Pomona Valley Hospital etc. v. Kaiser Foundation Health etc.

BACKGROUND

The parties Kaiser is a health care service plan that, with affiliated entities, has providers, hospitals, and other medical facilities throughout California. Although Kaiser members predominantly receive medical care through the Kaiser system, in an emergency they may go to the closest emergency department, including one not associated with Kaiser. Kaiser hospitals likewise provide emergency care to non-Kaiser patients.

3 Pomona Valley Hospital is a full-scope hospital and regional medical center with operations including a trauma center and other specialized care. As a hospital with an emergency department, Pomona Valley Hospital treats patients in need of emergency care, including Kaiser members. For the period at issue in this case, from October 1, 2017, through March 31, 2020, a total of 4,078 claims for emergency care services provided by Pomona Valley Hospital were for Kaiser members. Emergency services and reimbursement As previously noted, under federal and state law, a hospital emergency department must provide emergency services to anyone in need of such care. (42 U.S.C. § 1395dd(b); Health & Saf. Code, 1 § 1317, subd. (a).) California’s Knox-Keene Health…