Group Health Cooperative v. City of Seattle

146 Wash. App. 80
CourtCourt of Appeals of Washington
DecidedJuly 21, 2008
DocketNo. 60301-9-I
StatusPublished
Cited by9 cases

This text of 146 Wash. App. 80 (Group Health Cooperative v. City of Seattle) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Group Health Cooperative v. City of Seattle, 146 Wash. App. 80 (Wash. Ct. App. 2008).

Opinion

Dwyer, A.C.J.

¶1 Group Health Cooperative is a state-licensed health maintenance organization (HMO). It alleges that the city of Seattle (City) wrongly assessed business and occupation (B&O) taxes against health care [84]*84premium payments made to it by its customers, as well as against premium payments made by the federal government from the Federal Employee Health Benefits Fund (FEHBF). A controlling statute, RCW 48.14.0201(7), precludes Washington municipalities from assessing local taxes on health care premium payments made to HMOs. Similarly, the Federal Employee Health Benefits Act (FEHBA), 5 U.S.C. §§ 8901-8914, bars local government taxation of payments made to HMOs out of the FEHBF. 5 U.S.C. § 8909(f)(1). The trial court ruled that the City wrongly assessed B&O taxes against both health care premium payments and payments from the FEHBF. The City appeals this ruling. In addition, Group Health cross-appeals, alleging that the trial court erred by ruling that the City was not entirely barred from assessing B&O taxes after 2004. This preclusion arises, according to Group Health, as a result of the inclusion of flawed interest provisions in the model B&O tax ordinance adopted by the City, as mandated by the legislature. We affirm the trial court in all respects.

I

¶2 Group Health is a nonprofit corporation licensed to operate as an HMO in Washington. Its headquarters are in Seattle. It sells a variety of health care benefit plans in exchange for health care premium payments. Individuals enrolled in Group Health’s benefit plans are entitled to receive some health care services at Group Health’s facilities, including those in Seattle. Premiums charged by Group Health to federal employees with employer-provided health insurance are paid by the federal government from the FEHBF.

¶3 Depending on the extent of an individual’s health care coverage under a Group Health benefit plan, the individual may have to pay Group Health additional co-payments, deductibles, or coinsurance payments. If individuals who are not enrolled in a Group Health benefit plan [85]*85seek care at a Group Health facility, Group Health directly charges them (or their health insurer, if they have one) fees for the health care services provided. Thus, Group Health has two revenue streams — revenue it receives from enrollees in the form of premium payments (premium revenue) and revenue it receives as direct fees for services provided that fall outside the coverage of a benefit plan (service revenue).

¶4 The State of Washington taxes the premium revenue of health insurers and HMOs at a rate of two percent. RCW 48.14.0201(1), (2). Federal law, however, bars states (and municipalities) from taxing payments made from the FEHBF. 5 U.S.C. § 8909(f)(1). The State also imposes its own B&O tax “for the act or privilege of engaging in business activities” in the state, RCW 82.04.220, including the provision of health care services, at a rate of one and one-half percent. RCW 82.04.290(2). The State classifies Group Health’s premium revenue as taxable pursuant to the state premium tax statute and Group Health’s service revenue as taxable pursuant to the state B&O tax statute. There is no overlap.

¶5 Between January 1, 2000, and December 31, 2004, Group Health reported and paid to the State the premium tax imposed on its premium revenue (except for those revenues exempt from state or local taxation either because of federal law or for other reasons). It also reported and paid the state B&O tax on its service revenue. During this period, Group Health also paid a B&O tax to the City.

¶6 This is the tax that is at issue in this case. On August 30, 2004, Group Health filed a petition with the City requesting a refund of B&O taxes it paid to the City between January 1, 2000, and December 31, 2004. The basis for this refund request was Group Health’s contention that the City had assessed B&O taxes on premium revenue and that, “beginning on January 1, 2000, business license tax does not apply to any health maintenance organization in respect to premiums or prepayments that are taxable under Revised Code of Washington (RCW) 48.14.0201.” [86]*86Group Health also claimed that the City was assessing B&O taxes on FEHBF payments, in violation of federal law.

¶7 In response to Group Health’s refund claim, the City conducted an audit of Group Health for the period at issue. The City then issued an audit determination that partly granted and partly denied Group Health’s requested refund for 2000 through 2003, while asserting that Group Health owed additional B&O taxes for 2004. According to the City, the B&O tax that it imposed on Group Health during the audit period was justified because “it is necessary in the audit to split the [Group Health] premium revenue between taxable and nontaxable amounts,” and that a tax on the “taxable premium amount” was not, in fact, a tax on premiums. The City asserted that it was entitled to impose a B&O tax to be paid out of premium revenue because a portion of that premium revenue was later dedicated to paying for medical services provided by Group Health’s employees. To arrive at the portion of Group Health’s premium revenue that the City considered to be taxable, the City calculated the portion of Group Health’s total expenses dedicated to providing medical services through its own employees, and then applied that percentage directly to Group Health’s gross premium revenue:

A percentage of medical services provided directly by [Group Health] employees was arrived at by [taking] the total [Group Health] medical service expenses and dividing by the total [Group Health] expenses. This percentage was then applied to the dues revenue to establish the taxable portion of dues revenue under [Seattle Municipal Code (SMC)] 5.45.090(Y).

[87]*87Of this overall “taxable portion” of the premium payments made to Group Health by its benefit plan enrollees, the City then determined the amount of medical service expenditures provided in Seattle (as opposed to other Washington localities) to arrive at the final portion of Group Health’s premium revenue, upon which it imposed its B&O tax.

¶8 The City then calculated interest on both the partial B&O tax refunds and the asserted 2004 B&O tax deficiency according to the formula that it had used prior to its enactment of the “model ordinance” governing municipal B&O taxes mandated by the passage of Laws of 2003, chapter 79 (codified at chapter 35.102 RCW). It used these rates because it was directed to do so by the model ordinance, which provided, at the time that the City was required to enact it, that (as to underpayment and overpayment, respectively):

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Bluebook (online)
146 Wash. App. 80, Counsel Stack Legal Research, https://law.counselstack.com/opinion/group-health-cooperative-v-city-of-seattle-washctapp-2008.