In re Blue Cross Blue Shield Antitrust Litigation

238 F. Supp. 3d 1313, 2017 WL 713579, 2017 U.S. Dist. LEXIS 25370
CourtDistrict Court, N.D. Alabama
DecidedFebruary 23, 2017
DocketMaster File No.: 2:18-CV-20000-RDP (MDL No.: 2406)
StatusPublished

This text of 238 F. Supp. 3d 1313 (In re Blue Cross Blue Shield Antitrust Litigation) is published on Counsel Stack Legal Research, covering District Court, N.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re Blue Cross Blue Shield Antitrust Litigation, 238 F. Supp. 3d 1313, 2017 WL 713579, 2017 U.S. Dist. LEXIS 25370 (N.D. Ala. 2017).

Opinion

[1316]*1316MEMORANDUM OPINION

R. DAVID PROCTOR, UNITED STATES DISTRICT JUDGE

• This matter is before the court on the following cross motions for partial summary judgment: (1) Defendants’ Amended and Restated Motion Based on the Filed Rate Doctrine for Summary Judgment on the Alabama Subscribers’ Damages Claims (Doc. # 733); and (2) Alabama Subscriber Plaintiffs’‘ Cross-Motion for Partial Summary Judgment on the Filed-Rate Doctrine (Doc. # 770). The motions have been fully briefed. (Docs. # 734, 805, 835, 838, 839, 903, and 904).

I. Introduction

The Filed Rate Doctrine1 is judicially created and finds its origins in priri-[1317]*1317ciples of federal preemption. See Am. Tel. & Tel. Co, v. Cent. Office Tel., Inc., 524 U.S. 214, 222, 118 S.Ct. 1956, 141 L.Ed.2d 222 (1998); Louisville & Nashville R.B. Co. v. Maxwell, 287 U.S. 94, 97, 35 S.Ct. 494, 59 L.Ed. 853 (1915). In the antitrust context, it operates to bar treble damages claims that are based upon challenges to rates that have been filed with regulatory agencies, Keogh v. Chicago & Northwestern Railway Co., 260 U.S. 156, 43 S.Ct. 47, 67 L.Ed. 183 (1922); Square D Co. v. Niagara Frontier Tariff Bureau, Inc., 476 U.S. 409, 106 S.Ct. 1922, 90 L.Ed.2d 413 (1986); Taffet v. Southern Co., 967 F.2d 1483 (11th Cir. 1992); Hill v. BellSouth Telecommunications, Inc., 364 F.3d 1308 (11th Cir. 2004). Defendants contend that application of the doctrine entitles them to summary judgment on the damages claims asserted by the two named Subscriber Plaintiffs. Subscriber Plaintiffs respond that it is actually they who are entitled to judgment as- a matter of law on this affirmative defense because Blue Cross and Blue Shield of Alabama (“BCBSAL”) has systematically charged rates that varied from the rates they filed with the Alabama Department of Insurance (“DOI”). After careful review, and with the benefit of oral argument and supplemental briefing, the court concludes that both Motions are due to be granted in part and denied in part.

II. Relevant Undisputed Facts

Pursuant to Alabama Code § 10A-20-6.10, the Alabama DOI is tasked with reviewing certain insurance rates that are filed with it and either approving or disapproving them. (Doc. # 738-58 pp. 243-255; Doc. # 738-2 ¶ 19). The setting of BCBSAL’s rates is also governed by the Alabama Department of Insurance Regulation 482-1-116 (“Regulation 116”). Ala. DOI Reg. 482-1-116. (Doc. #738-82). BCBSAL is the only defendant in this action that has filed rates with the DOI. No other “Blue” filed rates in Alabama with the DOI-. (Doc. # 738-58 pp. 125-26).

