Representative Court Decisions

In addition to the cases cited below, Hooper, Lundy & Bookman has successfully prosecuted and defended numerous high profile cases at the trial and arbitration level, which do not result in published citations, but which represent significant expertise in these types of proceedings.

Medicare Cases

Sharp Healthcare v. Leavitt, 2009 WL 790113(S.D. Cal. March 25, 2009)
Sharp Healthcare v. Leavitt, 555 F.Supp.2d 1121 (S.D. Cal. April 4, 2008) (Plaintiffs Granted Preliminary Injunction to Halt Medicare Lab Demonstration Project)
Foothill Hosp. – Morris L. Johnson Memorial v. Leavitt, 558 F.Supp.2d 1 (D.D.C., May 30, 2008) (Presumption of Collectability Violates Medicare Bad Debt Moratorium)Labotest, Inc. v. Bonta, 297 F.3d 892 (9th Cir. 2002). Court holds that plaintiffs are prevailing parties and, thus, entitled to attorneys’ fees under the Civil Rights Act based on favorable Court approved settlement.
Alhambra Hospital v. Thompson, 259 F.3d 1071 (9th Cir. 2001). Ninth Circuit holds that the Medicare program improperly restricted the count of Medicaid subacute patient days in the calculation of hospitals’ Medicare disproportionate share hospital payments.
United States v. Mackby, 243 F.3d 1159 (9th Cir. 2001). Ninth Circuit holds that per claim penalties and treble damages provisions of the federal False Claims Act are subject to review under the Excessive Fines Clause of the Eighth Amendment.
County of Los Angeles v. Shalala, 192 F.3d 1005 (D.C. Cir. 1999). Court holds that Medicare Act does not require a minimum annual amount of outlier payments, but holds that the Secretary of Health and Human Services did not state sufficient reasons for her methodology for setting outlier thresholds for 1985 and 1986.
Alvarado Community Hospital v. Shalala, 155 F.3d 1115 (9th Cir. 1998). Court holds that Medicare under-paid hospitals for outlier patients in 1985 and 1986 and orders retroactive payments in a case involving 140 hospitals.
United States ex. rel.Thompson v. Columbia/HCA Healthcare Corporation, 125 F.3d 899 (5th Cir. 1997). Circuit Court reverses District Court holding that qui tam action alleging Medicare false claims for services rendered in violation of the anti-kickback statute and self-referral statute did not state valid claim.
Hanlester Network v. Shalala, 51 F.3d 1390 (9th Cir. 1995). Court holds, inter alia, that, in order to find violation of antikickback statute, court must find that defendant knowingly and willfully engaged in prohibited conduct with specific intent to disobey law.
Athens Community Hospital, Inc. v. Shalala, 21 F.3d 1176 (D.C. Cir. 1994). Court invalidates Medicare regulation which prohibited hospitals from being geographically reclassified under the Prospective Payment System unless the county in which the hospital was located was adjacent to the Metropolitan Statistical Area or rural area to which reclassification was sought.
Mt. Diablo Medical Center v. Bowen, 860 F.2d 951 (9th Cir. 1988). Court invalidates Medicare policy prohibiting payment of TEFRA bonuses until final settlement.
National Medical Enterprises. v. Bowen, 662 F. Supp. 476 (C.D. Cal. 1987); aff’d, 851 F.2d 291 (9th Cir. 1988). Court holds that Medicare policy excluding return on equity capital earned during a current period from a provider’s ending equity capital calculation is inconsistent with the Medicare regulations.
Tallahassee Regional Medical Center v. Bowen, 815 F.2d 1435 (11th Cir. 1987), aff’g Parkway Regional Medical Center v. Bowen, 614 F. Supp. 564 (S.D. Fla. 1985). Court holds that Medicare program’s 1979 Malpractice Rule is invalid and that 1986 Malpractice Rule may not be given retroactive effect .

