Advanced Benefit Concepts, Inc. v. Blue Cross and Blue Shield of Alabama, Access Health, Inc. & Preferred Care Services, Inc.

CourtSupreme Court of Louisiana
DecidedSeptember 6, 2024
Docket2023-CC-01291
StatusPublished

This text of Advanced Benefit Concepts, Inc. v. Blue Cross and Blue Shield of Alabama, Access Health, Inc. & Preferred Care Services, Inc. (Advanced Benefit Concepts, Inc. v. Blue Cross and Blue Shield of Alabama, Access Health, Inc. & Preferred Care Services, Inc.) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Advanced Benefit Concepts, Inc. v. Blue Cross and Blue Shield of Alabama, Access Health, Inc. & Preferred Care Services, Inc., (La. 2024).

Opinion

FOR IMMEDIATE NEWS RELEASE NEWS RELEASE #041

FROM: CLERK OF SUPREME COURT OF LOUISIANA

The Opinions handed down on the 6th day of September, 2024 are as follows:

BY Hughes, J.:

2023-CC-01291 ADVANCED BENEFIT CONCEPTS, INC. VS. BLUE CROSS AND BLUE SHIELD OF ALABAMA, ACCESS HEALTH, INC. & PREFERRED CARE SERVICES, INC. (Parish of East Baton Rouge)

REVERSED AND REMANDED. SEE OPINION.

Weimer, C.J., dissents and assigns reasons. Knoll, J., additionally concurs and assigns reasons. SUPREME COURT OF LOUISIANA

No. 2023-CC-01291

ADVANCED BENEFIT CONCEPTS, INC.

VS.

BLUE CROSS AND BLUE SHIELD OF ALABAMA, ACCESS HEALTH, INC. & PREFERRED CARE SERVICES, INC.

On Writ of Certiorari to the Court of Appeal, First Circuit, Parish of East Baton Rouge

HUGHES, J.1

This case arises out of a petition for breach of contract filed by

Plaintiff/Respondent, Advanced Benefits Concepts, Inc. (“ABC”) in district court,

against Defendants/Applicants, Access Health, Inc., Preferred Care Services, Inc.,

and Blue Cross and Blue Shield of Alabama (collectively “Access Health”). 2 In

response, Access Health alleged, as a basis for its claim in its reconventional

demand, its motion for summary judgment, and as an affirmative defense, that the

contract was null and void because ABC violated the Louisiana Code of Ethics when

it failed to register itself, its principal, and the agreement as required by the

Executive Branch Lobbying Act (“the Act”) (La. R.S. 49:71-78.1), particularly La.

R.S. 49:78.1. We granted writs to determine this res novo issue of whether the Board

of Ethics (“the Board”) has exclusive jurisdiction to determine whether the

agreement is void under La. R.S. 49:78.1, as held by the appellate court, or whether

the district court has jurisdiction to determine the issue as urged by Access Health.

For the reasons discussed below, we conclude the district court has subject matter

1 Retired Justice Jeannette T. Knoll, appointed Justice pro tempore, sitting for the vacancy in the Third District. 2 Access Health, Blue Cross and Blue Shield of Alabama, and Preferred Care Services, Inc. operated as a single business enterprise. jurisdiction to consider Access Health’s affirmative defenses and reconventional

demand. As a result, the appellate court’s decision is reversed and this matter is

remanded to the appellate court to consider the exception of prescription and the

motion for summary judgment on the merits.

FACTUAL AND PROCEDURAL HISTORY

ABC entered into an agreement with Access Health. ABC helped Access

Health identify, establish, and enter into relationships with employer groups, which

Access Health could contract with to provide healthcare benefits.3 Among the

groups identified by ABC was the State of Louisiana’s Office of Group Benefits

(“OGB”). The contract between Access Health and OGB provided that Access

Health would provide a primary healthcare network and services to OGB plan

participants. The agreement between ABC and Access Health provided for Access

Health to pay ABC a fee of $1.25 per month for each employee covered under the

OGB contract. 4

In December of 2020, OGB sent Access Health a demand letter claiming

Access Health owed it money for failure to meet the return on investment

benchmarks mandated in the OGB contract. In February of 2021, OGB began

withholding payments to Access Health. Later that year, OGB and Access Health

reached a settlement and amended the OGB contract.

