Molina’s records show that you are a qualified medical provider who performed certain Medicaid primary care evaluation and management services and vaccinations between January 1, 2013 and December 31, 2014 for which you are entitled to enhanced payments from Molina under Section 1202 of the Patient Protection and Affordable Care Act.  A Settlement has been reached in a class action lawsuit against Molina that affects your legal rights.

Judge Kenneth R. Freeman of the Superior Court of California for the County of Los Angeles, who is overseeing this Lawsuit, ordered that you, along with other providers who have been identified as being entitled to additional enhanced payments from Molina (the “Settlement Class”), be sent a Notice because each member of the Settlement Class has a right to know about the Settlement and the options available to him or her. 

In a class action lawsuit, one or more people, called class representatives, assert claims on behalf of themselves and other people.  All of these people together are called a class or class members.  In a class action, one court resolves the issues for all class members, except those who specifically ask to be excluded from the class, thus providing the class members with both consistency and efficiency.  When class representatives reach a proposed settlement with defendants in a class action, the proposed settlement must be approved by the court, after court-approved notice is provided to the potential class members and the court holds a hearing, which class members can attend, to determine, among other things, that the settlement is fair, reasonable, adequate and in the best interests of the class.

Manuel I. Figueroa, M.D., the class representative in this case, on behalf of himself and others similarly situated (“Plaintiff”), filed this Lawsuit, captioned as Figueroa v. Molina Healthcare of California, Inc., Superior Court of Los Angeles County Case No. BC645344, on December 30, 2016.  The Lawsuit alleges that Molina failed to comply with certain provisions of the Patient Protection and Affordable Care Act (“ACA”) that required health plans, including Molina, to make enhanced payments to qualified medical providers to compensate them at 100% of the Medicare allowable payment rate for certain Medicaid primary care evaluation and management services and vaccinations (“E&M Services”) provided between January 1, 2013 and December 31, 2014 (“Enhanced Payments”).

On January 16, 2018, Plaintiff filed an Amended Class Action Complaint, which included causes of action for violation of California’s Unfair Competition Law and for breach of fiduciary duty.  The Court subsequently dismissed the claim for breach of fiduciary duty and part of the claim under the Unfair Competition Law.  Molina has denied and continues to deny the allegations in the Lawsuit.

There was no trial to determine the truth of the allegations in the Lawsuit.  Instead, after other court proceedings and significant mediation and settlement efforts, which included, among other things, an extensive exchange and evaluation of information and data necessary for a class-wide settlement and a mediation with the assistance of an independent mediator, the Honorable Carl J. West (retired), the parties agreed to a Settlement of the claims in the Lawsuit.  The Settlement is not an admission by Molina of any fault, wrongdoing or liability; rather Molina has agreed to the Settlement to avoid the expense, risk, delay, and uncertainty of further litigation.

No.  The Court has only decided that you should receive a copy of the Notice so that you can review the proposed Settlement and determine whether you wished to participate, object, or exclude yourself from the Settlement.

If you received a Notice, then Molina’s records indicate that you are a member of the Settlement Class and are, therefore, affected by this Settlement.

After investigating the claims in the Lawsuit, exchanging relevant information and documents, and engaging in settlement negotiations with the assistance of a neutral third-party mediator, the parties agreed to settle claims that were or could have been asserted against Molina in the Lawsuit with regard to the Enhanced Payments at issue in exchange for the monetary payments to be made to members of the Settlement Class as part of this Settlement. By settling, the parties avoid the expense, risk, delay, and uncertainty of further litigation, and members of the Settlement Class receive the settlement payments described herein. The Settlement represents a compromise of disputed claims and is not an admission that Molina violated the law.  Plaintiff and his attorneys believe the Settlement is in the best interests of the Settlement Class.

Molina has agreed to pay an estimated $3,488,489.53 in payments to members of the Settlement Class to settle the claims in the Lawsuit.  Members of the Settlement Class who did not request to be excluded from the Settlement will receive a share of the Settlement in the amount of the Individual Settlement Payment identified in the Claims Information Sheet included with your Notice and will release any claims they may have against Molina that were or could have been raised in the Lawsuit with respect to the Enhanced Payments at issue.

The Court has preliminarily appointed Douglas P. Dehler and Gregory W. Lyons of O’Neil, Cannon, Hollman, DeJong & Laing S.C. and Gretchen M. Nelson and Gabriel S. Barenfeld of Nelson & Fraenkel LLP as Class Counsel for settlement purposes to represent you and other members of the Settlement Class.  You may contact Class Counsel at:

You do not have to pay Class Counsel.  Subject to Court approval, Class Counsel will be paid for their fees and costs by Molina as part of this Settlement (see FAQ 16 below).

You do not need to hire your own lawyer because Class Counsel are working on your behalf, unless you excluded yourself from participation in the Settlement by opting out by the deadline, as described in FAQ 21 below.  Nonetheless, you may hire your own lawyer if you wish.  If you hire your own lawyer, you are responsible for paying that lawyer.

