HomeMy WebLinkAbout2005-07-19; City Council; 18218; Settlement of Scripps Clinic Health Plan ServicesCITY OF CARLSBAD - AGENDA BILL
AB# 18,218
MTG. 711 9/05
DEPT. CA
- TITLE: REPORTING OUT THE TERMS AND CONDITIONS OF
THE SETTLEMENT AS REQUIRED BY THE BROWN ACT IN
SCRIPPS CLINIC HEALTH PLAN SERVICES INC.
RECOMMENDED ACTION:
There is no action the Council needs to take.
ITEM EXPLANATION:
The patties have now settled this claim under the authority given to the City Attorney by the
City Council. This item satisfies the Brown Act requirement to report the fact of a settlement of
a claim approved in a prior closed session, and makes the terms and conditions of the
settlement available to the public.
FISCAL IMPACT:
The cost of the settlement is $1 5,390.05.
EXHIBITS:
Settlement Agreement and Mutual Release
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SETTLEMENT AGREEMENT AND MUTUAL RELEASE
This Settlement Agreement and Mutual Release (“Agreement”) is entered into by
and between Scripps Clinic Health Plan Services, Inc., a Delaware corporation
(hereinafter “SCHPS”), and the City of Carlsbad, a California public agency, (hereinafter
“City”), with reference to the following facts:
RECITALS
A. During the years 2002, 2003, and 2004, the City provided ambulance
services to Medicare beneficiaries in the City of Carlsbad and subsequently billed
SCHPS for the costs of the services. SCHPS paid the City for services on behalf of the
Medicare beneficiaries. SCHPS claims that during the years 2002, 2003, and 2004, it
overpaid the City for the aforementioned services.
B. The parties hereto now wish to settle and resolve all claims, disputes, and
differences existing between them upon the terms and conditions set forth below.
C. Nothing herein is intended to constitute an admission of liability by the
City, which liability is expressly denied. The City believes that neither the City nor billing
agent have been guilty of any wrongdoing or negligence in billing practices from the
year 2002 to the date of mutual execution of this Agreement.
FOR GOOD AND VALUABLE CONSIDERATION, the parties covenant
and agree as follows:
1. The City shall pay the sum of FIFTEEN THOUSAND THREE
HUNDRED NINETY DOLLARS AND FIVE CENTS ($15,390.05) to SCHPS within ten
(1 0) business days of the City’s receipt of SCHPS’ signed Agreement. These proceeds
represent the agreed-upon settlement amount for the alleged claims of overpayment
during the years of 2002, 2003, and 2004. SCHPS waives any further right to
reimbursement for the alleged claims of overpayment to the City that occurred from
2002-2004.
2. SCHPS agrees that from the effective date of this Agreement
forward, it shall use its best efforts to calculate the blended amount owed to the City
using a percentage of the reasonable chargelcost and fee schedule amounts or as
otherwise required by the applicable federal law, and SCHPS will make reasonable
efforts to keep informed as to the current state of the applicable federal law.
3. The parties hereto shall bear their own attorney’s fees and costs
incurred in connection with this Agreement, or otherwise.
4. SCHPS and its members, officers, directors, agents, employees,
successors, assigns, both in their individual and representative capacities, agree that
they shall not, at any time hereinafter commence, maintain or prosecute any action, at
law, or otherwise, or assert any claim against the parties herein released for damages,
losses or for equitable relief relating to the matters herein released.
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5. Except for the obligations created by or arising out of this
Agreement, SCHPS and the City, and their members, officers, directors, agents,
employees, successors, assigns both in their individual and representative capacities,
hereby release, quitclaim, and forever discharge each other, their successors, assigns,
former and present officers, directors, shareholders, agents and attorneys, both in their
individual and representative capacities, for all claims, demands, liabilities, and causes
of action of any kind, whether known or unknown, foreseen or unforeseen, patent or
latent, arising out of or related to SCHPS’ claim for reimbursement of overpayments
made to the City during the years of 2002, 2003, and 2004 for ambulance services
furnished by the City to Medicare beneficiaries (hereinafter “Released Matters”). The
parties hereto understand and agree that this release shall be applicable to any and all
known or unknown claims.
6. The parties hereto intend and agree that this Agreement shall be
effective as a full and final accord and satisfaction and general release of and from all
Released Matters. In furtherance thereof, the parties hereto acknowledge that they are
familiar with Section 1542 of the Civil Code of the State of California, which provides as
follows:
A general release does not extend to claims which the
Creditor does not or suspect to exist in this or her favor
at the time of executing the release, which if known by
him or her must have materially affected his or her
settlement with the debtor.
SCHPS and the City, and their members, officers, directors, agents, employees,
successors, assigns, both in their individual and representative capacities, expressly
waive and release any and all rights or benefits which such parties have or may have
with respect to the Released Matters under Section I542 of the Civil Code of the State
of California and/or similar Federal statute, any successor statute or any similar law or
rule of any jurisdiction.
In connection with such waiver and relinquishment, each party acknowledges
that such party is aware that claims or facts in addition to, or different from, those which
such party presently knows or believes to exist may be discovered and that the release
herein given shall be and remain in effect as a full complete release notwithstanding the
discovery of the existence of any additional, new or different claims or facts.
7. This Agreement is binding upon and inures to the benefit of the parties hereto and their respective successors, assigns, and legal representatives, unless
otherwise expressly set for herein. Each patty hereto represents and warrants that said
patty has not heretofore assigned or transferred any claim, demands, liability or cause
of action, which is the subject of this Agreement.
8. Each party hereto represents and warrants that said party is authorized to
enter this Agreement.
9. Each party hereto represents that this is a negotiated Agreement, and that
any ambiguity herein shall not be construed against the initial drafter of the Agreement.
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10. Each party hereto acknowledges that this Agreement effects the
settlement of claims, which have been and are denied and contested, and nothing
herein is intended to constitute an admission of liability by any party hereto.
1 ?. Each party acknowledges that he, she or it has had the opportunity to
review the Agreement with legal counsel, each party further acknowledges that is has
read this Agreement and fully understands its provisions, and that no other
representations or promises have been made to induce said party to enter into this
Agreement. No party to the Agreement relies upon any statement, representation or
promise of any other party, not contained herein, in executing this Agreement.
12. This Agreement embodies the entire agreement and understanding
between the parties relating to the subject matter contained herein and supersedes all
prior agreements and understanding between them with respect thereto. There are no
agreements, representations, warranties, or statements, whefher oral or in writing, with
respect to the subject of this Agreement, except as expressly set forth herein.
13. This Agreement may be amended or modified only by a writing, signed by
the party against whom enforcement is sought.
14. This Agreement may be executed in counterparts, all of which taken
together shall constitute one agreement binding upon all the parties hereto.
15. Each party acknowledges and warrants that his, her or its execution of the
Agreement is free and voluntary.
16. Each party to this Agreement shall cooperate fully in the execution of any
and all other documents, and in the completion of additional actions that may be
necessary or appropriate to give full force and effect to the terms, conditions, and intent
of the Agreement.
17. This Agreement is made and entered into in the State of California and
shall be interpreted and enforced under the laws of the State of California. Whenever possible, each provisiorl of this Agreement shall be interpreted in such a manner as to
be effective and valid under applicable law, such provision shalt be ineffective only to
the extent of such prohibition or invalidity, without invalidating the remainder of such
provision or the remaining provisions of this Agreement.
DATED: XddoCBy: __ Scripps Clinic
a Delaware Corporation .I”
a California public agency
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