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  • THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, A CALIFORNIA CONSTITUTIONAL CORPORATION, ON BEHALF OF UCLA HEALTH SYSTEM VS MAGELLAN HEALTH SERVICES, INC., A DELAWARE FOR-PROFIT CORPORATION, ET AL. Contract/Warranty Breach - Seller Plaintiff (no fraud/negligence) (General Jurisdiction) document preview
  • THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, A CALIFORNIA CONSTITUTIONAL CORPORATION, ON BEHALF OF UCLA HEALTH SYSTEM VS MAGELLAN HEALTH SERVICES, INC., A DELAWARE FOR-PROFIT CORPORATION, ET AL. Contract/Warranty Breach - Seller Plaintiff (no fraud/negligence) (General Jurisdiction) document preview
  • THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, A CALIFORNIA CONSTITUTIONAL CORPORATION, ON BEHALF OF UCLA HEALTH SYSTEM VS MAGELLAN HEALTH SERVICES, INC., A DELAWARE FOR-PROFIT CORPORATION, ET AL. Contract/Warranty Breach - Seller Plaintiff (no fraud/negligence) (General Jurisdiction) document preview
  • THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, A CALIFORNIA CONSTITUTIONAL CORPORATION, ON BEHALF OF UCLA HEALTH SYSTEM VS MAGELLAN HEALTH SERVICES, INC., A DELAWARE FOR-PROFIT CORPORATION, ET AL. Contract/Warranty Breach - Seller Plaintiff (no fraud/negligence) (General Jurisdiction) document preview
  • THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, A CALIFORNIA CONSTITUTIONAL CORPORATION, ON BEHALF OF UCLA HEALTH SYSTEM VS MAGELLAN HEALTH SERVICES, INC., A DELAWARE FOR-PROFIT CORPORATION, ET AL. Contract/Warranty Breach - Seller Plaintiff (no fraud/negligence) (General Jurisdiction) document preview
  • THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, A CALIFORNIA CONSTITUTIONAL CORPORATION, ON BEHALF OF UCLA HEALTH SYSTEM VS MAGELLAN HEALTH SERVICES, INC., A DELAWARE FOR-PROFIT CORPORATION, ET AL. Contract/Warranty Breach - Seller Plaintiff (no fraud/negligence) (General Jurisdiction) document preview
  • THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, A CALIFORNIA CONSTITUTIONAL CORPORATION, ON BEHALF OF UCLA HEALTH SYSTEM VS MAGELLAN HEALTH SERVICES, INC., A DELAWARE FOR-PROFIT CORPORATION, ET AL. Contract/Warranty Breach - Seller Plaintiff (no fraud/negligence) (General Jurisdiction) document preview
  • THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, A CALIFORNIA CONSTITUTIONAL CORPORATION, ON BEHALF OF UCLA HEALTH SYSTEM VS MAGELLAN HEALTH SERVICES, INC., A DELAWARE FOR-PROFIT CORPORATION, ET AL. Contract/Warranty Breach - Seller Plaintiff (no fraud/negligence) (General Jurisdiction) document preview 
						
                                
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                                20SMCV00240
Electronically FILED by Superior Court of California, County of Los Angeles on 02/11/2020 02:32 PM Sherri R. Carter, Executive Officer/Clerk of Court, by M. Mariscal,Deputy Clerk
                                 Assigned for all purposes to: Santa Monica Courthouse, Judicial Officer: Marc Gross




              I      STEPHENSON, ACQUISTO & COLMAN
                     MELANIE JOY YOUNG (STEPHENSON), ESQ. (SBN 113755)
              2
                     BARRY SLTLLIVAN, ESQ. (SBN 136571)
              3      RICHARD A. LOVICH, ESQ. (SBN 113472)
                     CHRISTOPHER HAPAK, ESQ. (SBN 267212)
              4
                     303 N. Glenoaks Blvd., Suite 700
              5      Burbank, CA 91502
                     Telephone: (818) 559-4477
              6
                     Facsimile: (818) 559-5484
              7                                                                                                                                No Filing Fee
                     Attorneys for Plaintiff,                                                                                                  Required Per
              8      THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, a                                                                            Cal. Gov't
              9      California constitutional corporation, on behalf of UCLA Health                                                           Code g 6103
                     System
            10
                                           SUPERIOR COURT OF CALIFORNIA
                                                         FOR THE COUNTY OF LOS ANGELES
                          SANTA MONICA COURTHOUSE — UNLIMITED CIVIL JURISDICTION
            13