The Settlement Administrator is a third party appointed by the Court to send the Notice, facilitate the payments to members of the Settlement Class, and otherwise administer the Settlement according to the terms agreed to by the parties and approved by the Court.  You may contact the Settlement Administrator to provide updated contact information, dispute the amount of your Individual Settlement Payment, object to the Settlement, or request exclusion from the Settlement.  You may contact the Settlement Administrator at:

Figueroa v. Molina Healthcare
c/o JND Legal Administration
P.O. Box 91413
Seattle, WA  98111

Email: info@ACAMedicalProviderSettlement.com

It is important that you keep the Settlement Administrator advised of any changes in your address or other updates to your contact information.

Molina has agreed that it will make Enhanced Payments under Section 1202 of the ACA for amounts that it has determined are owed to members of the Settlement Class.  Molina estimates that the total amount of such payments is $3,488,489.53.  If you did nothing, you will receive a payment in the amount of the Individual Settlement Payment identified in the Claims Information Sheet included with the Notice.

Molina also has agreed to pay additional Enhanced Payments for eligible E&M Services that were provided by members of the Settlement Class during 2013 and 2014 to the extent claims or encounter data for those E&M Services were previously submitted to Molina and not denied, provided that such Enhanced Payments are determined to be due and owing by the Settlement Administrator.

In addition to any payments made to members of the Settlement Class, Molina has agreed to pay the cost of the Settlement Administrator, the amount of any incentive award approved by the Court, and the amount of any attorneys’ fees and costs awarded to Class Counsel.

Please refer to the Claims Information Sheet included with your Notice for the amount you are owed under the terms of this Settlement (your “Individual Settlement Payment”) for outstanding Enhanced Payments due to you under Section 1202 of the ACA for eligible E&M Services you provided in 2013 and 2014 that were not previously paid to you by Molina. As part of this Settlement, Molina has agreed to make payment to you in the full amount of this Individual Settlement Payment.  If the amount of your Individual Settlement Payment is $0.00, this is because Molina contends that you were compensated, pursuant to separate contractual arrangements, at rates equal to or in excess of the amount of the Enhanced Payments otherwise owed to you.

If you believed that the amount shown as being owed to you is incorrect or you otherwise wished to dispute the amount of your Individual Settlement Payment, you must have submitted a dispute in writing to the Settlement Administrator along with your supporting evidence within 100 days of the date of your Notice.  It is important that you provided the required supporting evidence to the Settlement Administrator if you disputed the amount of your Individual Settlement Payment. The deadline to dispute has passed. 

The Court held a Final Approval Hearing on November 9, 2023 to consider whether the Settlement should be approved. The Court granted Final Approval of the Settlement on December 13, 2023. Within 30 days after entry of the Final Approval Order, Molina will need to transfer to the Settlement Administrator the funds necessary to make the payments called for by the Settlement. The Settlement Administrator will then make payment to members of the Settlement Class within 21 days of when the time to appeal has expired or following the resolution of all appeals of the Final Approval Order.

Any checks not cashed after two hundred and seventy (270) days from the date of the class-wide distribution shall be void.  After the deadline to cash checks has passed, the funds from all uncashed payments will be directed to the Controller of the State of California to be held in Settlement Class Members’ names pursuant to the California Unclaimed Property Law.  In the event you fail to timely cash your check, you may lose the right to the money; nevertheless, the Settlement shall remain binding on you, and the release of claims shall remain in effect.

Molina has agreed to pay all reasonable fees, costs, and expenses related to the administration of the Settlement or otherwise incurred by the Settlement Administrator in an amount not to exceed $200,000.  The payment of such fees, costs, and expenses will be paid by Molina in addition to any payments it makes to members of the Settlement Class. Thus, any payments made to the Settlement Administrator will not reduce the amount of the total Settlement payments to be made by Molina to members of the Settlement Class.

In class action lawsuits, the court may provide class representatives an incentive award in recognition of the time and effort they expended and the risks they took in litigating the case on behalf of the class.  In this Lawsuit, Molina has agreed not to object to a request for an incentive award for Manuel I. Figueroa, M.D. in an amount not to exceed $2,500.  The total amount of any incentive award to Dr. Figueroa approved by the Court will be paid by Molina in addition to any payments it makes to members of the Settlement Class.  Thus, any incentive payment made to Dr. Figueroa will not reduce the amount of the total Settlement payments to be made by Molina to members of the Settlement Class.

