Asmita G. Patel, Etc. v. Hackensack University Medical Center

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited . R. 1:36-3. SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. A-0685-24 ASMITA G. PATEL, on behalf of herself and those similarly situated, Plaintiff-Appellant, v. HACKENSACK UNIVERSITY MEDICAL CENTER, NEW JERSEY HEALTHCARE SPECIALISTS, P.C., Defendants-Respondents. ___________________________ Argued September 29, 2026 – Decided October 13, 2026 Before Judges Firko and Vanek. On appeal from the Superior Court of New Jersey, Law Division, Bergen County, Docket No. L-6491-19. Yongmoon Kim argued the cause for appellant (Kim Law Firm LLC) and Scott C. Borison (Borison Firm LLC) of the Maryland bar, admitted pro hac vice, attorneys (Yongmoon Kim and Scott C. Borison, on the briefs). Jacqueline R. D'Alessandro argued the cause for respondent New Jersey Department of Health (Jennifer Davenport, Attorney General, attorney; Janet Greenberg Cohen, Assistant Attorney General, of counsel; Jacqueline R. D'Alessandro, Deputy Attorney General, on the brief). Steven Stadtmauer argued the cause for respondent Hackensack University Medical Center (Celentano Stadtmauer & Walentowicz LLP, attorneys; Steven Stadtmauer, on the brief). Rebecca Zisek argued the cause for respondent New Jersey Healthcare Specialists, PC (Greenberg Traurig LLP, attorneys; David Jay and Rebecca Zisek, of counsel and on the brief). PER CURIAM Plaintiff Asmita G. Patel 1 appeals from an October 30, 2023 Law Division order granting defendant Hackensack University Medical Center's (HUMC) motion to issue a stay and transfer jurisdiction to the New Jersey Department of Health (DOH) pursuant to the primary jurisdiction doctrine and a January 5, 2024 order denying her motion for reconsideration. Plaintiff also appeals from a September 24, 2024 "state agency decision." We affirm both Law Division orders, dismiss the remainder of the appeal as interlocutory, and remand for further proceedings. 1 For the sake of consistency, we refer to Asmita G. Patel as "plaintiff" throughout our opinion. A-0685-24 2 I. Factual Background We derive the following facts from the record. In August 2018, plaintiff experienced a severe headache. She went to St. Joseph's Regional Medical Center for an evaluation. Plaintiff was transferred to HUMC, where she underwent emergency brain surgery. The anesthesiologist was provided by defendant New Jersey Healthcare Specialists, P.C. (NJHS), a private medical group. Plaintiff submitted an application to HUMC seeking coverage of her medical expenses under New Jersey's Charity Care (Charity Care) regulations, N.J.A.C. 10:52-11.1 to -11.17. HUMC found plaintiff was eligible for Charity Care. However, NJHS was owed a balance of $4,110.50 for unpaid expenses related to anesthesia services. The Passaic County Litigation On July 17, 2019, NJHS filed a Special Civil Part complaint in Passaic County against plaintiff demanding judgment for $4,110.50, plus costs. A statement annexed to the complaint showed NJHS billed $8,221.00, however, a Charity Care credit equal to approximately one-half of the charges was applied, resulting in the $4,110.50 demand. A-0685-24 3 On August 26, 2019, plaintiff filed an answer, separate defenses, jury demand, and a Rule 4:18-2 demand for documents, which requested the application for Charity Care. According to plaintiff, all expenses were covered 100% under Charity Care. Plaintiff sought dismissal of NJHS's complaint with prejudice, an injunction to prevent NJHS from conducting any collection efforts against her, and to prevent selling or assigning the claim. Plaintiff also sought attorney's fees and costs. The Bergen County Litigation On September 13, 2019, plaintiff filed a three-count class action complaint in the Bergen County Law Division alleging HUMC and NJHS committed unlawful billing and collection practices against members of the class who were covered under Charity Care. Plaintiff alleged HUMC engaged in "unfair, deceptive or illegal debt collection," and that NJHS was its "agent." Plaintiff asserted that HUMC is responsible for the debt because it was "vicariously liable" for NJHS's acts. Plaintiff sought: (1) declaratory and injunctive relief under Charity Care; (2) damages under