Justia Public Benefits Opinion SummariesArticles Posted in Louisiana Supreme Court
Louisiana ex rel. Caldwell v. Molina Healthcare, Inc.
Louisiana, represented by its Attorney General, filed this lawsuit in 2014 against defendants, Molina Healthcare, Inc., Molina Information Systems, L.L.C. d/b/a Molina Medicaid Solutions, and Unisys Corporation. As described in the state’s petition, “[o]ver the last thirty (“30”) years, the Defendants have been the fiscal agent responsible for processing Louisiana’s Medical pharmacy provider reimbursement claims.” Pursuant to a contract to which the state itself was allegedly a party, “the Defendants assumed operational liability” of a “customizable” computerized system known as the Louisiana Medicare Management Information System (“LMMIS”). As part of defendants’ duties, they were “responsible for the operation and maintenance of LMMIS, as well as creating and implementing design changes to the LMMIS that comply with State and federal mandates.” The crux of the state’s allegations in this lawsuit is that Unisys caused the Louisiana Department of Health (“LDH”) to overpay Medicaid pharmacy providers through Unisys’ improper operation and management of LMMIS. The Louisiana Supreme Court granted certiorari review in this case to review the correctness of the appellate court’s ruling, sustaining an exception of no right of action for the Attorney General’s lawsuit against the defendants. By statute, the Louisiana Department of Health had the capacity to sue and be sued for programs that it administered, such as Medicaid. However, because the Louisiana Department of Health delegated–and defendants allegedly contractually accepted–some of the administrative functions of the state’s Medicaid program, the Supreme Court found the Attorney General had the capacity, and hence a right of action, to prosecute this lawsuit. View "Louisiana ex rel. Caldwell v. Molina Healthcare, Inc." on Justia Law
Louisiana v. Foret
The Louisiana Supreme Court granted certiorari to determine whether the Sledge Jeansonne Louisiana Insurance Fraud Prevention Act, and the Louisiana Unfair Trade Practice and Consumer Protection Act, could be applied retroactively to defendant’s criminal misconduct which occurred prior to the effective dates of these statutes. Defendant Lynn Foret, a medical doctor who specialized in orthopedic surgery, pled guilty in federal court to one count of health care fraud, for criminal acts that occurred between 2003 and 2009. The trial court granted Dr. Foret’s declinatory exceptions, dismissing with prejudice, the State's action for penalties under the Sledge Jeansonne Act and dismissed with prejudice causes of action under the Louisiana Unfair Trade Practices Act. The court of appeal affirmed the trial court’s rulings, finding that the conduct regulated by the substantive statute was the underlying fraud, rather than the subsequent guilty plea. Therefore, even though the State's cause of action could not have accrued until Dr. Foret pled guilty, application of the Acts nonetheless attached new consequences to his criminal misconduct, which occurred before the Acts became effective. One judge on the appellate panel dissented, reasoning the plain language of the Sledge Jeansonne Act demonstrated it was the guilty plea that gave the State Attorney General the authority to act, not the criminal activity, and because the guilty plea was entered after the effective date of the statute, its application herein would be prospective, not retroactive. The State appealed to the Supreme Court, arguing that the Sledge Jeansonne Act was not an impermissible retroactive application of the law. After review, the Supreme Court held that both the Sledge Jeansonne Act and Louisiana Unfair Trade Practice and Consumer Protection Act operated prospectively only, applying to causes of action arising after the effective date of each Act. The Court affirmed the court ofappeal ruling finding that the statutes at issue could not be retroactively applied to this defendant’s past criminal conduct. View "Louisiana v. Foret" on Justia Law
Born v. City of Slidell
The Supreme Court granted certiorari in this matter to determine whether a retiree of the City of Slidell, plaintiff Dean Born, could continue participating in the City of Slidell's health insurance plan following the City's adoption of Ordinance No. 3493, which required each city retiree to apply for Medicare coverage upon reaching the age of sixty-five. After review, the Supreme Court affirmed the Court of Appeal's finding that the City could not terminate plaintiff's desired plan coverage and require him to accept Medicare coverage, because plaintiff retired before the effective date of the Ordinance. View "Born v. City of Slidell" on Justia Law
