Bradley A. Chicoine, D.C. Dr. Bradley A. Chicoine, P.C. Mark A. Niles, D.C. Niles Chiropractic, Inc. and Rod R. Rebarcak, D.C., on behalf of themselves and those like situated v. Wellmark, Inc. d/b/a Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Health Plan of Iowa, Inc.

CourtSupreme Court of Iowa
DecidedJanuary 26, 2024
Docket22-0303
StatusPublished

This text of Bradley A. Chicoine, D.C. Dr. Bradley A. Chicoine, P.C. Mark A. Niles, D.C. Niles Chiropractic, Inc. and Rod R. Rebarcak, D.C., on behalf of themselves and those like situated v. Wellmark, Inc. d/b/a Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Health Plan of Iowa, Inc. (Bradley A. Chicoine, D.C. Dr. Bradley A. Chicoine, P.C. Mark A. Niles, D.C. Niles Chiropractic, Inc. and Rod R. Rebarcak, D.C., on behalf of themselves and those like situated v. Wellmark, Inc. d/b/a Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Health Plan of Iowa, Inc.) is published on Counsel Stack Legal Research, covering Supreme Court of Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Bradley A. Chicoine, D.C. Dr. Bradley A. Chicoine, P.C. Mark A. Niles, D.C. Niles Chiropractic, Inc. and Rod R. Rebarcak, D.C., on behalf of themselves and those like situated v. Wellmark, Inc. d/b/a Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Health Plan of Iowa, Inc., (iowa 2024).

Opinion

IN THE SUPREME COURT OF IOWA

No. 22–0303

Submitted December 13, 2023—Filed January 26, 2024

BRADLEY A. CHICOINE, D.C.; DR. BRADLEY A. CHICOINE, D.C., P.C.; MARK A. NILES, D.C.; NILES CHIROPRACTIC, INC.; and ROD R. REBARCAK, D.C., on behalf of themselves and those like situated,

Appellants,

and

BEN WINECOFF; STEVEN A. MUELLER, D.C.; BRADLEY J. BROWN, D.C.; BROWN CHIROPRACTIC, P.C.; MARK A. KRUSE, D.C.; MARK A. KRUSE, D.C., P.C.; KEVIN D. MILLER, D.C.; and LARRY E. PHIPPS, on behalf of themselves and those like situated,

Plaintiffs,

vs.

WELLMARK, INC. d/b/a WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA and WELLMARK HEALTH PLAN OF IOWA, INC.,

Appellees.

Appeal from the Iowa District Court for Polk County, Sarah E. Crane,

Business Specialty Court Judge.

Chiropractors appeal the district court ruling denying their motion for

class certification. AFFIRMED.

Waterman, J., delivered the opinion of the court, in which all participating

justices joined. Mansfield, J., took no part in the consideration or decision of the

case. 2

Glenn L. Norris (argued) of Hawkins & Norris, P.C., Des Moines; Steven P.

Wandro, Kara M. Simons, and Ben Arato of Wandro & Associates, P.C.,

Des Moines; and Harley C. Erbe of Erbe Law Firm, Des Moines, for appellants.

Zachary D. Holmstead (argued), Daniel E. Laytin, and Alyssa C. Kalisky of

Kirkland & Ellis LLP, Chicago, Illinois, and Benjamin P. Roach of Nyemaster,

Goode, P.C., Des Moines, for appellees. 3

WATERMAN, Justice. In this appeal, we must decide whether the district court abused its broad

discretion in denying the plaintiffs’ motion for class certification. The plaintiffs,

three chiropractors, allege Wellmark1 violated the Iowa Competition Law, Iowa

Code chapter 553 (2015), through “Administrative Services Agreements” with

over 400 employers that self-fund healthcare benefits for their employees. The

plaintiffs claim that but for these agreements, the self-funded employers would

compete independently for chiropractic services, resulting in higher profits for

chiropractors. The plaintiffs filed a motion to certify a class of approximately

1,300 Iowa chiropractors. Wellmark resisted class certification on several

grounds. The district court ultimately denied certification on the ground that

individual issues predominate over any common question on the threshold

liability issue of antitrust injury. The plaintiffs appealed, and we retained the

case.