the New Jersey Consumer Fraud Act (CFA), N.J.S.A. 56:8-1 to -223; and (3) damages for unjust enrichment. A-0685-24 4 Motion Practice On October 25, 2019, the Passaic County matter was consolidated with the Bergen County matter. On January 17, 2020, HUMC and NJHS both filed motions to dismiss plaintiff's complaint under Rule 4:6-2(e).2 The judge denied the motion to dismiss reasoning plaintiff was entitled to conduct discovery on defendants' billing practices and procedures for Charity Care patients. Three years later, on September 6, 2023, HUMC filed a motion to stay the litigation and transfer plaintiff's Charity Care claims to the DOH pursuant to the primary jurisdiction doctrine. NJHS joined in HUMC's motion. Defendants argued that because all of plaintiff's claims are derived from "her interpretation of various DOH regulations" pertaining to hospitals and Charity Care, the DOH has "special expertise" to address them. Plaintiff opposed the motion. On October 30, 2023, the court conducted oral argument on the motion to stay the litigation and transfer plaintiff's Charity Care claims to the DOH. Following argument, the court granted the motion and rendered an oral opinion. 2 Every defense, legal or equitable, in law or fact, to a claim for relief in any complaint, counterclaim, cross-claim, or third-party complaint shall be asserted in the answer thereto, except that the following defenses, unless otherwise provided by R[ule] 4:6-3, may at the option of the pleader be made by motion, with briefs: (a) lack of jurisdiction over the subject matter, (b) lack of jurisdiction over the person, (c) insufficiency of process, (d) insufficiency of service of process, (e) failure to state a claim upon which relief can be granted. A-0685-24 5 The court found it was "appropriate" to ask the DOH for "its guidance" and "determine the issue preliminarily." The court framed the issue as whether a hospital is required to provide anesthesia services as part of its Charity Care services. The court highlighted that "N.J.S.A. 26:2H-2(b), which lists healthcare services within the [C]harity [C]are program, specifically says that services provided by physician[s] in their private practices can be excluded." A memorializing order was entered, which transferred two issues to the DOH: (1) "whether [defendants] were required to provide anesthesia services as part of Charity Care"; and (2) "whether [defendants] are permitted to seek payment from [plaintiff] for those services." On November 15, 2023, plaintiff filed a motion for reconsideration and to revise the October 30, 2023 order, proposing the DOH appear as amicus curiae instead of transferring jurisdiction. On December 6, 2023, while plaintiff's motion for reconsideration was pending, the DOH confirmed in a letter its receipt of the October 30, 2023 order transferring jurisdiction and plaintiff's subsequent motions. The DOH's letter stated it took "no position on [p]laintiff's [m]otion, but [would] offer [] the following explanation of its governing statute and regulations" to guide the court: "that if [a] physician was contracted by the [h]ospital to provide services, the physician would be permitted to bill separately A-0685-24 6 for their services, and such services would not be covered for purposes of Charity Care. N.J.A.C. 10:52-1.6, 1.8." On January 4, 2024, the court conducted oral argument on plaintiff's motion for reconsideration. The court denied the motion noting that the DOH has the "background and experience" and "a mechanism in place" to give the parties "the opportunity to present the arguments and to render a determination." The court reiterated it considered the factors for primary jurisdiction, would not change its decision, and it awaited the DOH's decision. The next day, January 5, 2024, a memorializing order was entered. On February 15, 2024, we denied plaintiff's motion for leave to appeal the court's October 30, 2023 order temporarily transferring jurisdiction to the DOH. We determined the order was not a final order. The DOH's Response On September 23, 2024, the DOH's Executive Director – Office of Health Care Financing, sent a letter to all counsel declining to render a declaratory ruling. The DOH stated "in its discretion," that a declaratory ruling "is not