People v. Guiamelon
205 Cal. App. 4th 383
Cal. Ct. App.2012Background
- Guiamelon paid marketers $20 per patient referred who enrolled in CHDP or Family PACT; payments documented and reported as business expenses.
- She was charged with offering rebates for patient referrals under Bus. & Prof. Code §650; other counts were dismissed/acquitted.
- She argued §650 is preempted by the federal Medicaid anti-kickback statute, or is vague; claimed it conflicts with policy to serve the uninsured.
- The program context includes Medi-Cal/CHDP/Family PACT; CHDP acts as a gateway to Medi-Cal and related services for low-income, uninsured children.
- The trial court convicted on §650 count; this appeal follows; the legislature included §650 without adopting a safe harbor for this conduct.
- Guiamelon testified she believed payments were lawful and intended to promote preventive care for the uninsured, while the jury rejected a good-faith defense.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether §650 is preempted by the federal anti-kickback statute | Guiamelon asserts conflict/obstacle preemption due to higher scienter | Guiamelon argues federal law preempts state remedy; state law blocks compliance | No preemption; §650 supplements, not conflicts with federal law. |
| Whether conflict preemption applies given different mens rea | Guiamelon claims §650 lacks knowledge of unlawfulness; federal statute requires knowledge | State & federal schemes allow some conduct despite differing mens rea; not impossible to comply | Conflict preemption not shown; possible to comply with both statutes. |
| Whether obstacle preemption applies to §650 as applied | §650 obstructs Congress’s objective to provide care to the underserved | §650 aligns with reducing fraud and may promote access safely | No obstacle preemption; §650 advances Congress’s dual aims. |
| Whether §650 is unconstitutionally vague as applied to this case | Argues vagueness and unfair notice about marketing distinctions | Statute sufficiently clear; no vagueness in prohibiting referral payments | §650 not unconstitutionally vague as applied. |
| Whether the First Amendment challenges invalidate §650 | Argues marketing payments are protected speech (Sorrell-type argument) | Criminal statute penalizes conduct, not speech; not overbroad | No First Amendment violation. |
Key Cases Cited
- Olszewski v. Scripps Health, 30 Cal.4th 798 (Cal. 2003) (Medicaid cooperative federalism and state role preserved; rich preemption analysis context)
- Hanlester Network v. Shalala, 51 F.3d 1390 (9th Cir. 1995) (Antikickback purpose; knowledge/willfulness aspects discussed)
- Wyeth v. Levine, 555 U.S. 555 (U.S. 2009) (Circumstantial preemption guidance; cannot infer preemption where Congress silent)
- Bronco Wine Co. v. Jolly, 33 Cal.4th 943 (Cal. 2004) (Presumption against preemption; dual aims of federal/state schemes considered)
- Viva!, Internal Voice for Animals v. Adidas Promotional Retail Operations, Inc., 41 Cal.4th 929 (Cal. 2007) (Presumption against preemption; state law not preempted in field traditionally state-regulated)
- In re Pharmaceutical Industry Average Wholesale Price Litigation, 478 F. Supp. 2d 164 (D. Mass. 2007) (Federal vs. California antikickback standards; distinctions in scienter noted)