On our review, we conclude that the district court did not abuse its broad

discretion in denying the plaintiffs’ motion for class certification. To establish an

antitrust injury, the plaintiffs must prove that they would have been better off

without the challenged agreements as numerous self-funded employers would then theoretically compete with one another for chiropractic services, driving up

rates paid for chiropractic services. The plaintiffs offered no expert testimony or

model to address that threshold issue on a classwide basis. The district court

carefully reviewed the extensive evidentiary record to determine that too many

individual local variables precluded an efficient classwide determination of

antitrust injury, as the plaintiffs ultimately conceded. We agree with that

1The plaintiffs sued Wellmark, Inc.—doing business as Wellmark Blue Cross and Blue

Shield of Iowa—and Wellmark Health Plan of Iowa, Inc., that we collectively refer to as “Wellmark” in this opinion. 4

determination. The district court also correctly applied judicial estoppel to

preclude the plaintiffs from belatedly reviving a theory they previously disavowed

to avoid a motion to dismiss asserting the single entity defense—that Wellmark’s

operation of the agreements illegally underpaid chiropractors. Finding no abuse

of discretion, we affirm.

I. Background Facts and Proceedings.

This is the sixth appeal we have adjudicated in this complex litigation

spanning over a decade.2 In this round, the named plaintiffs

are Bradley A. Chicoine, D.C., Mark A. Niles, D.C., and Rod R. Rebarcak, D.C.,

and their respective business entities providing chiropractic services in several

Iowa cities. Dr. Chicoine practices in Sioux City, Dr. Niles in Tipton, and

Dr. Rebarcak in Ames. We will refer to these plaintiffs collectively as “Chicoine.”

Chicoine filed this putative class action against Wellmark, Iowa’s largest

health insurer and claims administrator. Chicoine alleges that Wellmark has

violated Iowa antitrust laws through its Administrative Service Agreements with

over 400 Iowa employers who self-fund healthcare benefits for their employees.

The self-funded employers pay their employees’ healthcare costs but hire

Wellmark to administer their healthcare plans. The employers pay Wellmark administrative and network access fees, allowing access to Wellmark’s provider

networks paying healthcare practitioners under rates negotiated by Wellmark.

The self-funded employers contracting with Wellmark range in size from Iowa’s

largest private employers—Hy-Vee and John Deere—to numerous small

businesses who lack the staff or expertise to administer employee healthcare

2Chicoine v. Wellmark, Inc., 894 N.W.2d 454 (Iowa 2017); Abbas v. Iowa Ins. Div., 893 N.W.2d 879 (Iowa 2017); Wellmark, Inc. v. Iowa Dist. Ct., 890 N.W.2d 636, 638–42 (Iowa 2017) (summarizing prior opinions); Mueller v. Wellmark, Inc. (Mueller II), 861 N.W.2d 563 (Iowa 2015); Mueller v. Wellmark, Inc. (Mueller I), 818 N.W.2d 244 (Iowa 2012). 5

claims. Chicoine alleges that Wellmark conspired with the self-funded employers

to unlawfully fix prices paid for chiropractic services.

Wellmark filed a motion to dismiss Chicoine’s lawsuit, arguing Wellmark

acted as the agent for the self-funded employers to administer their healthcare

plans and, therefore, no conspiracy claim exists under the single entity doctrine

(it takes two to conspire and a principal cannot be liable for conspiring with its

agent as they are regarded as one actor).3 The district court stated:

It appears the plaintiffs agree that when Wellmark enters into and enforces the practitioner service agreements with health care providers, including chiropractors, they are administering the self-funded employers’ plans and are acting as their agents. If plaintiffs’ anti-trust argument was based solely upon Wellmark’s enforcement of the practitioner service agreements, the court might agree dismissal under the single-entity doctrine would be appropriate.

Chicoine, to avoid dismissal, argued that the antitrust violation did not occur

when Wellmark administered the agreements, but instead occurred earlier when

entry into the agreements removed the self-funded employers from competing

with one another—competition that would result in higher prices for

chiropractors. In denying the motion to dismiss, the district court relied on that

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Bradley A. Chicoine, D.C. Dr. Bradley A. Chicoine, P.C. Mark A. Niles, D.C. Niles Chiropractic, Inc. and Rod R. Rebarcak, D.C., on behalf of themselves and those like situated v. Wellmark, Inc. d/b/a Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Health Plan of Iowa, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/bradley-a-chicoine-dc-dr-bradley-a-chicoine-pc-mark-a-niles-dc-iowa-2024.