Judge: Michael Shultz, Case: 22STCV02147, Date: 2024-12-03 Tentative Ruling
DEPARTMENT 40 - JUDGE ANNE RICHARDSON - LAW AND MOTION RULINGS
The Court issues tentative rulings on certain motions.The tentative ruling will not become the final ruling until the hearing [see CRC 3.1308(a)(2)]. If the parties wish to submit on the tentative ruling and avoid a court appearance, all counsel must agree and choose which counsel will give notice. That counsel must 1) email Dept 40 by 8:30 a.m. on the day of the hearing (smcdept40@lacourt.org) with a copy to the other party(ies) and state that all parties will submit on the tentative ruling, and 2) serve notice of the ruling on all parties. If any party declines to submit on the tentative ruling, then no email is necessary and all parties should appear at the hearing in person or by Court Call.
Case Number: 22STCV02147 Hearing Date: December 3, 2024 Dept: 40
22STCV02147 Mission City Community Network, Inc. v. California
Department of Health Care, et al.
[TENTATIVE] ORDER
I.
BACKGROUND
On July
10, 2024, the Hon. Anne Richardson, sustained the California Department of
Health Care’s (“DHCS”) demurrer to the third amended complaint as to the first
cause of action for violation of a federal payment right under Section 1902(bb)
of the Social Security Act and the third cause of action for unjust enrichment.
The court overruled demurrer to the second cause of action for negligence.
Plaintiff filed a fourth amended complaint (“4AC”) against new individual
defendants as well as DHCS.
Plaintiff
alleges that DHCS is an agency that administers California’s Medi-Cal program,
which provides health care insurance to the state’s low-income and other
eligible populations. (4AC ¶ 7.) Defendant Bruce Lim (“Lim”) is the Deputy
Director of DHCS’s Audits and Investigations Division, whose responsibilities
are to establish Medi-Cal polices and procedures within the division,
coordinating Medi-Cal antifraud efforts, and placing, monitoring, and lifting
temporary Medi-Cal sanctions, such as suspensions. (4AC ¶ 9.) Defendant,
Deborah Manduca, (“Manduca”) was the Branch Chief of the DHCS Special
Investigation Unit and regularly imposed sanctions like the suspension issued
here against Plaintiff, a Medi-Cal provider. (4AC ¶ 10.) Lim and Manduca demur
to the 8th, 9th and 10th causes of
action. DHCS demur to the following
causes of action:
4th cause of action for breach of
contract
5th cause of action for breach of
implied-in-fact contract;
6th cause of action for quantum meruit;
7th cause of action for breach of
implied in law contract;
8th cause of action for intentional
interference with contract
9th cause of action for negligent
interference with contract
10 cause of negligence
11th cause of action for declaratory
relief.
II.
LEGAL STANDARDS
A demurrer tests the sufficiency of a
complaint as a matter of law and raises only questions of law. (Schmidt
v. Foundation Health (1995) 35
Cal.App.4th 1702, 1706.) In testing the complaint’s sufficiency, the court must
assume the truth of the properly pleaded factual allegations as well as facts
that can be reasonably inferred from those expressly pleaded facts. The court
may also consider matters properly subject to judicial notice. (Blank
v. Kirwan (1985) 39 Cal.3d
311, 318.)
Sufficient facts are the essential facts
of the case "with reasonable precision and with particularity that is
sufficiently specific to acquaint the defendant with the nature, source, and
extent of his cause of action.” (Gressley
v. Williams (1961) 193
Cal.App.2d 636, 643-644.) Whether the
Plaintiff will be able to prove the pleaded facts is irrelevant. (Stevens
v. Superior Court (1986) 180
Cal.App.3d 605, 609–610.)
A demurrer may also be sustained if a
complaint is “uncertain.” Uncertainty exists where a complaint’s factual
allegations are so confusing, they do not sufficiently apprise a defendant of
the issues it is being asked to meet. (Williams
v. Beechnut Nutrition Corp. (1986) 185 Cal.App.3d 135, 139, fn. 2; Code Civ. Proc., § 430.10(f).)
A pleading is required to assert general
allegations of ultimate fact. Evidentiary facts are not required. (Quelimane Co. v. Stewart Title Guaranty
Co. (1998) 19 Cal. 4th 26, 47; Lim
v. The.TV Corp. Internat.
