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

Supreme Court of Louisiana·Decided September 6, 2024·No. 2023-CC-01291·Published

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.

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

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 the agreement was a contract for ABC to provide lobbying services on behalf of Access Health and that ABC and Mr. Calvi met the requirements of being executive branch lobbyists under Louisiana law. In addition to arguing that the agreement was not a lobbying contract and that it and Mr. Calvi were not lobbyists, ABC argued Access Health was not entitled to summary judgment as a matter of law because the district court lacked subject matter jurisdiction to declare the agreement void pursuant to La. R.S. 49:78.1.

A hearing was held on ABC’s exceptions of lack of subject matter jurisdiction and prescription, and Access Health’s motion for summary judgment. At the

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

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.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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