Abrons Fam. Prac. & Urgent Care, PA v. N.C. Dep't of Health & Hum. Servs. ( 2018 )


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  •               IN THE SUPREME COURT OF NORTH CAROLINA
    No. 427A16
    Filed 2 March 2018
    ABRONS FAMILY PRACTICE AND URGENT CARE, PA; NASH OB-GYN
    ASSOCIATES, PA; HIGHLAND OBSTETRICAL-GYNECOLOGICAL CLINIC,
    PA; CHILDREN’S HEALTH OF CAROLINA, PA; CAPITAL NEPHROLOGY
    ASSOCIATES, PA; HICKORY ALLERGY & ASTHMA CLINIC, PA; HALIFAX
    MEDICAL SPECIALISTS, PA; and WESTSIDE OB-GYN CENTER, PA,
    Individually and on Behalf of All Others Similarly Situated
    v.
    NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES and
    COMPUTER SCIENCES CORPORATION
    Appeal pursuant to N.C.G.S. § 7A-30(2) from the decision of a divided panel of
    the Court of Appeals, ___ N.C. App. ___, 
    792 S.E.2d 528
     (2016), reversing an order
    dated 12 June 2015 by Judge Gregory P. McGuire, Special Superior Court Judge for
    Complex Business Cases, in Superior Court, Wake County, and remanding for
    additional proceedings.   On 26 January 2017, the Supreme Court allowed both
    defendants’ petitions for discretionary review of additional issues. Heard in the
    Supreme Court on 12 December 2017.
    Williams Mullen, by Camden R. Webb, Elizabeth C. Stone, and Ruth A. Levy,
    for plaintiff-appellees.
    Joshua H. Stein, Attorney General, by Olga Vysotskaya de Brito and Amar
    Majmundar, Special Deputy Attorneys General, for defendant-appellant North
    Carolina Department of Health and Human Services.
    Brooks, Pierce, McLendon, Humphrey & Leonard, LLP, by Charles F. Marshall
    III and Jennifer K. Van Zant, for defendant-appellant Computer Sciences
    Corporation.
    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    Parker Poe Adams & Bernstein LLP, by Matthew W. Wolfe, for American
    Medical Association, North Carolina Academy of Family Physicians, North
    Carolina Hospital Association, North Carolina Health Care Facilities
    Association, and North Carolina Medical Society, amici curiae.
    Ott Cone & Redpath, P.A., by Matthew Jordan Cochran, Thomas E. Cone,
    Curtis B. Venable, and Stephen J. White, for Charlotte−Mecklenburg Hospital
    Authority, Duke University Medical Center, Mission Hospitals, Inc., The Moses
    H. Cone Memorial Hospital Operating Corporation, North Carolina Baptist
    Hospital, and WakeMed, amici curiae.
    JACKSON, Justice.
    In this appeal we consider whether the Court of Appeals correctly held that the
    trial court erroneously dismissed plaintiffs’ action for lack of subject-matter
    jurisdiction due to plaintiffs’ failure to exhaust administrative remedies in seeking
    damages for denied Medicaid reimbursement claims.         Because we conclude that
    plaintiffs have failed to exhaust their available administrative remedies, we reverse
    the decision of the Court of Appeals reversing the trial court’s order granting
    defendants’ motions to dismiss for lack of subject-matter jurisdiction.
    Plaintiffs Abrons Family Practice and Urgent Care, PA; Nash OB-GYN
    Associates, PA; Highland Obstetrical-Gynecological Clinic, PA; Children’s Health of
    Carolina, PA; Capital Nephrology Associates, PA; Hickory Allergy & Asthma Clinic,
    PA; Halifax Medical Specialists, PA; and Westside OB-GYN Center, PA are medical
    practices in North Carolina, all of which provide care to Medicaid-eligible patients
    pursuant to Medicaid contracts with the State of North Carolina. Defendant North
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    Carolina Department of Health and Human Services (DHHS or the Department)
    administers the State’s Medicaid plan. Defendant Computer Sciences Corporation
    (CSC) is a Nevada corporation with its principal office in Falls Church, Virginia.
