Medcost, L.L.C. v. Loiseau

166 S.W.3d 421, 2005 Tex. App. LEXIS 3992, 2005 WL 1241090
CourtCourt of Appeals of Texas
DecidedMay 26, 2005
Docket03-04-00489-CV
StatusPublished
Cited by19 cases

This text of 166 S.W.3d 421 (Medcost, L.L.C. v. Loiseau) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Medcost, L.L.C. v. Loiseau, 166 S.W.3d 421, 2005 Tex. App. LEXIS 3992, 2005 WL 1241090 (Tex. Ct. App. 2005).

Opinions

OPINION

Opinion by

Justice PURYEAR.

Appellant MedCost, a preferred provider organization (“PPO”), filed a special appearance in this action concerning the receivership of certain health insurance companies after the receiver, appellee Robert Loiseau,1 joined MedCost as a defendant to collect for claims made against the entities in receivership (“the Neal entities”).2 ■ The district court denied Med-Cost’s special appearance, and this interlocutory appeal followed. Because we hold that the district court cannot properly exercise personal jurisdiction over MedCost, we will reverse the judgment.

BACKGROUND

MedCost is a Delaware corporation with its principal place of business in North Carolina. As ■ a PPO, it organizes and maintains a network made up of lists of health care providers practicing only in North and South Carolina who agree to provide services at pre-negotiated rates to clients of the PPO. MedCost sells its PPO lists to larger PPO organizations, which provide the lists to employers and health [425]*425insurers. MedCost does not handle claims for health care recipients or providers and does not provide health insurance.

MedCost contracted with American Healthcare Alliance (“AHA”), a national PPO based in Missouri, giving AHA access to MedCost’s North and South Carolina networks. AHA independently contracted with Progressive Administrators Resources (“PAR”), a third-party administrator in California, giving PAR access to the AHA network, which, through AHA’s contract with MedCost, included MedCost’s network. UltraMed, an Oklahoma entity, contracted with PAR for third-party administrator services and claims processing and American Benefits Plan (ABP), one of the Neal entities based in Texas, to pay the networks and route claims.

ABP provided the UltraMed Choice Health Plan to its insureds, including residents of the Carolinas. The card issued by the UltraMed Choice Health Plan indicated that the insurance was sponsored by the National Association of Working Americans (“NAWA”) and referenced the United Employers Voluntary Employers Beneficiary Association (“UEVEBA”) and PAR. ABP, NAWA, and UEVEBA are all Texas entities with their principal places of business in the Dallas-Fort Worth area.

MedCost did not enter into contracts with UltraMed, ABP, NAWA, UEVEBA, or Neal, but it did approve the UltraMed insurance identification card for use in its network in the Carolinas. It received $3 monthly from AHA for each of the 379 individual insureds in the Carolinas who enjoyed access to the MedCost network through the NAWA UltraMed plan. They and the health care providers suffered losses when the NAWA UltraMed coverage turned out to be worthless. The Texas companies were ultimately placed into receivership, and MedCost terminated access to its network,3 issuing an internal email reporting that the coverage should have raised a “red flag” from the beginning because UltraMed was a coalition of employees.4

Robert Loiseau is the receiver for ABP, NAWA, and UEVEBA, as well as other companies. The receivership court found that these companies engaged in improper insurance practices by creating, marketing, and selling unauthorized health insurance plans, collecting money, and failing to pay claims. When the Texas companies went into receivership, the Receiver was charged with paying claims of insureds and providers, including those within Med-Cost’s network. North and South Carolina insureds with claims against ABP and related companies in receivership have assigned their claims to the Receiver. Various departments of insurance in states where ABP and related entities offered insurance decided it would be easier and cheaper to handle all these claims in one state, Texas, because the largest number of ABP insureds and claims come from this state and because the Neal entities were based here. None of the claims of Texan insureds or claims originating in Texas involved MedCost’s networks. The Receiver has filed suit against MedCost seeking damages under section 101.201 of the Texas Insurance Code for assisting in [426]*426the procurement of the illegal insurance contracts.5

MedCost filed a special appearance, which the district court denied after a hearing. MedCost appeals that denial, claiming that it does not have minimum contacts with Texas sufficient to confer personal jurisdiction upon Texas. The Receiver counters that, because MedCost’s contracts facilitated the Texas-based entities’ providing illegal health insurance to users of MedCost’s network in the Car-olinas, the trial court properly held that MedCost is subject to personal jurisdiction in Texas, where all the receivership entities are based.

DISCUSSION

Standard of Review

Whether a court has personal jurisdiction over a defendant is a question of law, which we review de novo. American Type Culture Collection, Inc. v. Coleman, 83 S.W.3d 801, 805-06 (Tex.2002); BMC Software Belg., N.V. v. Marchand, 83 S.W.3d 789, 794 (Tex.2002). However, where the trial court issues findings of fact and conclusions of law h. denying a special appearance, the conclusions of law are reviewed de novo and challenged fact findings are reviewed under no-widence and insufficient evidence standards for legal and factual sufficiency. Marchand, 83 S.W.3d at 794; Botter v. American Dental Ass’n, 124 S.W.3d 856, 861 (Tex.App.-Austin 2003, no pet.). In this case, MedCost argues that the court’s findings of fact and conclusions of law are factually and legally insufficient to confer jurisdiction.6 We assume for purposes of this analysis that the court’s findings of fact are supported by sufficient evidence, but because we hold that the court’s conclusions of law are erroneous, we must reverse and need not decide the sufficiency of the evidence supporting the fact findings.

Jurisdiction

Texas courts may exercise jurisdiction over nonresident defendants if the Texas long-arm statute authorizes the exercise of jurisdiction and that exercise is consistent with federal and state standards of due process. Guardian Royal Exch. Assurance, Ltd. v. English China Clays, P.L.C., 815 S.W.2d 223, 226 (Tex.1991); Botter, 124 S.W.3d at 861. The Texas long-arm statute permits courts to exercise personal jurisdiction over a nonresident defendant when such power is permitted by the federal constitutional requirements of due process. Tex. Civ. Prac. & Rem. Code Ann. §§ 17.041-.045 (West 1997); Marchand, 83 S.W.3d at 795; Pessina v. Rosson, 77 S.W.3d 293, 297 (Tex.App.-Austin 2001, pet. denied) (broad language of statute permits expansive reach limited only by federal requirements of due process). Federal standards of due process require that (1) the defendant has purposefully established minimum contacts with Texas, and (2) the exercise of jurisdiction comports with traditional notions of fair play and substantial justice. Burger King Corp. v. Rudzewicz, 471 U.S. 462, 475-76, 105 S.Ct. 2174, 85 L.Ed.2d 528 (1985); Marchand, 83 S.W.3d at 795 (citing International Shoe Co. v. Washington, 326 U.S.

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Medcost, L.L.C. v. Loiseau
166 S.W.3d 421 (Court of Appeals of Texas, 2005)

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Bluebook (online)
166 S.W.3d 421, 2005 Tex. App. LEXIS 3992, 2005 WL 1241090, Counsel Stack Legal Research, https://law.counselstack.com/opinion/medcost-llc-v-loiseau-texapp-2005.