necessary or appropriate to adjudicate the matter at hand." However, the DOH's letter provided an "analysis to aid the [c]ourt," stating: . . . the [DOH] has consistently interpreted the statutes and rules governing the Charity Care program such that A-0685-24 7 medical services provided and billed to a patient separately from hospital charges are excluded from coverage under Charity Care. Accordingly, it is not necessary for the [DOH] to issue a declaratory ruling in this matter. The DOH found "Charity Care does not cover services that are billed separately, such as professional service bills, from the hospital services charges." Pointing to the New Jersey Hospital Care Payment Assistance Fact Sheet3 on the DOH's website, which states that "[s]ome services such as . . . anesthesiology fee . . . are separate from hospital charges and may not be eligible for reduction," the [DOH] noted it "has consistently held that vendor service charges that are billed by a vendor and are separate from hospital charges are not covered under Charity Care." The DOH concluded, "because the NJHS charges billed to [p]laintiff are vendor charges, not hospital charges, they are not covered under the Charity Care program, as clearly stated in N.J.A.C. 10:52- 1.8." The DOH also rejected plaintiff's claim that because a hospital must provide anesthesia services as a condition of being licensed under N.J.A.C. 3 See N.J. Dep't of Health, New Jersey Hospital Care Payment Assistance Fact Sheet, New Jersey State Department of Health Health Care for the Uninsured Program (August 2016), https://www.nj.gov/health/charitycare/documents/char itycare_factsheet_en.pdf. A-0685-24 8 8:43G-2.12, then expenses for such services must be covered by Charity Care. It explained, "the licensing rules do not determine what is or is not a covered hospital charge under the Charity Care rules," N.J.A.C. 10:52. The DOH observed "the Charity Care rules . . . set the Charity Care requirements," unlike the licensing rules, which mandate services "an acute care hospital must provide, such as anesthesia services, in order for the hospital to maintain it[s] license issued by the [DOH]." Further, the DOH noted, "there is nothing in the hospital licensing rules that prohibits a hospital from providing a required services by way [of] a contracted vendor." Post-DOH Letter Following the DOH's letter, the case was reassigned to another court. On October 28, 2024, the second court held a case management conference, where the Deputy Attorney General posited that the DOH's letter was a final, appealable agency determination. This appeal followed. On appeal plaintiff argues the primary jurisdiction doctrine does not empower a court to transfer jurisdiction to an executive branch agency to decide questions of statutory interpretation. Plaintiff contends the DOH's "decision" is contrary to the Charity Care statute and inconsistent with the regulations A-0685-24 9 governing Charity Care, warranting reversal. Plaintiff also asserts the intent of the Charity Care statute seeks equal treatment for all, including the indigent. II. An appellate court's review of agency determinations is limited. In re Stallworth, 208 N.J. 182, 194 (2011). "In administrative law, the overarching informative principle guiding appellate review requires that courts defer to the specialized or technical expertise of the agency charged with administration of a regulatory system." In re Application of Virtua-W. Jersey Hosp. Voorhees for a Certificate of Need, 194 N.J. 413, 422 (2008). Further, "[a]n administrative agency's interpretation of statutes and regulations within its implementing and enforcing responsibility is ordinarily entitled to our deference.'" Wnuck v. N.J. Div. of Motor Vehicles, 337 N.J. Super. 52, 56 (App. Div. 2001) (alteration in original) (quoting In re Appeal by Progressive Cas. Ins. Co., 307 N.J. Super. 93, 102 (App. Div. 1997)). "[A]n appellate court ordinarily should not disturb an administrative agency's determinations or findings unless there is a clear showing that (1) the agency did not follow the law; (2) the decision was arbitrary, capricious, or unreasonable; or (3) the decision was not supported by substantial evidence." Ibid. A-0685-24 10 "The decision to invoke the doctrine of primary jurisdiction rests within the sound discretion of the [trial] court." Est. of Kotsovska v. Liebman, 221 N.J. 568, 588 (2015) (alteration in original) (quoting Nordstrom v. Lyon, 424 N.J. Super. 