YANA ANDERSON v. OCHSNER HEALTH SYSTEM AND OCHSNER CLINIC FOUNDATION
NO. 2013-CC-2970
Supreme Court of Louisiana
July 1, 2014
134 So.3d 1184
CLARK, JUSTICE
NEWS RELEASE #20235
FOR IMMEDIATE NEWS RELEASE
FROM: CLERK OF SUPREME COURT OF LOUISIANA
The Opinions handed down on the 1st day of July, 2014, are as follows:
BY CLARK, J.:
2013-CC-2970 YANA ANDERSON V. OCHSNER HEALTH SYSTEM AND OCHSNER CLINIC FOUNDATION (Parish of Jefferson)
Accordingly, we affirm the lower courts’ denial of summary judgment and remand for proceedings consistent with this opinion.
AFFIRMED AND REMANDED.
VICTORY, J., dissents for the reasons assigned by Justice Guidry.
GUIDRY, J., dissents and assigns reasons.
07/01/14
SUPREME COURT OF LOUISIANA
NO. 2013-CC-2970
YANA ANDERSON
VERSUS
OCHSNER HEALTH SYSTEM AND OCHSNER CLINIC FOUNDATION
ON SUPERVISORY WRITS TO THE TWENTY-FOURTH JUDICIAL DISTRICT COURT FOR THE PARISH OF JEFFERSON
CLARK, JUSTICE
FACTS AND PROCEDURAL HISTORY
The plaintiff, Yana Anderson, alleges that she was injured in a automobile accident caused by a third party on or about August 4, 2010 in Baton Rouge, Louisiana. Thereafter, she received medical treatment at an Ochsner facility.1 For all relevant times and purposes, Anderson was insured by UnitedHealthcare. Pursuant to her insurance contract, Anderson paid premiums to UnitedHealthcare in exchange for discounted health care rates. These reduced rates were available pursuant to a member provider agreement, wherein UnitedHealthcare contracted with Ochsner to secure discounted charges for its insureds. Thus, at the time of Anderson‘s treatment, Ochsner was a “contracted health care provider” with UnitedHealthcare, as defined in
Anderson presented proof of insurance to Ochsner in order for her claims to be submitted to UnitedHealthcare for payment on the agreed upon reduced rate. However, Ochsner refused to file a claim with her insurer. Instead, Ochsner sent a letter to Anderson‘s attorney, asserting a medical lien for the full amount of undiscounted charges on any tort recovery Anderson received for the underlying automobile accident.2
On June 16, 2011, Anderson filed a putative class action against Ochsner, seeking, among other remedies, damages arising from Ochsner‘s billing practices.3 Anderson, individually and on behalf of the class, claimed Ochsner‘s actions violated
In response, Ochsner filed a motion for summary judgment, arguing no private right of action exists under the Balance Billing Act.4 Anderson opposed the motion, arguing
The text of the Balance Billing Act,
La. R.S. 22:1874 et al [sic], neither explicitly grants a right of private action nor prohibits a private right of action in thisparticular situation. After reviewing the language and structure of the statute, the purpose of the act, and the judicial opinions interpreting the statute, the Court finds that the legislature intended to provide a private cause of action under the Balance Billing Act. . . .
The fact that the Balance Billing Act provides for partial enforcement through the Attorney General does not preclude a concurrent private right of action. In Jefferson v. Chevron, 713 So.2d 785, 791 (La. App. 4 Cir. 1998), the Fourth Circuit noted that a statutory scheme which provided for proceedings through the [A]ttorney [G]eneral, also provided a concurrent private right of action. It does not appear that a private right of action would run counter to the purpose of the act or the enforcement efforts of the [A]ttorney [G]eneral, nor were the litigants able to supply any such bases.
The Balance Billing Act clearly provides a private right of action when a provider wrongfully seeks reimbursement with an action at law. Ochsner argues that the instant case does not present an action at law because they only sent out lien letters and did not file a formal suit. The Court finds that that to be a tenuous position, as
La. R.S. 9:4754 clearly imposes legal duties and penalties for failure to heed a lien letter.
Ochsner applied for supervisory writs from the trial court‘s judgment. The court of appeal denied the writ, noting the existence of an adequate remedy on appeal.5
Ochsner subsequently filed a writ application with this court. We granted the application to determine whether Anderson has a private right of action for damages under the Balance Billing Act.6
RULES OF STATUTORY INTERPRETATION
Both parties concede that because the statute is silent on the existence of a private right of action, the court, in interpreting the statute, is tasked with determining the legislative intent. The function of statutory interpretation and the construction given to legislative acts rests with the judicial branch of the government. Red Stick Studio Dev., L.L.C. v. State ex rel. Dep‘t of Econ. Dev., 2010-0193, p. 9 (La. 1/19/11), 56 So. 3d 181, 187. The paramount question in all cases of statutory interpretation is legislative intent; ascertaining the reason that triggered the enactment of the law is the fundamental aim of statutory interpretation. In re: Succession of Boyter, 99-0761, p. 9 (La.1/7/00), 756 So.2d 1122, 1128. The rules of statutory construction are designed to unveil and enforce the intent of the legislature. Id.; Stogner v. Stogner, 98-3044, p. 5 (La.7/7/99), 739 So.2d 762, 766. Legislation is the solemn expression of legislative will; thus, interpretation of a statute involves primarily a search for the legislature‘s intent.