    After being required by the federal Centers for Medicare and Medicaid Services
    (CMS) to replace its Medicaid Management Information System (MMIS), the State of
    North Carolina awarded a contract to CSC to develop a new MMIS. CSC designed
    and developed NCTracks, the new system intended to manage reimbursement
    payments to health care providers for services provided to Medicaid recipients across
    North Carolina. NCTracks went live on 1 July 2013, and plaintiffs began submitting
    claims to DHHS for Medicaid reimbursements under the new system. In the first few
    months of being in operation, NCTracks experienced over 3,200 software errors,
    resulting in delayed, incorrectly paid, or unpaid reimbursements to plaintiffs.
    On 31 January 2014, plaintiffs filed a First Amended Class Action Complaint
    against defendants. Plaintiffs asserted that NCTracks ultimately proved to be “a
    disaster, inflicting millions of dollars in damages upon North Carolina’s Medicaid
    providers.” Specifically, plaintiffs alleged that CSC was negligent in its design and
    implementation of NCTracks and that DHHS breached its contracts with each of the
    plaintiffs by failing to pay Medicaid reimbursements. Plaintiffs also alleged that they
    had a contractual right to receive payment for reimbursement claims and that this
    was “a property right that could not be taken without just compensation.” As a result
    of these allegations, plaintiffs sought damages based upon claims of negligence and
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    unfair and deceptive acts against CSC, and claims of breach of contract and violation
    of Article I, Section 19 of the North Carolina Constitution against DHHS.
    Additionally, plaintiffs sought a declaratory judgment that the methodology for
    payment of Medicaid reimbursement claims established by DHHS violated Medicaid
    reimbursement rules.
    Plaintiffs further maintained that, because the available administrative
    procedures would not compel the State to adhere to Medicaid reimbursement rules or
    provide recovery of certain damages, plaintiffs were not required to exhaust their
    administrative remedies before filing their civil action.     Additionally, plaintiffs
    contended that “the administrative procedures [were] futile and inadequate.”
    On 4 April 2014, defendants filed motions to dismiss pursuant to North
    Carolina Rules of Civil Procedure 12(b)(1), 12(b)(2), and 12(b)(6). Defendants argued,
    inter alia, that plaintiffs’ complaint failed to establish personal and subject-matter
    jurisdiction. The trial court concluded that plaintiffs had failed to exhaust their
    administrative remedies and had not demonstrated that the available administrative
    remedies were inadequate. Because the trial court determined that it lacked subject-
    matter jurisdiction over plaintiffs’ claims, it denied as moot defendants’ motions to
    dismiss pursuant to Rules 12(b)(2) and 12(b)(6).
    The Court of Appeals majority reversed the trial court’s order, holding that the
    trial court erred by dismissing plaintiffs’ complaint for failure to exhaust
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    administrative remedies without resolving “whether DHHS issues final agency
    decisions in Medicaid claim matters and whether DHHS supplies providers with
    written notice of its final agency decisions.” Abrons Fam. Prac. & Urgent Care, PA v.
    N.C. Dep’t of Health & Hum. Servs., ___ N.C. App. ___, ___, 
    792 S.E.2d 528
    , 539
    (2016). The Court of Appeals majority also concluded that plaintiffs sufficiently
    demonstrated that it would be futile to pursue administrative remedies. 
    Id.
     at ___,
    792 S.E.2d at 538. Because the Court of Appeals reversed the trial court’s order, it
    did not address plaintiffs’ remaining arguments. See id. at. ___, 792 S.E.2d at 539.
    Judge McCullough dissented, concluding that the trial court’s decision should
    be affirmed because plaintiffs did not exhaust the available administrative remedies
    or prove that those remedies were inadequate to resolve their claims. Id. at ___, 792
    S.E.2d at 539-540 (McCullough, J., dissenting). Both defendants appealed based on
    the dissent and sought discretionary review of additional issues, which this Court
    allowed.
