Antitrust Law Daily Wrap Up, ANTITRUST—S.D. Fla.: Settlement agreement released health insurance companies from antitrust claims, (Aug 21, 2013)

By Jody Coultas, J.D.

Corey Musselman was denied a declaration that federal antitrust claims filed by a chiropractor against health care companies were not released claims under a settlement agreement between health care providers and the companies by the federal district court in Miami (Musselman v. Blue Cross and Blue Shield of Alabama, August 20, 2013, Moreno, F.).

Thomas v. Blue Cross and Blue Shield Ass'n was a class action brought on behalf of all providers who submitted claims to health care companies for the provision of medical services. The providers alleged that health care companies engaged in a common scheme to systematically deny, delay, and diminish payments to the providers. In exchange for a settlement, Blue Cross and the other companies received broad releases from the providers in this action and injunctions from the court barring releasing parties from bringing Released Claims.

Years after the settlement, an Alabama chiropractor filed Conway v. Blue Cross and Blue Shield of Alabama, et al. alleging that the health care companies violated federal antitrust law by conspiring with each other and with other Blue Cross and Blue Shield plans to reduce competition, inflate insurance premiums, and undercompensate physicians for their services. Musselman sought a declaration that the antitrust claims asserted in Conway were not Released Claims under a settlement agreements approved by the court in Thomas.

The language of the order approving the settlement clearly prohibited class members from initiating lawsuits against the released parties for any claims released by the settlement. Thus, the court looked at whether the Conway complaint shared the same operative nucleus of fact' as the Thomas complaint. A claim is a released claim if it was asserted by reason of, arose out of, or related to any of the facts or other matters referenced in the Thomas action or to the business practices that are the subject of the settlement agreements and arose on or before the effective date.

Because the Conway claims arose out of the same operative facts as the Thomas claims, the court denied Musselman’s declaration that the Conway claims were released claims. Conway and Thomas were based on allegations that the health care companies, acting through Blue Cross and Blue Shield of Alabama conspired to reduce provider reimbursement. The claims were also released because they involved the amount providers were paid for services provided to Blue Cross members. A claim is a released claim if it involves any aspect of any fee for service claim.

Musselman’s claims arose before the effective date of the settlement agreement, according to the court. The release only applied to claims that arose on or before the effective date' of the settlement agreements. Musselman argued that the Conway claims only pertained to anticompetitive conduct that occurred after the effective dates. However, Conway was based on an alleged conspiracy dating back long before the effective dates. Because the Conway plaintiffs could have asserted their claims before Thomas was settled, the claims were released.

The case is No. 13-20050-CV-MORENO.

Attorneys: Edith M. Kallas (Whatley Drake & Kallas LLC) for Corey Musselman. Carlos Francisco Concepcion (Concepcion Martinez & Bellido) for Blue Cross and Blue Shield of Alabama.

Companies: Blue Cross and Blue Shield of Alabama

Cases: Antitrust FloridaNews