In ascertaining the true meaning of a word, phrase, or section of a statute, the act as a whole must be considered. Fruge v. Muffoletto, 242 La. 569, 137 So.2d 336, 339 (1962). When doubt exists as to the proper interpretation of a statute, the title or preamble may be used to determine legislative intent. Authement v. Shappert Engineering, 02- 1631, p. 8 (La. 2/25/03), 840 So.2d 1181,1186.
A. (1) A contracted health care provider shall be prohibited from discount billing, dual billing, attempting to collect from, or collecting from an enrollee or insured a health insurance issuer liability or any amount in excess of the contracted reimbursement rate for covered health care services.
(2) No contracted health care provider shall bill, attempt to collect from, or collect from an enrollee or insured any amounts other than those representing coinsurance, copayments, deductibles, noncovered or noncontracted health care services, or other amounts identified by the health insurance issuer on an explanation of benefits as an amount for which the enrollee or insured is liable.
(3) However, in the event that any billing, attempt to collect from, or the collection from an enrollee or insured of any amount other than those representing copayment, deductible, coinsurance, payment for noncovered or noncontracted health care services, or other amounts identified by the health insurance issuer as the liability of the enrollee or insured is based on information received from a health insurance issuer, the contracted health care provider shall not be in violation of this Subsection.
Anderson alleges that Ochsner‘s billing practices clearly violate this statute and nothing in the Act prohibits a private right of action. Contrarily, Ochsner argues, while nothing prohibits an individual remedy under this statute, nothing expressly grants one either. Rather, Ochsner contends
(1) Any enrollee or insured who receives a bill or consolidated activity statement and bill from a contracted health care provider in violation of
R.S. 22:1874(A) or a health insurance issuer acting on behalf of an enrollee or insured, may file a complaint with the Consumer Protection Division of the Department of Justice.(2) The enrollee or insured, or health insurance issuer acting on behalf of the enrollee or insured, shall provide to the attorney general a copy of the original bill or consolidated activity statement and bill issued pursuant to
R.S. 22:1873 and such additional information that may be requested by the attorney general, documenting an attempt by a contracted health care provider to collect or the collection of any amount from the enrollee or insured that is the liability of the health insurance issuer or that is in excess of the contracted reimbursement rate. In the event it is determined that billing activity was based on information received from the health insurance issuer, the contracted health care provider shall not be in violation, and the attorney general shall refer the violation to the commissioner.(3) If the attorney general concludes, based on the information submitted, that a contracted health care provider has attempted to collect, or collected, any amount from the enrollee or insured that is the liability of the health insurance issuer or that is in excess of the contracted reimbursement rate, the attorney general may pursue remedies as provided for in
R.S. 51:1401 et seq., beginning with a notice of unfair trade practices.(4) Any contracted health care provider who has demanded or received payment
from an enrollee or insured for any amount which he is
prohibited from billing or collecting by
R.S. 22:1874(A) shall correct his billing and refund any such amount paid within forty-five days of service of the notice of unfair trade practices.(5) The notice of unfair trade practices shall be satisfied by the attorney general within thirty days of receipt of information from the contracted health care provider that shows that any such billing or collection efforts were not in violation of
R.S. 22:1874(A) .(6) In the event that a contracted health care provider fails to comply with a notice of unfair trade practices, the attorney general may proceed in accordance with the Unfair Trade Practices and Consumer Protection Law,
R.S. 51:1401 et seq.
