Advanced Choices, Inc. v. State Department of Health Services

Plaintiff Advanced Choices, Inc. (Advanced Choices), submitted bills to and received remittances paid through the Medi-Cal program, which is administered by defendant State Department of Health Services (the Department). Advanced Choices was not a Medi-Cal provider and was ineligible to participate in the program. When the Department discovered the facts, it demanded return of $1,454,840.10. Advanced Choices sought formal proceedings, which were held before an administrative law judge of the Department’s Office of Administrative Hearings and Appeals (OAHA). The OAHA issued a tentative ruling, which the Department adopted, affirming the Department’s action. Advanced Choices then filed a petition for writ of mandate in the superior court; the court denied the petition.

Advanced Choices now appeals, contending it is entitled to retain the $1,454,849.10 under several theories in equity. We shall affirm.

BACKGROUND

Statutory and Regulatory Framework

California participates in Medicaid, the federal medical assistance program ( 42 U.S.C. § 1396 et seq.), through the Medi-Cal program. (Welf. & Inst. Code, §§ 10720 et seq., 14000 et seq. ; Cal. Code Regs., tit. 22, § 51000 et…