ATLANTIC AMBULANCE CORPORATION VS. JOHN G. CULLUMÂ ATLANTIC AMBULANCE CORPORATION VS. HALA HITTI(L-264-12 AND L-2097-12, MORRIS COUNTY AND STATEWIDE)(RECORD IMPOUNDED) , 451 N.J. Super. 247 ( 2017 )


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  •                      RECORD IMPOUNDED
    NOT FOR PUBLICATION WITHOUT THE
    APPROVAL OF THE APPELLATE DIVISION
    SUPERIOR COURT OF NEW JERSEY
    APPELLATE DIVISION
    DOCKET NO. A-1622-16T2
    ATLANTIC AMBULANCE CORPORATION,
    Plaintiff-Respondent,
    v.                                      APPROVED FOR PUBLICATION
    JOHN G. CULLUM and MARY CLARE                June 29, 2017
    CULLUM,                                   APPELLATE DIVISION
    Defendants-Appellants.
    ___________________________
    ATLANTIC AMBULANCE CORPORATION,
    Plaintiff-Respondent,
    v.
    HALA HITTI and ANTOINE HITTI,
    Defendants-Appellants.
    _____________________________________
    Argued May 23, 2017 - Decided June 29, 2017
    Before Judges Reisner, Koblitz and Mayer.
    On appeal from an interlocutory order of the
    Superior Court of New Jersey, Law Division,
    Morris County, Docket Nos. L-264-12 and
    L-2097-12.
    Robert W. Mauriello, Jr., argued the cause for
    appellants (Graham Curtin, P.A., attorneys;
    Kelley J. Hastie and Mr. Mauriello, on the
    briefs).
    James W. Brown (Skadden, Arps, Slate, Meagher
    & Flom) of the New York bar, admitted pro hac
    vice, argued the cause for respondent (Schenck
    Price Smith & King, LLP and Mr. Brown,
    attorneys; Lauren E. Aguiar (Skadden, Arps,
    Slate, Meagher & Flom) of the New York bar,
    admitted pro hac vice, Mr. Brown and Peter A.
    Marra, on the brief).
    The opinion of the court was delivered by
    MAYER, J.S.C. (temporarily assigned)
    Appellants John G. Cullum and Mary Clare Cullum (Cullum) and
    Hala Hitti and Antoine Hitti (Hitti)1 were granted leave to appeal
    denial of their motion for class certification.       We affirm in part
    and remand in part.
    In reaching this decision, we hold that ambulance service
    providers are not subject to consumer fraud claims under the
    "learned professional" exception because ambulance services are
    comprehensively regulated by a State agency.         We also hold that
    the reasonableness of rates charged for ambulance services is a
    policy matter to be addressed by the Legislature and agencies
    within the Executive branch of government.         We further determine
    that consumers are not required to pay a defendant's bill for
    allegedly    overpriced   services,   in   order     to   establish    an
    ascertainable loss under the Consumer Fraud Act.
    1
    Because Hitti and Cullum were defendants and counterclaimants,
    for simplicity we refer to them as "appellants" although we usually
    refer to parties by their status in the trial court.
    2                             A-1622-16T2
    We briefly recite the relevant procedural history.                  Atlantic
    Ambulance Corp. (Atlantic) filed complaints in the Special Civil
    Part   against      Cullum   and    Hitti       seeking   payment   for   ambulance
    services.      Cullum and Hitti filed answers and counterclaims,
    alleging     that    Atlantic      overbilled      for    ambulance   services     in
    violation of the Consumer Fraud Act, N.J.S.A. 56:8-1 to -20 (CFA).
    The counterclaims also asserted causes of action against Atlantic
    for negligence, common law fraud, breach of contract and unjust
    enrichment.2     Appellants also sought class certification on behalf
    of themselves as class representatives and on behalf of all
    proposed class members who were overcharged for ambulance services
    during a six-year period.              The Cullum and Hitti matters were
    transferred from the Special Civil Part to the Law Division and
    were consolidated.           After five years of discovery, appellants
    filed a motion seeking class certification.