(2002) 99 Cal. App. 4th 684, 690.) However, unlike federal courts, California
state courts are not a notice pleading jurisdiction, and notice alone is not a
sufficient basis for any pleading. California is a fact pleading jurisdiction.
Merely putting an opposing party on notice is not sufficient. (Bach
v. County of Butte (1983) 147
Cal.App.3d 554, 561; see Diodes,
Inc. v. Franzen (1968) 260
Cal.App.2d 244, 250.)
III.
DISCUSSION
A.
Demurrer to the 4th cause of action
for breach of written contract is OVERRULED.
Plaintiff
alleges that it was a party to a written contract (the “Provider Agreement”) with
Defendants DHCS wherein Plaintiff agreed to provide services to Medi-Cal
beneficiaries in exchange for payment. Plaintiff alleges Defendant breached the
agreement by suspending Plaintiff’s from payment and deactivating its provider
numbers resulting in Plaintiff’s inability to obtain payment for services that
it was still required by statute to provide. (4AC ¶¶ 170-172.)
Defendant
argues that Plaintiff failed to set out the terms of the agreement verbatim in
the complaint or attach a copy of the agreement. Defendant argues that
Plaintiff cannot recover payment for services that Defendant prohibited
Plaintiff from providing services. Plaintiff failed to allege a mutual
understanding or expectation between the parties that Defendant would pay
Plaintiff for services rendered during the period of Plaintiff’s suspension.
Contrary
to DCHS’ argument, the contract claim is adequately alleged. To state a cause
of action for breach of contract, the plaintiff must allege and prove facts
showing (1) the existence of the contract, (2) the plaintiff's performance or
excuse for nonperformance, (3) the defendant's breach, and (4) resulting
damages to the plaintiff. (Maxwell
v. Dolezal (2014) 231 Cal.App.4th 93, 97–98.) Plaintiff may also allege
the legal effect of the contract rather than its precise language. Construction
Protective Services, Inc. v. TIG Specialty Ins. Co. (2002) 29 Cal.4th 189,
199. Alleging the legal effect means alleging the making and the substance
of the relevant terms. (Perry
v. Robertson (1988) 201 Cal.App.3d 333, 341.) Plaintiff may also attach
a copy of the written contract to the complaint. (Id.)
Plaintiff
has alleged the contract based on legal effect by alleging its material terms.
(4AC ¶¶ 170-172.)
B.
DHCS and the individual Defendants have not
alleged immunity from liability as to the 8th, 9th, and 10th
causes of action for intentional and negligent interference with contract and
negligence
The
4AC alleges that DCHS breach its statutory duty to Plaintiff to “carefully
consider” any allegations of fraud before imposing a suspension, ignored all
evidence demonstrating that Plaintiff was not engaged in fraud and often failed
to consider any evidence related to its own allegations of fraud in violation
of Welfare and Institutions Code § 14107.11(d)[1].
(4AC ¶¶ 231-239.) DCH argues that Plaintiff did not allege a statutory basis
for liability which is contrary to the express allegations. (Id.)
1)
Defendants have not established that discretionary
immunity bars liability.
Defendants
argue that they are immune from suit because the alleged wrongful acts were the
result of an exercise of discretion. (Gov.
Code, § 820.2 ["Except as otherwise provided by statute, a public
employee is not liable for an injury resulting from his act or omission where
the act or omission was the result of the exercise of the discretion vested in
him, whether or not such discretion be abused."].)
Discretionary
immunity is reserved for “those ‘basic policy decisions [which
have] been [expressly] committed to
coordinate branches of government,’ and as to which judicial interference would
thus be ‘unseemly.’" (Barner
v. Leeds (2000) 24 Cal.4th 676, 685.) The scope of the immunity
"should be no greater than is required to give legislative and executive
policymakers sufficient breathing space in which to perform their vital
policymaking functions.” (Id.
at 685). However, "there is no basis for immunizing lower-level
decisions that merely implement a basic policy already formulated." (Id.)
In government tort cases, “the rule is liability, immunity is the
exception.” (Taylor
v. City of Los Angeles Dept. of Water & Power (2006) 144 Cal.App.4th
1216, 1239.)
