Capital Imaging Associates, P.C. v. Mohawk Valley Medical Associates, Inc.

725 F. Supp. 669, 1989 U.S. Dist. LEXIS 14145, 1989 WL 145228
CourtDistrict Court, N.D. New York
DecidedNovember 28, 1989
Docket88-CV-1291
StatusPublished
Cited by31 cases

This text of 725 F. Supp. 669 (Capital Imaging Associates, P.C. v. Mohawk Valley Medical Associates, Inc.) is published on Counsel Stack Legal Research, covering District Court, N.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Capital Imaging Associates, P.C. v. Mohawk Valley Medical Associates, Inc., 725 F. Supp. 669, 1989 U.S. Dist. LEXIS 14145, 1989 WL 145228 (N.D.N.Y. 1989).

Opinion

MEMORANDUM-DECISION AND ORDER

McCURN, Chief Judge.

I. Background

A. Parties

Plaintiff, Capital Imaging Associates, P.C. (“Capital”), is one of only two private radiology practices offering a full range of diagnostic imaging services in an extensive region around Albany, New York, including parts of southern Vermont and western Massachusetts. It is a major regional health care facility with annual gross re *672 ceipts of $3,800,000, approximately 14% of which are reimbursed by Medicare. Plaintiffs only competitor is Two Rivers Radiology, a private radiology practice with offices located across the street from plaintiff in Latham, a community in northern Albany County, New York. Although Two Rivers is not a party to this case, it is under contract with the defendants’ health insurance plan to provide a specialized radiological procedure known as Magnetic Resonance Imaging (“MRI”). It is this relationship between Two Rivers and defendants which is the foundation for plaintiff’s allegations.

Defendant, Mohawk Valley Medical Associates (“Associates”) is an independent practice association (“IPA”) of member physicians organized to provide medical care to enrollees of defendant Mohawk Valley Physicians Health Plan, Inc. (“MVP”). The defendants together constitute an example of an IPA-model health maintenance organization (“HMO”) in which an HMO (MVP) contracts with an organization of physicians (Associates) to provide physician services to the HMO members in the individual physician member offices.

B. Complaint

Plaintiff invokes the jurisdiction of this court under the provisions of Sections 4 and 16 of the Clayton Act, 15 U.S.C. Sections 15 and 26 1 , to recover treble damages for and obtain injunctive relief from defendants’ violations of Sections 1 and 2 of the Sherman Act, 15 U.S.C. Sections 1 and 2 2 , and the costs of this suit including reasonable attorney’s fees.

Plaintiff’s complaint contains three counts. The first involves violations of Sections 1 and 2 of the Sherman Act, 15 U.S.C. Sections 1 and 2. Plaintiff contends that at a date at least as early as September 16, 1986, and continuing to the present time, the defendants, Two Rivers and other unnamed co-conspirators engaged in an unlawful combination or conspiracy in unreasonable restraint of interstate commerce in violation of Section 1. This alleged combination or conspiracy consists of a continuing agreement, understanding, and concert of action among the defendants and co-conspirators to exclude plaintiff from membership in Associates and thereby unlawfully restricting plaintiff’s access to the market for radiological services controlled by defendants. Plaintiff claims that in formulating and effecting the conspiracy, the defendants and co-conspirators did those things which they conspired to do, including, inter alia:

a. Held meetings at various times at which meetings defendants and co-conspirators agreed to refuse plaintiff’s application for membership in Associates in violation of the Membership Procedure as provided by the By-Laws of Associates and to give plaintiff false and misleading reasons for such refusal;
*673 b. Rejected the plaintiffs application for membership in Associates in accordance with the agreement reached;
c. Telephoned and otherwise contacted one another between meetings concerning such agreement.

Complaint, par 11.

In addition, plaintiff contends that defendants have engaged in unlawful conduct with the intent to monopolize and to attempt to monopolize trade and commerce in violation of Section 2. Plaintiff contends that in pursuing their attempt to monopolize the relevant market, defendants, for the purpose of injuring, destroying and eliminating plaintiff as a viable business and competitor in the market and with the economic power to exclude plaintiff and with full knowledge that such acts and conduct, if successful, would have an adverse impact on plaintiff and destroy or injure it as a viable competitor, undertook the following acts:

a. MVP has wrongfully induced Associates to exclude plaintiff from membership in Associates;
b. MVP and Associates have wrongfully rejected plaintiffs application for membership in Associates.

Complaint, par. 12.

The other two counts of the complaint are pendent state claims alleging the same activities as violations of Section 340 of the New York State General Business Law and the New York State common law against unfair competition.

C. Health Maintenance Organizations (“HMOs”)

In order to put this case in context, it is necessary to understand how an HMO functions. An HMO is one form of a managed care delivery system. It has been described as “any arrangement for health care delivery or financing that operates on a basis other than the traditional fee-for-service system [which is] designed to control health care [costs] by increasing price competition between providers and encouraging providers to reduce utilization.” Walsh & Feller, Provider Sponsored ADS: Reducing Antitrust Liability After Maricopa, Specialty Law Digest—Health Care 5 (Apr.1985). The growth of HMOs has been dramatic. In 1970 there were approximately 30 HMOs in the country serving three million enrollees. Today, 643 HMOs serve more than 31 million people. InterStudy, The InterStudy Edge 1 (June 1988). MVP currently has approximately 78,000 enrollees.

Health maintenance organizations have been widely viewed as pro-competitive entities with the capacity to substantially reduce health care costs. 3 One of the essential features of an HMO is that it selects preferred physicians and excludes others thereby creating competition among the providers of health care services. Antitrust enforcement agencies consider exclusions of physicians from HMOs and other managed care delivery systems as procom-petitive. 4

In order for an entity to operate as an HMO, it must apply to the New York State Department of Health (“Department”) for a certificate of authority. N.Y.Pub.Health Law section 4402.1 (Consol.1976). As part of the certification process, the Department approves the service area within which an HMO can provide its approved benefits *674 package. N.Y.Comp.Codes R. & Regs. tit. 10, section 98.7. In addition, to expand its service area, an HMO must apply for and receive an amended certificate of authority. N.Y.Comp.Code R.

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Bluebook (online)
725 F. Supp. 669, 1989 U.S. Dist. LEXIS 14145, 1989 WL 145228, Counsel Stack Legal Research, https://law.counselstack.com/opinion/capital-imaging-associates-pc-v-mohawk-valley-medical-associates-inc-nynd-1989.