Seniors' Club, L.L.C., a Louisiana liablilty company, Senior's Club ADHC and PCA Center, (Louisiana Medicaid Provider No. 17259), Senior's Club Adult Day Health (Louisiana Medicaid Provider No. 56088, Senior's Club (Louisiana Medicaid Provider No. 11460) v. State of Louisiana, through the Department of Health and Hospitals; Hon. Kathy H. Kliebert, in her official capacity as Secretary, Louisiana Department of Health and Hospitals

STATE OF LOUISIANA
COURT OF APPEAL, FIRST CIRCUIT

SENTORS' CLUB, LLC., A NO. 2020 CW 04271
LOUISIANA LIABILITY COMPANY, Page 1 of 2
SENTOR'S CLUB ADHC AND PCA

CENTER (LOUISTANA MEDICAID

PROVIDER NO. 17259),

SENIOR'S CLUB ADULT DAY

HEALTH (LOUISIANA MEDICAID

PROVIDER NO. 56088),

SENIOR'S CLUB (LOUISIANA

MEDICAID PROVIDER NO.

11460),

VERSUS

STATE OF LOUISTANA, THROUGH
THE DEPARTMENT OF HEALTH AND
HOSPITALS, HON. KATHY H,
RLIEBERT, IN HER OFFICIAL
CAPACITY AS SECRETARY,
LOUISIANA DEPARTMENT OF
HEALTH AND HOSPITALS

AUGUST 03, 2020

In Re: The State of Louisiana, through the Department of
Health and Hospitals, Kathy Liebert , in her official
Capacity as former secretary of the Louisiana
Department of Kealth and Hospitals, Ruth Kennedy, in
her official capacity as the Medicaid Director of the
Louisiana Department of Health and Hospitals, and
Joseph Kopsa, in his official Capacity as former
Section Chief of Program Interity of the Louisiana
Department of Health and Hospitals, applying for
Supervisory writs, 19th Judicial District Court,
Parish of Bast Baton Rouge, No. 630653.

BEFORE: HIGGINBOTHAM, PENZATO, AND LANIER, JJ.

WRIT GRANTED IN PART AND DENIED IN PART. The district
court’s March 12, 2020 judgment which denied the motion for
summary judgment filed by the defendants, State of Louisiana,
through the Department of Health and Hospitals; Hon. Kathy H.
Kliebert, in her official Capacity as Secretary, Louisiana
Department of Health and Hospitals, is reversed in part.

Administrative agencies and their officers are immune from
liability when those agencies and officers perform discretionary
acts within the course and scope of their lawful powers and
duties. La. R.S, 9:2798.1(B). The Medical Assistance Programs
Integrity Law (“MAPTL”} was enacted for the purpose of
protecting the fiscal integrity of Louisiana’s medical
assistance programs from health Care providers who engage in
fraud, misrepresentation, abuse, or other ill Practices to
obtain payments to which these providers are not entitled, and
the Louisiana Department of Health and Hospitals (“LDH”) is
tasked with promulgating rules and regulations to enforce MAPTII,.
La. R.S. 46:437.2(B}). “Post-payment review is conducted at the
absolute discretion” of LpH. 90 La. Admin. Code, Pt. I, §
Al17(A) (2) {d). After payment to a provider, LDH may review any

STATE OF LOUISIANA
COURT OF APPEAL, FIRST CIRCUIT

NO. 2020 CW 0421
Page 2 of 2?

or all payments made to a provider for the Purpose of
determining if the amounts paid were for valid claims. 50 La.
Admin. Code, Pt. I, § 4117, If it is determined that the
provider may have been overpaid, LDH must conduct an
investigation to determine the reasons for and estimated amounts
of the alleged Overpayments, and the results of the post-payment
review may result in the imposition of sanctions. Id.

Accordingly, we find that the defendants met their burden
of proving that their actions herein were discretionary,
entitling them to immunity pursuant to La. R.S. 9:2798.1(B).
The burden then shifted to the plaintiffs, Seniors’ Club,
L.L.C., A Louisiana Liability Company, Senior's Club ADHC and
PCA Center {Louisiana Medicaid Provider No. 17259), Senior’s
Club Adult Day Health {Louisiana Medicaid Provider No, 26088},
Senior’s Club (Louisiana Medicaid Provider No. 11460), Mra.
Karen R. Mccoy, and Mr. T.Q. Mccoy, Jr., to show that a genuine
issue of material fact existed or that the defendants were not
entitled to judgment as a matter of law based on an exception to
that immunity as set forth in La. R.S. 9:2798.1(C) (2), which the
plaintiffs failed to meet.

Lastly, governmental discretionary immunity only applies to
tort claims. see City of Shreveport v. Caddo Parish., 27,519
(La. App. 2d Cir. 6/23/95), 658 So.2d 786, 797, writs denied,
95-2285, 95-2298 (La. 11/27/95), 663 So.2dq 728, 729. Therefore,
the motion for summary judgment is granted in Part, and all of
the plaintiffs’ Lert claims against the defendants are
dismissed. The writ application is denied as to the plaintiffs’
breach of contract claims.

WIL

COURT OF APPEAL, FIRST CIRCUIT

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NEPUTY CLERKYOF CouRT
FOR THE COURT