Beginning in December of 2020, Access Health stopped paying ABC’s

monthly fee under the agreement. ABC claims it is owed $6,930,000. ABC filed a

petition for damages asserting breach of contract against Access Health.

Access Health answered ABC’s lawsuit with a general denial and asserted a

3 The agreement provided in part: “Whereas, ABC has and may continue to provide efforts and expend resources for the purpose of assisting [Access Health] in identifying and establishing business relationships with various [Employer groups].” 4 The term of the OGB contract was from July 1, 2019 to June 30, 2022, with two one-year options to extend the term to June 30, 2024. 2 reconventional demand followed by a supplemental and amended reconventional

demand. Pertinent to this case, Access Health asserted as separate affirmative

defenses in its answer that the agreement was “an absolute nullity and void ab initio”

and that “the Fee Agreement is void.” In the first supplemental and amended answer

and reconventional demand, it asserted as separate affirmative defenses that the

agreement was “an absolute nullity and void ab initio” and that “the Fee Agreement

(and any alleged preexisting oral agreement) is void . . . pursuant to [La. R.S.]

49:78.1.”

In Count I of its reconventional demand, Access Health alleged “ABC

represented [Access Health] as a lobbyist[,]” and “[d]uring its representation of

[Access Health], ABC, through its principal, Charles Calvi, directly communicated

with the chief executive officer of the OGB . . . for the purpose of influencing the

OGB to award the OGB Agreement to [Access Health].” Access Health asserted

that OGB was an executive branch agency of the state, and, as such, ABC and Mr.

Calvi were required to register as lobbyists in the State of Louisiana pursuant to La.

R.S. 49:78.1. Access Health alleged that because neither ABC nor Mr. Calvi were

registered as lobbyists with the State of Louisiana when they entered into the

agreement, ABC and Mr. Calvi engaged in a misrepresentation that rendered the

agreement void pursuant to La. R.S. 49:78.1. Access Health asserted that because

the agreement was void, ABC was not entitled to any of the payments established by

the agreement, and ABC was unjustly enriched. Access Health prayed for a

judgment declaring the agreement void and awarding as damages payments that

Access Health had tendered to ABC under the agreement.

In response to the reconventional demand, ABC filed a declinatory exception

of lack of subject matter jurisdiction, arguing that the district court did not have

jurisdiction over enforcement provisions of the Code of Ethics. Rather, the

legislature had provided the enforcement provisions of the Act to be within the

3 exclusive purview of the Board, absent a challenge to the constitutionality of a

provision of the Code of Ethics. As a result, the district court lacked subject matter

jurisdiction to hear Access Health’s reconventional demand claim, and the claim

should be dismissed with prejudice. In the alternative, ABC argued that the time for

the Board to take action to void the contract had prescribed. See La. R.S. 49:78(A)

and (B).

Access Health moved for summary judgment seeking dismissal of ABC’s

cause of action for breach of contract on the ground that the agreement was an

“absolute nullity and void ab initio due to [ABC’s] failure to register that contract

with the State or . . . to register as a lobbyist.” Access Health requested the district

court take judicial notice that ABC and Mr. Calvi were not registered as lobbyists

via a “lobbying portal” located at HTTSP://ethics.la.gov/LobbyistData.5 Access

Health also argued it was entitled to summary judgment for unjust enrichment to

recover the amounts paid to ABC pursuant to the null agreement.

ABC filed an opposition to the motion for summary judgment, disputing that

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Advanced Benefit Concepts, Inc. v. Blue Cross and Blue Shield of Alabama, Access Health, Inc. & Preferred Care Services, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/advanced-benefit-concepts-inc-v-blue-cross-and-blue-shield-of-alabama-la-2024.