California City Sues County Health System for Failure to Reimburse Medical Transports

In a complaint filed last Thursday in San Mateo County Superior Court, the city of South San Francisco alleged that the San Mateo Health Commission, the Health Plan of San Mateo, and other defendants broke the law by failing to provide reimbursement to the city for its transportation of patients enrolled in the Medi-Cal program.

Central to the case is California Senate Bill 523, the Medi-Cal Emergency Medical Transportation Reimbursement Act. Under the law, the complaint said, providers of medical transport services pay into a fund which is then disbursed to the entities that provide those services to Medi-Cal payments. The plaintiff city said this means that it pays into the fund and receiving payments under SB 523.

According to the city, however, they did not receive the full amount owed. According to the complaint, “Defendants contends that only non-contract providers are entitled to the SB 523 Add-On and that the City, as a contract provider, is not entitled to the SB 523 Add-On.”

“The City was supposed to start receiving the SB 523 Add-On payments for each GEMT it provided to Medi-Cal patients enrolled beginning on July 1, 2018. However… Defendants withheld those payments and contend that the City is subject to a much lower reimbursement methodology,” the complaint said. The city estimated that it had been underpaid $336,720 or more.

The plaintiff city is seeking a writ of mandate, declaratory relief, and judgment on claims of breach of contract and the implied covenant of good faith. They argued that the refusal to pay SB 523 payments is “contrary to law and does not withstand scrutiny.”

The city is represented by Meyers Nave.