            14       THE REGENTS OF THE
                     UNIVERSITY OF CALIFORNIA, a
            15       Caljfprnia constitutipnal corppratjpn on COMPLAINT FOR DAMAGES
            16       behalf of UCLA Health System,
            17                                         Plaintiff,                               BREACH OF WRITTEN
                                vs.                                                             CONTRACT

            19       MAGELLAN HEALTH SERVICES,
                     INC., a Delaware for-profit corporation;
            20
                     MAGELLAN BEHAVIORAL
            21       HEALTH, INC., a Delaware for-profit
                     corporation; MAGELLAN HEALTH
            22
                     SERVICES OF CALIFORNIA, INC.—
            23       EMPLOYER SERVICES, a California
                     for-profit corporation; and DOES I
            24
                     THROUGH 25, INCLUSIVE,
            25
                                                       Defendants.

            27
            28
                     22696-Complaint                                                                   COMPLAINT FOR DAMANGES
                                             PARTIES
                       1.   Plaintiff The Regents of the University of California (the
     "Regents" ) is a California constitutional corporation established and recognized
     pursuant to the Constitution of the State of California, Article 9, section 9, with full
     powers of organization and government. The Regents is authorized to administer
     various medical facilities within the University of California system, including the
     various components of UCLA Health System, such as the Ronald Reagan UCLA
     Medical Center, the UCLA Medical Center, Santa Monica, the Resnick
10   Neuropsychiatric Hospital at UCLA, Mattel Children's Hospital UCLA, and the
     UCLA Medical Group (all such components shall be collectively referred to as
12   nUCLA Health" ) (Regents and UCLA Health shall be collectively referred to as
13   oUCLA Health" ). UCLA Health has its principal place of operation in the City of
14   Los Angeles, County of Los Angeles, California. UCLA Health provides medical
     care to patients.
16

17                     2.   Defendant Magellan Health Services, Inc. is a for-profit
     corporation qualified to do business in the State of California, and is organized and
19   existing pursuant to the laws of the State of Delaware. Magellan Health Services,
20   Inc. has its principal place of business in the Town of Avon, County of Hartford,
21   State of Connecticut. Magellan Health Services, Inc. is an organization that
22   provides, arranges, and/or pays for healthcare for its members.
23
24                     3.   Defendant Magellan Behavioral Health, Inc. is a for-profit
25   corporation qualified to do business in the State of California, and is organized and
     existing pursuant to the laws of the State of Delaware. Magellan Behavioral
27   Health, Inc. has its principal place of business in the Town of Avon, County of
28   Hartford, State of Connecticut. Magellan Behavioral Health, Inc. is an
     22696-Complaint                                   COMPLAINT FOR DAMANGES
     organization that provides, arranges, and/or pays for healthcare for its members.

                                                                      California,
                        4.   Defendant Magellan Health Services of                  Inc.—

     Employer Services is a for-profit corporation qualified to do business in the State
     of Californi, and is organized and existing pursuant to the laws of the State of
     Californi. Magellan Health Services of California, Inc. — Employer Services has
     its principal place ofbusiness in the City    of El Segundo, County of Los Angeles,
     State of California. Magellan Health Services of California, Inc.      —   Employer
     Services is an organization that provides, arranges, and/or pays for healthcare for
10   its members.