Slaughter v. Louisiana State Employees’ Retirement System
In 2009, plaintiff Dr. Ralph Slaughter retired as president of Southern University System (“Southern”) after thirty-five years of service. Upon retirement, the Louisiana State Employees’ Retirement System (“LASERS”) began paying plaintiff retirement benefits. Plaintiff filed suit against Southern for past due wages. The district court ruled that Southern had miscalculated plaintiff’s income base by including supplemental pay plaintiff had received from the Southern University Foundation, and determined plaintiff’s terminal pay (500 hours of unused leave) and retirement should have been calculated only on his annual base salary due from Southern. The court of appeal affirmed on appeal, noting plaintiff “manipulated the system and used his position for his own benefit.” Southern sent a letter to LASERS advising it had committed an error in including supplemental funds in plaintiff’s earnings. Because plaintiff's lawsuit was ongoing at the time, LASERS filed a concursus proceeding seeking to deposit the disputed amount of plaintiff’s benefit in the registry of court pending resolution of the litigation. Plaintiff filed an exception of no cause of action. The district court granted the exception and dismissed the second suit with prejudice. LASERS did not appeal this judgment. After the first suit became final, LASERS sent correspondence to plaintiff advising it intended to retroactively reduce his retirement benefit starting June 1, 2012 “due to an error made by Southern University in the reporting of your earnings.” Relying on La. R.S. 11:192, LASERS maintained it could adjust benefits and further reduce the corrected benefit to recover overpayment within a reasonable number of months. Plaintiff then filed the instant suit against LASERS, seeking a writ of mandamus, injunctive relief, and a declaratory judgment confirming LASERS had no authority or ability to reduce his retirement benefits. The petition alleged plaintiff’s retirement benefits should have been calculated based on the entirety of his earnings over thirty-five years of employment, including salary supplements. The Supreme Court was called on to determine whether the lower courts erred in finding the defendant retirement system failed to prove that it followed the proper procedure before initiating action to reduce and recoup plaintiff’s retirement benefits. The Court found the lower courts did not apply the proper statutory analysis and reached an erroneous result. The case was remanded for further proceedings. View "Slaughter v. Louisiana State Employees' Retirement System" on Justia Law
In re: Katrina Canal Breaches Litigation
To provide relief in the aftermath of Hurricanes Katrina and Rita, Congress appropriated funds to Louisiana which distributed some of those funds through the "Road Home" program. The State required more than 150,000 Road Home grant recipients to execute a "Limited Subrogation/Assignment Agreement." The Road Home program created "perverse incentives" for insurance companies and their insured homeowners: some insurers inadequately adjusted and paid grant-eligible claims, and some grant-eligible homeowners had little motivation for file insurance claims. As a result, Road Home applications skyrocketed and created a $1 billion shortfall in the program. The State filed suit against more than 200 insurance companies, seeking to recover the funds spent and yet to be spent on claims under the Road Home program. The Insurance Companies successfully removed the case to the federal district court. The Insurance Companies then sought to dismiss the State's case, arguing that as a matter of law, anti-assignment clauses in the homeowners' policies invalidated the subrogation/assignment to the State. The federal district court denied the Companies' motion to dismiss. The Companies appealed to the Fifth Circuit. Because interpretation of the policy provisions at issue was a matter of State law, the Court certified interpretation to the Louisiana Supreme Court. The Supreme Court found that there is no public policy in Louisiana that precludes anti-assignment claims from applying to post-loss assignments. The Court commented that the language of the anti-assignment clause must clearly and unambiguously express that it applies to post-loss assignments, and as such must be evaluated on a policy-by-policy basis.