Justia Government Contracts Opinion Summaries

Central Coast Development Company (“Central Coast”) owns a parcel of property within the City of Pismo Beach (“City”). The City approved Central Coast's application for a development permit. The City and Central Coast applied to the San Luis Obispo Local Agency Formation Commission (LAFCO) to annex the property. LAFCO denied the annexation application. The Special District Risk Management Authority ("SDRMA"), a public entity self-insurance pool, paid for LAFCO's fees and costs. The City sued Central Coast to recover fees and costs expended in the Central Coast action against LAFCO. LAFCO and SDRMA cross-complained against the City and Central Coast for fees and costs. The trial court granted the City and Central Coast’s judgment on the pleadings against LAFCO and SDRMA (collectively LAFCO). The court denied LAFCO's request for leave to amend its pleadings. LAFCO appealed.The Second Appellate Division affirmed and while the appeal in LAFCO I was pending, the City and Central Coast moved for attorney fees based on section 1717. The trial court granted the motion. The court awarded $172,850 to the City and $428,864 to Central Coast. LAFCO again appealed (“LAFCO II).”The court reversed the judgment order finding that section 1717 cannot apply because it is beyond LAFCO’s powers to bind itself or an applicant to the attorney fee agreement at issue. The lack of such authority renders the contract unenforceable against LAFCO. Further, Central Coast may not recover fees for the same reason that LAFCO could not recover fees. View "San Luis Obispo Local etc. v. Central Coast etc." on Justia Law

Dorsa joined Miraca, which offers pathology services for healthcare providers. His employment agreement contained a binding arbitration clause. Dorsa claims that, during his employment, he observed Miraca giving monetary donations and free services to healthcare providers to induce pathology referrals, in violation of the AntiKickback Statute, the Stark Law, and the False Claims Act (FCA), 31 U.S.C. 3729(a)(1). Dorsa lodged internal complaints. Dorsa claims that Miraca fabricated a sexual harassment complaint against him. Dorsa filed a qui tam action against Miraca in September 2013. Days later, Miraca fired Dorsa, citing workplace harassment. Dorsa added an FCA retaliation claim.The government investigated the FCA claims and, in 2018, intervened for purposes of settlement, under which Miraca agreed to pay $63.5 million to resolve FCA claims. Miraca moved to dismiss the remaining retaliation claim, citing the arbitration clause, Dorsa argued that the clause did not apply because his claim was independent from the employment agreement. Miraca then asserted that the court did not have the authority to decide a threshold question of arbitrability. The district court ruled in favor of Dorsa. Miraca later moved to stay the proceedings and compel arbitration. The Sixth Circuit affirmed the denial of that motion. Miraca forfeited and waived its arguments about the district court’s authority to decide threshold questions of arbitrability and its ruling on the merits. Filing the motion to dismiss was inconsistent with Miraca’s later attempts to rely on the arbitration agreement. View "Dorsa v. Miraca Life Sciences, Inc." on Justia Law

Cummings, who is deaf and blind, sought physical therapy services from Premier, requesting an American Sign Language interpreter at her sessions. Premier declined. Cummings sought damages, alleging discrimination on the basis of disability under the Rehabilitation Act and the Affordable Care Act. Premier is subject to those statutes because it receives reimbursement through Medicare and Medicaid. The district court determined that the only compensable injuries allegedly caused by Premier were emotional in nature.The Fifth Circuit and Supreme Court affirmed the dismissal of the complaint. Spending Clause legislation, including the statutes at issue, operates based on consent; a particular remedy is available in a private Spending Clause action only if the funding recipient is on notice that, by accepting federal funding, it exposes itself to liability of that nature. Because the statutes at issue are silent as to available remedies, the Court followed the contract analogy. A federal funding recipient is on notice that it is subject to the “usual” remedies traditionally available in breach of contract suits; emotional distress is generally not compensable in contract.The Court rejected an argument that such damages may be awarded where a contractual breach is particularly likely to result in emotional disturbance. Even if it were appropriate to treat funding recipients as aware that they may be subject to rare contract-law rules, they would lack the requisite notice that emotional distress damages are available under these statutes. There is no majority rule on what circumstances may trigger the allowance of such damages. View "Cummings v. Premier Rehab Keller, P.L.L.C." on Justia Law

