In Moran v. Prime Healthcare Management, Inc., ___ Cal.App.5th ___ (Sept. 14, 2016; pub. ord. Oct. 5, 2016), the Court of Appeal (Fourth Appellate District, Division Three) considered UCL and CLRA claims involving the cost of emergency room medical care for uninsured ("self-pay") patients. Essentially, the lawsuit alleges that the defendant unfairly charges uninsured patients more than it charges insurers (or other third-party payors) for insured patients. Slip op. at 2-4.
The trial court dismissed the entire action, but the Court of Appeal held that parts of the case survived:
- Plaintiff's discriminatory pricing theory enjoyed a Cel-Tech "safe harbor," but his theory that the self-pay patients are charged "artificial and grossly excessive rates" did not. Slip op. at 7-8.
- The UCL "unlawful" prong claim, which was predicated on CLRA violations, largely failed for lack of standing. Id. at 8-15. However, the claim survived to the extent it asserted unconscionability in violation of the CLRA (Civil Code section 1770(a)(19)). Id. at 15-18.
- The UCL "fraudulent" prong claim failed for lack of standing because the plaintiff did not adequately allege his reliance on specific misrepresentations. Id. at 18-19.
- The UCL "unfair" prong claim survived, again to the extent based on the theory that "biling the full amount to self-pay patients is unconscionable." Id. at 19-21. This section of the opinion discussed the three-way split in authority on the proper formulation of "unfair" in consumer actions, but the Court concluded that it did not have to resolve the split in order to decide the appeal. Id. at 20.
- The CLRA claim survived as to the unconscionability theory only. Id. at 21-22.
- The declaratory relief claim survived. Id. at 23-24.