South Peninsula Hospital v. Xerox State Healthcare LLC
South Peninsula Hospital v. Xerox State Healthcare LLC
Opinion of the Court
ORDER RE: DEFENDANT’S MOTION TO DISMISS
I. INTRODUCTION
This matter is now before the Court on Defendant Xerox State Healthcare, LLC’s (“Xerox”) Motion to Dismiss Plaintiffs First Amended Complaint. The Court heard oral argument on Xerox’s motion on June 29, 2016.
II. BACKGROUND
a. Procedural History
Plaintiffs South Peninsula Hospital (“South Peninsula”), Alaska Speech and Language Clinic, Inc. (“Alaska Speech”), and Kenai Vision Center, LLC (“Kenai Vision”) initiated this action on September 24, 2015, on behalf of themselves and all others similarly situated.
Xerox moved to dismiss the FAC pursuant to Fed. R. Civ. P. 12(b)(1) and Fed. R. Civ. P. 12(b)(6) on February 8, 2016.
b. Factual Background
Among other things, the FAC alleges that:
The parties. Plaintiffs are all healthcare providers enrolled in Medicaid who submitted claims for reimbursement for Medicaid services from October 1, 2013 to present using the State of Alaska’s Medicaid Management Information System (“MMIS”).
Xerox is a limited liability company based in Atlanta, Georgia and with an office in Anchorage, Alaska.
Health Enterprise. Alaska’s Medicaid program is administered by the Alaska Department of Health and Social Services (“DHSS”).
Alaska’s original MMIS was established in 1987 to process and pay Medicaid claims.
DHSS’ contract for the new MMIS contemplated three phases: (1) design, devel
“Go-live" crisis. After a series of delays, Health Enterprise went live on October 1, 2013.
Almost immediately after Health Enterprise went live, it became clear that the system was not able to perform the functions required of it under the MMIS contract.
Those delayed reimbursements resulted in financial harms to Medicaid providers, including loss of the time value of money, increased operational costs expended to recover backlogged payments, business injury due to interruption of cash flow, and even going out of business.
Because of the number and degree of delayed reimbursements caused by material defects with Health Enterprise, the State has issued advance payments to Medicaid providers for valid claims that were erroneously denied or suspended.
Class action allegations. Plaintiffs bring this action for negligence and unfair trade practices on behalf of themselves and, pursuant to Fed. R. Civ. P. 23, on behalf of a putative class defined as “[a]ll Alaska-enrolled Medicaid healthcare providers who submitted a claim for reimbursement from October 1, 2013 to the present whose payment was identified by the State as having been suspended or denied in error by the State’s [MMIS], and was subsequently paid by the State.”
III. LEGAL STANDARD
Xerox seeks dismissal of Plaintiffs’ claims pursuant to Rule 12(b)(1) and Rule 12(b)(6). When faced with a challenge to its subject matter jurisdiction under Rule 12(b)(1), a court must resolve that issue before determining whether a complaint states a cause of action under Rule 12(b)(6).
Rule 12(b)(1) allows a party to move to dismiss an action at any stage in the litigation for lack of subject matter jurisdiction. If a court determines at any time, whether by suggestion of the parties or otherwise, that it lacks subject matter jurisdiction, “the court must dismiss the action.”
Under Rule 12(b)(6), dismissal is appropriate if a plaintiff’s complaint fails to state a claim upon which relief can be granted. Under the “facial plausibility” pleading standard set forth by the Supreme Court in Ashcroft v. Iqbal, “a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim for relief that is plausible on its face.’ ”
While a court is limited in its review of a motion pursuant to Rule 12(b)(6) to the factual allegations contained in the complaint, no such limitation exists as to Rule 12(b)(1), and the Court will consider matters outside of the FAC.
