36 Cal. App. 5th 413
Cal. Ct. App. 5th2019Background
- Hoag Memorial Hospital (Hoag), a non‑contract acute care hospital, received a final Medi‑Cal audit for fiscal year ending Sept. 30, 2009, showing a $2,413,623 reimbursement reduction based on AB 5 and AB 1183.
- Hoag filed a timely Statement of Disputed Issues (SODI) on May 19, 2012, challenging the legality of AB 5 and AB 1183 (a global challenge to the lawfulness of the reductions).
- On December 12, 2013, Hoag submitted a second SODI (over 18 months later) seeking to add a discrete challenge that the Department had incorrectly included 448 nursery days in the AB 1183 calculation, seeking $620,903.
- OAHA initially acknowledged receipt of both submissions but issued an order to show cause and ultimately dismissed the December 2013 SODI as untimely under Cal. Code Regs., tit. 22, § 51022.
- Hoag petitioned for writ of administrative mandate; the trial court denied relief as to the December 2013 SODI (but remanded the legality issue of AB 5/1183). This appeal follows.
- The appellate court reviewed de novo and affirmed dismissal: the calculation‑error claim was a separate, untimely issue, and Hoag waived any good‑cause argument by not raising it administratively.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Timeliness of Hoag's December 2013 SODI (calculation error) | Second SODI merely elaborates on the originally appealed audit finding and therefore relates back to the timely May 2012 appeal | The nursery‑day calculation was a separate, distinct issue that had to be raised within 60 days of the audit report under § 51022 | The December 2013 SODI was a separate issue and untimely; dismissal affirmed |
| Whether an accepted OAHA receipt letter fixes timeliness | OAHA's "accepted as an appeal" notices constituted definitive acceptance and precluded later timeliness dismissal | OAHA receipt notices do not decide timeliness; ALJ may adjudicate timeliness later | Notices acknowledging receipt do not preclude the ALJ from dismissing as untimely |
| Applicability of § 51022 amendment/30‑day relief | Hoag contends it could amend SODI or get 30 more days to add issue | § 51022(d) allows amendment only within the original 60‑day period; late SODIs governed by § 51022(c) and require showing good cause within 15 days of notice | The 30‑day/amendment provision does not excuse a wholly untimely new issue; Hoag’s argument rejected |
| Good‑cause for late filing | Hoag now argues practical impossibility of immediately auditing the audit and other justifications | Hoag failed to present any good‑cause justification during administrative proceedings | Hoag waived good‑cause arguments by not raising them below; late filing denied |
Key Cases Cited
- Santa Rosa Memorial Hospital, Inc. v. Kent, 25 Cal.App.5th 811 (affirming challenges to AB 5/AB 1183 and addressing federal review limits)
- Mission Hospital Regional Medical Center v. Shewry, 168 Cal.App.4th 460 (discussing reimbursement methods for non‑contract hospitals)
- Kaiser Foundation Hospitals v. Belshe, 54 Cal.App.4th 1547 (limitations on appeal where no adjustment in amount claimed)
- Coastal Community Hospital v. Belshe, 45 Cal.App.4th 391 (scope of appeals under audit/examination process)
- Palmdale Hospital Medical Center v. Department of Health Services, 8 Cal.App.4th 1306 (distinguishing review processes for audits vs settlements)
- County of San Joaquin v. Belshe, 35 Cal.App.4th 6 (requiring written specification of disputed issues under § 51022)
- Mission Community Hospital v. Kizer, 13 Cal.App.4th 1683 (timeliness requirements for appealing audit findings)
- Department of Corrections & Rehabilitation v. State Personnel Board, 238 Cal.App.4th 710 (standard of review for administrative mandate appeals)
- Hi‑Desert Medical Center v. Douglas, 239 Cal.App.4th 717 (abuse of discretion review in administrative mandate context)