    On appeal to this Court, defendants contend that the Court of Appeals erred
    by reversing the dismissal of plaintiffs’ claims because plaintiffs failed to exhaust
    their available administrative remedies prior to filing a lawsuit. Defendants also
    argue that plaintiffs only have speculated that pursuing the available administrative
    remedies would be futile or inadequate. We agree.
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    Section 108C-12 explicitly indicates that the Administrative Procedure Act
    (APA) governs the appeals process for Medicaid providers. N.C.G.S. § 108C-12 (2017).
    The APA states in relevant part that “any dispute between an agency and another
    person that involves the person’s rights, duties, or privileges . . . should be settled
    through informal procedures.” Id. § 150B-22 (2017). If the parties do not resolve the
    dispute through informal procedures, either party may request a formal
    administrative proceeding, “at which time the dispute becomes a ‘contested case.’ ”
    Id. “[A] request for a hearing to appeal an adverse determination of the Department
    [of Health and Human Services] . . . is a contested case subject to the provisions of”
    the   Administrative   Procedure    Act.      N.C.G.S.    § 108C-12.   An “[a]dverse
    determination” is defined, in relevant part, as “[a] final decision by [DHHS] to deny,
    terminate, suspend, reduce, or recoup a Medicaid payment.” Id. § 108C-2(1) (2017).
    Finally, if a party is aggrieved by the outcome of a contested case hearing and has
    exhausted all available administrative remedies, the party “is entitled to judicial
    review of the decision [pursuant to] this Article.” Id. § 150B-43 (2017).
    As authorized by the General Assembly in N.C.G.S. § 108A-54, the Department
    has promulgated specific rules governing the informal review process. See generally
    10A NCAC Subchapter 22J (2016).            These regulations enumerate the rights of
    providers to appeal reimbursement rates and challenge the Department’s decisions
    on various claims related to payments. 10A NCAC 22J .0101.
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    When a provider submits a Medicaid reimbursement claim, the Department
    responds by sending the provider a “Remittance Statement” that discloses the initial
    disposition of the claim. At this stage, claims are either paid, denied, or placed in
    “pending” status. A provider may then request a reconsideration review, but must
    do so within thirty calendar days “from receipt of final notification of payment,
    payment    denial,   disallowances,    payment      adjustment,   notice   of   program
    reimbursement and adjustments.” Id. .0102(a). This “final notification . . . means
    that all administrative actions necessary to have a claim paid correctly have been
    taken by the provider and . . . the fiscal agent has issued a final adjudication.” Id. If
    the provider fails to request a reconsideration review within the specified time period,
    the state agency’s decision becomes final. Id. In the alternative, a provider may
    resubmit a denied claim to DHHS at any time within eighteen months “after the date
    of payment or denial of [the] claim.” 10A NCAC 22B .0104(b) (2016).
    If a provider seeks a reconsideration review and disagrees with the result, the
    provider may request a contested case hearing before the Office of Administrative
    Hearings (OAH). Id. 22J .0104. Then, as outlined in the statutory framework, once
    all administrative remedies are exhausted, the provider may seek judicial review.
    N.C.G.S. § 150B-43. Judicial review “is generally available only to aggrieved persons
    who have exhausted all administrative remedies made available by statute or agency
    rule.” Empire Power Co. v. N.C. Dep't of Env't, Health & Nat. Res., 
    337 N.C. 569
    , 594,
    
    447 S.E.2d 768
    , 783 (1994) (citing N.C.G.S. § 150B-43 (1991)). A plaintiff’s failure to
    -7-
    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    exhaust administrative remedies may result in the dismissal of the complaint for lack
    of subject-matter jurisdiction. See Presnell v. Pell, 
    298 N.C. 715
    , 722, 
    260 S.E.2d 611
    ,
    615 (1979); see also Vass v. Bd. of Trs. of the Teachers’ & State Emps.’ Comprehensive
    Major Med. Plan, 
    324 N.C. 402
    , 408-09, 
    379 S.E.2d 26
    , 30 (1989).