80, 99 (App. Div. 2012)). Therefore, the trial court's decision "should not be disturbed on appeal unless the decision was 'made without rational explication, inexplicably departed from established practices, or rested on an impermissible basis.'" Ibid. (quoting Flagg v. Essex Cnty. Prosecutor, 171 N.J. 561, 571 (2002)). The Appellate Division reviews a trial judge's decision on whether to grant or deny a motion for reconsideration under Rule 4:49-2 for an abuse of discretion. Branch v. Cream-O-Land Dairy, 244 N.J. 567 , 582 (2021). An abuse of discretion arises when the court's decision was "based on plainly incorrect reasoning or failure to consider evidence or a good reason for the court to reconsider new information." Pressler & Verniero, Current N.J. Court Rules, cmt. 2 on R. 4:49-2 (2027). III. We first address whether plaintiff's appeal should be dismissed as interlocutory. A party can only appeal a decision as of right from a "final judgment." Janicky v. Point Bay Fuel, Inc., 396 N.J. Super. 545, 549 (App. Div. A-0685-24 11 2007); see R. 2:2-3(a)(1) ("stating appeals may be taken to the Appellate Division as of right . . . from final judgments of the Superior Court trial divisions, or the judges thereof sitting as statutory agents . . . [and] to review final decisions or actions of any state administrative agency or officer"). For a decision to qualify as a final judgment, it must "dispose of all claims against all parties." Id. at 549-50 (quoting S.N. Golden Ests., Inc. v. Cont'l Cas. Co., 317 N.J. Super. 82, 87 (App. Div. 1998)); see also In re Donohue, 329 N.J. Super. 488, 494 (App. Div. 2000) (stating an "administrative determination must be final as to all parties and all issues"). However, if an order does not qualify as a final judgment, then a party must seek leave to appeal from this court. Janicky, 396 N.J. at 550; see R. 2:2- 4; R. 2:5-6(a)). A grant of leave to appeal from an interlocutory order is left to this court's sound discretion, which is typically exercised sparingly and "in the interest of justice." See R. 2:2-3(c) ("On application made pursuant to R[ule] 2:5-6, appeals may be taken to the Appellate Division by leave granted, in extraordinary cases and in the interest of justice, from final judgments of a court of limited jurisdiction"). Under N.J.S.A. 52:14B-8, "issuance of a declaratory ruling by an agency is discretionary." United Sav. Bank v. State, 360 N.J. Super. 520, 524 (App. A-0685-24 12 Div. 2003 ). The provision defines an agency decision as final and therefore subject to review when such agency elects to make an official declaratory ruling. Only then will it bind the agency and all parties involved in the proceeding. The statute provides: an agency upon the request of any interested person may in its discretion make a declaratory ruling with respect to the applicability to any person, property or state of facts of any statute or rule enforced or administered by that agency. A declaratory ruling shall bind the agency and all parties to the proceedings on the state of facts alleged. Full opportunity for hearing shall be afforded to the interested parties. Such ruling shall be deemed a final decision or action subject to review in the Appellate Division of the Superior Court. Nothing herein shall affect the right or practice of every agency in its sole discretion to render advisory opinions. [N.J.S.A. 52:14B-8 (emphasis added).] Here, although requested by the court, the DOH declined to provide a declaratory ruling. In pertinent part, the letter states: .... For the for[e]going reasons, the [DOH], in its discretion, has determined that a declaratory ruling that when a hospital determines a patient is eligible for charity care, then all the care that the patient receives at the hospital, regardless of whether the hospital provided the service directly or through a vendor, must be covered by the charity care program[,] is not necessary or proper. A-0685-24 13 [(Emphasis added).] Contrary to the Deputy Attorney General's representation, we conclude the DOH merely provided an