In its motion to dismiss, Xerox argues that Plaintiffs’ claims should be dismissed because Plaintiffs failed to exhaust administrative remedies; because Xerox, as the State’s fiscal agent, is immune from suit; and because Plaintiffs’ negligence and Alaska Unfair Trade Practices Act (“UTPA”) claims fail as a matter of law. Xerox further argues that Plaintiffs’ class action demand faüs as a matter of law and should be stricken. The Court addresses each argument in turn, beginning, as it must, with Xerox’s exhaustion challenge.
a. Exhaustion
Xerox argues, as a threshold matter, that the Court lacks subject matter jurisdiction to hear Plaintiffs’ claims because Plaintiffs failed to exhaust administrative remedies, and must therefore dismiss this case. Plaintiffs contend that they were not required to submit them claims for administrative review because the State voluntarily authorized payment for the delayed reimbursements at issue in this case without first requiring administrative review.
Under Alaska law, a party typically “may not seek relief in a judicial forum until that party has exhausted his or her available administrative remedies.”
The Alaska Administrative Code (“AAC”) provides for a two-tiered administrative review process for resolving Medicaid payment disputes. Specifically, 7 AAC 105.270 permits a provider to request a first-level appeal of “a denied or reduced claim or service,”
But Xerox’s argument mischaracterizes Plaintiffs’ complaint, as confirmed and clarified during oral argument.
b. Immunity
Xerox contends that the FAC must be dismissed in its entirety for the additional reason that it is the State’s fiscal agent and therefore entitled to invoke sovereign immunity against actions such as this one. Plaintiffs contend that Xerox is not a fiscal agent of the State, but rather an independent contractor, and as such cannot cloak itself in the State’s sovereign immunity.
“The preeminent purpose of state sovereign immunity is to accord States the dignity that is consistent with their status as sovereign entities.”
In Del Campo v. Kennedy, the Ninth Circuit considered the extension of state
Plaintiffs in this case argue that the holding in Del Campo controls, and that Xerox is not entitled to state sovereign immunity. Plaintiffs highlight similarities in the contract language between ACCS and the government in Del Campo, which Plaintiff claims is nearly identical to the contract language between Xerox and DHHS.
Xerox argues that Del Campo is distinguishable, that it should be considered the State’s fiscal agent, and that as the State’s fiscal agent, it merely “processes and pays provider claims on behalf of the department,”
Applying this framework, Xerox is an independent contractor that has contracted with DHSS to “build and operate the new Health Enterprise system,” as well as provide other services related to the State’s Medicaid program.
Having resolved Xerox’s exhaustion and immunity arguments, the Court turns to Xerox’s 12(b)(6) arguments.
c. Negligence
Count One of the FAC asserts that Xerox acted negligently and/or with reckless indifference when it failed to use reasonable care in designing and implementing Healthcare Enterprise and then falsely representing that the system was ready to go live when it was not, causing foreseeable economic injury to Plaintiffs and other Medicaid providers.
To recover under a theory of negligence in Alaska, a plaintiff “must establish (1) a duty of care; (2) breach of the duty; (3) causation; and (4) harm.”
In this case, Xerox argues that Plaintiffs’ negligence claim must be dismissed because the MMIS contract between the State and Xerox expressly disclaims any third party beneficiaries and, under Alaska law, a plaintiff cannot recover for pure economic loss based upon a negligence theory absent privity of contract between the plaintiff and tortfeasor.
As summarized above, Plaintiffs’ FAC alleges that it was foreseeable that a failure of Health Enterprise would prevent Medicaid providers from receiving timely reimbursements, which would cause substantial economic harm to those providers, and also have a direct impact and significant consequences to Alaska’s Medicaid system and Medicaid patients.
d. Unfair Trade Practices
In addition to their negligence claim, Plaintiffs allege that Xerox violated the UTPA, Alaska Stat. 45.50.471, by falsely representing that Health Enterprise was adequately tested and sufficiently operational to “go live” on October 1, 2013, when in fact it was not.
The UTPA makes unlawful “[u]nfair methods of competition and unfair or deceptive acts or practices in the conduct of trade or commerce.”
To establish a prima facie case of unfair or deceptive acts or practices under the UTPA, a plaintiff must prove two elements: “(1) that the defendant engaged in trade or commerce; and (2) that in the conduct of trade or commerce, an unfair act or practice has occurred.”