    Here, after receiving Remittance Statements that indicated an adverse
    determination on a Medicaid reimbursement claim, the providers failed to request a
    reconsideration review or file a petition for a contested case. Instead, plaintiffs
    bypassed the administrative procedures set forth above and filed a class action
    complaint in the trial court.    To justify their failure to exhaust administrative
    remedies, plaintiffs rely upon 10A NCAC 22J .0102 which indicates that the provider
    has thirty calendar days “from receipt of final notification of payment [or] payment
    denial” to request reconsideration review. 10A NCAC 22J .0102(a). Plaintiffs argue
    that defendants cannot assert the defense of failure to exhaust administrative
    remedies because defendants failed to provide the required final notification that
    triggers the administrative review process. Subsection 150B-23(f) mandates that the
    time limit to file a petition in a contested case commences “when notice is given of the
    agency decision to all persons aggrieved” and states that the notice “shall be in
    writing, and shall set forth the agency action, and shall inform the persons of the
    right, the procedure, and the time limit to file a contested case petition.” N.C.G.S.
    § 150B-23(f) (2017). CSC argued before the trial court that a provider’s receipt of the
    Remittance Statement triggers the option to pursue resubmission or administrative
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    remedies. On the other hand, plaintiffs contend that defendants never provided the
    required final notification. In addition to arguing that defendants failed to provide
    final notification, plaintiffs also contend that defendants provided defective notice to
    plaintiffs of their rights to pursue administrative remedies.
    In support of these arguments, plaintiffs cite Davidson County v. City of High
    Point, 
    321 N.C. 252
    , 
    362 S.E.2d 553
     (1987). The dispute in Davidson County centered
    around the County’s issuance of a special use permit to allow renovation of a City-
    owned sewage treatment plant. 
    Id. at 253
    , 
    362 S.E.2d at 554
    . The County argued
    that the City could not challenge the meaning of one of the prerequisite conditions
    necessary to receive a permit because the City had failed to pursue the administrative
    remedies afforded pursuant to the special use permit. 
    Id. at 260
    , 
    362 S.E.2d at 558
    .
    Plaintiffs in the present case contend that in Davidson County, the County provided
    no notice of administrative remedies and that as a result, this Court rejected the
    County’s assertion that the City failed to exhaust administrative remedies. This is
    an incorrect interpretation of our conclusion in Davidson County. Moreover, an
    administrative appeal that falls outside the framework of the APA does not provide
    the best analog for analysis of a dispute that lies squarely within the purview of the
    APA.
    In Davidson County this Court determined that “the City was unaware of the
    County’s differing interpretation of” a prerequisite condition to receive a permit and
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    as a result, “could not have known that it should have appealed the issue . . . within
    thirty days of receiving the permit.” 
    Id. at 260
    , 
    362 S.E.2d at 558
    . We concluded that
    “[t]he County cannot now be heard to assert that the City should have pursued
    administrative remedies for a problem it was unaware existed.” 
    Id. at 260
    , 
    362 S.E.2d at 558
    . The issue in Davidson County turned on whether one party was even aware
    that a problem existed, not whether a party was aware of the available administrative
    remedies. Unlike the plaintiffs in Davidson County, plaintiffs in the case sub judice
    were aware not only of the existence of the problem but also of the existence of the
    available administrative remedies.
    In addressing the applicable time limits in which a provider must appeal an
    adverse determination, the Administrative Code states that a provider may seek
    reconsideration review after receiving “final notification of payment.” 10A NCAC 22J
    .0102(a). The Code further states that if a provider does not seek such review within
    thirty days “from receipt of final notification,” then the Department’s “action shall
    become final.” 
    Id.