On an annual basis, BCBSAL submits rate filings for each insurance product in each of three market segments: individual policies, group policies with 2-14 eligible employees, and group policies with 15-50 eligible employees. Regulation 116 does not require the filing of rates for group policies which cover more than 50 eligible employees. Ala. DOI Reg. 482-1-116. (Doc. # 738-82). The purpose of DOI filings is to set forth the rating factors used to determine “reasonable” rates. (Doc. #738-58 pp. 87, 88-89, 90-91; Doc. # 773-10 pp. 63, 64-66).2BCBSAL has employed rating classifications for its group insurance products as follows: (a) for groups of 2-14, BCBSAL has applied a “community-rating” methodology, and adjusts base rates using benefit plan arid group-size adjustment factors (see Doc. # 738-2 ¶¶ 14-18; Doc. #738-68; Doc. #773-5); (b) for groups of 15-50, BCBSAL has applied a “demographic-rating” methodology, and adjusts base rates, using demographic adjustment factors (such as gender and age); and (c) for groups of 50 or more, BCBSAL has applied an" “experience-rating,” or “merit-rating,” methodology, adjusting base rates using the claims experience of each group (see Doc. # 738-68; Doc. # 738-58 p. 282).

Regulation 116 defines a “small employer” based upon the number of “eligible employees” who work 30 or more hours per week. Ala. DOI Reg. 482—1—116—.04(18) (Doc. # 738-87). During the relevant time period, BCBSAL did not define or measure its groups based on the number of [1318]*1318“.eligible employees.” (Doc. #773-10 pp. 73-75, 77-80). Instead, BCBSAL defined its groups based on the number of “enrolled subscribers,” or the number of employees who opted to purchase insurance under the employer’s plan. (Id). That is, rather than counting all “eligible employees” pursuant to Regulation 116, BCBSAL classified groups based only on those who actually enrolled in a given plan. (Id). This is an important distinction because smaller size rating classifications are generally associated with higher insurance premiums. For example, in BCBSAL’s 2011 small group rate filing, groups with fewer than 15 enrolled subscribers had a rate adjustment factor of 1.15, whereas groups with 15 to 50 enrolled subscribers had a rate adjustment factor of 1.00. In other words, the smallest groups paid premiums that were 15% higher than the larger groups. (Doc. # 738-68; Doc. # 775-23).

Rate filings made with the DOI are required to contain an actuarial certification that the carrier is in compliance with the governing regulations and that the rating methods are actuarially sound. See Ala. DOI Reg. 482-l-116-.05(g)(2). (Doc. # 738-87). In its Small Group rate filings with the DOI from 2008 through 2013, BCBSAL certified that “[a]ll premium rates for this [Small Group] category have been developed in compliance with the Alabama Department of Insurance Departmental Regulation No. 482-1-116.” (Doc. # 738-82).

In a May 3, 2016 report regarding BCBSAL’s 2013 Medical Loss Ratio, the Centers of Medicaid and Medicare Services (“CMS”) found a “lack of accurate documentation supporting group size and market classification determinations,” which prevented CMS from (1) assessing BCBSAL’s medical loss ratios and (2) determining whether BCBSAL could face rebate liability in its small group or large group markets. (Doc. # 738-77 p. 4; Doc. # 738-58 pp. 162-63). As CMS explained: “The Company did not correctly obtain the number of employees of each group policyholder at the time of initial application or policy renewal and therefore could not correctly determine each group’s size and market classification.” (Doc. #738-77 pp. 5, 10). Further, the CMS found that, “[i]n addition to not employing procedures to correctly determine the number of employees,” BCBSAL “did not consistently assign policies to the correct market classification. ...” (Doc. # 738-77 p. 10). The CMS also found examples of group policies “incorrectly classified as small group policies” that “should have been reported in the large group market.” (Id).

As to the DOI’s evaluation of the rates filed with it, the only “test” for whether the DOI should approve a rate filing is “reasonableness,” and, somewhat surprisingly, there are no written standards for determining whether a proposed rate is “reasonable.” (Doc. # 738-58 pp. 61-62, 63-64; Doc. # 738-65).

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Bluebook (online)
238 F. Supp. 3d 1313, 2017 WL 713579, 2017 U.S. Dist. LEXIS 25370, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-blue-cross-blue-shield-antitrust-litigation-alnd-2017.