    The   facts   giving     rise   to       appellants'   overbilling    claims
    against Atlantic are undisputed.                   Cullum and Hitti initially
    alleged that they did not receive services from Atlantic and,
    therefore, the fees charged by Atlantic for services were improper
    and/or excessive.        However, during oral argument on the class
    2
    On appeal, appellants are pursuing their CFA and breach of
    "quasi-contract" claims only.
    3                               A-1622-16T2
    certification motion, counsel clarified that Cullum and Hitti
    received    services,     but   claimed     the   bills     they   received   were
    unconscionably high.        The dispute focused on Atlantic's provision
    of ALS services, which are divided into three categories: ALS
    Assessment, ALS-1 and ALS-2.           Different services are provided to
    patients for each ALS category, ranging from a basic physical
    examination and electrocardiogram readings to more complex medical
    treatments.
    The amount billed to patients receiving ambulance services
    depends on the category of the support rendered. For ALS services,
    Atlantic charged the following: $1500 for an ALS Assessment, plus
    a mileage fee; $1750 for ALS-1 services, plus a mileage fee; and
    $2300   for     ALS-2    services,   plus    a    mileage    fee.     Appellants
    challenged Atlantic's formulation of the billing rates for ALS
    services.       They claimed that Atlantic's fees for ALS services
    should be itemized, specifying the amount charged for each service,
    rather than bundled.        Appellants alleged that Atlantic's uniform
    flat    rates     were     excessive      and     disproportionate       to    the
    reimbursement rates assessed by insurance providers for similar
    services.
    In Cullum's case, he passed out at his gym and Atlantic was
    called to provide ambulance services.              Other than blood pressure
    monitoring, Cullum denied receiving any medical services from
    4                                 A-1622-16T2
    Atlantic.      Cullum's bill from Atlantic was $1750, plus a mileage
    fee    for   transporting       him   to   the   hospital.         Cullum's     health
    insurance provider paid a portion of Atlantic's bill, and he was
    responsible for payment of the outstanding balance of $1459.20.
    In    Hitti's    case,   she    fainted       in    her   home   and   Atlantic
    performed an ALS Assessment.           Hitti declined transportation to the
    hospital but was charged $14 for transport of one mile.                        Hitti's
    bill was $1500, plus the mileage fee.                     Hitti's health insurance
    provider declined to pay Atlantic's bill due to a purported billing
    code error.
    Appellants sought class certification on behalf of themselves
    and approximately 36,000 individuals who were allegedly overbilled
    by Atlantic.3          Appellants claimed that their cause of action
    satisfied the requirements for class certification.                     See R. 4:32-
    1(a); see also Muise v. GPU, Inc., 
    371 N.J. Super. 13
    , 30 (App.
    Div.    2004)    (the     requirements         are    numerosity,       commonality,
    typicality and adequacy).             Appellants also argued that they met
    the requirements of Rule 4:32-1(b)(3) by raising "questions of law
    3
    In the six-year period, appellants contend there were
    approximately 10,000 individuals who were charged a $14 mileage
    fee despite not being transported to a hospital (the non-
    transported individuals are identified as the "Hitti class") and
    26,000 individuals who were transported to a hospital but were
    charged an exorbitant bundled rate for ambulance services (these
    individuals are identified as the "Cullum class").
    5                                   A-1622-16T2
    or fact common to the members of the class [that] predominate over
    any questions affecting only individual members, and that a class
    action   is   superior   to   other   available    methods   for    fair      and
    efficient adjudication of the controversy."           R. 4:32-1(b)(3); see
    also Iliadis v. Wal-Mart Stores, Inc., 
    191 N.J. 88
    , 106-07 (2007).
    Appellants maintained their claims were common, typical and
    adequate with respect to the claims of the proposed class members
    because all were victims of Atlantic's unlawful billing practices
    and unconscionable rates in violation of the CFA.4                 Appellants
    contended that Atlantic had a duty to charge a reasonable fee for
    services and breached that duty.            For the Hitti class, the issue
    was Atlantic's $14 mileage fee for patients not transported to a
    hospital.5    For the Cullum class, the issue was the reasonableness
    of the fee charged by Atlantic for ALS-1 and ALS-2 services.
    Appellants reasoned that the time, energy and cost to pursue
    individual lawsuits against Atlantic would make it financially
    unfeasible for aggrieved class members to pursue their claims in
    the absence of class certification.
