Vermont State Auditor, Douglas R. Hoffer v. OneCare Accountable Care Organization, LLC, d/b/a OneCare Vermont

2022 VT 29, 280 A.3d 377
CourtSupreme Court of Vermont
DecidedJuly 1, 2022
Docket21-AP-271
StatusPublished
Cited by10 cases

This text of 2022 VT 29 (Vermont State Auditor, Douglas R. Hoffer v. OneCare Accountable Care Organization, LLC, d/b/a OneCare Vermont) is published on Counsel Stack Legal Research, covering Supreme Court of Vermont primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Vermont State Auditor, Douglas R. Hoffer v. OneCare Accountable Care Organization, LLC, d/b/a OneCare Vermont, 2022 VT 29, 280 A.3d 377 (Vt. 2022).

Opinion

NOTICE: This opinion is subject to motions for reargument under V.R.A.P. 40 as well as formal revision before publication in the Vermont Reports. Readers are requested to notify the Reporter of Decisions by email at: JUD.Reporter@vermont.gov or by mail at: Vermont Supreme Court, 109 State Street, Montpelier, Vermont 05609-0801, of any errors in order that corrections may be made before this opinion goes to press.

2022 VT 29

No. 21-AP-271

Vermont State Auditor, Douglas R. Hoffer Supreme Court

On Appeal from v. Superior Court, Washington Unit, Civil Division

OneCare Accountable Care Organization, LLC, April Term, 2022 d/b/a OneCare Vermont

Robert A. Mello, J.

Thomas J. Donovan, Jr., Attorney General, and Joshua R. Diamond, Deputy Attorney General, Montpelier, and Andrew C. Boxer of Boxer Blake & Moore PLLC, Springfield, for Plaintiff-Appellant.

Ritchie E. Berger, Shapleigh Smith, Jr. and Anne B. Rosenblum of Dinse P.C., Burlington, for Defendant-Appellee.

PRESENT: Reiber, C.J., Eaton, Carroll and Waples, JJ., and Grearson, Supr. J. (Ret.), Specially Assigned

¶ 1. WAPLES, J. In February 2021, the Vermont State Auditor of Accounts, Douglas

Hoffer, filed a complaint alleging that defendant OneCare Accountable Care Organization, LLC,

had breached various provisions in its contract with the Department for Vermont Health Access

(DVHA) by denying the Auditor’s requests for OneCare’s employee payroll and benefits records

for fiscal years (FY) 2019 and 2020. The civil division granted OneCare’s motion to dismiss,

concluding that the Auditor lacked contractual or statutory authority to demand the records, and

the Auditor appealed. We affirm. ¶ 2. The Auditor made the following allegations in his complaint. Vermont has adopted

a statewide health care delivery and payment system referred to as the All-Payer ACO Model.

This model relies on private-sector health-care providers voluntarily working together as part of

what is called an Accountable Care Organization (ACO). The goal of the model is to reduce

health-care spending and improve patient outcomes.

¶ 3. OneCare is a Vermont limited-liability company. It is the only ACO in Vermont.

It was founded by and includes the University of Vermont Medical Center, Dartmouth-Hitchcock,

a dozen other hospitals and more than one hundred additional participating providers. OneCare

serves insureds covered by Blue Cross and Blue Shield of Vermont, MVP, and Medicare. It also

administers a portion of Vermont’s Medicaid program under a contract with DVHA. OneCare’s

anticipated budget for FY 2020 exceeded $1.2 billion and was estimated to impact approximately

250,000 people.

¶ 4. OneCare is required to obtain budget approval from the Green Mountain Care

Board. The Board reviews OneCare’s administrative expenses, including payroll and benefits.

OneCare’s budget approval filings for FY 2020 showed a significant increase in payroll expenses.

In FY 2019, OneCare submitted a budget identifying $8.7 million in salary and benefits. That

figure increased to $11.8 million in OneCare’s FY 2020 budget.

¶ 5. In March 2020, the Auditor emailed OneCare requesting an explanation for this

increase, as well as documents establishing payroll for FY 2020. OneCare responded that the

increase was due to “repatriating positions that were split with the Adirondack ACO in 2019,

converting a legal services contract to an employed position, annualizing positions that were

scheduled mid-year hires in 2019, and regular annual comp increases for all staff filling vacancies.”

OneCare did not provide the documents requested by the Auditor. The Auditor believed that the

response did not explain inconsistencies with OneCare’s prior payroll filings. The Auditor again

requested the payroll documents, asserting that he was entitled to the information under OneCare’s

2 contract with DVHA. OneCare’s CEO responded that salary information would be submitted to

the Board in due course and that outside of those filings, the requested information was exempt

from disclosure under the Public Records Act.

¶ 6. The Auditor then filed this breach-of-contract action in the civil division. The

Auditor alleged that he was entitled to access OneCare’s accounting records, including payroll

records, under his statutory authority and the terms of OneCare’s contract with DVHA. He asked

the court for specific performance in the form of an order directing OneCare to turn over all payroll

and benefits records for calendar years 2019 and 2020.

¶ 7. OneCare moved to dismiss the Auditor’s complaint pursuant to Vermont Rule of

Civil Procedure 12(b)(1) for lack of standing. OneCare argued that the Auditor’s powers were

limited by statute and that its authority did not extend to an ACO like OneCare. It contended that

the OneCare-DVHA contract did not give the Auditor the right to obtain the records. It further

argued that DVHA’s right to access records under the contract was limited to records pertaining

to performance under the agreement, and payroll information did not fall within this category.

¶ 8. The Auditor responded that the contract granted authorized representatives of any

state agency access to the accounting and financial records of OneCare to the extent they related

to the business done with other public entities under the contract. He argued that accounting

records included payroll records. He further argued that the Auditor was an authorized agent of

the state, and an intended beneficiary of the contract, because the Auditor is empowered by statute

to conduct audits of any “department, institution, [or] agency of the State.” See 32 V.S.A. §§ 163,

167(a). Finally, he argued the court should treat OneCare as the functional equivalent of an

“agency” that is subject to the Auditor’s authority under 32 V.S.A. § 167(a).

¶ 9. After a hearing, the trial court granted OneCare’s motion to dismiss. The court

concluded that standing was the wrong framework for resolving the issue before it, because

OneCare was essentially arguing that the Auditor lacked a legally cognizable claim under the

3 contract and relevant statutes. The court therefore treated OneCare’s motion as a motion to dismiss

for failure to state a claim under Rule 12(b)(6).1 The court found that the OneCare-DVHA

contract, which was attached to the complaint, did not define who was an “authorized

representative” entitled to demand financial records from OneCare. However, the Auditor did not

appear to be included in that definition because the contract did not state that the Auditor was an

authorized representative or otherwise mention the Auditor. The court concluded that no other

source of authority would empower the Auditor to demand the production of documents within

the scope of the contract. It reasoned that the powers of the Auditor were defined and limited by

statute, which authorized the Auditor to audit departments, institutions, and agencies of the state.

The court concluded that a private entity that contracted with the state did not fall within this

definition. The court declined the Auditor’s invitation to apply the functional-equivalency test

used by some courts in the public-records context to find that OneCare was effectively a state

agency for purposes of 32 V.S.A. § 167(a). The court reasoned that the case was not a public-

records case and furthermore noted that this Court had not adopted the functional-equivalency test

in that context.

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2022 VT 29, 280 A.3d 377, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vermont-state-auditor-douglas-r-hoffer-v-onecare-accountable-care-vt-2022.