     As the Court of Appeals majority highlighted, the central problem
    here is that the status of the Remittance Statement seems unclear if a “final
    notification” later becomes “final.” Abrons, ___ N.C. App. at ___, 792 S.E.2d at 536
    (majority opinion). The Administrative Code allows a provider to resubmit a denied
    claim to DHHS at any time within eighteen months after receiving the Remittance
    Statement, 10A NCAC 22B .0104(b); yet the previously mentioned provision indicates
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    that if a provider does not seek reconsideration review within the thirty-day window,
    then that decision becomes final, id. 22J .0102.
    There does appear to be confusion surrounding the time frame in which a
    provider must seek reconsideration review, and the State conceded as much in oral
    argument, acknowledging that there was no statute of limitations running, given the
    inadequacy of notice. During rebuttal, the State addressed the Court’s question
    originally posed to counsel for the appellee, as to whether Section 150B-23(f) tolls the
    statute of limitations. Counsel for the State answered, “Of course it does.”
    Notwithstanding this inadequacy of notice, if a provider was aggrieved by the
    denial of a reimbursement claim, a reconsideration review should have been
    requested, followed by the filing of a petition for a contested case hearing, if
    necessary.   In addition, the APA establishes a process by which a party may
    commence a contested case by, inter alia, showing that an agency has failed to use
    proper procedure. See N.C.G.S. § 150B-23(a) (2017) (providing that a petition for a
    contested case shall state facts establishing that the agency has, inter alia, “[f]ailed
    to use proper procedure” or “[f]ailed to act as required by law or rule”). The APA also
    gives an aggrieved party the opportunity to request a declaratory ruling to determine
    “the validity of a rule” or to resolve a conflict “regarding an interpretation of” a rule.
    See id. § 150B-4(a) (2017). The declaratory ruling has the same effect as a final
    agency decision and would have provided certainty to plaintiffs in pursuit of their
    determination of whether the Remittance Statement itself was in fact a final
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    statement by the Department.1 Although any procedural confusion as to finality and
    notice does not relieve plaintiffs from the requirement to exhaust their available
    administrative remedies, here the State has conceded that there is no issue with the
    statute of limitations running; therefore, plaintiffs remain free to appeal the adverse
    determinations by initiating contested case hearings at OAH.2
    This is an essential step in addressing the disputed payments.                   The
    requirement to exhaust administrative remedies ensures that “matters of regulation
    and control are first addressed by commissions or agencies particularly qualified for
    the purpose.” Presnell, 
    298 N.C. at 721
    , 
    260 S.E.2d at 615
    . Although administrative
    remedies were available to plaintiffs, none of the plaintiffs appear to have invoked
    these available remedies. Without a single provider having initiated an appeal from
    a denied reimbursement claim, it cannot be said that plaintiffs have exhausted all
    available administrative remedies.
    As to their claims against CSC, plaintiffs contend that these claims “are
    independent of [their] claims for reimbursement against DHHS”; however, their
    1  With that certain determination, there also would have been a very clear path for
    plaintiffs to exhaust their administrative remedies prior to seeking relief in the General
    Court of Justice.
    2 We express no opinion as to what our decision would have been in the absence of the
    State’s concession; however, faced with a statute of limitations that concededly is not a bar
    to plaintiffs’ pursuit of their administrative remedies, we are in the unusual position of
    allowing them to do so notwithstanding the present action. Our research has disclosed no
    similar precedent in our law, and we caution that the circumstances in the instant case and
    magnitude of the current dispute present unique challenges that mandate a resolution which
    should not be read broadly.
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    amended complaint reveals how intertwined its claims are against DHHS and CSC.
    For example, plaintiffs allege that “CSC’s contract obligated CSC to design and
    develop NCTracks so that it provided a common, unified, and flexible system meeting
    DHHS’ business requirements regarding Medicaid.” Plaintiffs further allege that
    “DHHS and CSC have also placed thousands of reimbursement claims in ‘limbo’ by
    failing to issue decisions on reimbursement claims.” The actual language of these
    excerpts from the complaint indicate the sheer difficulty in wholly separating the
    actions of DHHS from the actions of CSC.