    4
    Atlantic did    not   dispute      the    numerosity   prong    for     class
    certification.
    5
    During this litigation, Atlantic conceded that it was improper
    to charge a $14 mileage fee for individuals who were not
    transported to a hospital.
    6                                  A-1622-16T2
    Atlantic countered that appellants' claims were not typical
    because proof of their claims would not prove the claims of the
    proposed class members.       Atlantic highlighted the dissimilar aid
    and assistance rendered to individuals who received ALS-1 services
    and ALS-2 services, and noted that neither Cullum nor Hitti
    received ALS-2 services.       Atlantic claimed the reasonableness of
    the fees charged for the services required individual adjudication
    on a patient-by-patient basis and, therefore, was not amenable to
    class certification.        Further, Atlantic contended that neither
    Cullum nor Hitti suffered damages under a breach of contract theory
    or CFA violation claim because: (1) appellants denied receiving
    any services from Atlantic, and (2) even if they conceded receipt
    of services, appellants did not pay Atlantic's bill to establish
    an ascertainable loss under the CFA.
    In deciding the motion, the judge found that appellants'
    claims were not common, not typical and not in alignment with the
    claims of proposed class members because appellants did not receive
    ALS-2 services and did not pay for Atlantic's services.             The judge
    ruled that appellants did not suffer an ascertainable loss under
    the CFA because Cullum and Hitti failed to pay Atlantic's bill.
    The   judge   expressly     rejected       appellants'   argument    that    an
    excessive     bill   from   Atlantic       was   sufficient   to    prove    an
    ascertainable loss.
    7                              A-1622-16T2
    On appeal, Cullum and Hitti argue the judge erred in denying
    class certification based upon his determination that they were
    unable to prove an ascertainable loss to sustain a CFA claim.           We
    conclude that the judge's denial of class certification on that
    basis was flawed because appellants were not required to have paid
    Atlantic's bill to demonstrate an ascertainable loss.
    The certainty implicit in the concept of an
    "ascertainable"    loss   is    that    it  is
    quantifiable or measurable. Moreover, it need
    not yet have been experienced as an out-of-
    pocket loss to the plaintiff.     An "estimate
    of damages, calculated within a reasonable
    degree   of   certainty"   will    suffice  to
    demonstrate an ascertainable loss.
    [Thiedemann v. Mercedes-Benz USA, LLC, 
    183 N.J. 234
    , 248-49 (2005) (quoting Cox v. Sears
    Roebuck & Co., 
    138 N.J. 2
    , 22-23 (1994)).]
    In the seminal CFA case, Cox v. Sears Roebuck & Company, the
    Supreme Court held that non-payment did not preclude the plaintiff
    from establishing an ascertainable loss.        Cox, 
    supra,
     
    138 N.J. at 22
     ("[T]o demonstrate a loss, a victim must simply supply an
    estimate of damages, calculated within a reasonable degree of
    certainty.   The victim is not required actually to spend the money
    for the repairs before becoming entitled to press a claim.").
    While   we   agree   with   denial   of   class   certification    on
    appellants' CFA claim, we do so for reasons other than those
    expressed by the motion judge.     We affirm or reverse judgments and
    8                            A-1622-16T2
    orders, not reasons.     Isko v. Planning Bd. of Twp. of Livingston,
    
    51 N.J. 162
    , 175 (1968); Walker v. Briarwood Condo Ass'n, 
    274 N.J. Super. 422
    , 426 (App. Div. 1994).        A correct result, even if
    grounded on an erroneous basis in fact or in law, will not be
    overturned on appeal.    See GNOC, Corp. v. Dir., Div. of Taxation,
    
    328 N.J. Super. 467
    , 474 (App. Div. 2000), aff'd, 
    167 N.J. 62
    (2001).
    While we disagree with the motion judge's rationale, we agree
    with Atlantic's alternative argument, that the CFA is inapplicable
    to ambulance service providers under the "learned professional"
    exception to the CFA.6
    The "learned professional" exception was first recognized by
    the Supreme Court in Macedo v. Dello Russo, 
    178 N.J. 340
     (2004).