Here, Plaintiffs have pleaded facts showing that Xerox engaged in trade or commerce, that Xerox misrepresented that Health Enterprise was ready to go live when it was not, and that Plaintiffs, as users of the defective MMIS, suffered economic harms caused by significantly delayed reimbursements for properly submitted, valid claims. That is sufficient to survive Xerox’s 12(b)(6) challenge.
e. Class Claims
In addition to its 12(b)(1) and 12(b)(6) challenges, Xerox challenges the sufficiency of Plaintiffs’ class allegations. It contends that the FAC “simply does not properly allege a cognizable class,” and that the Court should therefore dismiss Plaintiffs’ class allegations.
Y. CONCLUSION
For the reasons set forth above, Defendant Xerox State Healthcare, LLC’s Motion to Dismiss Plaintiffs’ First Amended Complaint at docket 35 is DENIED. Xerox
IT IS SO ORDERED.
. See Dkt. 50.
. Dkt. 1.
.Dkt. 34 at ¶¶ 120-129 (Count One), ¶¶ 130-136 (Count Two).
. Id. at ¶¶ 1-2; see also id. at 27 (stating Plaintiffs are seeking actual and statutory damages “for excess costs associated with, resubmitting valid claims; costs of disputing erroneous denials; and lost time value of money for payments that were unreasonably delayed”).
. Dkt. 35.
. Dkt. 39.
. Dkt. 40.
. Dkt. 34 at ¶ 3,
. Id. at Í 3.
. Id. at ¶ 29.
. Id.
. Id. at ¶ 34.
. Id. at ¶ 38.
. Id.
. Id. a^37.
. Id. at ¶ 39.
. Id. at ¶¶ 39-41; see also id. at ¶¶ 44-47, 50.
. Id. at ¶ 42.
. Id. atfl48.
. Id. at ¶ 48; Dkt. 36-2 at 15.
. Dkt. 36-2 at 20.
. Dkt. 34 at ¶ 49.
. Id. at ¶ 55.
.Id. at ¶ 58.
. Id. at ¶ 8.
. Id. at ¶¶ 9, 59.
. Id. at ¶ 134.
. Id. at ¶¶ 9, 134.
. Id. at ¶1¶ 15-16, 62.
. Id. at ¶ 28.
. Dkt. 24-1 at ¶ 32.
. Dkt. 34 at ¶ 20.
. Dkt. 34 at ¶ 67; Dkt. 34-1,
. Dkt. 34 at ¶ 109.
. Alaska v. Kerry, 972 F.Supp.2d 1111, 1120 (D. Alaska 2013) (citing Steel Co. v. Citizens for a Better Env't, 523 U.S. 83, 93-94, 118 S.Ct. 1003, 140 L.Ed.2d 210 (1998)).
. Fed. R. Civ. P. 12(h)(3).
. Standard Alaska Prod. Co. v. Alaska Dep’t of Revenue, 773 P.2d 201, 210 (Alaska 1989) (citing Marathon Oil Co. v. United States, 807 F.2d 759, 768 (9th Cir. 1986), cert. denied, 480 U.S. 940, 107 S.Ct. 1593, 94 L.Ed.2d 782 (1987)).
. See City of Oakland, Cal. v. Hotels.com LP, 572 F.3d 958, 960 (9th Cir. 2009) (applying California exhaustion requirements, where claims related to state law and procedure).
. 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)).
. Rouse v. U.S. Dep’t of State, 567 F.3d 408, 411 (9th Cir. 2009) (quoting Navarro v. Block, 250 F.3d 729, 732 (9th Cir. 2001)).
. Safe Air for Everyone v. Meyer, 373 F.3d 1035, 1039 (9th Cir. 2004) (noting that a district court may review evidence beyond the complaint without converting a motion to dis
. Seybert v. Alsworth, 367 P.3d 32, 36 (Alaska 2016) (quoting Winterrowd v. State, Dep’t of Admin., Div. of Motor Vehicles, 288 P.3d 446, 450 (Alaska 2012)).
. Winterrowd, 288 P.3d 446, 450 (Alaska 2012); accord RBG Bush Planes, LLC, v. Kirk, 340 P.3d 1056, 1061 (Alaska 2015).
. Seybert, 367 P.3d at 36; RBG Bush Planes, 340 P.3d at 1061.
