146 So. 3d 921
La. Ct. App.2014Background
- Plaintiffs alleged MMC used a hospital-wide policy to bill insured patients involved in motor vehicle accidents, allegedly violating the Health Care Consumer Billing and Disclosure Protection Act (HCCBDPA).
- The Act prohibits discount billing and collecting from insureds or health insurers in excess of the contracted reimbursement rate under La. R.S. 22:1872 et seq.; the contractor’s liability is defined by R.S. 22:1872(20).
- The trial court certified a class for claims from 2004–2011, subdividing into Payor and Attempt to Recover subclasses under Desselle v. Acadian Ambulance Serv., 83 So.3d 1243 (La.App.3d Cir. 2012).
- MMC challenged the class on (i) absence of action under the Act for 2000–2003, (ii) disparate factual circumstances among named plaintiffs, and (iii) novelty/untested legal theories requiring experience with Act litigation.
- Louisiana law requires Article 591 prerequisites (numerosity, commonality, typicality, adequacy, ascertainability) plus Article 591(B) factors (predominance and superiority).
- The Louisiana Supreme Court later limited guidance by recognizing private rights of action under the Act, but emphasized unresolved damages calculations and the need for developed law before class certification.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether common questions predominate for a class under the Act | Baker/Wiginton/Allen argue common breach questions exist. | MMC contends novel, untested theory and varied damages defeat predominance. | No; predominance not shown; unresolved Act framework precludes class. |
| Whether the class is superior for resolving the controversy | Class action better for small/nominal claims. | Class devices would misalign individual damages and novel issues. | No; superior method not established given undeveloped legal issues. |
| Whether the Act provides a private right of action for injured insureds or payors | Ochsner and private action recognized; damages may flow from liens. | Private action uncertain regarding damages and computation. | Not resolved for class; need legislative/court clarification. |
| Whether 2000–2003 claims fall within the Act’s scope | Harms from 2000–2003 fall within Act; at least some claims covered. | Act not in effect for 2000–2003; exclusion applies. | No; class improper due to non-applicability for early years. |
Key Cases Cited
- Brooks v. Union Pac. R.R. Co., 13 So.3d 546 (La. 2009) (class action prerequisites and commonality rules)
- Dupree v. Lafayette Ins. Co., 51 So.3d 673 (La. 2010) (rigorous analysis required for certification)
- Howard v. Willis-Knighton Med. Ctr., 924 So.2d 1245 (La.App.2d Cir. 2006) (burden on party seeking class certification; abuse of discretion standard)
- Ford v. Murphy Oil U.S.A., Inc., 703 So.2d 542 (La. 1997) (novel/untested theories unsupported for class certification)
- Banks v. New York Life Ins. Co., 722 So.2d 990 (La. 1998) (support for caution in certifying nonconventional classes)
- Desselle v. Acadian Ambulance Serv., Inc., 83 So.3d 1243 (La.App.3d Cir. 2012) (approved subclass framework for health-care billing disputes)