Health Law Daily Wrap Up, ANTITRUST—M.D. Fla.: Health First monopolization case will not proceed as class-action, (Apr 6, 2026)

By: David Yucht, J.D.

Plaintiffs might not adequately protect the interests of the entire class because interests of insurers and insureds- both of whom were members of the class -might be antagonistic.

The federal district court in Orlando, Florida declined to certify a proposed class in an antitrust action brought against the owner of several Brevard County Florida hospitals. Two Florida residents alleged that Health First Inc. maintained an illegal monopoly in the market for acute care. The court determined that the residents lacked standing to assert claims pertaining to inpatient treatment because insurance paid the residents’ claims and, thus, did not owe any money for inpatient care. Additionally, the residents failed to demonstrate typicality and adequacy, both needed for class action certification (Powers v. Health First Inc., No. 6:23-cv-00375-JSS-RMN (M.D. Fla. Mar. 27, 2026)).

Background. Two Florida residents, whose family members were treated at Health First affiliated hospitals sued Health First alleging the organization maintained a monopoly in the market for acute care in Brevard County, Florida. The plaintiffs asserted Health First’s expansive Brevard County market share and vertically integrated business model enabled it to illegally control physician referrals, obtain preferential vertical agreements with competing providers, deter competitors from entering the market; and carve up the market with one of its competitors. The plaintiffs alleged market harm in the form of uncompetitive prices for consumers. Based upon these allegations, plaintiffs asserted antitrust causes of action under both state and federal law.

Specifically, the four counts in the first amended complaint consisted of: unlawful monopolization; horizontal market division in restraint of trade; exclusive dealing, and violation of the Florida Antitrust Act. In September 2024, the court denied Health First, Inc.’s motion to dismiss. It found that the complaint sufficiently explained why urgent care and similar facilities are not interchangeable with emergency rooms.

Class certification. The plaintiffs moved for class certification of a class of persons insured by health plans and their health plans which purchased inpatient and emergency room hospital care from Health First’s acute care hospitals since March 1, 2019.

The court denied class certification, finding plaintiffs lacked standing to sue regarding inpatient treatment claims. Additionally, they failed to demonstrate typicality and adequacy, which is needed for class actions under Federal Rules of Civil Procedure 23(a) and 23(b)(2) as well as predominance, superiority and manageability which is required for class actions under Rule 23(b)(3).

Plaintiff does not have standing. The court found one of the plaintiffs lacked standing pertaining to inpatient treatment. Class certification requires representatives to have standing to pursue claims for which class wide relief is sought. Standing means a plaintiff suffered a real injury traceable to a defendant’s challenged conduct which is “likely to be redressed by a favorable judicial decision.” Further, to represent a class, a party must “be part of the class and possess the same interest and suffer the same injury as the class members.” Plaintiff conceded that her insurance plan paid her claim and that, consequently, she owed no money towards inpatient care. Accordingly, she suffered no injury requiring redress, and thus, no standing to proceed as to inpatient care claims.

Rule 23(a) factors. Federal Rule of Civil Procedure 23(a) requires a plaintiff seeking class certification to show the potential class is too numerous for traditional procedures to be workable; there are common questions of law or fact; that the representative plaintiffs’ claims are typical of the class claims; and that the proposed representative “will fairly and adequately protect the interests of the class.” Although plaintiffs satisfied the numerousness and commonality requirements, the court found they had not shown typicality because the court had concluded that the representative plaintiffs did not have standing to raise claims as to inpatient services. Moreover, the court was not satisfied that the named plaintiffs would adequately protect the interest of the class. Plaintiffs’ argument that they had no conflict in representing the class was based on generalizations which did not calm the court’s fear that the interests of insurers and insureds -both of whom were members of the proposed class-could become antagonistic.

Rule 23(b)(2) certification. A Rule 23(b)(2) class is permitted when “the party opposing the class has acted or refused to act on grounds that apply generally to the class, so that final injunctive relief or corresponding declaratory relief is appropriate respecting the class as a whole.” Problematically, the plaintiffs here were not seeking a proper injunction, as they sought an injunction to require defendant to obey the law and not engage in anticompetitive conduct. Additionally, claims for monetary relief may not be certified under this rule.

Rule 23(b)(3) class certification. A Rule 23(b)(3) class is permitted if “the court finds that the questions of law or fact common to class members predominate over any questions affecting only individual members, and that a class action is superior to other available methods for fairly and efficiently adjudicating the controversy.” Here, some of the proposed class members, like Powers, suffered no injury and thus lacked standing. The court was concerned that reviewing thousands of claims to determine which class members suffered an injury sufficient to confer standing would require individualized analyses that would prevent finding predominance.

Rule 23(b)(3)’s superiority provision requires a determination that a class action is superior to other available methods for proper adjudication. The court found individualized issues in this case predominated as scrutinizing records to determine who has standing “would involve a lengthy and particularized inquiry…for countless individual plaintiffs.” Therefore, class action was not superior to other methods for managing this litigation.

The Case is No. 6:23-cv-00375-JSS-RMN.

Judge: Sneed, J.

Attorneys: Robert Stephen Berry (Berry Law PLLC) for Laura Powers. Elizabeth B. Honkonen (Sperling Kenny Nachwalter, LLC) for Health First, Inc.

Companies: Health First, Inc.

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