Ochsner avers this complaint process is exclusive, citing to the established legal maxim, expressio unius et exclusio alterius, which embodies the principle that when a law specifically enumerates certain items but omits other items, the omission is deemed intentional. Ochsner‘s argument follows, then, that the inclusion of the administrative remedy is the exclusion of a private right of action. Furthermore, Ochsner relies on
Conversely, Anderson, in advancing the position that there is a private right of action under
Armed with the statute‘s language, rules of statutory interpretation, and the arguments made by the parties, we turn to our analysis. First, we look to the language of the statute itself and find nothing that expressly prohibits a private right of action. Courts can find the existence of a private right of action where the statute does not contain limiting language expressly barring such action. Cheramie Services, Inc. v. Shell Deepwater Production, Inc., 09-1633 (La. 4/23/10), 35 So.3d 1053. Because the statute itself does not provide a clear, unequivocal expression that prohibits an individual remedy, further investigation into the legislature‘s intent is required.7
In reaching this conclusion, we find the purpose of the administrative remedy granted to the attorney general is not thwarted by allowing private lawsuits. The procedure allows the attorney general, an official state representative, to enforce the law against illegal billing a law that is justified by substantial public policy considerations that affect individuals statewide. Thus, the offending practice sought to be tamed is one of such import that the legislature gave additional powers of enforcement to a state agency. As stated above, the purpose behind this administrative regime is not to shield offenders against civil liability but to offer concurrent, albeit optional, relief via the attorney general‘s enforcement. Nothing in the statute or the Act, strips an aggrieved insured of his/her right to recover any property of which he/she was divested or prevent him/her from being made whole. See generally
The discretionary nature of the grant of authority given to the attorney general to enforce the statute further evidences the existence of an implied private right of action in
Having found an implied right of action based on the legislative purpose and the spirit of the law, we advance to an alternative argument that may give Anderson a direct right of action.
No contracted health care provider may maintain any action at law against an enrollee or insured for a health insurance issuer liability or for payment of any amount in excess of the contracted reimbursement rate for such services. In the event of such an action, the prevailing party shall be entitled to recover all costs incurred, including reasonable attorney fees and court costs. However, nothing in this Subsection shall be construed to prohibit a contracted health care provider from maintaining any action at law against an enrollee or insured after a health insurance issuer determines that the health insurance issuer is not liable for the health care services rendered.
(Emphasis added).
Anderson argues the lien asserted by Ochsner constitutes “an action at law,” entitling her to a private right of action. Conversely, Ochsner asserts a lien is not “an action at law” but a mere privilege or placeholder to preserve a party‘s rights. For the reasons that follow, we agree with Anderson.9
A health care provider, hospital, or ambulance service that furnishes services or supplies to any injured person shall have a privilege for the reasonable charges or fees of such health care provider, hospital, or ambulance service on the net amount payable to the injured person, his heirs, or legal representatives, out of the total amount of any recovery or sum had, collected, or to be collected, whether by judgment or by settlement or compromise, from another person on account of such injuries, and on the net amount payable by any insurance company under any contract providing for indemnity or compensation to the injured person. The privilege of an attorney shall have precedence over the privilege created under this Section.
Any person who, having received notice in accordance with the provisions hereof, pays over any monies subject to the privilege created herein, to any injured person, or to the attorney, heirs, or legal representatives of any injured person, shall be liable to the licensed health care provider, hospital, or ambulance service having such privilege for the amount thereof, not to exceed the net amount paid.
Based on the foregoing statutes, we find a lien in this context operates automatically as a matter of law. Legal consequences attach when the lien is ignored.11
CONCLUSION
In conclusion, we find an implied private right of action exists under
AFFIRMED AND REMANDED.
07/01/14
SUPREME COURT OF LOUISIANA
NO. 2013-CC-2970
YANA ANDERSON
VERSUS
OCHSNER HEALTH SYSTEM AND OCHSNER CLINIC FOUNDATION
ON SUPERVISORY WRITS TO THE TWENTY-FOURTH JUDICIAL DISTRICT COURT FOR THE PARISH OF JEFFERSON
J. VICTORY dissents for the reasons assigned by J. Guidry.
07/01/14
SUPREME COURT OF LOUISIANA
No. 2013-CC-2970
YANA ANDERSON
VERSUS
OCHSNER HEALTH SYSTEM AND OCHSNER CLINIC FOUNDATION
GUIDRY, Justice, dissents and assigns reasons.
I respectfully dissent from the majority‘s holding that the legislature intended, albeit implicitly, to allow a private right of action under the Health Care and Consumer Billing and Disclosure Protection Act,
First, if the insured receives a bill or statement in contravention of
In Monier v. St. Charles Parish, 10-526 (La. App. 5 Cir. 5/10/11), 65 So.3d 731, the court declined to find a private right of action under the Teacher Bill of Rights Act, because the act provided for no remedy to anyone. A fortiori, where the legislature prohibits certain conduct and then provides the remedy or remedies for a violation of that prohibition, remedies that do not include a private right of action, the better view is that the legislature has intentionally circumscribed such a remedy. As the Monier court noted, had the legislature intended for there to be a private right of action, it could have provided for one. 65 So.3d at 733 (citing Voltolina v. St. Tammany Fire Dist., 06-1498 (La. App. 1 Cir. 9/19/07), 970 So.2d 1015).
In sum, I believe the Balance Billing Act clearly sets forth the exclusive remedies for a violation thereof, and I see no basis in our law or jurisprudence for creating the additional remedy of a private right of action where the legislature otherwise provided. Accordingly, I respectfully dissent.