Brokerage Concepts v. US Healthcare Inc (Part II)

140 F.3d 494, 49 Fed. R. Serv. 518, 1998 U.S. App. LEXIS 6591, 1998 WL 151237
CourtCourt of Appeals for the Third Circuit
DecidedApril 2, 1998
Docket96-1891, 96-1892, 96-1922, 96-1923, 97-1013 and 97-1014
StatusUnknown
Cited by192 cases

This text of 140 F.3d 494 (Brokerage Concepts v. US Healthcare Inc (Part II)) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Brokerage Concepts v. US Healthcare Inc (Part II), 140 F.3d 494, 49 Fed. R. Serv. 518, 1998 U.S. App. LEXIS 6591, 1998 WL 151237 (3d Cir. 1998).

Opinion

OPINION OF THE COURT

BECKER, * Chief Circuit Judge.

TABLE OF CONTENTS

I. INTRODUCTION.................................................. 501

II. FACTS & PROCEDURAL HISTORY................................ 504

A. The Parties .................................................... 504

B. Gary’s Decision to Self-insure..................................... 505

C. Gary’s Switch to CHA/U.S. Healthcare ............................ 507

D. Economic Evidence ............................................. 508

1. Impact on Gary’s............................................ 508

2. Knowlton’s Survey........................................... 509

3. Interaction Between U.S. Healthcare and Other Pharmacy Operations ....................................................... 509

4. The Setting of Reimbursement Prices.......................... 509

E. The Jury Verdict................................................ 509

III. THE ANTITRUST ISSUES......................................... 510

A. Introduction—Characterization of BCI’s Claim...................... 510

B. Per se Liability................................................. 512

1. Defining the Relevant Market................................. 513

a. The Product Market...................................... 513

*501 b. The Geographic Market................................... 515

2.U.S. Healthcare’s Power in the Tying Market................... 516

a. Evidence of Market Share................................. 517

b. Other Factors Bearing on Market Power.................... 517

C. The Rule of Reason Claim........................................ 519

D. Conclusion..................................................... 520

IV. CIVIL RICO ............................................ 520

A. Introduction.................................................... 520

B. RICO Standing................................................. 520

C. Predicate Acts of BCI’s RICO Claim.............................. 521

1. Extortion under the Hobbs Act................................ 522

a. The Definition of “wrongful”................................ 522

b. Lawful Versus Unlawful Claims to Property.................. 524

c. Evidence of Other Unlawful Objectives...................... 526

2. Commercial Bribery......................................... 527

3. Mail and Wire Fraud ........................................ 528

4. The Travel Act.............................................. 529

D. Conclusion..................................................... 529

V. TORTIOUS INTERFERENCE ..................................... 529

VI. CONCLUSION.................................................... 535

I. INTRODUCTION:

The revolutionary changes in the health care field over the past decade have spawned many novel market arrangements. Perhaps the most significant development is the ascendency of managed-care driven health maintenance organizations (“HMOs”), whose hold over a large number of subscribers has permitted them to wield considerable economic power over health care providers. This antitrust, civil RICO, and state law tortious interference case against defendant U.S. Healthcare, one of the nation’s largest HMO’s, two of its wholly-owned subsidiaries, and three of its top officers, is an exemplar of the legal fallout from this development.

This appeal presents several quite difficult and important first impression questions for us, including: (1) whether the defendants’ use of economic fear in the context of hard business bargaining constitutes wrongful conduct amounting to extortion for civil RICO purposes; (2) whether the inability of the plaintiff to prevail on antitrust and extortion-based civil RICO claims forecloses a successful state law tortious interference claim based on the same facts; and (3) whether the defendants’ hard bargaining constituted “wrongful means” so as to forfeit the defense of privileged business competition to a tortious interference claim.

The lawsuit emanates from U.S. Healthcare’s refusal to approve the application of a new Abington, Pennsylvania store of “I Got It at Gary’s” (“Gary’s”), a small southeastern Pennsylvania pharmacy, health and beauty aid chain, for membership in U.S. Healthcare’s network of medical prescription providers. U.S. Healthcare conditioned membership in its provider network on Gary’s agreement to discontinue its contractual relationship with plaintiff Brokerage Concepts, Inc. (“BCI”), a health care consulting firm whose specialty is serving as a Third Party Administrator (“TPA”) for health benefit self-insurers (such as Gary’s), and to give its TPA business to a U.S. Healthcare subsidiary, Corporate Health Administrators (“CHA”).

U.S. Healthcare also applied pressure on Gary’s in other ways—through “hard-ball” negotiation tactics, which deliberately left Gary’s “hanging” as to whether its new application would be approved, and a seemingly vindictive audit of Gary’s generic prescription drug dispensing policy at one of its stores that was already part of the U.S. Healthcare network. Since U.S. Healthcare subscribers constituted a significant portion of its customer base, Gary’s understandably yielded to the pressure and gave its TPA business to CHA. BCI thereupon sued in federal district *502 court asserting Sherman Act and civil RICO claims, as well as a claim of tortious interference with contractual relations under Pennsylvania law. BCI sought compensatory and treble damages, injunctive relief, and counsel fees on its antitrust and civil RICO claims, and compensatory and punitive damages on its state law tortious interference claim. Gary’s is not a party to the lawsuit.

The case proceeded to trial before a jury, which rendered a verdict finding U.S. Healthcare and its officers liable to BCI on all of BCI’s claims, and awarding compensatory and punitive damages. On post-trial motions, the district court upheld the verdict but ruled that: (1) BCI must elect between the punitive damages awarded on its state law claim and the treble damages awarded on its federal claims (i.e., that it cannot recover both); and (2) if it elects the state law remedies, BCI cannot also collect the attorney’s fees that are available under its RICO and antitrust claims.

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140 F.3d 494, 49 Fed. R. Serv. 518, 1998 U.S. App. LEXIS 6591, 1998 WL 151237, Counsel Stack Legal Research, https://law.counselstack.com/opinion/brokerage-concepts-v-us-healthcare-inc-part-ii-ca3-1998.