Empire State Pharmaceutical Society, Inc. v. Empire Blue Cross & Blue Shield of Greater New York

778 F. Supp. 1253, 21 Fed. R. Serv. 3d 111, 1991 U.S. Dist. LEXIS 16552, 1991 WL 253300
CourtDistrict Court, S.D. New York
DecidedNovember 12, 1991
Docket86 Civ. 3889 (JES)
StatusPublished
Cited by2 cases

This text of 778 F. Supp. 1253 (Empire State Pharmaceutical Society, Inc. v. Empire Blue Cross & Blue Shield of Greater New York) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Empire State Pharmaceutical Society, Inc. v. Empire Blue Cross & Blue Shield of Greater New York, 778 F. Supp. 1253, 21 Fed. R. Serv. 3d 111, 1991 U.S. Dist. LEXIS 16552, 1991 WL 253300 (S.D.N.Y. 1991).

Opinion

OPINION AND ORDER

SPRIZZO, District Judge:

Plaintiff Empire State Pharmaceutical Society, Inc. (“Empire State”) brings this action against Empire Blue Cross and Blue Shield (“Blue Cross”), and certain of its officers, directors, and employees (the “individual defendants”) for violations of the antitrust laws because Blue Cross charged plaintiff a higher rate for major medical insurance coverage for its members than that charged to one of its competitors, Long Island Pharmaceutical Company (“Long Island”). Plaintiff’s amended complaint alleges that Blue Cross violated the Robinson-Patman Act, 15 U.S.C. § 13 (1988), and engaged in a combination and conspiracy in restraint of interstate commerce in violation of the Clayton Act, 15 U.S.C. § 12 (1988), and the Sherman Act, 15 U.S.C. § 1 (1988).

On September 25, 1987, after hearing Oral Argument, the Court dismissed the Robinson-Patman and Clayton Act claims, 1 but concluded that plaintiff’s complaint adequately alleged a conspiracy in violation of the Sherman Act. See 15 U.S.C. § 1 (1988). Upon completion of discovery, all defendants moved for summary judgment on the Sherman Act claims, and for sanctions. On January 12, 1990, after hearing Oral Argument, the Court granted the defendants’ motion for summary judgment, but ordered additional briefing and argument on the question of whether sanctions should be imposed pursuant to Fed.R.Civ.P. 11. For the reasons that follow, the Court concludes that Rule 11 sanctions are appropriate.

BACKGROUND

Empire State is a professional society of pharmacies, whose membership is comprised of pharmacies located throughout New York state. 2 It offers its members a variety of services and benefits, including major medical and hospitalization insurance coverage. Defendant Blue Cross is a not-for-profit health service organization orga *1255 nized under Article 43 of the New York Insurance Law. Blue Cross provides insurance coverage for hospitalization and health-related services for several million covered persons in a 28 county area in the state of New York, including the New York metropolitan area. The individual defendants are former or present officers, directors, or employees of Blue Cross. Long Island, which is not a party to this action, is also a professional society of pharmacies in New York state and offers services and benefits to its members similar to those offered by Empire State, including major medical and hospitalization insurance. It competes with Empire State for members. 3 See Wagner Dep. at ¶ 5; Letter of Jerome Sager to Erwin L. Werner, December 26, 1985.

Empire State purchased group major medical health insurance coverage from Blue Cross in December, 1984, which became effective January 1, 1985. 4 At that time, insurance premiums for group major medical insurance were set based upon one of two possible classifications: “experience-rated” or “community-rated.” Experience-rated groups paid premiums based upon the cost of coverage to the individual members of the group, see Deposition of Ronald D. Zammit (“Zammit Dep.”) at 6; Defendants’ Rule 3(g) Statement at ¶ 5, whereas the community-rated groups premiums were calculated based upon the costs of providing coverage to the community as a whole. See Defendants’ Rule 3(g) Statement at 11 5. It is undisputed that the community-rated premiums were significantly less expensive than experience-rated premiums. See, e.g., Plaintiff’s Complaint at 1111(c); Plaintiff’s Amended Complaint at 1111(c); Letter of Jerome Sager to Erwin L. Werner (October 2, 1984); Letter of Jerome Sager to Erwin L. Werner (December 26, 1985); Wagner Dep. at ¶ 5.

During the years from 1978 to 1986, underwriting guidelines for purchases of group major medical coverage provided that if a group contained less than 100 subscribers, community-rated premiums were charged whereas experience-rated premiums were charged to groups with 100 or more subscribers. See Deposition of Harry Nicholsen (“Nicholsen Dep.”) at 33; Zammit Dep. at 61; Deposition of Adrienne Rosenbluth (“Rosenbluth Dep.”) at 14. Moreover, subdividing experience-rated groups into smaller groups for the sole purpose of avoiding the unfavorable experience-rating and qualifying for the community-rating was prohibited both by Blue Cross’ underwriting regulations, see Blue Cross Blue Shield Underwriting Manual 111.6 at 25; Zammit Dep. at 67, and New York state law. See 11 N.Y.C.R.R. § 52.-40(c)(2)(vii) (1984); See also Deposition of Leslie Strassberg (“Strassberg Dep.”) at 75.

Therefore, when Empire State applied for group major medical insurance its representatives were told that since it was applying on behalf of a group consisting of more than 100 members the premium would be based on the experience-rating method, see Fisher Aff. at U 4; Wagner Aff. at 114; Sager Dep. at 126, and that Empire State could not meet the requirements for a community-rating by grouping its members in smaller segments. See Wagner Aff. 11 5; Affidavit of Harry Nicholsen (“Nicholsen Aff.”) at 113; Sager Dep. at 153; Strassberg Dep. at 81. Empire State objected to paying the higher rate because it claimed that its rival, Long Island, was accorded community-rating for similar coverage. See Wagner Aff. at 115; Sager Dep. at 127, 140, 152; Nicholsen Dep. at 50. Nevertheless, Empire State entered into major medical insurance cover *1256 age with Blue Cross for the years 1985, 1986, and 1987. See Sager Dep. at 121.

The evidence indicates that Long Island received its community-rating in the following manner. Individual pharmacies or groups of pharmacies who were members of Long Island had begun contacting Blue Cross by telephone in 1978 to secure major medical coverage, well before Empire State sought similar coverage. See Rosenbluth Dep. at 30-33, 36-38, 77, 82; Zammit Dep. at 45-57, 61-62, 65-66, 70-71, 77; Strassberg Dep. at 58, 64; Affidavit of Lucy McCarthy (“McCarthy Aff.”) at ¶1¶ 2, 4; see also Affidavit of James J. Sabella, Esq. (“Sabella Aff.”) at Exhibit 12. These telephone enrollments were followed by the later submission of completed enrollment forms by each group. See McCarthy Aff. at 112. Since these individual or groups of pharmacies consisted of fewer than 100 members, they were given a community-rating. 5 See Rosenbluth Dep. at 30-33, 36-38, 77, 82; Zammit Dep. at 27-28, 35-39, 45-46, 61-62, 65; Nicholsen Dep. at 32-34, 64-65, 88; Strassberg Dep. at 58, 64.

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778 F. Supp. 1253, 21 Fed. R. Serv. 3d 111, 1991 U.S. Dist. LEXIS 16552, 1991 WL 253300, Counsel Stack Legal Research, https://law.counselstack.com/opinion/empire-state-pharmaceutical-society-inc-v-empire-blue-cross-blue-nysd-1991.