Fair Care Foundation, A.G. v. District of Columbia Department of Insurance & Securities Regulation

716 A.2d 987, 1998 D.C. App. LEXIS 157
CourtDistrict of Columbia Court of Appeals
DecidedAugust 27, 1998
Docket98-AA-94, 98-CV-401
StatusPublished
Cited by20 cases

This text of 716 A.2d 987 (Fair Care Foundation, A.G. v. District of Columbia Department of Insurance & Securities Regulation) is published on Counsel Stack Legal Research, covering District of Columbia Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fair Care Foundation, A.G. v. District of Columbia Department of Insurance & Securities Regulation, 716 A.2d 987, 1998 D.C. App. LEXIS 157 (D.C. 1998).

Opinion

GALLAGHER, Senior Judge:

The petition before us seeks review of a decision and order issued by respondent District of Columbia Department of Insurance and Securities Regulation (“the DISR” or “Agency”) approving a proposed business combination agreement between Group Hospitalization and Medical Services, Inc. (“GHMSI”) and Blue Cross and Blue Shield of Maryland (“BCBSMD”). We also review a clarifying and interpreting letter, which we treat as a supplemental order, issued under exceptional circumstances by the DISR after entry of the original order.

Before us on appeal is also the dismissal of a Superior Court action which sought relief substantially the same as that forming the basis of the petition for review.

Petitioners 1 contend that (1) the DISR violated statutorily mandated hearing procedures by denying petitioners the right to live cross-examination of witnesses; (2) the DISR incorrectly relied on the District of Columbia Hospital and Medical Services Corporation Regulatory Act to the detriment of petitioners; (8) the decision was arbitrary and capricious and an abuse of discretion because the DISR failed to consider issues related to the charitable nature of GHMSI and executive officer integrity; and (4) the DISR prejudiced petitioners by substantively altering the decision and order in a subsequent letter issued after impermissible ex parte contacts with GHMSI and BCBSMD.

In the appeal from the Superior Court judgment, appellants argue that (1) this court’s exclusive jurisdiction to review administrative actions does not eliminate the trial court’s jurisdiction over common law claims; (2) appellants had standing to pursue claims against GHMSI for the violation of fiduciary duties; (3) appellants have standing to pursue derivative and quasi-derivative claims against GHMSI; (4) the trial court erred in determining that appellants’ claim for civil conspiracy should be dismissed for lack of alleged harm; and (5) the trial court erred by considering facts outside the record in ruling on appellees’ motion to dismiss.

In relation to the administrative petition for review, we affirm the DISR’s decision and order of December 23, 1997. At the same time, however, we vacate the DISR’s clarification and interpretation letter of January 16,1998, which we treat as a supplemental order, concluding that the modifications made in that order were issued without proper notice and opportunity for petitioners to be heard. In relation to the appeal from the Superior Court, we affirm the trial court’s dismissal of appellants’ complaint.

I. Facts

The material and undisputed facts are as follows: Group Hospitalization, Inc. (“GHI”) was a non-profit, charitable corporation established by federal charter in 1939 pursuant to an Act of Congress in order to provide hospital services to residents of the District of Columbia. 2 In 1984, GHI merged with Medical Services of the District of Columbia to form appellee GHMSI, and Congress *990 amended the federal charter to permit GHMSI to arrange for the provision of medical services. 3 In 1992, Congress again amended GHMSI’s charter to provide that it would be regulated by the District of Columbia Insurance Administration, now the DISR. 4

GHMSI is the Blue Cross and Blue Shield licensee for the District of Columbia, Northern Virginia and Prince George’s and Montgomery Counties in Maryland. BCBSMD is the Blue Cross and Blue Shield licensee for the remainder of the State of Maryland, and is regulated as a non-profit health service plan by the Maryland Insurance Administration.

On March 27, 1997, GHMSI and BCBSMD entered into a Business Combination Agreement. The agreement proposed the creation of an upstream non-profit Maryland holding company, now called CareFirst, that would be the sole voting member of GHMSI and BCBSMD. GHMSI and BCBSMD would continue to operate within their existing service areas and under their respective regulatory oversight. The combination would allow the two companies to collaborate at the business operations level without altering their corporate existences. The agreement proposed an eighteen member board of directors for CareFirst, with two-thirds representation for BCBSMD and one-third representation for GHMSI, roughly proportionate to the relative size of the two entities. The purpose of the agreement was to establish a more efficient and competitive non-profit health service plan. Specifically, the intent was to enhance the financial posture of the two companies, to maintain local control, to take advantage of the resources of the two companies, to gain efficiencies of scale and to enhance the ability of the two companies to offer health services and products to policyholders.

The two companies also drafted an Inter-company Agreement that would govern transfers of assets and services between GHMSI and BCBSMD. The agreement established four categories of transfers of assets: (1) to meet statutory or regulatory capital reserve requirements; (2) to satisfy member claims; (3) to satisfy other legally enforceable obligations, such as judgments, creditor demands and surplus notes; and (4) discretionary transfers. For all four categories of transfers of assets, GHMSI and BCBSMD would not be required to make a transfer to the extent that the transfer would cause reserves to fall below required levels or would cause a violation of any specific legal prohibitions. There were no other conditions placed on the first three categories of transfers, and the transfers could be made without any agency or board approval. The fourth category, discretionary transfers, required increasingly stringent approvals as the size of the asset transfer, or annual aggregate total of transfers, increased.

On February 6, 1997, GHMSI and BCBSMD jointly filed with the DISR a Statement Regarding the Acquisition of Control of or Merger with a Domestic Insurer. The DISR then proceeded to exercise its jurisdiction to approve or disapprove the proposed transaction pursuant to the District of Columbia Holding Company Systems Act of 1993, D.C.Code §§ 35-3701 to -3728 (1997) (“HCA”), and the District of Columbia Administrative Procedure Act, D.C.Code §§ 1-1501 to -1542 (1997). 5 While the DISR proceedings were pending, Congress enacted legislation that amended GHMSI’s charter to allow GHMSI to have one class of members. 6 The amended charter permitted GHMSI to have non-profit corporate members, such as CareFirst.

The DISR conducted an extensive fact finding process in order to determine whether to approve the proposed transaction. The Agency held meetings with GHMSI and BCBSMD, obtained voluminous documentation regarding the financial and operational *991

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Bluebook (online)
716 A.2d 987, 1998 D.C. App. LEXIS 157, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fair-care-foundation-ag-v-district-of-columbia-department-of-insurance-dc-1998.