Health Maintenance Network v. Blue Cross of Southern California

202 Cal. App. 3d 1043, 249 Cal. Rptr. 220, 1988 Cal. App. LEXIS 630
CourtCalifornia Court of Appeal
DecidedJuly 13, 1988
DocketB017620
StatusPublished
Cited by13 cases

This text of 202 Cal. App. 3d 1043 (Health Maintenance Network v. Blue Cross of Southern California) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Health Maintenance Network v. Blue Cross of Southern California, 202 Cal. App. 3d 1043, 249 Cal. Rptr. 220, 1988 Cal. App. LEXIS 630 (Cal. Ct. App. 1988).

Opinion

Opinion

BOREN, J.

Blue Cross of Southern California and other related defendants 1 (collectively referred to as Blue Cross) appeal from the issuance of a permanent injunction prohibiting them from interfering with the operation of plaintiff, Health Maintenance Network of Southern California (Health Net).

Overview

The instant action in equity traces its genesis to an attempt by a health insurance organization, Blue Cross, to assert control over an autonomous health maintenance organization (HMO) it helped establish, Health Net.

In 1977, Blue Cross set up Health Net under California nonprofit corporation laws to benefit from various marketing advantages of a federally qualified HMO. At the same time, Health Net was also structured as a nonprofit hospital service plan under the Insurance Code. 2 Both Health Net and Blue Cross were separate legal entities, yet Blue Cross sought to make Health Net a subsidiary company, “operating under the Blue Cross umbrella.” Essentially, Blue Cross received additional exposure by which to attract new subscribers, while Health Net benefited from Blue Cross’s established subscriber roster, business experience and capital.

Health Net’s incorporating articles contained a provision authorizing corporate “members.” 3 Health Net’s accompanying bylaws provided that its *1049 members would be “designated annually by the Board of Directors of Blue Cross of Southern California.” The bylaws also provided that, upon dissolution of Health Net, its residual assets would be distributed to Blue Cross.

For 1983, the Health Net nine-member board of directors was composed of eight of the Blue Cross-selected Health Net members and one nonmember. This board unanimously approved a proposed bylaw amendment eliminating the existence of “members.” The board’s action was subsequently ratified by written consents obtained from its interlocking corporate members. Approximately one year later, in 1984, Blue Cross claimed to have discovered “inadvertently” Health Net’s 1983 bylaw amendment. Blue Cross attempted to negotiate a revocation of the amendment. When the negotiations proved unsuccessful, Blue Cross simply appointed new members who, in turn, purported to replace the existing Heath Net board with new directors. This act prompted Health Net to seek injunctive relief in order to preserve its autonomy. 4 Health Net also sought declaratory relief and damages. Blue Cross cross-complained for damages against the officers and directors of Health Net. (The cross-complaint is not at issue on this appeal.)

The trial court found in Health Net’s favor and granted both a preliminary and permanent injunction. Blue Cross appeals. We affirm.

Facts

Viewing the record in a light most favorable to the judgment (Overton v. Vita-Food Corp. (1949) 94 Cal.App.2d 367, 370 [210 P.2d 757]), we recite the following operative facts.

In 1977, Blue Cross (more specifically, Blue Cross South), a nonprofit organization selling “fee for service” health insurance, 5 formed Health Net as an HMO and a nonprofit hospital service plan wherein providers would receive a flat monthly fee per patient regardless of the quantity of service *1050 rendered. The marketing advantage which precipitated the decision to establish an HMO stems from a federal requirement that employers offer employees a qualified HMO program if so requested.

Blue Cross spent a year and a half obtaining state and federal certification for Health Net. Under federal law, acquisition of such certification required Health Net to maintain an independent legal existence. (42 U.S.C. § 300e; 42 C.F.R. § 110.108(h).) To comply with then-applicable state procedures, Health Net, as a nonprofit corporation, was required to have “members” instead of shareholders. 6 To further define Health Net’s autonomy, Health Net’s articles of incorporation provided that the number, qualifications, property interests, and rights of members, inter alia, be set forth in the bylaws. 7 Health Net’s bylaws specified a single class of nine members “designated annually by the board of directors of Blue Cross of Southern California.” 8 Through 1982, Blue Cross appointed Health Net members, after consulting with Health Net executives. 9

Thus, the formal relationship between Health Net and Blue Cross as it existed at the inception of Health Net was reflected not in Health Net’s articles but in its bylaws. However, the relationship was also shaped by two written agreements, a finance agreement and a service agreement, both dated September 30, 1977. Each agreement was terminable on 120 days’ notice by either party. The finance agreement provided that funds advanced to Health Net by Blue Cross, to the extent that such were loans, were to be paid back by Health Net at the prime interest rate.

During the early years of Health Net’s life, officers and employees of Blue Cross also served on Health Net’s board of directors. Roger Greaves, the president of Health Net, was employed by Blue Cross when officials of Blue *1051 Cross suggested he become a Health Net director. Greaves was still employed by Blue Cross when he became president of Health Net.

At various times, Blue Cross officials represented to regulatory agencies that Health Net was a fully independent organization. In a certification application to the federal Office of HMO’s (OHMO), Blue Cross, together with Health Net, represented that the latter was an “independent legal entity” which would be directed by an “independent” board of directors and “managed” by individuals “employed by Health Net.” In order to convince OHMO officials of Health Net’s independence, the application also stated that “the number of Directors representing Blue Cross will be diminished, and Blue Cross Corporate Directors will comprise no more than 1/3 of Health Net’s Board of Directors.”

In applying for an exemption from the United States Internal Revenue Service (IRS), Blue Cross, again with Health Net, answered an IRS question of whether it was “connected in any way with any other organization” as follows: “Yes, Health Net has entered into a Service Agreement. . . and a Financial Agreement. . . with Blue Cross of So.

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Bluebook (online)
202 Cal. App. 3d 1043, 249 Cal. Rptr. 220, 1988 Cal. App. LEXIS 630, Counsel Stack Legal Research, https://law.counselstack.com/opinion/health-maintenance-network-v-blue-cross-of-southern-california-calctapp-1988.