12                      5.   UCLA Health is unaware of the true names and capacities,
13   whether corporate, associate, individual, partnership or otherwise of defendants
14   Does   I   through 25, inclusive, and therefore sues such defendants by such fictitious
15   names. UCLA Health will seek leave of the Court to amend this complaint to
16   allege their true names and capacities when ascertained.
17

18                      6.   Magellan Health Services, Inc., Magellan Behavioral Health,
19   Inc., Magellan Health Services of California, Inc.     —   Employer Services, and Does     I

20   through 25, inclusive, shall be collectively referred to as Magellan.
21
                                                                   California,
22                      7.   Defendants, and each of them, at all relevant times, have
23   conducted business in the State of Californi. The violations alleged within this
24   complaint have been and are taking place in the State of                   County of Los
25   Angeles.
26
27                      8.   At all relevant times each of the defendants, including the
     defendants named "Doe," was and is the agent, employee, employer, joint venturer,
     22696 — Complamt                                   COMPLAINT FOR DAMAN(IES
     representative, alter ego, subsidiary, and/or partner of one or more of the other
     defendants, and was, in performing the acts complained of herein, acting within the
     scope of such agency, employment, joint venture, or partnership authority, and/or
     is in some other way responsible for the acts                of one or more of the other
     de fendants.


                                COMMON FACTUAL BACKGROUND


                       9. UCLA Health is informed and believes and thereon alleges that
10   at all relevant times the patients set forth in the attached Exhibit "A" (the
     "Patients" ) were members of
                             Magellan.'0.
12

13                              UCLA Health is informed and believes and thereon alleges that
14   at all relevant times, Magellan provided, arranged, and/or paid for healthcare
15   services for its members, including Patients.
16
17                     11.     UCLA Health alleges that on dates of service set forth in
     Exhibit "A" UCLA Health provided medically necessary treatment and care to
19   Patients.
20
21                     12.     The Patient claims are subject to the written letter of agreement
22   between UCLA Health and Magellan, dated January                         1,   2012. The letter of
23   agreement and its subsequent amendments shall be referred to as the "Letter of
24   Agreement". Pursuant to the Letter of Agreement, UCLA Health agreed to provide
25   medically necessary services to Magellan beneficiaries. In exchange, Magellan
26
     I
       In deference to the Patients'rivacy concerns enumerated in Cal. Const. art. I, section I as well as the Health
27   Insurance portability and Accountability Act of 1996 (42 U.S.C. sections 1320 et seq.), UCLA Health omitted here
     information sufficient to reveal the identity of Patient.
28
     22696 complaint                                                COMPLAINT FOR DAMANGES
     agreed to pay UCLA Health at the rates set forth in the Letter of Agreement for the
     health care services UCLA Health rendered to Magellan beneficiaries.


                        13.      At all times alleged herein, the medically necessary services
     provided to Patients were governed by the terms of the Letter of Agreement,


                        14.      For the medical care UCLA Health rendered to Patients, UCLA
     Health is entitled to be reimbursed in at the rates set forth under the Letter of
     Agreement.
10
                        15.      However, despite numerous demands thereof, Magellan failed
12   to fully pay UCLA Health for the medically necessary services rendered to
13   Patients.
14

15                      16.      As a direct and proximate result of Magellan's wrongful
16   conduct, UCLA Health has suffered damages in the principal amount of
17   $ 504,807.12, plus applicable interest.
18

19                                            CAUSE OF ACTION
20                            (Breach of Written Contract — Letter of Agreement)
21                                      ((Against defendant Magellan)
22                             (and/or including Does   1   through 25, inclusive))


                        17.      UCLA Health incorporates by reference and re-alleges
25   paragraphs     1   through 16 as though set forth in full.


                        18.      As stated above, the parties entered into a written Letter of
     Agreement dated January            1,   2012, in which UCLA Health agreed to render
     22696 -Complaint                                          COMPLAINT FOR DAMANGES
     medically necessary care to Magellan beneficiaries (including Patients listed in
     Exhibit "A"), in exchange for which Magellan agreed to pay UCLA Health
     pursuant to the negotiated rates in the Letter of Agreement.


                         19.   UCLA Health performed all conditions, covenants, and
     promises required on its part to be performed in accordance with the terms and
     conditions o f the Letter o f Agreement.