    In Macedo, the Court noted that the CFA had not changed in the
    nearly forty years since its enactment.      
    Id. at 344
    .   The Court
    analyzed the cases involving professional services during that
    forty-year span, and concluded "our jurisprudence continues to
    identify learned professionals as beyond the reach of the [CFA]
    so long as they are operating in their professional capacities.
    The Legislature is presumed to be aware of that judicial view."
    6
    In light of this decision, we need not address the parties'
    disputes concerning satisfaction of the requirements for class
    certification on appellants' fraud claim.
    9                         A-1622-16T2
    
    Id. at 345-46
    .    The Macedo Court held that advertisements by
    learned professionals, specifically physicians:
    in respect of the rendering of professional
    services are insulated from the CFA but
    subject to comprehensive regulation by the
    relevant regulatory bodies and to any common-
    law remedies that otherwise may apply.     We
    consider ourselves bound by that Legislative
    acquiescence.   If we are incorrect in our
    assumption, we would expect the legislature
    to take action to amend the statute.
    [Id. at 346.]
    In the thirteen years since Macedo, the Legislature has not
    amended the CFA to include learned professionals.         Thus, our
    jurisprudence continues to exempt professionals from the CFA.    See
    Manahawkin Convalescent v. O'Neill, 
    426 N.J. Super. 143
    , 155-56
    (App. Div. 2012) (nursing homes insulated from CFA), aff'd, 
    217 N.J. 99
     (2014);7 Plemmons v. Blue Chip Ins. Servs., Inc., 
    387 N.J. Super. 551
    , 556 (App. Div. 2006) (insurance brokers, as semi-
    professionals, insulated from CFA); Hampton Hosp. v. Bresan, 
    288 N.J. Super. 372
    , 383 (App. Div.) (hospitals insulated from CFA),
    7
    The Supreme Court did not decide whether the nursing home's
    conduct was exempt from the CFA under the "learned professional"
    exception as the Court concluded the nursing home did not commit
    an "unlawful practice" under the CFA.       In dicta, the Court
    expressed "doubt" whether the "billing and collection function at
    issue in [the Manahawkin Convalescent] case would qualify for the
    learned professional exception." Manahawkin Convalescent, supra,
    217 N.J. at 124.     However, the Manahawkin Convalescent case
    addressed who was responsible for payment of the nursing home's
    bill, not the reasonableness of the billing rates.
    10                           A-1622-16T2
    certif. denied, 
    144 N.J. 588
     (1996); Vort v. Hollander, 
    257 N.J. Super. 56
    , 62 (App. Div.) (attorneys insulated from CFA), certif.
    denied, 
    130 N.J. 599
     (1992).    But see Suarez v. E. Int'l Coll.,
    
    428 N.J. Super. 10
    , 39 (App. Div. 2012) (educational and vocational
    training program governed by the CFA because the program was not
    overseen by any regulatory body and there were no regulations
    governing the school that would present "a patent and sharp"
    conflict with the CFA), certif. denied, 
    213 N.J. 57
     (2013).
    In Neveroski v. Blair, 
    141 N.J. Super. 365
     (App. Div. 1976),8
    we held that real estate brokers were not subject to the CFA
    because:
    A real estate broker is in a far different
    category from the purveyors of products or
    services or other activities. He is in a semi-
    professional status subject to testing,
    licensing, regulations and penalties through
    other legislative provisions.    Although not
    on the same plane as other professionals such
    as lawyers, physicians, dentists, accountants
    or engineers, the nature of his activity is
    recognized as something beyond the ordinary
    commercial seller of goods or services -- an
    activity beyond the pale of the act under
    consideration.
    Certainly no one would argue that a member of
    any of the learned professions is subject to
    the provisions of the Consumer Fraud Act
    8
    In 1976, the Legislature amended the CFA to include real estate,
    thereby abrogating the court's holding in Neveroski. See N.J.S.A.
    56:8-2. The Neveroski decision remains instructive as it supports
    the CFA's exclusion of learned professionals absent express
    legislative authority.
    11                          A-1622-16T2
    despite the fact that he renders "services"
    to the public.      And although the literal
    language   may   be    construed to   include
    professional services, it would be ludicrous
    to construe the legislation with that broad a
    sweep in view of the fact that the nature of
    the services does not fall into the category
    of consumerism.