Policy-making
decisions which are immunized from liability are distinguished from
“operational” decision making that “implement” a basic policy. The operational
implementation is not entitled to discretionary immunity. (Cleveland
v. Taft Union High School Dist. (2022) 76 Cal.App.5th 776, 801
["subsequent ministerial actions in the implementation of that basic
decision still must face case-by-case adjudication on the question of
negligence."].) However, where a public entity is under a mandatory duty
imposed by an enactment designed to protect against the risk of a particular
injury, "the public entity is liable for an injury of that kind
proximately caused by its failure to discharge the duty unless the public
entity establishes that it exercised reasonable diligence to discharge the
duty." (Gov.
Code, § 815.6.)
Defendant,
Daniel Ibarra, allegedly prepared affidavits to support the issuance of search
warrants based on false or misleading information provided by Manduca that
Plaintiff was involved in a federal False Claims Act lawsuit (“FCA”) although
that litigation had been resolved in Plaintiff’s favor a year before the
affidavit was signed which a “quick PACER records search” would have shown.
(4AC ¶¶ 29-32.) Plaintiff alleges that Defendant Lim approved of Plaintiff’s
suspension with knowledge that there was no factual support for the allegations
to make the referral to DOJ. (4AC ¶ 39. He failed to take any corrective
action, to supervise or provide guidance to Manduca, knew the consequences of
an unlawful suspension but did nothing to prevent it, and therefore
participated in depriving Plaintiff of its constitutional rights for 18 months
at which time the temporary suspension was lifted. (4AC ¶ 38-41.)
Defendants
argue that they were not discharging a mandatory duty, and therefore, the
actions Defendants undertook were discretionary and subject to immunity. To be
mandatory, the enactment at issue must be obligatory, not "merely
discretionary or permissive, in its directions to the public entity; it must require,
rather than merely authorize or permit, that a particular action be taken or
not taken.” (Danielson
v. County of Humboldt (2024) 103 Cal.App.5th 1, 14.)
Section
14017.11 subd. (d) provides for that mandatory obligation stating that with
respect to the department’s “credible” allegation of fraud for which an
investigation is pending or the commencement of suspension, the department “shall
carefully consider the allegations, facts, data, and evidence with the same
thoroughness as a state or federal court would use in approving a warrant for a
search or seizure." (Welf.
& Inst. Code, § 14107.11 subd. (d).)
To
establish the application of discretionary immunity, Defendants must show
"that the decisions in question are properly considered as ‘basic policy
decisions’ made at the ‘planning stage of [the entity's] operations,’ rather
than ‘routine duties incident to the normal operations of the employee's office
or position.’" (Taylor
at 1238–1239.) The statute at issue requires constitutional level scrutiny
in assessing the evidence and does not amount to discretionary acts and are not
immunized "because they entail the fulfillment of enacted
requirements." (Danielson
at 14.)
The
claims for negligence and intentional contract interference flow from the conduct
alleging Defendants failed to exercise their mandatory, statutory obligations and
are not subject to immunity based on the alleged facts.
Defendants
cite Hacala
v. Bird Rides, Inc. (2023) 90 Cal.App.5th 292 which is factually
distinguishable. There, the statutes at issue expressly included discretionary
language:
"On the contrary, while the Permit mandates that ‘Operators
shall remove electric scooters from the public right-of-way on a daily
basis,’ it stipulates that ‘[a]ny Vehicle that is parked in one location for
more than 5 consecutive days without moving may be removed by the City's
Bureau of Sanitation and taken to a City facility for storage at the expense of
the Operator. (Italics added.) Consistent with this discretionary language, the
Permit provides that ‘[i]f Vehicle parking standards are not met on a monthly
basis, the City reserves the right to revoke the Program permit.’
(Italics added.) Construing these terms ‘in a reasonable fashion and
attributing to [them their] ordinary and proper meaning’ (Posey v. State of
California (1986) 180 Cal.App.3d 836, 850, 225 Cal.Rptr. 830), we conclude
the City had the discretion—but was not under a mandatory duty—to remove
improperly parked scooters or to revoke Bird's permit for noncompliance."
(Hacala
at 306.)
2) Defendants
have not established that licensing immunity applies to shield them from
liability.
