Academy of Medicine v. Aetna Health, Inc.

108 Ohio St. 3d 185
CourtOhio Supreme Court
DecidedMarch 1, 2006
DocketNo. 2004-0001
StatusPublished
Cited by90 cases

This text of 108 Ohio St. 3d 185 (Academy of Medicine v. Aetna Health, Inc.) is published on Counsel Stack Legal Research, covering Ohio Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Academy of Medicine v. Aetna Health, Inc., 108 Ohio St. 3d 185 (Ohio 2006).

Opinions

Pfeifer, J.

Factual and Procedural Background

{¶ 1} Plaintiffs-appellees, Academy of Medicine of Cincinnati, Butler County Medical Society, Luis Pagani, M.D., Paul Jennewine, M.D., Bradford H. Woodall, M.D., William Randall Cox, M.D., and Newton H. Bullard, M.D., allege that defendant-appellant, United Healthcare of Ohio (“United”), one of the largest providers of group health-insurance policies in Hamilton, Warren, Clermont, and Butler Counties, engaged in a conspiracy with other such providers to maintain artificially low reimbursement rates paid to physicians in the region in violation of the antitrust provisions of the Valentine Act, R.C. Chapter 1331.

{¶ 2} In response to appellees’ complaint filed in Hamilton County Common Pleas Court, appellant moved to stay the trial court proceedings and compel arbitration of the antitrust claims. The motion was based on the arbitration clause in the physician-appellees’ provider agreements with appellant. The clause requires binding arbitration of disputes “about [the parties’] business relationship.”

{¶ 3} The trial court denied the motion to stay and to compel arbitration, reasoning that since the plaintiffs alleged a conspiracy of price fixing by the defendant and other providers, that dispute “[did] not arise out of or relate to the contracts between the Plaintiffs and Defendant^, nor [did] it involve disputes about the parties’ business relationships.” The court found that “[t]he parties never agreed to arbitrate claims that were independent of any breach of contract.”

[186]*186{¶ 4} The court of appeals affirmed the trial court, finding that the appellees’ antitrust claims were not within the scope of the arbitration provisions in the provider agreements. Relying on this court’s decision in Council of Smaller Enterprises v. Gates, McDonald & Co. (1998), 80 Ohio St.3d 661, 687 N.E.2d 1352, the appellate court set forth the test for determining the arbitrability of a given dispute:

{¶ 5} “ ‘[T]he Ohio Supreme Court has adopted four rules, common to both state and federal courts, for reviewing decisions concerning a dispute’s “arbitrability”: (1) that “arbitration is a matter of contract and a party cannot be required to so submit to arbitration any dispute which he has not agreed to so submit”; (2) that the question whether a particular claim is arbitrable is one of law for the court to decide; (3) that when deciding whether the parties have agreed to submit a particular claim to arbitration, a court may not rule on the potential merits of the underlying claim; and (4) that when a “contract contains an arbitration provision, there is a presumption of arbitrability in the sense that ‘[a]n order to arbitrate the particular grievance should not be denied unless it may be said with positive assurance that the arbitration clause is not susceptible of an interpretation that covers the asserted dispute.’ ” ’ ” 155 Ohio App.3d 310, 2003-Ohio-6194, 800 N.E.2d 1185, ¶ 12, quoting Cohen v. PaineWebber, Inc., Hamilton App. No. C-010312, 2002 WL 63578, quoting Council of Smaller Enterprises, 80 Ohio St.3d at 665-666, 687 N.E.2d 1352, quoting AT & T Technologies, Inc. v. Communications Workers of Am. (1986), 475 U.S. 643, 650, 106 S.Ct. 1415, 89 L.Ed.2d 648.

{¶ 6} This case revolves around the application of the first rule enunciated in Council of Smaller Enterprises, i.e., whether the parties agreed to submit the dispute at issue to arbitration. In determining whether a claim based upon an alleged conspiracy to set artificially low reimbursement rates was within the scope of the arbitration agreements between the parties in this case, the appellate court relied upon a federal case, Fazio v. Lehman Bros., Inc. (C.A.6, 2003), 340 F.3d 386. In Fazio, the Sixth Circuit Court of Appeals held that “a proper method of analysis * * * is to ask if an action could be maintained without reference to the contract or relationship at issue. If it could, it is likely outside the scope of the arbitration agreement.” Id. at 395, citing Ford v. NYLCare Health Plans of Gulf Coast, Inc. (C.A.5, 1998), 141 F.3d 243, 250-251.