    Similarly, in the absence of clear and
    explicit language in the statute, a broker who
    negotiates the sale of real estate and thereby
    renders "services" is nevertheless outside the
    scope of persons sought to be covered by the
    Act.
    [Id. at 379-80 (citations omitted).]
    We review the relevant statutory and regulatory provisions
    to    determine    whether     ambulance    service   providers      are   learned
    professionals exempt from consumer fraud claims.               By statute, the
    Department of Health (Department) is charged with overseeing the
    provision of health care services to the public, and ensuring that
    the services provided are "at a reasonable cost."              N.J.S.A. 26:2H-
    1.    The definition of health care services specifically includes
    ambulance    services.          N.J.S.A.     26:2H-2(b).       The    Department
    regulates ambulance service providers in accordance with N.J.S.A.
    26:2H-1 to -26 and N.J.S.A. 26:2K-7 to -20.
    Pursuant     to   its     statutory     authority,      the    Department
    promulgated regulations governing "Mobility Assistance Vehicle and
    Basic Life Support Ambulance Services," N.J.A.C. 8:40-1.1 to -7.4,
    and    "Advanced    Life     Support   Services;      Mobile   Intensive       Care
    12                                  A-1622-16T2
    Programs,      Specialty       Care    Transport       Services    and     Air   Medical
    Services," N.J.A.C. 8:41-1.1 to -12.5.                  These regulations "define
    the operational requirements" of non-volunteer mobility assistance
    vehicles, basic life support ambulance services, mobile intensive
    care programs and specialty care transport services in the State.
    N.J.A.C.       8:40-1.2;       N.J.A.C.         8:41-1.2.         The     Department's
    regulations      establish           stringent       licensure    requirements         for
    ambulance service providers.              N.J.A.C. 8:40-2.1 to -2.3; N.J.A.C.
    8:41-2.1 to -2.3.           Additionally, the Department has the right to
    take    enforcement         action    against     ambulance      service    providers.
    N.J.S.A. 26:2H-13; N.J.S.A. 26:2H-14; N.J.A.C. 8:40-7.2; N.J.A.C.
    8:41-12.3.
    Whether labeled "professionals" or "semi-professionals," we
    find that ambulance service providers are excluded from liability
    under    the    CFA    for     services        rendered     consistent     with     their
    professional license because they are regulated by the Department.
    The undisputed goal of the CFA is to protect consumers.                          Hampton
    Hosp.,   supra,       
    288 N.J. Super. at
       378   (citing     Martin    v.   Am.
    Appliance, 
    174 N.J. Super. 382
    , 384 (App. Div. 1980)).                      In Hampton
    Hospital, we noted that because hospitals are regulated by the
    Department, there was "no purpose to a requirement that hospital
    services be within the purview of the Consumer Fraud Act when
    those same services fall within the purview of the Department of
    13                                     A-1622-16T2
    Health."     
    Id. at 383
    .       Here, the Department adopted extensive
    regulations governing ambulance services, and is authorized to
    take measures against ambulance service providers for violation
    of its regulations, including revocation of licensure.         N.J.S.A.
    26:2H-13; N.J.S.A. 26:2H-14; N.J.A.C. 8:40-7.2; N.J.A.C. 8:41-
    12.3.
    Based upon the Department's rigorous regulation of ambulance
    services, the learned professional exception to the CFA precludes
    appellants' consumer fraud claim.        To hold otherwise would present
    a   situation     "with    a     real    possibility   of   conflicting
    determinations, rulings and regulations affecting the identical
    subject matter."    Daaleman v. Elizabethtown Gas Co., 
    77 N.J. 267
    ,
    272 (1978).     Since we determine that ambulance service providers
    are excepted from the CFA, denial of appellants' motion for class
    certification on the consumer fraud claim was the correct result.
