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

CourtLouisiana Court of Appeal
DecidedAugust 8, 2023
Docket2022CA1193
StatusUnknown

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 Louisiana Court of Appeal 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. Ct. App. 2023).

Opinion

STATE OF LOUISIANA

COURT OF APPEAL

FIRST CIRCUIT

2022 CA 1193 2022 CW 1270

ADVANCED BENEFIT CONCEPTS, INC.

VERSUS

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

DATE OF JUDGMENT: AUG 0 8 2023

ON REVIEW FROM THE NINETEENTH JUDICIAL DISTRICT COURT PARISH OF EAST BATON ROUGE, STATE OF LOUISIANA NUMBER 709719, SECTION 27

HONORABLE TRUDY WHITE, JUDGE

Alesia M. Ardoin Counsel for Plaintiff A - ppellant R. Gray Sexton Advanced Benefits Concepts, Inc. Baton Rouge, Louisiana

Timothy Stephen Babcock Baton Rouge, Louisiana

Tedrick K. Knightshead Baton Rouge, Louisiana

Renee C. C3ra.sto Counsel for Defendants -Appellees J. E. Cullens, Jr. Blue Cross and Blue Shield of Andree M. Cullens Alabama, Access Health, Inc., and S. Layne Lee Preferred Care Services, Inc. Baton Rouge, Louisiana

Carl S. Burkhalter Matthew J. Bowness Harold William Bloom Birrningharn, .Alabama

BEFORE: THERIOT, CRUTZ, AND RESTER, JJ.

Disposition: MAY 20, 2022 JUDGMENTS REVERSED. WRIT GRANTED AND October 24, 2022 JUDGMENT REVERSED. REMANDED. CHUTZ, J.

Plaintiff-appellant, Advanced Benefits Concepts, Inc. ( ABC), appeals the

district court' s judgment, granting a motion for summary judgment asserted by

defendants -appellees, Access Health, Inc., Preferred Care Services, Inc., and Blue

Cross and Blue Shield of Alabama ( collectively Access Health), 1 and dismissing

ABC' s cause of action for breach of a lobbying contract based on a finding that the

contract was a nullity. ABC also challenges, by writ and appeal, the district court' s

interlocutory judgments, overruling declinatory exceptions asserting objections of

lack of subject matter jurisdiction. We reverse the interlocutory judgments and the

grant of summary judgment and remand.

FACTUAL AND PROCEDURAL BACKGROUND

On ruly 16, 2021, ABC initiated this litigation in district court, seeking to

enforce a fee agreement it had entered into with Access Health, a written version of

which the parties executed on June 1, 2019. According to the allegations of the

petition, in the written fee agreement ABC agreed to " represent Access Health and

help Access Health identify, establish, and enter business relationships and

contracts with various [ employer groups]," and Access Health agreed " to pay

ABC] $ 1, 25 per month per employee covered under Access Health' s contract with

employer groups] that [ ABC] helped establish." The agreement expressly stated

that it " shall be evergreen and remain in full force until the termination of all

employer groups contracts]." Thus, ABC averred that Access Health " agreed to

pay [ ABC] the fees until the termination of the contract between Access Health

and the [ employer group] [ ABC] helped establish."

1 In its petition, ABC alleged, and Access Health, Preferred Care Services, Inc., and Blue Cross and Blue Shield of Alabama admitted in their respective answers, that Preferred Care Services, Inc. owns approximately 80% of Access Health' s stock and that Blue Cross and Blue Shield of Alabama owns 100% of Preferred Care Services, Inc. For ease of reference where the three defendants acted in unity, we refer to them collectively as Access Health. 2 ABC further alleged that it helped Access Health establish and enter into a

business relationship and contract with the State of Louisiana, Office of Group

Benefits ( OGB), through which Access Health agreed to provide the primary

health care network and services to the OGB plan participants for a monthly

capitation payment as evidenced by a contract between Access Health and OGB

executed on May 9, 2019 ( the OGB contract). Based on an application of the ABC

and Access Health fee agreement, for its role in securing the OGB contract, ABC

calculated Access Health owed a total fee of $6, 930,000.00.2 Access Health

initially tendered payments to ABC, but discontinued those payments on December

1, 2020. ABC claimed entitlement to the remainder of the fees owed it under the

fee agreement as well as the expenses it incurred.

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

reconventional demand,' which sought an award for ABC' s alleged unjust

enrichment of fees Access Health paid that it averred were not owed to ABC under

the written terms of the June 1, 2019 fee agreement because ABC had breached the

contract,' On February 4, 2022, Access Health filed a supplemental and amended

pleading, modifying its allegations in support of its reconventional demand.

Recognizing that ABC was the lobbyist who represented Access Health in the

establishment of a business relationship and contract with OGB and claiming that

neither ABC nor its principal, Charles Calvi, were registered as lobbyists with the

State of Louisiana, Access Health asserted that ABC and Calvi engaged in a

2 The term of the OGB contract for which ABC alleged its fee was due began on July 1, 2019 and continued through June 30, 2022, with two one- year options for extensions through June 30, 2024. Based on the monthly fee of $144, 375. 00 that ABC averred it was owed, the total fee ABC claimed is for a period of 49 months.

3 Preferred Care Services, Inc. and Blue Cross and Blue Shield of Alabama filed individual answers, generally denying ABC' s claims, but did not file individual reconventional demands.

4 Access Health alleged that a dispute arose between it and OGB, which resulted in an amendment of the May 9, 2019 OGB contract. Because the terms of the OGB contract were modified, retroactive to July 1, 2019, without ABC' s participation, Access Health averred that ABC had no entitlement to any fees tendered after July 1, 2019 and breached the fee agreement by failing to reimburse Access Health for the payments. 3 misrepresentation that rendered the fee agreement between ABC and Access

Health void. Access Health asked that the district court enter a judgment declaring

the fee agreement was void and awarding the total amount of payments Access

Health had tendered to ABC under the fee agreement as an alternative basis for

unjust enrichment damages.

On March S, 2022, ABC fled a declinatory exception of lack of subject

matter jurisdiction and, in the alternative, a peremptory exception of prescription,

directed at Access Health' s reconventional demand for declaratory relief ordering

that the fee agreement was void because neither ABC nor Calvi registered as a

lobbyist with the State of Louisiana. On March 26, 2022, Access Health moved for

summary judgment, seeking dismissal of ABC' s cause of action for breach of

contract on the grounds that the fee agreement was a nullity.

A hearing was held on April 27, 2022, after which the district court

overruled ABC' s exceptions of subject matter jurisdiction and prescription, and

granted summary judgment in favor of Access Health, dismissing ABC' s claim for

breach of contract with prejudice. On May 20, 2022, the district court issued a

written interlocutory judgment, overruling ABC' s exceptions of lack of subject

matter jurisdiction and prescription. It issued a second written judgment, granting

summary judgment in favor of Access Health and dismissing ABC' s cause of

action for breach of contract expressly determining the judgment was final for the

purpose of an immediate appeal.'

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Bluebook (online)
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-lactapp-2023.