Legal Advocacy

CAL/ACEP is committed to promoting and protecting the interests of emergency physicians and their patients in every arena, including the courts. Rather than representing individual emergency physicians, CAL/ACEP advocates on behalf of all emergency physicians in cases broadly impacting health care policy. Our legal advocacy efforts include the filing of amicus curiae, or "Friend of the Court", briefs in cases of major importance to the practice of emergency medicine. Most recently, CAL/ACEP filed a lawsuit against the State of California to stop the 10% provider rate cut in Medi-Cal reimbursement that the Legislature and Governor adopted as part of the state budget.

CAL/ACEP FIGHTS TO MAINTAIN ACCESS TO COURTS

Last month, CAL/ACEP filed an amicus brief in a 2008 case brought by the City of Los Angeles against Anthem Blue Cross on behalf of patients who were victims of the plan’s rescission practices. We filed the brief to defend our access to the courts in seeking justice after amicus briefs filed in the case by Blue Shield and DMHC argued that the case should be dismissed because DMHC has exclusive jurisdiction over “virtually every aspect of the relationship among health care plans, their enrollees, and service providers.” DMHC also argued that “the Knox-Keene Act is a comprehensive and specific enactment granting all health plan regulatory and enforcement authority to the Department.” If the court agreed, it could mean emergency physicians seeking redress against plans – including for unfair payment– would be unable to sue in court and would be forced to depend exclusively on DMHC for enforcement action.

Attached is Wellpoint's response to the various amicus briefs filed in the case, including CAL/ACEP’s. They clearly took our brief seriously. Wellpoint has narrowed its view from contending that the DMHC has exclusive jurisdiction over everything to their current position, which is in this case, government agencies can't sue over recission issues. Significantly, they do not criticize Bell in any way, and affirm the rights of private parties (e.g., emergency physicians) to continue to utilize the courts for fair reimbursement. We will have to wait for the Court of Appeal's decision, but as it stands now, Wellpoint is leaving emergency physicians alone.

CAL/ACEP's amicus brief

People v Wellpoint - Defendant-Petitioners' Response to Amici Curiae Briefs

PROTECTING MEDI-CAL REIMBURSEMENT

Independent Living Center v Shewry
CAL/ACEP supported ILC v Shewry, in which the 10% Medi-Cal Provider Rate Cuts were overturned, by submitting declarations to the court, in addition to having CAL/ACEP's attorney provide support at the hearing.

UPDATE: Federal Appeals Court Upholds Lower Court Ruling Blocking Medi-Cal Cuts, Orders Retroactive Payments. Opinion

Yesterday, the 9th U.S. Circuit Court of Appeals upheld a lower court ruling in a CAL/ACEP supported case blocking a 10 percent Medi-Cal rate cut enacted in the state budget in 2008. The 9th U.S. Circuit Court of Appeals said the California Department of Health Services violated federal law by failing to consider the impact of the cut on quality and access to health care. The appeals court said a state budget crisis could not be used as a justification for illegal cuts in the program.

A three-judge panel upheld a preliminary injunction issued by U.S. District Judge Christina Snyder in Los Angeleslast year. The reductions would have amounted to several hundred million dollars. The cuts were due to go into effect on July 1, 2008. Later last year, the Legislature replaced those cuts with a 5 percent reduction for pharmacies and hospitals effective in March 2009, but those cuts were also blocked by court orders.

The panel said the injunction against the 10 percent cuts should apply retroactively for the period between July 1, 2008, when the reduction went into effect, and Aug. 18, 2008, when the injunction was issued.

ILC v Shewry - Respondents' Opposition to Motion for Preliminary Injunction (June 2008)
ILC v Shewry - Order Granting Preliminary Injunction (August 2008)
ILC v Shewry - 9th Circuit Order (September 2008)
ILC v Shewry - Respondents' Report of Compliance with Preliminary Injunction (September 2008)
ILC v Maxwell-Jolly (Shewry) - 9th Circuit Opinion (July 2009)

CMA v Shewry
Along with six other lead plaintiffs, CAL/ACEP filed suit against the Department of Health Care Services to block the 10% Medi-Cal Provider Rate Cuts that were approved by Governor Schwarzenegger and the legislature in early 2008. While the judge found that CAL/ACEP had argued successfully in showing the irreparably harmful effects of the cuts, ultimately a preliminary injunction to stop the cuts was denied on narrow, procedural grounds.