Defendants
next argue that licensing immunity bars the tort claims alleged against them as
a public entity is not liable "for an injury caused by the issuance,
denial, suspension or revocation of, … any permit, license, certificate,
approval, order, or similar authorization where the public entity or an
employee of the public entity is authorized by enactment to determine whether
or not such authorization should be issued, denied, suspended or revoked."
(Gov.
Code, § 818.4.)
Plaintiff
alleges that in late 2018, DHCS decided to internally suspend Plaintiff’s
Medi-Cal billing numbers as well as Medi-Cal payments to Plaintiff. (4AC ¶ 58.)
Plaintiff alleges that it was subject to an internally “temporary payment
suspension” because of alleged double billing and false claims by Plaintiff.
(4AC ¶ 60, 63.) Plaintiff alleges that the planned suspension related solely to
Plaintiff’s ability to bill, and there was no direction that Plaintiff should
shut its doors or “go away.” (4AC ¶ 65, 70). Only payments to Plaintiff were
suspended; a provider such as Plaintiff could continue to bill for its
services. Plaintiff was informed that that Medi-Cal payments were suspended as
well as suspension of its 33 National Provider Identifier Numbers. (4AC ¶ 72,
79). Plaintiff was still required to continue to see and treat Medi-Cal
beneficiaries regardless of ability to pay; Plaintiff was prohibited from submitting
billing and collecting payment for those services for 18 months. (4AC ¶¶
98-100.)
Plaintiff
argues that licensing immunity does not apply because Plaintiff’s license was
not suspended. However, Section 818.4 applies broadly to include not just
suspensions of licensing, but also suspensions of approval or “similar
authorizations.” (Gov.
Code, § 818.4.) Neither party cites Kay
v. City of Rancho Palos Verdes (9th Cir. 2007) 504 F.3d 803
wherein the court determined that licensing immunity applies only to
discretionary activities. (Kay
at 810; Richards
v. Department of Alcoholic Beverage Control (2006) 139 Cal.App.4th 304, 318.)
As previously discussed, Defendants have not persuasively argued that they were
not under a mandatory obligation as set forth in Welf.
& Inst. Code, § 14107.11 subd. (d).
However,
as to the individual defendants, the interference claims (8th and 9th
causes of action) alleged against the individual Defendants fail for other
reasons as explained below.
3)
DHCS has not established that Plaintiff failed
to file the action against it within the limitations period after rejection of
Plaintiff’s claim against DHCS.
A
plaintiff cannot file a civil action unless all claims filing requirements are
satisfied. Plaintiff must generally
file suit within six months “after the date such notice is personally delivered
or deposited in the mail.” If the entity does not serve a notice of rejection,
suit must be filed within two years from accrual of the cause of action. (Gov. Code, § 945.6 subd. (a).)
Plaintiff alleges that its claim was rejected
by letter dated December 30, 2021. (4AC ¶ 140.) Plaintiff argues in opposition
that statute of limitations issues are factual and cannot be determined at the
pleading stage. Plaintiff argues that period for filing suit after rejection of
a government claim was extended to 120 days by virtue of Executive Orders
N-35-20 and N-71-20 extended the government’s time to respond by 120 days. (Id.) Defendant’s reply brief does not respond
to these contentions.
The 120th day expired on April
29, 2022. Plaintiff filed this action against DCHS on January 19, 2022.
4)
Demurrer
to the claims against the individual defendants (8TH cause of action
for intentional interference, 9th cause of action for negligent
interference, and 10th cause of action for negligence) is SUSTAINED.
The claims are barred for failure to file suit within the limitations period
after Plaintiff’s DHCS government claim was rejected; relation back does not
apply to avoid the bar.
The causes of action
against Lim and Manduca were alleged for the first time in the Fourth Amended
Complaint, which was not filed until January 24, 2024, long after the 120 days
expired. Plaintiff argues that a claim need not be presented against a public
employee as a prerequisite to maintaining a civil action. (Gov. Code, § 950.) This code section does not address
whether Plaintiff’s suit against the employees was required to be filed 120
days from notice of rejection of DHCS’s government claim.
Relation back does not apply to avoid the
statute of limitations in this context. The principle of “relation back” avoids
the statute of limitations where the plaintiff amends the complaint to
substitute a named defendant for a fictitiously named defendant if the
plaintiff was truly ignorant of that defendant’s identity at the time the
complaint was filed. (Code Civ. Proc., § 474.) An
amended complaint that adds new defendants does not relate back to the date of
filing the original complaint, and the statute of limitations is applied as of
the date the amended complaint is filed, not the date the original complaint is
filed. (Woo v. Superior Court (1999) 75 Cal.App.4th 169, 176).