    In further support of their argument that their claims against CSC are
    independent of their claims against DHHS, plaintiffs also contend that they are suing
    CSC for its conduct before it became the State’s fiscal agent, which took place on the
    “go-live” date of 1 July 2013. Again, plaintiffs’ amended complaint indicates the close
    involvement between the acts of DHHS and CSC. The amended complaint alleges
    that CSC was negligent in that it “failed to exercise due care,” inter alia, “in the
    attempts to fix defects found in NCTracks after go-live.”         Therefore, plaintiffs’
    amended complaint itself uses language that indicates plaintiffs are suing CSC not
    only for its conduct before it became the State’s fiscal agent, but also for its conduct
    after said time. Furthermore, plaintiffs’ claims against CSC will be affected by the
    outcome of their claims against DHHS. If, in fact, the reimbursement claims were
    denied properly, then plaintiffs’ claims against CSC may fail or the damages awarded
    may not be awarded in full. The record in this case reveals that plaintiffs’ claims
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    against DHHS and CSC would be difficult, if not impossible, to wholly disentangle.
    Similarly, the State’s and CSC’s defenses are interwoven as well.            Therefore,
    plaintiffs’ causes of action against CSC remain viable, too.
    Plaintiffs also alleged in their complaint that they are exempt from the
    requirement to exhaust administrative remedies because doing so would be futile and
    the remedies would be inadequate. Our courts have not required plaintiffs to exhaust
    administrative remedies prior to bringing suit, if the pursuit of administrative
    remedies would be futile. State ex rel. Utils. Comm’n v. S. Bell Tel. & Tel. Co., 
    93 N.C. App. 260
    , 268, 
    377 S.E.2d 772
    , 776 (1989), rev'd on other grounds, 
    326 N.C. 522
    ,
    
    391 S.E.2d 487
     (1990). The party claiming excuse from exhaustion bears the burden
    of alleging both the inadequacy and the futility of the available administrative
    remedies. See Snuggs v. Stanly Cty. Dep’t of Pub. Health, 
    310 N.C. 739
    , 740, 
    314 S.E.2d 528
    , 529 (1984) (per curiam). Plaintiffs first argue that initiating a dispute
    with DHHS “is not available to Medicaid providers because of the overwhelming
    number of reimbursement errors and because of [the] utter inability [of DHHS] to
    address providers’ issues.” Plaintiffs allege that defendants have “placed thousands
    of reimbursement claims in ‘limbo’ by failing to issue decisions on reimbursement
    claims.” Not only do plaintiffs fail to provide an exact number of claims at issue, but,
    given that there are eight plaintiffs, the inadequacy of the administrative procedures
    cannot be evaluated on the basis of this bare allegation. Furthermore, this Court
    previously has determined that the breadth of a claim may not create a burden
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    sufficient to relieve a plaintiff of the exhaustion requirement. See Lloyd v. Babb, 
    296 N.C. 416
    , 426-28, 
    251 S.E.2d 843
    , 850-51 (1979) (requiring exhaustion of
    administrative remedies notwithstanding plaintiffs having to individually challenge
    the voting rights of between 6,000 and 10,000 people). Here, the sheer number of
    claims does not satisfy plaintiff’s burden.
    Plaintiffs also asserted in their complaint that pursuing administrative
    remedies would be futile because “[n]o procedures exist to recover for damage to the
    Plaintiffs’ businesses, to recover for payment of the $100 re-enrollment fee . . . and to
    recover damages in the form of time value of money.” The reasoning in Jackson ex.
    rel. Jackson v. North Carolina Department of Human Resources Division of Mental
    Health, Developmental Disabilities, & Substance Abuse Services, 
    131 N.C. App. 179
    ,
    
    505 S.E.2d 899
     (1998), disc. rev. denied, 
    350 N.C. 594
    , 
    537 S.E.2d 213
    , 214 (1999)—
    that plaintiffs’ insertion of a prayer for monetary damages does not relieve them from
    the necessity for compliance with the exhaustion requirement—is persuasive here.