    Our determination that the CFA is inapplicable to Atlantic
    does not completely dispose of this matter. Appellants also sought
    class certification on their breach of contract claim against
    Atlantic.     There are two distinct breach of contract claims in
    this case.      One claim on behalf of the Cullum class is that
    Atlantic charged unreasonable rates for ambulance services. 9         And
    9
    In opposition to class certification on this breach of contract
    claim, Atlantic argued it is necessary to bundle rates for
    14                           A-1622-16T2
    the other claim on behalf of the Hitti class is that Atlantic
    improperly charged a $14 mileage fee.
    With respect to the breach of contract claim on behalf of the
    Cullum class, we determine that denial of class certification was
    proper, but for reasons other than those articulated by the motion
    judge.
    The health care regulations and statutes enacted by the
    State's Legislative and Executive branches establish that adequate
    and affordable health care services are of utmost importance.     In
    passing the Health Care Facilities Planning Act, N.J.S.A. 26:2H-1
    to -26 (Act), the Legislature proclaimed a strong public policy
    to establish, promote and ensure adequate health care services in
    this State.   The Act explicitly declares that it is "the public
    policy of this State that . . . related health care services of
    the highest quality, of demonstrated need, efficiently provided
    and properly utilized at a reasonable cost are of vital concern
    to the public health."   N.J.S.A. 26:2H-1.
    ambulance services, to cover the cost of providing trained and
    licensed professionals, in fully equipped specialty vehicles, to
    respond to medical emergencies.    The uniform rates charged by
    Atlantic for ambulance services also contemplate charity care
    subsidies and other financial considerations required to render
    ambulance services to patients who lack health care coverage or
    cannot afford health care services. See N.J.A.C. 8:33-4.10.
    15                          A-1622-16T2
    The Act further requires the Department to establish a State
    Health Planning Board (SHPB).          N.J.S.A. 26:2H-5.7.    The SHPB
    reviews    applications   for    certificates   of   need    and     makes
    recommendations to the Department's Commissioner regarding the
    issuance of those certificates.10       N.J.S.A. 26:2H-5.8(b).       Under
    the Act, "no new health care service shall be instituted . . .
    except on application for and receipt of a certificate of need
    . . . ."   N.J.S.A. 26:2H-7.11   To obtain a certificate of need, the
    Act provides:
    No certificate of need shall be issued unless
    the action proposed in the application for
    such certificate is necessary to provide
    required health care in the area to be served,
    can   be    economically   accomplished    and
    maintained, will not have an adverse economic
    or financial impact on the delivery of health
    care services in the region or Statewide, and
    will contribute to the orderly development of
    adequate and effective health care services.
    [N.J.S.A. 26:2H-8.]
    10
    "'Certificate of need' means the formal written approval of the
    New Jersey Department of Health and Human Services to construct
    or expand a health care facility or to institute a new health care
    service, in accordance with the requirements set forth at N.J.A.C.
    8:33." N.J.A.C. 8:41-1.3.
    11
    As used in this section of the Act, the term "health care
    service" includes "any service which is the subject of a health
    planning regulation adopted by the Department . . . ." N.J.S.A.
    26:2H-7.
    16                               A-1622-16T2
    The Department issued a certificate of need to Atlantic to
    provide ambulance services.         Prior to issuing a certificate of
    need, the Department and SHPB were required to consider whether
    the Atlantic's services could "be financially accomplished and
    licensed in accordance with applicable licensure regulations,"
    would "not have an adverse impact on access to health care services
    in the region or State-wide," and would "contribute to the orderly
    development   of   adequate   and   effective   health   care   services."
    N.J.A.C. 8:33-4.9. If Atlantic did not meet the statutory and
    regulatory requirements for issuance of a certificate of need, the
    Department would have denied the application.
    From our review of the statutes and regulations governing
    health care in this State, we discern an unequivocal legislative
    policy to ensure adequate and effective health care services for
    all residents.     The regulations governing certificates of need
    take into consideration many factors including, specifically,
    financial impacts and concerns.          N.J.A.C. 8:33-4.9 and -4.10.