5)
Demurrer to the 9th cause of action
for negligent interference of contract against the Individual Defendants is SUSTAINED.
Defendants correctly argue that such a claim does not exist.
Defendants’ case authority establishes
the principle that "[i]n California there is no cause of action for negligent
interference with contractual relations. While there exists a cause of action
for negligent interference with prospective economic advantage.” (Davis
v. Nadrich (2009) 174 Cal.App.4th 1, 9.”)
Plaintiff’s reliance on North
American Chemical Co. v. Superior Court (1997) 59
Cal.App.4th 764 is misplaced. The court acknowledged that
Plaintiff did not allege a claim for negligent interference with contract but
could allege a claim for negligent interference with prospective economic
advantage which Davis likewise acknowledged. (North
American Chemical Co. at 786.)
6)
Demurrer
to the fifth, sixth, and seventh causes of action alleged against DCHS is
SUSTAINED. These claims are precluded by claim preclusion.
DCHS argues that these
claims are barred because Judge Richardson sustained demurrer to the claim for
unjust enrichment without leave to amend since Plaintiff failed to allege a
federal basis for entitlement to Medi-Cal/Medicare reimbursement for services provided
during the 18-month payment suspension. Defendant argues that the unjust
enrichment claim depended on the Plaintiff’s claims for reimbursement under the
Social Security Act and the Public Health Service Act. (Dem. 16:20-17:6).
Defendant argues that Plaintiff has restyled the same unjust enrichment claim as
claims for breach of implied in fact and law contracts and for quantum meruit.
In its primary aspect, res judicata, or
“claim preclusion” prevents relitigation of the same cause of action in a
second suit between the same parties or their privities where the claim was
finally litigated. (DKN Holdings LLC v. Faerber (2015) 61 Cal.4th 813, 824.) The second aspect of res judicata known
as collateral estoppel, or issue preclusion, prohibits the relitigation of
issues decided in a prior proceeding. Issue preclusion applies "(1) after
final adjudication (2) of an identical issue (3) actually litigated and
necessarily decided in the first suit and (4) asserted against one who was a
party in the first suit or one in privity with that party." (DKN Holdings LLC v. Faerber (2015)
61 Cal.4th 813, 825.)
Collateral estoppel applies even if the second lawsuit alleges different causes
of action. (Id.)
The terms of an implied-in-fact contract are
manifested not by words but by conduct showing a mutual agreement and intent to
promise (Port Medical Wellness, Inc. v. Connecticut
General Life Insurance Company (2018) 24 Cal.App.5th 153, 177.) An implied-fact-contract is no different than an express contract.
Plaintiff is required to prove (1)
the existence of the contract, (2) the plaintiff's performance or excuse for
nonperformance, (3) the defendant's breach, and (4) resulting damages to the
plaintiff. (Maxwell v. Dolezal (2014) 231 Cal.App.4th 93,
97–98.)
Plaintiff
does not allege any facts demonstrating a contract that can be implied by the
parties’ conduct, nor does Plaintiff describe the conduct. Plaintiff alleges in
a conclusory manner that through their conduct, Plaintiff and DCHS knew or had
reason to know that Plaintiff would continue to provide services to Medi-Cal
beneficiaries. (4AC ¶ 191.) The court does not consider contentions, deductions, or conclusions of fact or
law. (Moore v. Conliffe
(1994) 7 Cal.4th 634, 638.) Plaintiff is required to allege facts sufficient to
establish every element of each cause of action. (Rakestraw v. California Physicians Service
(2000) 81 Cal.App.4th 39, 43.) Where the
complaint fails to state facts sufficient to constitute a cause of action,
courts should sustain the demurrer. Code Civ. Proc., § 430.10(e); (Zelig v. County of Los Angeles (2002) 27 Cal.4th 1112, 1126.)
