Humana Insurance v. LeBlanc

524 F. Supp. 2d 764, 2007 U.S. Dist. LEXIS 80741
CourtDistrict Court, M.D. Louisiana
DecidedOctober 31, 2007
DocketCivil Action 07-594, 07-532
StatusPublished

This text of 524 F. Supp. 2d 764 (Humana Insurance v. LeBlanc) is published on Counsel Stack Legal Research, covering District Court, M.D. Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Humana Insurance v. LeBlanc, 524 F. Supp. 2d 764, 2007 U.S. Dist. LEXIS 80741 (M.D. La. 2007).

Opinion

RULING ON APPLICATIONS FOR PRELIMINARY AND PERMANENT INJUNCTION AND DECLARATORY JUDGMENT

RALPH E. TYSON, Chief Judge.

Before the Court are the Applications for Preliminary Injunction (Docs. No. 6 and 62) and request for declaratory relief filed on behalf of Plaintiffs United Healthcare Insurance Company (“United”), Hu-mana Insurance Company, and Humana Health Benefit Plan of Louisiana, Inc. (Collectively “Humana”). Jurisdiction is based upon federal question, 28 U.S.C. § 1331, 28 U.S.C. § 1343 and 42 U.S.C. § 1983, since the parties assert constitutional claims under the Contracts Clause and the Commerce Clause as well as claims of Due Process violations. Further, United seeks declaratory relief pursuant to 28 U.S.C. § 2201. Venue is proper in this district since defendants Jerry Luke Le-Blanc and Tommy D. Teague maintain their offices in this district, and the events giving rise to this litigation occurred in this district.

*768 The court received testimony and physical evidence in this matter at hearings that were conducted over the course of five (5) days between September 14 and October 12, 2007. Now, having reviewed the submissions of the parties and the pertinent law, the Court finds that Plaintiffs’ requests for injunctive relief and declaratory judgment should be GRANTED.

I. BACKGROUND

This is a consolidated action for preliminary and permanent injunctive relief and declaratory judgment. United is a Connecticut healthcare corporation doing business in the State of Louisiana. Humana Insurance Company is a business corporation with its principal place of business in the state of Kentucky that is authorized to do business in the State of Louisiana. Hu-mana Health Benefit Plan of Louisiana, Inc. is a health maintenance organization under the laws of the State of Louisiana, with its principal place of business in the State of Louisiana.

Both Humana and United have entered into contractual agreements with the Office of Group Benefits (“OGB”), an executive branch agency within the Division of Administration of the Office of the Governor of the State of Louisiana. 1 The OGB procures and administers benefits for state employees, their dependents, and state retirees (“Participants”) in nine separate specifically defined regions of the state. Defendant Tommy D. Teague serves as the Chief Executive Officer for the OGB. Mr. Teague serves at the pleasure of defendant, Jerry Luke LeBlanc, who serves as the Commissioner of Administration for the State of Louisiana. 2

Until the 2006-2007 fiscal year, the benefit plans offered in each of the State’s nine regions consisted of three self-insured options and one fully-insured option 3 :

(1) Preferred Provider Organization (“PPO Plan”), a self-insured plan; 4
(2) Exclusive Provider Organization (“EPO Plan”) a self-insured plan;
(3) Managed Care Organization (“MCO Plan”), a self-insured plan; and
(4) Health Maintenance Organization (“HMO Plan”), a fully-insured plan.

Prior to 2006, Humana, Vantage Health Plan (“Vantage”) 5 , and others underwrote the OGB’s fully-insured HMO plan. However, beginning July 1, 2006, Humana administered the HMO option as a self-insured option in Regions 1-8 while Vantage provided the fully-insured HMO option only to plan participants in Region 9.

In 2006, during the time the OGB offered both a self-insured and fully-insured HMO option for its participants, it enlisted the actuarial advice of Mercer Health & Benefits, LLC. (“Mercer”), an independent consulting group. The State retained Mercer to perform studies to determine whether it could reduce and better manage *769 its costs for insurance coverage by self-insuring all of its medical coverage. The study revealed that the State could save an estimated $29.1 million, or approximately 11 percent, by switching most of its insureds to a self-funded benefit program. 6

Following the recommendation of Mercer, on August 28, 2006, the OGB publicly issued a Notice of Intent to Contract (“NIC”) for Administrative Services Only (“ASO”) for its EPO and HMO plans (for fiscal year 2006-2007). Around the same time, the OGB issued an additional NIC for the new Medicare Advantage Plan that it intended to offer participants in fiscal year 2007-2008.

On January 12, 2007, after a statewide competitive bidding process, the OGB accepted a bid from Humana to provide ASO for the OGB’s self-insured HMO plan. The OGB additionally contracted with Hu-mana to provide fully-insured Medicare Advantage plans to all OGB Medicare eligible retirees. United was awarded the contract as the ASO provider for the EPO benefit plan for the plan year beginning July 1, 2007. Vantage did not participate in the ASO NIC bid; and although it participated in the Medicare Advantage bid, it lost the bid to Humana.

On April 18, 2007, Louisiana State Representative Charles McDonald pre-filed House Bill 247 of the 2007 Regular Session of the Louisiana Legislature. Representative Francis Thompson co-authored the bill. The bill mandated that the OGB solicit proposals from and award fully-insured contracts to up to three “Louisiana HMOs” 7 in each of the state’s nine regions, defining the term “Louisiana HMOs” to exclude companies such as Hu-mana and United. Both legislative chambers ultimately passed House Bill 247 and sent it to Governor Blanco for executive action.

On July 19, 2007, Governor Kathleen Blanco signed House Bill 247 into law as Act 479 (2007) (“the Act”), which amended La. R.S. 42:802(B)(6) and enacted R.S. 42:802.1.

On July 27, 2007, United filed a complaint against Governor Blanco alleging that Act 479 violated the Contract and Commerce clauses as well as the Fifth and Fourteenth Amendments. On these premises, United sought several forms of relief: a declaratory judgment holding that Act 479 is unconstitutional, preliminary and permanent injunctive relief, and attorney’s fees.

On August 1, 2007, pursuant to the provisions of Act 479, OGB publicly issued two Notices of Intent to Contract: one for a fully-insured HMO and a second for a Medicare Advantage Plan. The NICs requested proposals from any Louisiana HMO to provide fully-insured HMO coverage on a regional basis, as well as to provide Medicare Advantage HMO coverage on a statewide basis.

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524 F. Supp. 2d 764, 2007 U.S. Dist. LEXIS 80741, Counsel Stack Legal Research, https://law.counselstack.com/opinion/humana-insurance-v-leblanc-lamd-2007.