    Applicants seeking a certificate of need for health care services
    are required to provide services to persons who are financially
    "unable to obtain care."      N.J.A.C. 8:33-4.10.12
    12
    Atlantic accepts discounted payment for ambulance services
    depending upon the situation. For example, Atlantic reduces its
    fee by as much as forty percent for services provided to uninsured
    patients.    Atlantic also has arrangements with third-party
    17                             A-1622-16T2
    Keeping in mind New Jersey's strong policies governing health
    care services, we consider the breach of contract claim on behalf
    of the Cullum class.    Health care costs are a significant issue
    in the United States.   Providing affordable health care services
    is a policy issue to be addressed by the Legislature and the
    Executive Branch agencies to which it has delegated the authority
    to carry out its policies.   See DiCarlo v. St. Mary's Hosp., 
    530 F.3d 255
    , 259 (3d Cir. 2008).13
    We find persuasive the decision of the Third Circuit Court
    of Appeals, which affirmed a trial court decision dismissing
    billing claims against a hospital:
    In the District Court, DiCarlo's primary
    argument was that the practice of charging
    uninsured patients significantly higher rates
    than insured patients and patients covered
    under Medicare, Medicaid, or the New Jersey
    Charity Care Program, for the same services
    and supplies, is wrongful and discriminatory.
    The District Court granted the defendants'
    motion for judgment on the pleadings and
    dismissed DiCarlo's complaint with prejudice.
    insurance companies to accept less than the billed amount for its
    ambulance services.
    13
    Appellants contend that Atlantic is precluded from arguing
    courts cannot determine reasonable rates for health care services
    because no cross-appeal was filed. We disagree.         Rule 2:3-4
    requires the filing of a cross-appeal where "respondent seeks to
    expand the substantive relief granted in the order, and not just
    provide further support for sustaining the order."       Pressler &
    Verniero, Current N.J. Court Rules, comment 2 on R. 2:3-4 (2017).
    See State v. Eldakroury, 
    439 N.J. Super. 304
    , 307 n. 2 (App. Div.),
    certif. denied, 
    222 N.J. 16
     (2015).
    18                        A-1622-16T2
    The District Court discussed the policy
    concerns about the rising cost of healthcare
    at length and found that the courts are ill-
    equipped to determine what reasonable hospital
    costs are, or to make a policy determination
    on behalf of the legislative branch.
    [DiCarlo v. St. Mary's Hosp., supra, 
    530 F.3d at 259
    .]
    Thus, we agree that denial of class certification for the
    breach of contract claim on behalf of the Cullum class, challenging
    the reasonableness of fees charged by Atlantic, was proper.
    We next review denial of class certification for the breach
    of contract claim on behalf of the Hitti class.             Individuals
    requiring ambulance services do not "contract" with Atlantic.          Nor
    can they negotiate with Atlantic regarding its services.               The
    relationship between Atlantic and its patients is based upon
    implied contract or quasi-contract.        See Wanaque Bor. Sewerage
    Auth. v. Twp. of West Milford, 
    144 N.J. 564
    , 574 (1996) (contracts
    implied-in-fact   for   services   are   inferred   from   the   parties'
    conduct or from the surrounding circumstances).
    Turning to the quasi-contract claim, patients not brought to
    a hospital, identified as the Hitti class, were charged for one
    mile of travel.     Atlantic now admits that patients in the Hitti
    class were not transported to a hospital and, therefore, the $14
    fee was improper.    However, Atlantic did not refund or credit the
    $14 amount to those individuals.         Consideration of the refund
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    issue for the Hitti class would not violate the policy concerns
    associated with the Cullum class because it is limited to a charge
    Atlantic    admits   was   billed   in     error   and   does   not   implicate
    Atlantic's rate-setting decisions for ambulance services.
    Because the judge did not consider whether the Hitti class
    could pursue class certification to recoup Atlantic's improperly
    charged $14 mileage fee under a breach of quasi-contract theory,
    we remand that issue to the trial court.                    The judge should
    determine    whether   the   breach   of    quasi-contract      claim   against
    Atlantic, limited to recovery of the $14 mileage fee, is suitable
    for class certification.
    In sum, we affirm denial of class certification on appellants'
    Consumer    Fraud    Act   claim.     We   also    affirm   denial    of     class
    certification on the breach of contract claim as to the Cullum
    class.     We remand the matter to the trial court to review class
    certification on the breach of quasi-contract claim as to the
    Hitti class.
    Affirmed in part and remanded in part.                 We do not retain
    jurisdiction.
    20                                   A-1622-16T2