Instead, Plaintiff continues to rely on DHCS’ awareness that “federal
law requires [Plaintiff] to provide services to beneficiaries regardless of
ability to pay.” (4AC ¶ 192.) The court may take judicial notice of court
records. (Evid. Code, §452 subp. (d). The court also has discretion to take
judicial notice of documents absent Defendant’s formal request and “on its own
volition.” (Scott v. JPMorgan Chase Bank, N.A. (2013) 214 Cal.App.4th 743, 752.)
In the operative pleading, Plaintiff dispenses with alleging any basis
for entitlement to reimbursement for services under a specific federal law but
alleges an amorphous and uncertain “federal law.” Whatever that federal law may
be, Plaintiff could have asserted these claims now relabeled as breach of
implied-in-fact contract at the time Judge Richardson considered Plaintiff’s
arguments before sustaining demurrer without leave to amend to the unjust
enrichment claim for reimbursements under federal law. (Min. Ord. 7/10/23, p. 8.)
An “implied-law-contract” is a “quasi contract” that implies is an “obligation
... created by the law without regard to the intention of the parties and is
designed to restore the aggrieved party to [its] former position by return of
the thing or its equivalent in money. [Citations.]’ The doctrine focuses on
equitable principles; its key phrase is ‘unjust enrichment,’ which is used to
identify the ‘transfer of money or other valuable assets to an individual or a
company that is not entitled to them.” (Welborne v. Ryman-Carroll Foundation (2018) 22 Cal.App.5th 719, 725.) “’Quasi-contract’
is simply another way of describing the basis for the equitable remedy of
restitution when an unjust enrichment has occurred. Often called quantum
meruit, it applies ‘w]here one obtains a benefit which he may not justly
retain.... The quasi-contract, or contract ‘implied in law,’ is an obligation
created by the law without regard to the intention of the parties and is
designed to restore the aggrieved party to his former position by return of the
thing or its equivalent in money.’ (1 Witkin, Summary of Cal. Law, supra,
Contracts, § 91, p. 122, italics omitted.) “’The so-called ‘contract implied in
law’ in reality is not a contract. [Citations.] ‘Quasi-contracts, unlike true
contracts, are not based on the apparent intention of the parties to undertake
the performances in question, nor are they promises. They are obligations
created by law for reasons of justice.’ [Citation.]” (Weitzenkorn v. Lesser
(1953) 40 Cal.2d 778, 794, 256 P.2d 947.)" (McBride v. Boughton (2004) 123 Cal.App.4th 379, 388, fn 6.)
Thus, the claim for quantum meruit, or unjust enrichment, predicated
on an obligation implied by law is no different than the claim for unjust
enrichment to which Judge Richardson sustained demurrer without leave to amend.
Re-casting the claims under different names contravenes the order denying leave
to amend.
7)
Demurrer
to the claim for declaratory relief is SUSTAINED for failure to state a claim.
A claim for declaratory relief is
adequately stated where it sets forth facts showing the existence of an actual
controversy relating to the legal rights and duties of the respective parties
under a contract or written instrument and requests that the rights and duties be
adjudged. (Condor Ins. Co. v. Williamsburg Nat. Ins.
Co. (1996) 49 Cal.App.4th
554, 565; Code Civ.
Proc., § 1060.) Plaintiff alleges that DHCS’ temporary suspension and refusal
to pay was invalid and unlawful in violation of federal law, federal
regulations, the “State Plan” the U.S. and California Constitutions, and
California laws. (4AC ¶ 253.) More specifically, Plaintiff alleges that the
dispute with DHCS concerns the validity of DHCS’ suspension of payments and
uncompensated care under Welfare and Institutions Code § 14043.36 which should
not have been applied. (4AC ¶ 254.)
As to Plaintiff’s constitutional argument
based on a lack of due process, neither party addressed Mednik v. State Dept. of Health Care
Services (2009) 175
Cal.App.4th 631, 642
which determined that "[t]he Department is authorized by statute to
temporarily suspend a Medi–Cal provider ‘[i]f it is discovered that a provider
is under investigation by the department or any state, local, or federal
government law enforcement agency for fraud or abuse.” (§ 14043.36, subd. (a);
see also Cal.Code Regs., tit. 22, § 51200, subd. (c).) A temporary suspension
generally does not implicate the same liberty interest as debarment [which is
permanent]." Moreover, Plaintiff does not allege the contract or written
instrument entitling Plaintiff to such a declaration.
