Louisiana ex rel. Caldwell v. Molina Healthcare, Inc.

Louisiana, represented by its Attorney General, filed this lawsuit in 2014 against defendants, Molina Healthcare, Inc., Molina Information Systems, L.L.C. d/b/a Molina Medicaid Solutions, and Unisys Corporation. As described in the state’s petition, “[o]ver the last thirty (“30”) years, the Defendants have been the fiscal agent responsible for processing Louisiana’s Medical pharmacy provider reimbursement claims.” Pursuant to a contract to which the state itself was allegedly a party, “the Defendants assumed operational liability” of a “customizable” computerized system known as the Louisiana Medicare Management Information System (“LMMIS”). As part of defendants’ duties, they were “responsible for the operation and maintenance of LMMIS, as well as creating and implementing design changes to the LMMIS that comply with State and federal mandates.” The crux of the state’s allegations in this lawsuit is that Unisys caused the Louisiana Department of Health (“LDH”) to overpay Medicaid pharmacy providers through Unisys’ improper operation and management of LMMIS. The Louisiana Supreme Court granted certiorari review in this case to review the correctness of the appellate court’s ruling, sustaining an exception of no right of action for the Attorney General’s lawsuit against the defendants. By statute, the Louisiana Department of Health had the capacity to sue and be sued for programs that it administered, such as Medicaid. However, because the Louisiana Department of Health delegated–and defendants allegedly contractually accepted–some of the administrative functions of the state’s Medicaid program, the Supreme Court found the Attorney General had the capacity, and hence a right of action, to prosecute this lawsuit. View "Louisiana ex rel. Caldwell v. Molina Healthcare, Inc." on Justia Law