{¶ 7} Applying Fazio, the appellate court concluded that “the doctors’ antitrust claim could be maintained without reference to their individual provider agreements.” 155 Ohio App.3d 310, 2003-Ohio-6194, 800 N.E.2d 1185, ¶ 5. The court found that “[t]he allegations that the HMOs, which controlled a majority of the health-care market in this region, colluded to fix reimbursement rates to medical practitioners arose out of actions that occurred prior to the existence of the [187]*187underlying provider agreements or business relationships between the doctors and HMOs. The allegations did not even presume the existence of an underlying provider agreement.” Id. at ¶ 6.

{¶ 8} Since the court found that the doctors’ cause of action could be maintained without reference to the individual provider agreements, it held that the antitrust claims were not subject to the arbitration provision in the provider agreements.

{¶ 9} Appellant appealed. This court granted appellant’s jurisdictional motion on a limited basis, ordering briefing only on the following issue: “In determining whether a cause of action is within the scope of an arbitration agreement, may a state court in Ohio base that determination on a federal standard that inquires whether the ‘action could be maintained without reference to the contract or relationship at issue?’ Fazio v. Lehman Bros., Inc. (C.A.6, 2003), 340 F.3d 386, 395, citing Ford v. NYLCare Health Plans of Gulf Coast, Inc. (C.A.5, 1998), 141 F.3d 243, 250-251.” 102 Ohio St.3d 1407, 2004-Ohio-1860, 806 N.E.2d 559.

Law and Analysis

{¶ 10} “Ohio and federal courts encourage arbitration to settle disputes,” ABM Farms, Inc. v. Woods (1998), 81 Ohio St.3d 498, 500, 692 N.E.2d 574, and Ohio has generally relied at least in part on federal law in developing its own jurisprudence. This court enunciated the four principles that guide determinations of arbitrability in Council of Smaller Enterprises v. Gates, McDonald & Co., 80 Ohio St.3d 661, 687 N.E.2d 1352, relying heavily on AT & T Technologies, 475 U.S. 643, 106 S.Ct. 1415, 89 L.Ed.2d 648. This court held:

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Youngstown Professional Firefighters v. Youngstown
2024 Ohio 940 (Ohio Court of Appeals, 2024)
Estate of Myers v. Healthcare Ventures of Ohio, L.L.C.
2023 Ohio 4254 (Ohio Court of Appeals, 2023)
Peskett v. Designer Brands CA2/6
California Court of Appeal, 2023
Newton v. U.S. Bancorp Invest., Inc.
2023 Ohio 1450 (Ohio Court of Appeals, 2023)
Duff v. Christopher
2023 Ohio 349 (Ohio Court of Appeals, 2023)
Franklin Dissolution L.P. v. Athenian Fund Mgt. Inc.
2022 Ohio 623 (Ohio Court of Appeals, 2022)
BST Ohio Corp. v. Wolgang (Slip Opinion)
2021 Ohio 1785 (Ohio Supreme Court, 2021)
Sebold v. Latina Design Build Group, L.L.C.
2021 Ohio 124 (Ohio Court of Appeals, 2021)
Fetzer v. Miley
2019 Ohio 4578 (Ohio Court of Appeals, 2019)
Avery v. Academy Invests.
2019 Ohio 3509 (Ohio Court of Appeals, 2019)
Fries v. Greg G. Wright & Sons, L.L.C.
2018 Ohio 3785 (Ohio Court of Appeals, 2018)
Katz v. Katz
2018 Ohio 3210 (Ohio Court of Appeals, 2018)
Knight v. Altercare Post-Acute Rehab. Ctr., Inc.
2017 Ohio 6946 (Ohio Court of Appeals, 2017)
Woodville Ent., L.L.C. v. Kokosing Materials, Inc.
2017 Ohio 5844 (Ohio Court of Appeals, 2017)
Wisniewshi v. Marek Builders, Inc.
2017 Ohio 1035 (Ohio Court of Appeals, 2017)

Cite This Page — Counsel Stack

Bluebook (online)
108 Ohio St. 3d 185, Counsel Stack Legal Research, https://law.counselstack.com/opinion/academy-of-medicine-v-aetna-health-inc-ohio-2006.