. Pepper v. Routh Crabtree, APC, 219 P.3d 1017, 1020 (Alaska 2009).
. 7 AAC 105.270(a).
. 7 AAC 105.270(c).
. 7 AAC 105.270(d).
. 7 AAC 105.270(e).
. 7 AAC 105.270(f).
. 7 AAC 105.270(g).
. 7 AAC 105.280(a).
. 7 AAC 105.280(e).
. In its motion to dismiss, Xerox notes that neither Alaska Speech nor Kenai Vision has appealed a claim denied or suspended under Health Enterprise, and that South Peninsula has appealed only 244 of 12,363 denials. Dkt. 35 at 25.
. To the extent the Court misunderstands Plaintiffs’ theory of liability, the issue of exhaustion may need to be revisited.
. See Hymes v. DeRamus, 222 P.3d 874, 881 (Alaska 2010) ("The decision whether exhaustion of remedies should apply to a given situation should be based on the particular case before the court.”).
. The Court agrees with Xerox that Plaintiffs may recover only for financial loss caused by reimbursements that were delayed due to system defects and not for any time or expense spent resubmitting claims that were delayed due to provider error. See Dkt. 35 at 28-29. That issue, however, strikes the Court as a damages issue rather than an exhaustion issue.
. Fed. Mar. Comm’n v. S.C. State Ports Auth., 535 U.S. 743, 760, 122 S.Ct. 1864, 152 L.Ed.2d 962 (2002).
. Del Campo v. Kennedy, 517 F.3d 1070, 1075 (9th Cir. 2008) (citing Hess v. Port Auth. Trans-Hudson Corp., 513 U.S. 30, 115 S.Ct. 394, 130 L.Ed.2d 245 (1994)).
. In re Lazar, 237 F.3d 967, 974 (9th Cir. 2001)(citing Hill v. Blind Indus. & Servs. of Md., 201 F.3d 1186 (9th Cir. 1999)).
. Del Campo, 517 F.3d at 1071.
. Id. at 1074.
. Id.
. Id. at 1075.
. Dkt 39 at 35.
. Dkt. 30-3 at 15.
. Id, at 21-22.
. Id. at 22-23.
. Dkt. 35 at 42.
. Id. at 42-43.
. Del Campo, 517 F.3d at 1078-79.
. Dkt. 35 at 21.
. Del Campo, 517 F.3d at 1078-79.
. Id. at 1076.
. See Lazar, 237 F.3d at 974.
. Dkt. 34 at ¶¶ 130-136. Alaska law does not recognize reckless indifference as a separate cause of action, but rather as an element of enhanced damages. Alaska Stat. 09.17.020(b)(2).
. Silvers v. Silvers, 999 P.2d 786, 793 (Alaska 2000) (citing Lyons v. Midnight Sun Transp. Servs., Inc., 928 P.2d 1202, 1204 (Alaska 1996)); see also Robles v. Shoreside Petroleum, Inc., 29 P.3d 838, 841 (Alaska 2001) (describing Alaska’s two-part test of legal causation in negligence cases).
. Sowinski v. Walker, 198 P.3d 1134, 1145 (Alaska 2008); accord McGrew v. State, 106 P.2d 319, 322 (Alaska 2005).
. 628 P.2d 554 (Alaska 1981).
. Geotek Alaska, Inc. v. Jacobs Eng'g Grp., Inc., 354 P.3d 368, 376 (Alaska 2015).
. D.S.W., 628 P.2d at 555; see also Geotek Alaska, 354 P.3d at 376 (explaining that the D.S.W. factors “are seven public policy considerations we use to determine whether we should recognize a negligence duty not otherwise defined by law").
. See State for Use of Smith v. Tyonek Timber, Inc., 680 P.2d 1148, 1154 (Alaska 1984) (holding plaintiff’s lack of privity with alleged tort-feasor precluded recovery for pure economic loss based upon a negligence theory).