    In Jackson the Court of Appeals acknowledged that, although the plaintiff sought
    damages that could not be awarded through administrative procedures, the plaintiff’s
    primary claim—“the provision of mental health care”—was an issue that first should
    be determined by the agency. Id. at 188-89, 
    505 S.E.2d at 905
    . Similarly, plaintiffs’
    claims in the present case stem from the failure of DHHS to pay Medicaid
    reimbursement claims. The majority of the claims for relief even specifically mention
    these unpaid reimbursements. Because resolution of the reimbursement claims must
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    come from DHHS, simply inserting a prayer for monetary damages does not
    automatically demonstrate that pursuing administrative remedies would be futile.
    Notwithstanding the claims that are outside the relief that can be granted by an
    administrative law judge, the reimbursement claims “should properly be determined
    in the first instance by the agenc[y] statutorily charged with administering” the
    Medicaid program. Id. at 188-89, 
    505 S.E.2d at 905
    . “Pursuing an administrative
    remedy is ‘futile’ when it is useless to do so either as a legal or practical matter.”
    Bailey v. State, 
    330 N.C. 227
    , 248, 
    412 S.E.2d 295
    , 308 (1991) (Mitchell, J., concurring
    in part and dissenting in part) (quoting Honig v. Doe, 
    484 U.S. 305
    , 327, 
    108 S. Ct. 592
    , 606, 
    98 L. Ed. 2d 686
    , 709 (1988)), cert. denied, 
    504 U.S. 911
    , 
    112 S. Ct. 1942
    ,
    
    118 L. Ed. 2d 547
     (1992), disavowed by Bailey v. State, 
    348 N.C. 130
    , 
    500 S.E.2d 54
    (1998). Plaintiffs have failed to demonstrate that pursuing reconsideration review or
    a contested case would be “useless.”
    Finally, in addressing plaintiffs’ allegations regarding business damages, the
    trial court, in its Amended Opinion and Order on Motions to Dismiss, included the
    following footnote:
    The Court notes that Plaintiffs did not cite to any authority
    to support their assertion that the business damages they
    seek could not be sought through the administrative
    process, and the Court is unable to find any specific statute,
    regulation, or case law expressly stating that tort-type
    damages are unavailable as a remedy at the administrative
    level in this context.
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    ABRONS FAM. PRAC. & URGENT CARE, P.A. V. N.C. DEP’T OF HEALTH & HUM. SERVS.
    Opinion of the Court
    This conclusion incorrectly interprets the scope of an administrative hearing. The
    purpose of the APA is to “ensure that the functions of rule making, investigation,
    advocacy, and adjudication are not all performed by the same person in the
    administrative process.” N.C.G.S. § 150B-1(a) (2017). Furthermore, five specific
    grounds for alleging an agency’s wrongdoing are enumerated in N.C.G.S. § 150B-
    23(a). By its very nature, the quasi-judicial forum of an administrative hearing
    precludes the adjudication of claims seeking compensatory damages; however, when
    any part of the relief sought is provided through an administrative process, a plaintiff
    must exhaust that process prior to seeking the same or related relief from the judicial
    system.
    In conclusion, the Department’s decision to deny plaintiffs’ claims would be
    subject to judicial review only after plaintiffs had exhausted their available
    administrative remedies or demonstrated that doing so would have been futile.
    Plaintiffs have not succeeded at either endeavor; however, given the inadequacy of
    notice, plaintiffs still are entitled to exhaust the available administrative remedies.
    Nevertheless, because plaintiffs have failed to exhaust their administrative remedies
    and have failed to demonstrate futility of the available remedies at this time, the
    Court of Appeals erred by reversing the dismissal of plaintiffs’ claims. For the
    foregoing reasons, we reverse the decision of the Court of Appeals.
    REVERSED.
    -17-