Hi-Lex Controls, Inc. v. Blue Cross and Blue Shield of Mich.

751 F.3d 740, 58 Employee Benefits Cas. (BNA) 1201, 2014 WL 1910554, 2014 U.S. App. LEXIS 8949
CourtCourt of Appeals for the Sixth Circuit
DecidedMay 14, 2014
Docket13-1773, 13-1859
StatusPublished
Cited by32 cases

This text of 751 F.3d 740 (Hi-Lex Controls, Inc. v. Blue Cross and Blue Shield of Mich.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hi-Lex Controls, Inc. v. Blue Cross and Blue Shield of Mich., 751 F.3d 740, 58 Employee Benefits Cas. (BNA) 1201, 2014 WL 1910554, 2014 U.S. App. LEXIS 8949 (6th Cir. 2014).

Opinion

OPINION

SILER, Circuit Judge.

The Hi-Lex corporation, on behalf of itself and the Hi-Lex Health & Welfare Plan, filed suit in 2011 alleging that Blue Cross Blue Shield of Michigan (BCBSM) breached its fiduciary duty under the Employee Retirement Income Security Act of 1974 (ERISA) by inflating hospital claims with hidden surcharges in order to retain additional administrative compensation. The district court granted summary judgment to Hi-Lex on the issue of whether BCBSM functioned as an ERISA fiduciary and whether BCBSM’s actions amounted to self-dealing. A bench trial followed in which the district court found that HaLex’s claims were not time-barred and that BCBSM had violated ERISA’s general fiduciary obligations under 29 U.S.C. § 1104(a). The district court also awarded pre- and post-judgment interest. We AFFIRM.

*743 I.

Hi-Lex is an automotive supply company with approximately 1,300 employees. BCBSM is non-profit entity regulated by the state of Michigan that contracts to serve as a third-party administrator (TPA) for companies and organizations that self-fund their health benefit plans.

Since 1991, BCBSM has been the contracted TPA for Hi-Lex’s Health and Welfare Benefit Plan (Health Plan). The terms under which BCBSM served as the Health Plan’s TPA are set forth in two Administrative Services Contracts (ASCs) the parties entered into in 1991 and 2002, respectively. The parties renewed those terms each year from 1991 to 2011 by executing a “Schedule A” document.

Under the ASCs, BCBSM agreed to process healthcare claims for Hi-Lex’s employees and grant those employees access to BCBSM’s provider networks. In exchange for its services, BCBSM received compensation in the form of an “administrative fee” — an amount set forth in the Schedule A on a per employee, per month basis.

In 1993, BCBSM implemented a new system whereby it would retain additional revenue by adding certain mark-ups to hospital claims paid by its ASG clients. These fees were charged in addition to the “administrative fee” that BCBSM collected from Hi-Lex under a separate portion of the ASC. Thus, regardless of the amount BCBSM was required to pay a hospital for a given service, it reported a higher amount that was then paid by the self-insured client. The difference between the amount billed to the client and the amount paid to the hospital was retained by BCBSM. This new system was termed “Retention Reallocation.”

The fees involved in this new system have been termed “Disputed Fees” by the district court. They include:

A. Charges for access to the Blue Cross participating provider and hospital network (Provider Network Fee);
B. Contribution to the Blue Cross contingency reserve (contingeney/risk fee);
C. Other Than Group subsidy (OTG fee); and
D. a retiree surcharge.

Hi-Lex asserts that it was unaware of the existence of the Disputed Fees until 2011, when BCBSM disclosed to the company in a letter the existence of the fees and described them as “administrative compensation.”

Following the disclosure, Hi-Lex sued BCBSM, alleging violations of ERISA as well as various state law claims. The district court dismissed the company’s state law claims as preempted, but granted HiLex summary judgment on its claim that BCBSM functioned as an ERISA fiduciary and that BCBSM had violated ERISA by self-dealing. Furthermore, after a nine-day bench trial, the district court ruled that BCBSM had violated its general fiduciary duty under § 1104(a) and that HiLex’s claims were not time-barred. The court awarded Hi-Lex $5,111,431 in damages and prejudgment interest in the amount of $914,241.

BCBSM asserts that the district court erred by (1) finding the company was an ERISA fiduciary, (2) ruling that BCBSM had breached its fiduciary duty under ERISA § 1104(a), (3) holding that BCBSM had conducted “self-dealing” in violation of ERISA § 1106(b)(1), and concluding that Hi-Lex’s claims were not time-barred. Hi-Lex cross-appealed, arguing that the district court abused its discretion by or *744 dering an insufficient prejudgment interest award.

II.

We review a district court’s summary judgment rulings de novo. Pipefitters Local 636 Ins. Fund v. Blue Cross & Blue Shield of Mich., 722 F.3d 861, 865 (6th Cir.2013) (Pipefitters IV). The same standard applies when this court reviews “a district court’s determination regarding ERISA-fiduciary status.” McLemore v. Regions Bank, 682 F.3d 414, 422 (6th Cir.2012). After a bench trial, a court’s legal conclusions are reviewed de novo while its factual findings are reviewed for clear error. James v. Pirelli Armstrong Tire Corp., 305 F.3d 439, 448 (6th Cir.2002).

III.

A. BCBSM’s ERISA Fiduciary Status

A threshold issue in this case is whether BCBSM functioned as an ERISA fiduciary for Hi-Lex’s Health Plan. In relevant part, ERISA provides that

a person is a fiduciary with respect to a plan to the extent (i) he exercises any discretionary authority or discretionary control respecting management of such plan or exercises any authority or control respecting management or disposition of its assets, ... or (iii) he has any discretionary authority or discretionary responsibility in the administration of such plan.

29 U.S.C. § 1002(21)(A) (emphasis added). The term person is defined broadly to include a corporation such as BCBSM. Id. § 1002(9). In Briscoe v. Fine, we found this statute “impose[d] fiduciary duties not only on those entities that exercise discretionary control over the disposition of plan assets, but also impose[d] such duties on entities or companies that exercise ‘any authority or control’ over the covered assets.” 444 F.3d 478, 490-91 (6th Cir.2006). Applying that standard, we recently held that BCBSM functioned as an ERISA fiduciary when it served as a TPA for a separate client under the same ASC terms at issue here. See Pipefitters PV, 722 F.3d at 865-67. In that case, we found that BCBSM functioned as an ERISA fiduciary with respect to hidden OTG fees that it unilaterally added to hospital claims subsequently paid by the Pipefitters Fund. Id. at 866-67.

BCBSM argues that the decisions in McLemore, 682 F.3d at 422-24, and Seaway Food Town, Inc. v. Med. Mut. of Ohio, 347 F.3d 610

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751 F.3d 740, 58 Employee Benefits Cas. (BNA) 1201, 2014 WL 1910554, 2014 U.S. App. LEXIS 8949, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hi-lex-controls-inc-v-blue-cross-and-blue-shield-of-mich-ca6-2014.