. See Mattingly v. Sheldon Jackson Coll., 743 P.2d 356, 360 (Alaska 1987) (holding that "a defendant owes a duty of care to take reasonable measures to avoid the risk of causing economic damages, aside from physical injury [or property damage], to particular plaintiffs or plaintiffs comprising an identifiable class [of persons who] defendant knows or has reason to know are likely to suffer such damages from its conduct”); see also Geotek Alaska, 354 P.3d at 378 (explaining that "it is clear that Alaska’s courts must still consider the full panoply of D.S.W. factors when deciding whether an actionable duty of case exists”); U.S. ex rel. N. Star Terminal & Stevedore Co. v. Nugget Const., Inc., 445 F.Supp.2d 1063, 1076 (D. Alaska 2006) ("Mattingly ... stands for the proposition that a party that is only economically injured can nonetheless sue for negligence, so long as a duty exists.”).
. Dkt. 40 at 19.
. See Dkt. 34 at ¶¶ 50, 133.
. Id. at ¶¶ 120-129.
. Alaska Stat. 45.50.471(a); see also Donahue v. Ledgends, Inc., 331 P.3d 342, 353 (Alaska 2014) (noting UTPA was "designed to meet the increasing need in Alaska for the protection of consumers as well as honest businessmen from the depredation of those persons employing unfair or deceptive trade practices” (citations omitted)).
. Alaska Stat. 45.50.531(a); accord Alaska Interstate Const., LLC v. Pacific Diversified Investments, Inc., 279 P.3d 1156, 1162 (Alaska 2012).
. State v. O’Neill Investigations, Inc., 609 P.2d 520, 534 (Alaska 1980).
. ASRC Energy Servs. Power and Commc’ns, LLC v. Golden Valley Elec. Ass'n, Inc., 267 P.3d 1151, 1159 (Alaska 2011) (quoting O’Neill Investigations, 609 P.2d at 524).
. O’Neill Investigations, 609 P.2d at 535.
. Id.
. Id.
. ASRC Energy Servs., 267 P.3d at 1159 (quoting O’Neill Investigations, 609 P.2d at 535).
. See Western Star Trucks, Inc. v. Big Iron Equip. Serv., Inc., 101 P.3d 1047, 1053 (Alaska 2004) ("The legislative history of the [UTPA] indicates that while consumer protection was the dominant motive underlying the act the act was not intended to be limited to consumer transactions”). Moreover, Xerox cites no Alaska decision adopting the remoteness doctrine, and the Court will not read that doctrine into Alaska law at this point in time.
. Dkt. 35 at 49.
. See Haley v. TalentWise, Inc., 9 F.Supp.3d 1188, 1195 (W.D. Wash. 2014), reconsideration denied, No. C13-1915 MJP, 2014 WL 1648480 (W.D. Wash. Apr. 23, 2014) ("Whether the Court should strike [plaintiff] 's class definition is not an appropriate issue to resolve on a motion to dismiss because ‘compliance with Rule 23 is not to be tested by a motion to dismiss for failure to state a claim.’ ” (quoting Gillibeau v. City of Richmond, 417 F.2d 426, 432 (9th Cir. 1969))); Cholakyan v. Mercedes-Benz USA, LLC, 796 F.Supp.2d 1220, 1245 (C.D. Cal. 2011) (explaining that "it is in fact rare” to strike class allegations in advance of a motion for class certification); In re Wal-Mart Stores, Inc. Wage & Hour Litig., 505 F.Supp.2d 609, 614-16 (N.D. Cal. 2007) (“[T]he granting of motions to dismiss class allegations before discovery has commenced is rare.”); Moreno v. Baca, No. CV007149ABC, 2000 WL 33356835, at *2 (C.D. Cal. Oct. 13, 2000) (holding that defendants’ motion to strike class allegations was premature because no motion for class certification had been filed); see also 7AA Charles Alan Wright, Arthur R. Miller & Mary K. Kane, Federal Practice and Procedure Civil § 1785.3 (3d 2005) (noting that the practice employed in the overwhelming majority of class actions is to resolve class certification only after an appropriate period of discovery).
Reference
- Full Case Name
- SOUTH PENINSULA HOSPITAL, Alaska Speech and Language Clinic, Inc. and Kenai Vision Center, LLC, on behalf of themselves and others similarly situated v. XEROX STATE HEALTHCARE LLC
- Cited By
- 3 cases
- Status
- Published