Hospitals provided emergency medical services to members of the county’s health plan, which is licensed and regulated by the state Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act, Health & Saf. Code 1340. The county reimbursed the Hospitals for $28,500 of a claimed $144,000. The Hospitals sued, alleging breach of an implied-in-fact or implied-in-law contract. The trial court rejected the county’s argument that it is immune from the Hospitals’ suit under the Government Claims Act (Gov. Code 810).The court of appeal reversed. The county is immune from common law claims under the Government Claims Act and the Hospitals did not state a claim for breach of an implied-in-fact contract. The county does not contest its obligation to reimburse the Hospitals for the reasonable and customary value of the services; the issue is what remedies may be pursued against the county when the reasonableness of the reimbursement is disputed. The Knox-Keene Act provides alternative mechanisms to challenge the amount of emergency medical services reimbursements. A health care service plan has greater remedies against a private health care service plan than it does against a public entity health care service plan, a result driven by the Legislature broadly immunizing public entities from common law claims and electing not to abrogate that immunity in this context. View "County of Santa Clara v. Superior Court" on Justia Law

Drinking water provided by North Edwards Water District (North Edwards) to its customers contained three times the legal limit of arsenic. Using funds earmarked for safe drinking water, the State of California (State) agreed to pay for North Edwards to construct a water treatment facility (the Project) to address this issue. In December 2013, Clark Bros., Inc. (Clark) was awarded the $6.2 million contract (Contract). But almost from inception, disputes arose between Clark and North Edwards. Ultimately in October 2014, while Clark still had three months to perform, North Edwards terminated the Contract. Clark sued North Edwards for breach of contract (and related claims); North Edwards cross-complained against Clark alleging similar theories. A jury unanimously found North Edwards breached the Contract and awarded Clark over $3 million in damages. Clark also prevailed on North Edwards’s cross-complaint. Under Public Contracts Code section 20104.50 (b), a local agency that fails to pay progress payments within 30 days “shall pay interest” on the late payment. Here, as it waited for money from the State, North Edwards frequently took 60 days or more to pay. Based on this statute, which was incorporated into the Contract, the court instructed the jury that North Edwards was contractually “required” to pay Clark within 30 days. On appeal, North Edwards contended the instruction was prejudicially erroneous because (1) section 20104.50 provided for interest on late payments, but did not make late payment a breach of contract; (2) the statute did not apply to State-funded projects; (3) Clark waived its claim by repeatedly accepting late payments; and (4) North Edwards was not required to pay Clark until it received reimbursement from the State for each payment claim. The Court of Appeal agreed with North Edwards’s first argument, but found the error was not prejudicial: the record affirmatively showed the verdict was unaffected by any instructional error concerning prompt payment requirements. In addition, North Edwards contended the trial court prejudicially erred in making several evidentiary rulings. Finding these unpersuasive, the Court affirmed the trial court's judgment. View "Clark Bros., Inc. v. North Edwards Water District" on Justia Law

Plaintiff, a hospice provider, challenges the Centers for Medicare and Medicaid Services (“CMS”) methodology, contending that it violates both the Medicare statute and the Budget Control Act and that CMS did not follow the required administrative procedures for adopting it.According to Plaintiff, the sequestration methodology violated the statute and the regulation by adding back the sequestration reduction withheld from the preliminary disbursements into the equation, such that — for overpayment purposes — funds the providers did not actually receive were being counted against them. Plaintiff contends that CMS was required to use the net payments methodology instead of the sequestration methodology.The court held that the regulations and guidance do not support Plaintiff’s contention that the statute unambiguously requires the net payments methodology. Reasoning that section 1395f(i)(2)(A) does not mandate any one methodology for applying the aggregate cap. Further, the plain meaning of the statute gives no instruction as to how overpayments should be calculated, the court concludes the statute is “silent . . . with respect to the specific issue” of what methodology CMS must use in applying the aggregate cap. Further, because the Secretary’s chosen methodology comports with the statutory text, purpose, and operation, Plaintiff has not shown that the Board’s decision was “arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.” Thus, the court affirmed the district court’s grant of summary judgment to the Secretary and denial of summary judgment to Plaintiff. View "Gentiva Health Services, Inc. v. Becerra" on Justia Law

