Judge: Lee W. Tsao, Case: 22NWCV00596, Date: 2023-03-23 Tentative Ruling

Case Number: 22NWCV00596    Hearing Date: March 23, 2023    Dept: C

PIH HEALTH HOSPITAL – WHITTIER v. LOCAL INITIATIVE HEALTH AUTHORITY FOR LOS ANGELES COUNTY

CASE NO.:  22NWCV00596

HEARING:  03/23/23

#2

TENTATIVE ORDER

Defendant LOCAL INITIATIVE HEALTH AUTHORITY FOR LOS ANGELES COUNTY’s Demurrer to Plaintiff’s First Amended Complaint is SUSTAINED without leave to amend.

Moving Party to give notice.

Defendant’s Request for Judicial Notice is GRANTED. (Cal. Ev. Code §452.)

Plaintiff provides medical care to patients. (FAC ¶¶1-2.) Defendant LOCAL INITIATIVE HEALTH AUTHORITY FOR LOS ANGELES dba L.A. Care Health Plain (“Defendant”) operates a health care service plan, licensed under the Knox-Keene Health Care Service Plan Act. (FAC ¶4.) Plaintiff alleges that it provided medical services to members of Defendant’s health plan, and submitted reimbursement claims. “Despite timely demand for full payment, L.A. CARE refused and continues to refuse to properly pay PIH for the medically necessary services, emergency services, supplies and/or equipment PIH rendered to the Patients.” (FAC ¶29.)

Plaintiff’s FAC asserts the following causes of action: (1) Breach of Oral Contract; and (2)  Breach of Implied-in-fact Contract.

The Knox-Keen Act provision requiring health care service plans to reimburse providers for emergency services and care provided to its enrollees does not create a private cause of action permitting noncontracting health care providers to bring an action against the operator of the public-entity health care service plan seeking reimbursement for full amounts of their claims for emergency medical services provided to members of the health care service plan. There is no express language provided for a private right of action under the Knox-Keen Act, and nothing in the provision demonstrates legislative intent to allow providers to sue directly to enforce obligation. (Cal. Health & Safety Code §1371.4; County of Santa Clara v. Sup. Ct. (2022) 77 Cal.App.5th 1018.) 

Government immunity applies here. Defendant is immune from contract claims based on the Knox-Keene Act. The Demurrer is SUSTAINED without leave to amend.