payments on allowed claims provided by a Chapter 9 Plan of Adjustment under the Bankruptcy Code, the creditor must file a proof of claim on the approved form.1 Filed claims can be amended. The question here is “when?” 1 Unless specified otherwise, all chapter, code and rule references are to the Bankruptcy Code, 11 U.S.C. §§ 101-1532, and the Federal Rules of In the Ninth Circuit, amendments to claims are “liberally” allowed unless leave to amend would prejudice an opposing party. “Prejudice,” though, means more than having to litigate about or pay the claim. The California Department of Health Care Services (“DHCS”) timely filed a proof of claim on the approved form in the Tulare Local Health Care District’s (“District”) Chapter 9 case. But the claim stated the amount was “[u]ndetermined at this time.” After District objected to allowance of the claim, filed a Disclosure Statement and Plan of Adjustment, obtained court approval of the Disclosure Statement, served the Disclosure Statement and Plan, District’s creditors voted to overwhelmingly support the Plan, and the court confirmed the Plan, DHCS filed a motion to amend the claim from “undetermined” to $5,520,423.33. DHCS had many reasons for the delay in specifying the claim amount. The court considered those and the prejudice District, its creditors, and other constituencies would experience if leave to amend was granted. Based on the evidence and status of the Chapter 9 case, the court DENIES the motion for leave to amend. Background Since 2002, District was a participant in a program administered by DHCS providing supplemental reimbursement to qualified health providers for outpatient services rendered to Medi-Cal patients. Doc. 2260. Annually, District provided cost Bankruptcy Procedure, Rules 100 1-9037. The Federal Rules of Civil Procedure are referred to as “Civ. Rule.” reports to DHCS for eligible outpatient services. Doc. 1513. Under California’s reimbursement plan, DHCS should annually reconcile District’s cost reports with settled/audited cost reports. After reconciliation, any underpayment or overpayment is to be reflected annually in DHCS’s supplemental payment to the participating provider under the program. Doc. 2260. Though District submitted its reports annually, no reconciliation followed. Docs. 1513, 2397. That is until after this case was filed, a claim deadline imposed, and District objected to DHCS’s claim – over sixteen years after the reimbursement program began. Why? Because, DHCS says, as of April 2018 (when it filed its proof of claim 197 in an “undetermined” amount) “final reconciliations [were] still pending.”2 Also, DHCS says “the reconciliation process is inherently complicated and necessarily time consuming.” Doc. 2259. Time is consumed because interim payments to District (and other providers) are calculated using “cost-to-charge ratios” from provider cost reports and Medi-Cal Fee-for-Service (“FFS”) charges. Id. But final reconciliations require audited cost reports and FFS charges and payments reconciled from the State’s “internal Medicaid Management Information System (“MMIS”).” Id. DHCS “experienced difficulties” during this sixteen-year period due to: “difficulties in extracting [outpatient fee-for- service] charges and revenues from MMIS;” “workforce Mendiol2 aD e wc al s. “S Sh ei ce tl ia o nM e Cn hd ii eo fl a o, f a Mt et da ic -h C. a lt o S up pr po lo ef m eo nf t ac ll a Pi am y m1 e9 n7 t. S eT ch te in o, n ,M s S. t aff Services Manager II, for the Safety New Financing Division of . . . [DHCS].” reductions;” and “inefficiencies with workflow logistics, some of which lasted for years.” Id. Once DHCS “developed the necessary framework for extracting the data, additional nuances needed to be addressed.” DHCS had to determine the amount of provider cost associated with professional services by using all providers’ MMIS data so it could be excluded. This proved to be “difficult” and led to further delays. Id. Meanwhile, beset with many financial and other problems complicated by its former management arrangement, District filed this Chapter 9 case September 30, 2017. Less than three months later, DHCS was added to the creditor list. After entering an order for relief, the court issued an order setting the claims bar date for April 10, 2018. Doc. 377. Thirteen months later, District filed its Plan of Adjustment and Disclosure Statement. Docs. 1440, 1441. The Disclosure Statement said allowed unsecured claims would be between $16.5 million and $26 million held by about 250 claimants. Doc. 1441. In a footnote, District explained the wide range of estimated claim amounts was due to disputed government reimbursement claims. District said it “believed” that after the audits are completed within two to three years, the overpayment claims will be eliminated. “Other reductions may be achieved through objections to claims and pending or to be filed.” Id. In August 2019, the Plan of Adjustment was confirmed.3 Doc. 1618. The success of District’s reorganization hinged on 3 DHCS was served all the ballot solicitation materials on July 9, 2019. Doc. 1545 at 11. DHCS did not return a ballot or participate in the two major conditions. First, District needed to lease most of its facilities. They did. Adventist Health is the lessee and is operating the hospital and accompanied facilities. Second, certain loans needed to be repaid which facilitated restructuring of some of District’s bond debt. District managed that as well. Cash flow from the lease payments and other sources under the plan permit District to attend to certain deferred maintenance projects and other needs. Under the Plan, the unsecured creditor class (class 8) is to receive between 19.2% and 30.3% distributions on allowed claims over five years. But payments do not begin until 2025. Chapter 9 A word about Chapter 9. This chapter of the Bankruptcy Code is available only to “municipalities” as defined in 11 U.S.C. § 101 (40). District is a municipality. This chapter permits reorganization of municipalities and represents a careful application of reorganization policies under bankruptcy law. Care is necessary because of the constitutional limitation on Federal “interference” with state governments. Very similar to Chapter 11, Chapter 9 incorporates many provisions of the Bankruptcy Code. A list of applicable sections is found in 11 U.S.C. § 901 (a). Among those incorporated are the provisions dealing with filing and solicitation process. Docs. 159 3-97. Further, DHCS did not object to plan confirmation. allowance of claims. Both §§ 501 and 502 are incorporated entirely.4 For our purposes, existing jurisprudence about claims and amendments involving other chapters of the Bankruptcy Code is largely applicable. This will become evident throughout the analysis. DHCS’s Claim DHCS filed a claim in April 2018 before the bar date.5 The claim is in an “undetermined amount.” Claim 197

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