CSI was awarded a government contract to provide “[a]ir charter services operated by brokers, and various auxiliary services that will be used to support the contract.” After U.S. Immigration and Customs Enforcement (ICE) canceled various removal flights, CSI sought payment ($40,284,548.89) from the Department of Homeland Security. The Civilian Board of Contract Appeals dismissed the action, concluding that the CSI Terms and Conditions, which include “Cancellation Charges” were not incorporated by reference into the Schedule Contract.The Federal Circuit vacated and remanded. The Schedule Contract expressly incorporates at least one document that unambiguously identifies the CSI Terms and Conditions and makes clear such terms and conditions apply to all operations. CSI’s Offer plainly identified the CSI Terms and Conditions—along with the CSI Commercial Sales Practice attachment, its Pricing Policy, and its Commercial Price List—in the “Pricing” section of its table of contents. View "CSI Aviation, Inc. v. Department of Homeland Security" on Justia Law

Global Rescue Jets, which does business as Jet Rescue, billed Kaiser at Jet Rescue’s usual and customary rates. Kaiser paid only a fraction of the billed amount, however, because in its view Jet Rescue’s services were covered by Medicare and thus subject to payment at the much lower Medicare-approved rates. Jet Rescue brought this action against Kaiser to recover the additional sums Kaiser allegedly owes. Jet Rescue argues that it was not required to exhaust administrative remedies before filing suit and that the exhaustion requirement should have been excused in any eventThe circuit court affirmed the district court’s dismissal, reasoning original Medicare beneficiaries must exhaust their administrative remedies before seeking judicial review of a claim for benefits. The panel also rejected Jet Rescue’s contention that the exhaustion requirement should be excused. The panel held that the exhaustion requirement may be excused if three conditions are satisfied: (1) the plaintiff’s claim is wholly collateral to a claim for Medicare benefits; (2) the plaintiff has made a colorable showing of irreparable harm; and (3) exhaustion would be futile. The panel concluded that Jet Rescue failed to meet the first and third requirements. Thus, the circuit court rejected both arguments and affirmed the district court’s judgment. View "GLOBAL RESCUE JETS, LLC V. KAISER FOUNDATION HEALTH PLAN" on Justia Law

Appellant, a California critical access hospital, sought Medicare reimbursement for the cost of keeping specialty doctors on call. Under the federal Emergency Medical Treatment and Active Labor Act, hospitals providing emergency room service must stabilize patients before releasing them or transferring them to another hospital. Additionally, California law requires all hospitals to perform certain procedures, including surgery. Appellant claims that it cannot comply with both state and federal law unless it can pay on-call compensation to specialists in surgery, obstetrics, pediatrics, and cardiology.Affirming the district court’s ruling, the D.C. Circuit held that Appellant is not entitled to Medicare reimbursement for the cost of keeping various specialty doctors on call. Appellant’s federal obligation to stabilize patients before release does not necessarily imply the need for various specialists. Thus, the Provider Reimbursement Review Board (“the Board”) reasonably concluded that Appellant had the ability to stabilize patients with existing emergency room physicians and that specialists were not required to be on call.Regarding Appellant’s state obligations, the Board’s conclusion that Appellant could satisfy the requirements by keeping a physician with surgical training on-site was reasonable. View "St. Helena Clear Lake Hospital v. Xavier Becerra" on Justia Law

In a suit under the False Claims Act (FCA), Proctor alleged that Safeway knowingly submitted false claims to government health programs when it reported its “retail” price for certain drugs as its “usual and customary” price, although many customers paid less than the retail price because of discount and price-matching programs. The district court granted Safeway summary judgment, concluding that Safeway’s pricing practices were “objectively reasonable” and no “authoritative guidance” cautioned against its interpretation of Medicare and Medicaid regulations.While the case was pending, the Seventh Circuit held that a defendant does not act with reckless disregard as long as its interpretation of the relevant statute or regulation was objectively reasonable and no authoritative guidance warned the defendant away from that interpretation. Failure to satisfy that standard for reckless disregard precludes liability under FCA’s actual knowledge and deliberate indifference provisions, which concern higher degrees of culpability.The Seventh Circuit then affirmed summary judgment in favor of Safeway. A footnote in a Centers for Medicare and Medicaid (CMS) manual does not constitute “authoritative guidance.” CMS can (and did) revise the manual at any time, and a single footnote in a lengthy manual does not support treble damages liability in this case. The other sources of guidance Proctor identified are unpersuasive because they do not come from the agency. View "Proctor v. Safeway, Inc." on Justia Law