Court Overturns Medi-Cal Suspension Against CA RN

We sued the California Department of Health Care Services (DHCS) because it suspended the Medi-Cal “provider status” of a registered nurse who had never actually been a Medi-Cal provider.  The DHCS blacklisted the RN by including the nurse on a list of individuals barred from employment by Medi-Cal facilities.  This unwarranted action prevented our client from working in all California hospitals and as lawyers who defend nurses we took action to remedy this.

The San Francisco Superior Court issued a writ of mandamus (mandate) against the DHCS ordering it to retract the Medi-Cal suspension.  The Superior Court also ordered the Department of Health Care Services to pay attorney’s in the amount of $7,500.

The law authorizes DHCS to suspend Medi-Cal “providers” who are convicted of felonies or misdemeanors involving fraud, abuse of the Medi-Cal program or any patient, or otherwise substantially related to the qualifications, functions, or duties of a provider of service. (Cal. Welf. & Inst. Code, §14123(a).)  Our client was convicted of drug-related charges and surrendered another health care license with discipline pending but preserved a clean RN license by completing the Board of Registered Nursing Diversion Program. The key point is that our client was never a Medi-Cal provider as Hospitals do not bill Medi-Cal for general nursing care. 

The Department of Health Care Services (commonly referred to as the DHCS) was formerly known as the Department of Health Services (DHS).  The Department of Health Services was, in turn, divided into the Department of Public Health (DPH) and the Department of Health Care Services (DHCS).  The DHCS oversees California’s Medicaid program, which is known as Medi-Cal.  

The Carpenter-Katz Small Business Equal Access to Justice Act of 1981 (Code Civ. Proc. § 1028.5) provides for the award of attorney’s fees and expenses up to $7,500 to a prevailing licensee if “the action of the agency was undertaken without substantial justification. . . .”  Citizens rarely win attorney’s fees under this statute, but we were successful in this case.

In many administrative agency cases, we utilize a related procedure -- the writ of administrative mandamus pursuant to §1094.5 of the Code of Civil Procedure -- when it is necessary to take legal action to correct improper administrative determinations. Here, however, the appropriate procedure was to seek a writ of mandamus pursuant to §1085 because there was no administrative hearing that caused the blacklisting.

This case was handled by California attorney Robert “Bo” Links, who has extensive experience representing health care professionals.

This is a summary which may simplify or omit facts and legal issues for the sake of brevity or to protect confidential information. You should not rely on this summary to predict the outcome in your case.
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