Lifeline Ltd. No. II v. Connecticut General Life Insurance

821 F. Supp. 1201, 1993 U.S. Dist. LEXIS 6705, 1993 WL 172662
CourtDistrict Court, E.D. Michigan
DecidedMarch 15, 1993
Docket92-CV-74752
StatusPublished
Cited by5 cases

This text of 821 F. Supp. 1201 (Lifeline Ltd. No. II v. Connecticut General Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lifeline Ltd. No. II v. Connecticut General Life Insurance, 821 F. Supp. 1201, 1993 U.S. Dist. LEXIS 6705, 1993 WL 172662 (E.D. Mich. 1993).

Opinion

OPINION AND ORDER

FEIKENS, District Judge.

Background

Plaintiff Lifeline Limited No. II (“Lifeline”) files suit against defendants Connecticut General Life Insurance Company (“Conn Gen”), Preferred Health Care Corporation (“PHC”), Joseph L. Posch, Jr., (“Posch”), and James Kinville (“Kinville”) alleging two counts of tortious interference with business expectancy and one count of restraint of trade in violation of § 1 of the Sherman Act, 15 U.S.C. § 1.

Defendant Conn Gen is under contract with non-party General Motors Corporation (“GM”) to perform certain delegated administrative functions on behalf of and as agent for GM as the plan administrator of the GM benefit plan (“plan”). 1 Such a plan is an *1204 employee welfare plan as defined under the Employee Retirement Income Security Act of 1974 (“ERISA”), as amended, 29 U.S.C. §§ 1001 et seq. Conn Gen administers the GM substance abuse benefit plan; GM employees and their dependents are beneficiaries under the benefit plan. As an agent for GM, Conn Gen contracts with health care providers who render the substance abuse treatment (“contract providers”).

Defendant PHC is under contract with GM to perform the service of reviewing and assessing proposed contract providers; PHC does not perform the actual contracting with plan providers. PHC recommends to Conn Gen those health care providers with which the benefit plan should contract. Defendant Kinville is an employee of PHC and is in charge of administering the substance abuse benefits program for GM. Defendant Posch is president and chief executive officer of non-party Doctors Hospital.

Plaintiff Lifeline provides inpatient treatment for persons addicted to cocaine and other chemicals. Lifeline is an Illinois limited partnership with its principal place of business in Illinois. Lifeline subcontracts with health care providers who are contract providers. Doctors Hospital, a contract provider, was the facility through which Lifeline last provided service under the benefit plan. Prior to Doctors Hospital, Lifeline subcontracted to provide substance abuse treatment at non-party Kern Hospital beginning in April 1987, changed to non-party Northwest General Hospital in April 1988, and then transferred to Doctors Hospital after June 1990. Lifeline’s relationship with Doctors Hospital ended in May 1992. After the termination of the Lifeline/Doctors Hospital relationship, Doctors Hospital continued as a contract provider.

Meanwhile, in June 1991, Lifeline contracted with non-party Michigan Health Center (“MHC”) to perform treatment at that facility knowing that MHC was not a contract provider. Even though Lifeline was continuing to provide in-patient substance abuse treatment at Doctors Hospital, it sought to have MHC approved as a contract provider. At the time Lifeline terminated its relationship with Doctors Hospital, it knew that MHC had not been approved as a contract provider. MHC is still not a contract provider. Plaintiff alleges, among other things, that defendants conspired to deny MHC contract provider-status. In effect, plaintiff would like this court to order Conn Gen and PHC to enter into a contract with MHC even though MHC is not a party to this suit. If this court were to order Conn Gen and PHC to contract with MHC, then because of MHC’s contract with Lifeline, Lifeline would be able to enjoy the benefits of the substance abuse treatment program of the GM plan.

Before me are defendant Conn Gen’s motion to dismiss, defendants PHC and Kin-ville’s joint motion to dismiss, and defendant Posch’s motion to dismiss plaintiffs claims of tortious interference with business expectancy (patients) [Count I], tortious interference with business expectancy (MHC) [Count II], and antitrust violation (restraint of trade) [Count III]. The parties have submitted three sets of briefs, and two sessions of oral arguments have been held. For the reasons explained below, I grant defendants’ motions to dismiss in part. I grant defendants’ motions to dismiss with regard to the antitrust count, but I decline to grant defendants’ motions to dismiss with regard to the counts of tortious interference.

Analysis

A. Antitrust Claim

The essential elements of a violation of § 1 of the Sherman Act are: (1) a contract, combination, or conspiracy (concerted action); (2) affecting interstate commerce; (3) which imposes an unreasonable restraint of trade; and (4) proximately causes an injury of the type that the antitrust laws were designed to prevent. Atlantic Richfield Co. v. U.S.A. Petroleum Co., 495 U.S. 328, 110 S.Ct. 1884, 109 L.Ed.2d 333 (1990); White & White, Inc. v. American Hospital Supply Corp., 723 F.2d 495, 504 (6th Cir.1983). Further, except for certain claims alleging horizontal price fixing, cases in the health care and health insurance fields are generally analyzed under the rule of reason rather than

*1205 the illegal per se rule. 2 Accordingly, Lifeline’s claim shall be analyzed under the rule of reason.

1. Concerted Action

Plaintiff must prove that defendants acted pursuant to a contract, combination, or conspiracy to restrain trade. A conspiracy requires at least two distinct entities capable of conspiring. Copperveld Corp. v. Independence Tube Corp., 467 U.S. 752, 104 S.Ct. 2731, 81 L.Ed.2d 628 (1984).

Further, a conspiracy can be proved either by direct evidence of agreement or circumstantial evidence. If proved circumstantially, there must be a plausible, economically rational motive to conspire. The circumstantial evidence must be sufficient to allow a rational jury to conclude that the challenged action was the product of a conspiracy, rather than a unilateral decision. Arnold Pontiac—G.M.C. v. Budd Baer, Inc., 826 F.2d 1335, 1338 (3d Cir.1987).

With the use of witnesses and documents, plaintiff claims it can prove that Conn Gen and PHC are economically distinct entities which have independent roles to play with respect to the administration of the GM benefit plan. Plaintiff claims it can show that the reason why defendants Conn Gen and PHC did not give MHC contractor provider status was to retaliate, not against MHC, but against plaintiff Lifeline because of Lifeline’s patient advocacy.

However, defendants Conn Gen and PHC are agents of the same principal—GM. They are imbued with the common purpose of reviewing and assessing proposed providers with Conn Gen having the final authority to appoint plan providers.

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Lifeline Ltd. No. II v. Connecticut General Life Insurance
821 F. Supp. 1213 (E.D. Michigan, 1993)

Cite This Page — Counsel Stack

Bluebook (online)
821 F. Supp. 1201, 1993 U.S. Dist. LEXIS 6705, 1993 WL 172662, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lifeline-ltd-no-ii-v-connecticut-general-life-insurance-mied-1993.