advisory opinion intended to provide guidance for the trial court to conduct its own analysis, which has not yet occurred. Thus, we conclude the DOH has not rendered a final decision for purposes of appellate review. N.J.S.A. 52:14B-8. Accordingly, the appeal is interlocutory and hereby dismissed. We remand for the trial court to adjudicate all remaining counts of plaintiff's complaint. IV. For the sake of completeness, we address plaintiff's argument that the court was not empowered to transfer jurisdiction to the DOH pursuant to the primary jurisdiction doctrine, notwithstanding our dismissal of the remainder of the appeal as interlocutory. Plaintiff maintains the DOH enforces and implements statutes, but it is the court's duty to interpret statutes. Plaintiff contends the court erred in determining the DOH's expertise would avoid inconsistent rulings and failed to articulate any instances of inconsistent court rulings to support its decision. Plaintiff asserts the court did not address the first and fourth factors in the primary jurisdiction analysis, which she contends weigh against invoking the primary jurisdiction doctrine. A-0685-24 14 "The doctrine of primary jurisdiction is applicable when a case is properly filed in the Superior Court[,] but the court declines original jurisdiction, referring specific issues to the appropriate administrative body." Magic Petroleum Corp v. Exxon Mobil Corp, 218 N.J. 390, 405 (2014). See Boldt v. Correspondence Mgmt., Inc., 320 N.J. Super. 74, 83 (App. Div. 1999) (finding a court should consider an application of the doctrine when "the case is properly before the court, but agency expertise is required to resolve the issue presented."). The trial court "gives deference to the administrative body's interpretation of its own regulations and findings of fact on particular issues that are within the special competence of the agency pursuant to applicable statutes." Magic Petroleum Corp, 218 N.J. at 405 . Our Supreme Court has recognized the primary jurisdiction doctrine is for "'promoting proper relationships between the courts and administrative agencies charged with particular regulatory duties.'" Ibid. (quoting Boss v. Rockland Elec. Co., 95 N.J. 33, 40 (1983)). "The forum or body," is in "the best position by virtue of its statutory status, administrative competence and regulatory expertise to adjudicate the matter.'" Boss, 95 N.J. at 40 (quoting Hinfey v. Matawan Reg'l Bd. of Educ., 77 N.J. 514, 531-32 (1978)). The doctrine A-0685-24 15 preserves uniformity in interpretation of agency regulations. Curzi v. Raub, 415 N.J. Super. 1, 20 (App. Div. 2010). Under the primary jurisdiction, "a case is properly before the court, but agency expertise is required to resolve the question presented[.]" Ibid. Therefore, it requires "only a stay of the proceedings pending the agency's determination." Richardson v. Standard Guardian Ins. Co., 371 N.J. Super. 449, 475 (App. Div. 2004). To determine applicability of the primary jurisdiction doctrine, our Supreme Court has established a four-part test: [(1)] whether the matter at issue is within the conventional experience of judges; [(2)] whether the matter is peculiarly within the agency's discretion, or requires agency expertise; [(3)] whether inconsistent rulings might pose a danger of disrupting the statutory scheme; and [(4)] whether prior application has been made to the agency. [Magic Petroleum Corp., 218 N.J. at 407 (quoting Boldt v. Correspondence Mgmt., Inc., 320 N.J. Super. 74, 85 (App. Div.1999)).] Here, we are convinced the court did not abuse its discretion in granting HUMC's motion to transfer jurisdiction temporarily to the DOH for the limited purpose of deciding two questions: (1) whether defendants were required to provide anesthesia services as part of Charity Care and (2) whether defendants A-0685-24 16 were permitted to seek payment from plaintiff for those services. Magic Petroleum Corp., 218 N.J. at 407 . Our review of the record satisfies us that the court analyzed all four factors, finding that although factor one weighed in plaintiff's favor because interpretation of a statute is "within the conventional experience of judges," it found factors two and three outweighed such a finding. The court also found factor