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36 Cal. App. 5th 413
Cal. Ct. App. 5th
2019
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Background

  • 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)
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Case Details

Case Name: Hoag Mem'l Hosp. Presbyterian v. Kent
Court Name: California Court of Appeal, 5th District
Date Published: Jun 17, 2019
Citations: 36 Cal. App. 5th 413; 248 Cal. Rptr. 3d 486; A153724
Docket Number: A153724
Court Abbreviation: Cal. Ct. App. 5th
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    Hoag Mem'l Hosp. Presbyterian v. Kent, 36 Cal. App. 5th 413