Plaintiff claims that suspension may not
be imposed under section 14043.36 in circumstances where DHCS begins its fraud investigation
rather than “learning of an investigation for fraud or abuse by another entity
from another entity. (4AC ¶ 255; § 14043.36 ["If it is discovered that a
provider is under investigation by the department or any state, local, or
federal government law enforcement agency for fraud or abuse, that provider
shall be subject to temporary suspension from the Medi-Cal program, which shall
include temporary deactivation of the provider's number, including all business
addresses used by the provider to obtain reimbursement from the Medi-Cal
program.”].)
DHCS’ explanation of these convoluted allegations
is that DHCS did not “learn of the investigation;” rather DHCS initiated the
investigation process by referring the matter to DOJ. The statute does not impose
the limitation that Plaintiff implies. It does not carve out suspensions for
fraud investigations that DHCS itself initiates.
Additionally, as Defendant observes, the
claim for a declaration that section 14043.36 is unconstitutional or wrongfully
applied is a new claim and was not asserted in the original or amended
complaints.
The statute of limitations for a
declaratory relief claim depends on the underlying allegations. (Snyder v. California Ins. Guarantee Assn. (2014) 229 Cal.App.4th 1196, 1208.) Defendant contends that the parties
always agreed that a two-year statute of limitations applied, but if a
declaratory relief claim was never previously alleged, it is not clear how the
parties could make such an agreement.
Claims for liability based on statute is
three years from the date of accrual. (Code Civ. Proc., § 338.) Plaintiff alleges that it learned of
its suspension (both temporary payment suspension under section 14107.11 and temporary
deactivation of provider identification numbers under 14043.36) on June 14, 2019.
(4AC ¶ 57, 67.) Two years from that date
was June 14, 2021. Plaintiff filed the 4AC asserting this new claim on June 24,
2024.
Notwithstanding the foregoing, Plaintiff can assert a new
claim that relates back to the original filing date if the new claim is based
on the same general set of facts. (Espinosa v. Superior Court (1988) 202 Cal.App.3d 409, 414.) Plaintiff has alleged the same general set of
facts arising from DCHS’ suspension of Plaintiff’s payment and provider number
numbers (albeit with alternating remedies) in all iterations of the complaint. The
claim, however, remains defective as alleged because it fails to state a cause
of action.
Defendant separately moved to strike the prayer for punitive
damages, which Plaintiff did not oppose. Plaintiff cannot recover punitive
damages against a public entity. (Gov Code § 818.) The claims against the
Individual Defendants do not survive and cannot provide a predicate for
imposition of punitive damages against them.
IV. CONCLUSION
Accordingly, demurrer to the 4th cause of action
for breach of contract against DHCS is OVERRULED. Demurrer to the 5th
cause of action for breach of implied-in-fact contract, 6th cause of
action for quantum meruit, and the 7th cause of action for breach of
implied-law-contract against DHCS is SUSTAINED without leave to amend as they
are barred by issue preclusion, and the court did not permit leave to amend the
claims.
Demurrer to the claims against the individual defendants (8TH
cause of action for intentional interference, 9th cause of action
for negligent interference, and 10th cause of action for negligence)
is SUSTAINED without leave to amend. The claims are barred for failure to file
suit within the limitations period after Plaintiff’s DHCS government claim was
rejected; relation back does not apply to avoid the bar. The 9th
cause of action is not a recognized claim.
Demurrer to the 10 cause of action for negligence against DHCS
is OVERRULED. None of the immunities raised by DHCS apply. The claim is
statutorily based.
Demurrer to the 11th cause of action for
declaratory relief is SUSTAINED for failure to state a claim and Plaintiff did
not demonstrate how the claim can be cured.
The individual defendants, Lim and Manduca, are dismissed from
the action.
The motion to strike the prayer for punitive damages against
DHCS and the individual defendants is GRANTED. (Code Civ. Proc., § 436.)
[1] "An
allegation of fraud shall be considered credible if it exhibits indicia of
reliability as recognized by state or federal courts or by other law sufficient
to meet the constitutional prerequisite to a law enforcement search or seizure
of comparable business assets. The department shall carefully consider the
allegations, facts, data, and evidence with the same thoroughness as a state or
federal court would use in approving a warrant for a search or seizure." (Welf.
& Inst. Code, § 14107.11 subd. (d).)