four did not apply. Factor One As to factor one, the trial court stated: As to the first factor, whether the matter at issue is within the conventional experience of judges, it's a matter of interpreting statute and regulations, and there's no doubt that that is within the conventional experience of judges. So the question in this case really turns on factors two and three . . . . [(Emphasis added).] Factor Two In analyzing factor two, or "whether the matter is peculiarly within the agency's discretion, or requires agency expertise," the court noted: [T]he [L]egislature has entrusted the DOH with the central responsibility for the development and administration of the State's policy with respect to A-0685-24 17 health planning hospital and related healthcare services, N.J.S.A. 26:2H-1[,] and that includes the Charity Care subsidy program and allocation of In re Reallocation of PBI Reg[']l Med[.] C[tr.] SFY 2007 Charity Care Subsidy, 406 N.J. Super. 629, 632 ([App. Div.] 2009). So the DOH has been charged with regulating, as defendants say[,] operation of hospitals and administering the [C]harity [C]are program . . . . If this were an action involving the validity of a statute, a state enactment or rule or regulation, then notice would have to be given to the Attorney General, and the Attorney General's position on behalf of the [DOH] would have to be taken into account. .... Coming back to the factors. [The court finds] . . . the issue about whether hospital are required to provide anesthesia services as part of the Charity Care is a matter peculiarly within the agency's discretion, or at least requires that the agency be given the opportunity to weigh in . . . . .... . . . [A]lthough courts are not bound by an agency's interpretation of it[s] statute . . . . The [c]ourt is convinced that it is appropriate in this case to ask the agency, the [DOH], for it[]s guidance to allow it to determine the issue preliminarily. Factor Three A-0685-24 18 In analyzing factor three, or "whether inconsistent rulings might pose a danger of disrupting the statutory scheme," the court found there is a potential conflict with how it compared to the DOH, might interpret the provision at issue: In considering those factors, the [c]ourt has reviewed the statutory and regulatory provisions cited by both parties, and does believe that there is . . . potentially a conflict, [with] the provision . . . N.J.S.A. 26:2H-2B, which suggests that the privately provided services are not within the healthcare services required to be provided under . . . Charity Care . . . . [P]laintiff proffers a statutory construction that would require the hospital to have an anesthesiology department as part of it's healthcare services and when read in congruence with or read with the Charity Care [s]tatute, should require that to be one of the services provided by the hospital as part of it's Charity Care services. .... . . . [The court] accept[s] the arguments and agree[s] that it is likely to have extremely broad ramifications. Plaintiff herself acknowledges that by having brought a class action. Plaintiff is seeking to have this ruling apply to a very substantial number of cases. The [c]ourt is not willing to do that without giving the agency the opportunity. [(Emphasis added).] The court found that the possibility of inconsistent rulings might pose a danger of disrupting the statutory scheme for the current plaintiff, and ostensibly for any future plaintiffs with similar cases. Contrary to plaintiff's contentions, A-0685-24 19 factor three does not require inconsistent rulings already exist; rather, the fact that they may or are likely to occur, as the court found, is sufficient. Factor Four In applying factor four, the court properly reasoned that "there[] [was] no indication that prior application was made to the agency so the fourth factor is not relevant." Therefore, we reject plaintiff's argument. In sum, we: (1) affirm the October 30, 2023 and January 5, 2024 orders; (2) dismiss the appeal as interlocutory; and (3) remand to the trial court for an adjudication of all remaining counts pled in plaintiff's complaint. We express no opinion as to the outcome or manner of the proceedings on remand. The appeal is dismissed as interlocutory. A-0685-24 20