Medicaid Cases

Simonyan v. Connell, 2000 WL 562861 (C.D. Cal., January 20, 2000). Court enjoins State Controller from investigating Medi-Cal claims and enjoins Department of Health Services from basing a Medi-Cal withhold on a Controller audit.
Fountain Valley Regional Hospital and Medical Center v. Bonta, 75 Cal. App. 4th 316 (1999). Court holds that burden of proof on issue of laches shifts to Department of Health Services, when Department assesses alleged Medi-Cal overpayments after analogous statute of limitations period has expired.
Doctor’s Medical Laboratory, Inc. v. Connell, 69 Cal. App. 4th 891 (1999). Court holds that federal Medic-aid law barred Department of Health Services from delegating to the State Controller the discretionary authority to audit Medi-Cal claims and to withhold alleged overpayments.
People v. Duz-Mor Diagnostic Laboratory, Inc., 68 Cal. App. 4th 654 (1998). Court holds that clinical laboratory, which provides services to Medi-Cal patients, did not violate unfair competition law by charging discounted fees to physicians’ private-pay patients.
Exeter Memorial Hospital Association v. Belshé, 145 F.3d 1106 (9th Cir. 1998). Court holds that State may not implement changes in Medicaid rate methodology prior to federal approval of State Plan amendment.
Beverly Community Hosp.Ass’n v. Belshé, 132 F. 3d 1259 (9th Cir. 1997). Reversal of District Court decision requiring State to pay Medicare deductibles and co-insurance for persons receiving both Medicare and Medicaid, after Congress retroactively amended statute governing states’ obligation.
Orthopaedic Hospital v. Belshé, 103 F.3d 1491 (9th Cir. 1997). Court holds that Medi-Cal hospital outpatient rates must bear a reasonable relationship to hospital costs.
Missouri Department of Social Services v. Great Plains Hospital, 930 S.W. 2d 429 (Mo. Ct. App. 1996). Court invalidates Missouri’s cap on Medicaid reimbursement for psychiatric services.
Physicians and Surgeons Laboratories, Inc. v. Department of Health Services, 6 Cal. App. 4th 968 (1992). Challenge by independent clinical laboratory to a Medicaid regulation prohibiting discriminatory billing practices.
AMISub (PSL), Inc. v. Colorado Dept. of Social Services, 789 F.2d 291 (10th Cir. 1989). Court invalidates Colorado Medicaid payment rate for inpatient hospital services due to use of budget factor which violated federal law.

Miscellaneous Cases

Mount Diablo Medical Center v. Health Net, 101 Cal.App.4th 711, 2002 (Certified for Publication). Court holds that Federal Arbitration Act does not preempt trial judge’s authority under California law to deny arbitration when choice of law provision in contract between hospital and health plan selected California law, and the contractual payment dispute overlapped with payment dispute with health plan’s delegated intermediary, who was not a party to the contract.
United States v. Mackby, 261 F.3d 821 (9th Cir. 2001). Ninth Circuit holds that per claim penalties and treble damages provisions of the federal False Claims Act are subject to review under the Excessive Fines Clause of the Eighth Amendment.

Medicare Cases

Labotest, Inc. v. Bonta, 297 F.3d 892 (9th Cir. 2002). Court holds that plaintiffs are prevailing parties and, thus, entitled to attorneys’ fees under the Civil Rights Act based on favorable Court approved settlement.
Alhambra Hospital v. Thompson, 259 F.3d 1071 (9th Cir. 2001). Ninth Circuit holds that the Medicare program improperly restricted the count of Medicaid subacute patient days in the calculation of hospitals’ Medicare disproportionate share hospital payments.
United States v. Mackby, 243 F.3d 1159 (9th Cir. 2001). Ninth Circuit holds that per claim penalties and treble damages provisions of the federal False Claims Act are subject to review under the Excessive Fines Clause of the Eighth Amendment.
County of Los Angeles v. Shalala, 192 F.3d 1005 (D.C. Cir. 1999). Court holds that Medicare Act does not require a minimum annual amount of outlier payments, but holds that the Secretary of Health and Human Services did not state sufficient reasons for her methodology for setting outlier thresholds for 1985 and 1986.
Alvarado Community Hospital v. Shalala, 155 F.3d 1115 (9th Cir. 1998). Court holds that Medicare under-paid hospitals for outlier patients in 1985 and 1986 and orders retroactive payments in a case involving 140 hospitals.
United States ex. rel.Thompson v. Columbia/HCA Healthcare Corporation, 125 F.3d 899 (5th Cir. 1997). Circuit Court reverses District Court holding that qui tam action alleging Medicare false claims for services rendered in violation of the anti-kickback statute and self-referral statute did not state valid claim.
Hanlester Network v. Shalala, 51 F.3d 1390 (9th Cir. 1995). Court holds, inter alia, that, in order to find violation of antikickback statute, court must find that defendant knowingly and willfully engaged in prohibited conduct with specific intent to disobey law.
Athens Community Hospital, Inc. v. Shalala, 21 F.3d 1176 (D.C. Cir. 1994). Court invalidates Medicare regulation which prohibited hospitals from being geographically reclassified under the Prospective Payment System unless the county in which the hospital was located was adjacent to the Metropolitan Statistical Area or rural area to which reclassification was sought.
Mt. Diablo Medical Center v. Bowen, 860 F.2d 951 (9th Cir. 1988). Court invalidates Medicare policy prohibiting payment of TEFRA bonuses until final settlement.
National Medical Enterprises. v. Bowen, 662 F. Supp. 476 (C.D. Cal. 1987); aff’d, 851 F.2d 291 (9th Cir. 1988). Court holds that Medicare policy excluding return on equity capital earned during a current period from a provider’s ending equity capital calculation is inconsistent with the Medicare regulations.
Tallahassee Regional Medical Center v. Bowen, 815 F.2d 1435 (11th Cir. 1987), aff’g Parkway Regional Medical Center v. Bowen, 614 F. Supp. 564 (S.D. Fla. 1985). Court holds that Medicare program’s 1979 Malpractice Rule is invalid and that 1986 Malpractice Rule may not be given retroactive effect .