                         20.   UCLA Health demanded that Magellan perform its obligations
10   to properly reimburse UCLA Health the contractual amount due for the medical
     care rendered to Patients at the rates set forth in the Letter of Agreement.
12

13                       21.   Magellan breached the Letter of Agreement by refusing to fully
14   pay UCLA Health for the medically necessary services rendered.
15

16                       22.   As a result of the breach by Magellan, UCLA Health suffered
17   damages for the principal sum of $ 504,807.12, plus applicable interest.
18

19

20
21

22
23
24
25


27
28
     22696 — Complaint                                   COMPLAINT FOR DAMANGES
                                           PRAYER FOR RELIEF


     WHEREFORE, UCLA Health prays for judgment as follows:


                         1)   For the principal sum to be proven at trial, but not less than the
                              amount of $ 504,807.12;


                         2) For interest on such principal sum at the rate of fifteen percent
                              (15%) per annum, pursuant to Cal. Health & Safety Code        tj   1371;
10                            or, in the alternative, for interest on such principal sum at the rate
                              of 10% per annum, pursuant to Cal. Civ. Code $ 3289;
12

13                       3) For all costs of suit incurred herein; and,
14

15                       4) For such other and further relief as the Court deems just and
16                            proper.
17
     Dated: February 11, 2020
19

20                                                              SON,                       LMAN
21



23
                                                              CHRISTOPHE
                                                                                laintiff
                                                                          Af'AR'ttorneys


24                                                    THE REGENTS 0 HE UNIVERSITY
                                                           OF CALIFORNIA, a California
25
                                                     constitutional corporation, on behalf UCLA
26                                                                      Health
27


     22696 — Complaint                                       COMPLAINT FOR DAMANGES
EXHIBIT A
 No.          Patient    Admit Date   Discharge Date   Dispute Balance
              Initials
1      R.A.                2/1/2016        2/26/2016        S1s,96o.oo'2,130.00
2      E.A.                4/3/2017        4/30/2017
3      EB.                 1/7/2016        1/12/2016         $ 2,645.00
4      C.B.               12/2/2015       12/30/2015        S14,650.00,
5      H.B.               3/29/2O16         4/9/2016          SS,29O.OOI
6      KC.               11/11/2015       11/25/2015          $ 4,728.00
7      AE.                7/27/2OES        7/31/2015          $ 4,942.00
lg     C.G.                6/2/2017        6/12/2017        S 10,676.00
 9     A.G.                5/5/2015        5/12/2015          $ 9,884.00
10     P.G.               7/31/2O17         8/7/2017        $ 19,628.00
11     B.H.              10/17/2016       10/26/2016        S 15, 870. 00
12     B.H.               3/11/2017        4/13/2017        $ 78,512.00
13     L.H.               7/11/2017        7/25/2017        $ 16,284.00
14     W.H.                7/6/201S        7/17/2O1S         S9,884.00
15     T.L.               4/17/2015        4/30/2015         $ 9,626.40
16     M.M.               10/5/2015       10/21/2015         $ 5,335.80
17     D.O.              12/30/2015         1/8/2016         $ 2,085.00
18     A.R,              11/10/2015       11/12/2015          $ 4,942.00
19     S.R.                5/5/2016        5/12/2016          $ 2,645.00
20     8.5.               4/21/2015         5/9/2015        $ 17,297.00
21     D.S.               S/23/2O17        5/31/2017         S2,804.00
22     I.S.               10/1/2015       10/21/2015          Ss,sso.oo
23     S.T.               1/17/2016        1/25/2016          $ 2,264.00
24     GT.                 5/1/2017        5/31/2017          $ 3,300.00
25     D.W.               4/11/2017        4/14/2017          $ 8,412.00
26     SW.                5/22/2017        5/25/2017          $ 8,412.00
27     J.W.               4/29/2017        5/29/2017         $ 34,563,92
28     M.W.               12/9/2014        5/22/2015       S178,417.00
29     H.Y.              12/18/2015       12/31/2015           Sg,o7o.oo
                                                           $ 504,807. 12