To date, Class Counsel have not received any payment for their services in prosecuting this Lawsuit and have not been reimbursed for any of their out-of-pocket expenses.  If the Court approves the proposed Settlement, Class Counsel will apply to the Court for an award of attorneys’ fees and out-of-pocket expenses.  Molina has agreed not to object to an application for fees and expenses in an amount up to 25% of the total payments made by Molina to the Settlement Class Members, not to exceed 25% of $3,488,489.53 (which is $872,122.38).  Any fees and expenses awarded to Class Counsel by the Court will be paid by Molina in addition to any payments it makes to members of the Settlement Class.  Thus, any attorneys’ fees and expenses paid to Class Counsel will not reduce the amount of the total Settlement payments to be made by Molina to members of the Settlement Class.

Members of the Settlement Class who did not request to be excluded from the Settlement by timely opting out fully release all claims that were alleged in, or that arise out of the facts asserted in, the Amended Class Action Complaint filed on January 16, 2018.  This release includes claims based on allegations that Molina failed to pay Enhanced Payments to qualified providers as required by Section 1202 of the ACA.  When claims are “released,” it means that a person covered by the release cannot sue Molina or the other released parties for these claims.

The full terms of the release are set forth in Paragraph 16 of the Settlement Agreement and Release.

You did not need to do anything in order to participate in the Settlement. If you received a Notice, Molina’s records indicate you are a member of the Settlement Class and, so long as you did not request to be excluded from the Settlement, you will automatically receive the Individual Settlement Payment identified in the Claims Information Sheet and will release claims as set forth in FAQ 17 above without any further action on your part.

If you wished to accept the terms of the Settlement but dispute the amount of the Individual Settlement Payment to be paid to you as identified in the Claims Information Sheet included with your Notice, you had the opportunity to do so by submitting a written dispute to the Settlement Administrator.  This dispute of the Individual Settlement Payment must be sent by first-class mail, postage pre-paid, and postmarked no later than 100 days from the date of your Notice. The deadline to dispute has passed. 

If the Settlement Administrator did not receive sufficient documentation to support the amount you claimed you are still owed from Molina in Enhanced Payments, then you will receive the Individual Settlement Payment amount identified in the Claims Information Sheet included with your Notice.

If the Settlement Administrator timely received sufficient documentation to support the amount you claimed you are still owed from Molina in Enhanced Payments, then, within 15 days, Molina was notified of the disputed amount and provided with a copy of your supporting documentation.  Molina then had 45 days to either contest some or all of the disputed amount with its own documentation or agree to pay the disputed amount you claim you are owed.

If Molina timely submitted its own documentation contesting the disputed amount, then the Settlement Administrator analyzed the submitted documentation and, within 30 days of receiving Molina’s documentation, made a final determination of the amount to be paid to you by Molina.

If you did not want to receive a payment under the Settlement or if you wished to keep any right you may have had to sue Molina for the claims alleged in the Lawsuit, then you must have excluded yourself or “opted out” of the Settlement.

If you wish to be excluded from the Settlement, you must opt out by sending a letter to the Settlement Administrator stating that you wish to be excluded from or opt out of the Settlement. This opt-out request must be sent by first-class mail, postage prepaid, and postmarked no later than 60 days from the date of your Notice. The deadline to opt out of the Settlement has passed.

If you did not opt out of the Settlement, you could have objected to the Settlement by sending a letter to the Settlement Administrator noting your objection to the Settlement.  The deadline to object has passed.

Objecting is telling the Court that you do not believe the Settlement is fair, reasonable, and adequate for the class, and asking the Court to reject it.  You could not object to the Settlement unless you are a member of the Settlement Class, which means that you could object only if you did not opt out of the Settlement.  If you objected to the Settlement and did not opt out, then you are entitled to a payment but you will release claims you might have against Molina.

Anyone who submitted both an objection and a requested to opt out shall be deemed to have opted out of the Settlement.

If you did nothing at all, then you will receive the Individual Settlement Payment identified in the Claims Information Sheet included with your Notice.  You will be considered one of the members of the Settlement Class, and you will give up claims you might have against Molina for the claims alleged in the Lawsuit.

The Court held a Final Approval Hearing in Department 14 of the California Superior Court for the County of Los Angeles located at Spring Street Courthouse, 312 North Spring Street, Los Angeles, CA 90012 on November 9, 2023 at 10:00 a.m. to decide whether to grant final approval of the Settlement.  The Court granted Final Approval of the Settlement on December 13, 2023. 

The Notice provides a summary of the basic terms of the Settlement.  For the Settlement’s complete terms and conditions, consult the Settlement Agreement and Release and other documents in the Lawsuit.  More information about the Lawsuit can be obtained through several methods:

1. You can contact the Settlement Administrator by mail, telephone, or email (contact information in FAQ 9 above);
2. You can contact Class Counsel by mail, telephone, or email (contact information in FAQ 8 above);
3. You can visit this website, to obtain certain key documents in the Lawsuit free of charge; or
4. For a small fee, all of the pleadings and other records in this litigation, including the Settlement Agreement and Release, may be examined online on the Los Angeles County Superior Court’s website at www.lacourt.org.