Facts

In 2006, California enacted the Hospital Fair Pricing Act, which was meant to address pricing policies at hospitals regarding uninsured and under-insured patients. Under the law, hospitals were mandated to provide free or discounted care to financially qualified patients as a condition of their licensure. It requires hospitals to identify financially qualified patients, notify them of the benefits under the law in their spoken language, and provide notices of the benefits at discharge and in billing statements.

On October 28, 2019, Emily Jeanne Hepner, Maria Angela Cortez, and Diego Armando Gallegos filed suit on behalf of themselves and the general public against the County of Santa Clara doing business as Santa Clara Valley Medical Center and its CEO.

PLAINTIFFS' CONTENTIONS: Plaintiffs contended that the defendants failed to comply with their obligations under the HFPA; that they were charged self-pay rates by the hospital for services instead of at free or reduced rates provided by the HFPA; and that the hospital turned their accounts over to collections and sued them. Plaintiffs contended that the defendants failed to provide patients about their eligibility as required by law; failed to provide written notice of the Act to patients in their spoken language; failed to request documents necessary to determine patients' eligibility; and that these failures resulted in substantial injustice to the patients and the public. The plaintiffs sought an order requiring the defendants abide by the HFPA' to recalculate patients' accounts based on their eligibility; and cease collection activities on accounts of qualified patients.

DEFENDANTS' CONTENTIONS: The defendants denied any wrongdoing or liability and all the plaintiffs' material allegations.

Result

The case settled. As part of settling this lawsuit, the County will provide an opportunity for patients whose bills were sent to collections between October 28, 2018, and December 31, 2021, to have their bills re-reviewed for full or partial discounts. Individuals who receive this notice will have 65 days to complete and return a form indicating their interest to apply. Individuals will then have an additional 150 days to complete their application by submitting documents to verify their information. Depending on when patients' bills were sent to collections, they may qualify for different financial assistance programs. Patients may be eligible for refunds for amounts they overpaid and to have court judgments corrected.