PRESS/BACKGROUND
CMA v Shewry Press Release (May 2008)
CMA v Shewry Explained (May 2008)
CMA v Shewry Q & A (May 2008)
CMA v Shewry Medi-Cal Facts (May 2008)

PLEADINGS
CMA v Shewry - Complaint for Injunctive Relief (May 2008)
CMA v Shewry - Petitioners Memorandum of Points and Authorities Supporting a Preliminary Injuction (July 2008)
CMA v Shewry - Respondents' Opposition to Motion for Preliminary Injunction (July 2008)
CMA v Shewry - Petitioners' Reply Brief in Support of Preliminary Injunction (July 2008)
CMA v Shewry - City and County of San Francisco Amicus Curiae Brief (July 2008)
CMA v Shewry - Order Denying Preliminary Injunction (July 2008)

EMERGENCY PHYSICIANS FIGHT BACK

Centinela v Shewry

California’s emergency physicians fought back against crumbling emergency care and woefully inadequate reimbursements by the State of California’s Medi-Cal program, by filing a class-action lawsuit against the State in Los Angeles Superior Court – Centinela v. Shewry. With increasing demand for emergency care services and a serious lack of funding for the emergency care safety net, the burden of caring for the State’s poorest citizens has fallen almost completely onto the backs of California’s Emergency Physicians. This suit seeks to force the State into paying for its societal obligation to the poor.

Centinela v Shewry - Complaint (January 2009)
Los Angeles Times Coverage

PROSPECT v. NORTHRIDGE

Supreme Court Opinion

On January 8, 2009, the California Supreme Court unanimously ruled that non-contracted emergency physicians are prohibited from balance billing patients who covered by Knox-Keene-regulated insurance. The Court stated in Prospect Medical Group v. Northridge Emergency Medical Group that "Emergency room doctors must resolved their differences with HMO's [sic] and not inject patients into the dispute. Interpreting the statutory scheme as a whole, we conclude that the doctors may not bill a patient for emergency services that the HMO is obligated to pay. Balance billing is not permitted."

Click here to read the California Supreme Court's Opinion in Prospect v Northridge.
Click here to read news paper coverage of the ruling.
Click here for FAQs about the Supreme Court's Opinion.

FIGHTING FOR FAIR PAYMENT

Coast Plaza Hospital v Blue Cross
A California Appellate Court rules that ERISA does not preclude a physician from suing under state law to seek fair reimbursement by a plan.

In this case, Coast Plaza Doctors Hospital (Coast Plaza) provided emergency care to Patient X, an enrollee of a group health plan insured by Blue Cross. When Blue Cross did not reimburse Coast Plaza for the cost of the emergency care, Coast Plaza sued Blue Cross in Superior Court, alleging a number of state law claims derived from the Knox-Keene Act. Because Patient X's group health plan qualified as an employee benefit plan subject to ERISA, the trial court sustained Blue Cross' demurrer on the grouds that Coast Plaza's state law claims were subject to ordinary preemption under ERISA.

The Appellate Court concluded that section 1371.4 is a state law that reqgulates insurance withing hte purview of ERISA's saving clause and, therefore, reversed the judgment and remanded the case for further proceedings. You can read the opinion here.

CMA v DMHC
CAL/ACEP is one of six lead plaintiffs who filed suit against the Department of Managed Health Care to block the department's dangerous regulations that would allow insurance companies to avoid paying for non-contracted emergency care and pass on their costs to patients. Oral arguments were presented on Friday, November 21, 2008 in Sacramento Superior Court.

CMA v DMHC - Petitioners' Opening Brief (September 2008)
CMA v DMHC - Petition for Writ of Mandate (September 2008)
CMA v DMHC - Defendants' Answer to Opening Brief (October 2008)
CMA v DMHC - CAPG Amicus Curiae Brief (November 2008)
CMA v DMHC - Kaiser Amicus Curiae Brief (November 2008)
CMA v DMHC - Petitioners' Opposition to Kaiser Amicus Curiae Brief (November 2008)
CMA v DMHC - DMHC Respondents' Hearing Brief (November 2008)
CMA v DMHC - Petitioners' Reply Brief (November 2008)
CMA v DMHC - Tentative Ruling (November 2008)

Prospect v Northridge
CAL/ACEP filed an amicus curiae brief supporting Northridge Emergency Medical Group against an IPA who sued Northridge claiming that balance billing by non-contracted emergency physicians is prohibited by California statute. The court has ruled in our favor thus far, and Prospect has appealed. Oral arguments were heard before the California Supreme Court on November 5, 2008.

Prospect v Northridge Emergency Medical Group - Supreme Court Opinion
Prospect v Northridge Emergency Medical Group - Appellants' Reply Letter Brief (November 2008)
Prospect v Northridge Emergency Medical Group - Respondents' Reply Letter Brief (November 2008)
Prospect v Northridge Emergency Medical Group - DMHC Letter Brief (October 2008)
Prospect v Northridge Emergency Medical Group - Respondents' Supplemental Brief (October 2008)
Prospect v Northridge Emergency Medical Group - Respondents' Letter Brief (October 2008)
Prospect v Northridge Emergency Medical Group - Appellants' Letter Brief (October 2008)
Prospect v Northridge Emergency Medical Group - CAL/ACEP Amicus Curiae Brief in Support of Respondents (December 2006)