Doctors Medical Center v. Kaiser Foundation CA5

Filed 7/21/14 Doctors Medical Center v. Kaiser Foundation CA5

NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIFTH APPELLATE DISTRICT

DOCTORS MEDICAL CENTER OF MODESTO, INC., F066017

Plaintiff and Appellant, (Super. Ct. No. 661566)

v. OPINION KAISER FOUNDATION HEALTH PLAN, INC.,

Defendant and Respondent.

APPEAL from a judgment of the Superior Court of Stanislaus County. Timothy W. Salter, Judge. Helton Law Group, Carrie McLain, Jonathan F. Buck, Joe Hee Kershner and Sharyld A. Brecht for Plaintiff and Appellant. Marion’s Inn, Brian S. Lee and David B. Anderson for Defendant and Respondent. -ooOoo- This appeal arises from a contract dispute between appellant Doctors Medical Center of Modesto (Hospital), an acute care hospital trauma center, and respondent

Kaiser Foundation Health Plan, Inc. (Kaiser), a health care service plan, over reimbursement for trauma services provided to Kaiser’s members by Hospital. Hospital sued Kaiser for breach of a May 2009 provider services agreement claiming that Kaiser failed to pay the contracted rate for trauma services and owed Hospital over $1 million. Kaiser moved for summary judgment on the ground that the 2009 agreement was superseded by a February 2010 agreement between Hospital and Kaiser. Shortly before the hearing on Kaiser’s summary judgment motion, Hospital moved for leave to amend its complaint to state a cause of action for rescission of the 2010 agreement based on mutual mistake of fact. The trial court granted summary judgment in Kaiser’s favor and denied Hospital’s motion for leave to amend. Hospital does not challenge the grant of summary judgment. Hospital argues the trial court erred in denying its motion to amend the complaint. The trial court correctly concluded that Hospital failed to provide any evidence of a mutual mistake of fact and therefore amending the complaint would have been an idle act. Accordingly, the judgment will be affirmed. BACKGROUND To pay for services provided to its members at a non-Kaiser hospital, Kaiser may access several “PPO-network lease providers.” These PPO-network lease providers negotiate discounted reimbursement rates with various hospitals and then enter into separate contracts with health plans such as Kaiser. This enables Kaiser to access the discounted “network” reimbursement rates in exchange for a fee. In 2003, Kaiser entered into a contract to “lease” a discounted “network” payment rate from Beech Street Corporation (Beech Street). In 2004, Hospital and Beech Street entered into a separate contract that set the rate that Kaiser was to pay for Hospital’s services. Kaiser’s payment rate under these Beech Street contracts was 66 percent of the billed charges for all inpatient and outpatient covered services.