Collins v. Anthem Health Plans, Inc.

880 A.2d 106, 275 Conn. 309, 2005 Conn. LEXIS 334
CourtSupreme Court of Connecticut
DecidedSeptember 6, 2005
DocketSC 17233
StatusPublished
Cited by22 cases

This text of 880 A.2d 106 (Collins v. Anthem Health Plans, Inc.) is published on Counsel Stack Legal Research, covering Supreme Court of Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Collins v. Anthem Health Plans, Inc., 880 A.2d 106, 275 Conn. 309, 2005 Conn. LEXIS 334 (Colo. 2005).

Opinion

Opinion

ZARELLA, J.

The defendant, Anthem Health Plans, Inc., appeals 1 from the trial court’s class certification 2 order that was rendered following proceedings that were conducted by the trial court pursuant to our remand order in Collins v. Anthem Health Plans, Inc., 266 Conn. 12, 67-68, 836 A.2d 1124 (2003). The plaintiffs *314 are orthopedic surgeons and groups of orthopedic surgeons who commenced this action against the defendant in 1999, alleging, inter alia, breach of contract, tortious interference with business expectancies, breach of the implied covenant of good faith and fair dealing, and violation of the Connecticut Unfair Trade Practices Act (CUTPA), General Statutes § 42-110a et seq. In Collins, we concluded that the trial court had abused its discretion in granting the plaintiffs’ motion for class certification as to three subparagraphs of the plaintiffs’ second amended complaint (complaint), namely, subparagraphs 20 (b), (g) and (m), because it had failed to undertake the predominance inquiry that is required by Practice Book § 9-8. 3 Id., 46. We further concluded that the trial court improperly had denied the plaintiffs’ motion for class certification with respect to their “illegal profiling” allegation, which is set forth in subparagraph 20 (j) of the complaint, on the ground that the plaintiffs’ claim was not typical of those of the putative class. (Internal quotation marks omitted.) Id., 65. We remanded the case to the trial court with direction to determine whether the predominance requirement was satisfied with respect to subparagraphs 20 (b), (g) and (m), and to evaluate whether the class certification requirements, other than typicality, were satisfied with respect to subparagraph 20 (j). Id., 67-68. The trial court thereafter concluded that all of these requirements were satisfied and certified the class for subparagraphs 20 (b), (g), (j) and (m), which apply to all counts set forth in the complaint. The defendant now appeals from the trial court’s certification order, claiming that the trial court abused its discretion *315 because: (1) the plaintiffs did not prove that the commonality and adequacy-of-representation requirements of Practice Book § 9-7 4 were satisfied with respect to the profiling allegation contained in subparagraph 20 (j); 5 (2) it did not apply the appropriate legal standards in evaluating whether the predominance requirement of Practice Book § 9-8 was satisfied with respect to all four subparagraphs; and (3) it failed to comprehend the management difficulties that would arise if this case were tried as a class action. We disagree with the defendant’s first claim but agree with its second and third claims. Accordingly, we reverse the order of the trial court certifying the class as to subparagraphs 20 (b), (g), (j) and (m) of the plaintiffs’ complaint.

The plaintiffs are eight orthopedic surgeons and four groups of orthopedic surgeons 6 who entered into written agreements with the defendant to provide medical services to persons enrolled in the defendant’s health insurance plans. The plaintiffs commenced this action in 1999 and thereafter filed an amended four count complaint, alleging breach of contract, tortious interfer *316 ence with business expectancies, breach of the implied covenant of good faith and fair dealing and a violation of CUTPA. Each of these four counts is based on the same sixteen factual allegations that are designated as subparagraphs 20 (a) through (p), inclusive, in the complaint.

In March, 2001, the plaintiffs filed a motion for class certification, seeking to serve as representative parties for all physicians and physician groups who had entered into contracts with the defendant, from 1993 through 2001, to provide medical services to persons enrolled in the defendant’s health insurance plans. 7 Id. The trial court granted the motion for class certification, but only with respect to three of the sixteen subparagraphs of the amended complaint. The trial court denied the plaintiffs’ motion for class certification as to the remaining thirteen subparagraphs, concluding that either: (1) the plaintiffs did not seek to establish, on their own behalf, the allegations embodied therein and, consequently, their claims were not typical of those of the putative class members; or (2) the allegations “relate[d] to discrete transactions concerning particular services in particular circumstances, with factual issues not common to other such transactions . . . .” Included in the first category was the plaintiffs’ profiling allegation contained in subparagraph 20 (j), which provides that the defendant made “payment for services dependent on profiling, a practice whereby treatment and/or payment for covered services for the patient is *317 permitted/disallowed ... by the use of statistical averages for the treating physician.” The court reasoned that this claim lacked the requisite typicality because none of the named plaintiffs had been terminated from the defendant’s provider network or denied payment as a result of the defendant’s practice of profiling.

The court, however, granted class certification with respect to subparagraphs 20 (b), (g) and (m), which describe general business practices of the defendant that purportedly applied uniformly to all members of the class. Subparagraph 20 (b) alleges that the defendant “[f]ail[ed] to provide the plaintiff[s] and other similarly situated physicians with a consistent medical utilization/quality management and administration of covered services by paying financial incentive and performance bonuses to providers and [the defendant’s] staff members involved in making utilization management decisions.” Subparagraph 20 (g) avers that the defendant “[f]ail[ed] to maintain accurate books and records whereby improper payments to the plaintiffs were made based on claim codes submitted.” Finally, subparagraph 20 (m) alleges that the defendant “failfed] to provide senior personnel to work with the plaintiffs or other similarly situated physicians [to secure preauthorization for certain medical services] . . . .” The court determined that these allegations satisfied the threshold requirements of Practice Book § 9-7. The court also determined that these allegations satisfied the superiority requirement of Practice Book § 9-8, concluding that “a class action [was] superior to other available methods for the fair and efficient adjudication of [these claims] . . . .” The court made no finding in accordance with Practice Book § 9-8, however, as to whether “the questions of law or fact common to the members of the class predominate over any questions affecting only individual members . . . .” Despite that omission, the court granted the plaintiffs’ motion to certify the *318 class with respect to subparagraphs 20 (b), (g) and (m).

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Cite This Page — Counsel Stack

Bluebook (online)
880 A.2d 106, 275 Conn. 309, 2005 Conn. LEXIS 334, Counsel Stack Legal Research, https://law.counselstack.com/opinion/collins-v-anthem-health-plans-inc-conn-2005.