MedCost, L.L.C. v. Robert Loiseau, Special Deputy Receiver of American Benefit Plans

CourtCourt of Appeals of Texas
DecidedMay 26, 2005
Docket03-04-00489-CV
StatusPublished

This text of MedCost, L.L.C. v. Robert Loiseau, Special Deputy Receiver of American Benefit Plans (MedCost, L.L.C. v. Robert Loiseau, Special Deputy Receiver of American Benefit Plans) 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. Robert Loiseau, Special Deputy Receiver of American Benefit Plans, (Tex. Ct. App. 2005).

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-04-00489-CV

MedCost, L.L.C., Appellant

v.

Robert Loiseau, Special Deputy Receiver of American Benefit Plans, et. al., Appellee

FROM THE DISTRICT COURT OF TRAVIS COUNTY, 53RD JUDICIAL DISTRICT NO. GN304388, HONORABLE LORA J. LIVINGSTON, JUDGE PRESIDING

OPINION

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

1 Appellee is the Special Deputy Receiver for the following entities: American Benefit Plans; National Association of Working Americans a/k/a National Association for Working Americans; United Employers Voluntary Employees Beneficiary Association; United Employers Voluntary Employees Beneficiary Association I; Electronic Benefits Group, Inc.; Enhanced Health Management, Inc.; Four Corners Company, LLC a/k/a Four Corners Co. LLC, a/k/a Four Corners Corp.; American Association of Agriculture, Forestry and Fishing Workers; American Association of Transportation, Communication, Electrical, Gas and Sanitary Workers; American Association of Wholesale Trade Workers; American Association of Manufacturer Workers; American Association of Service Workers; American Association of Construction Workers; and American Association of Professional Workers. the entities in receivership (“the Neal entities”).2 The district court denied MedCost’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 insurers. 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.

2 Robert David Neal, a Texas resident, operated several fraudulent insurance companies based in Texas, including American Benefit Plans, United Employers Voluntary Employee Beneficiary Association, and National Association of Working Americans, all of which are now in receivership in Texas.

2 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,

3 The record reflects that MedCost terminated network access after MedCost had become aware of UltraMed’s connection to the Neal entities and of Neal’s having encountered legal problems in Texas concerning his health insurance businesses and after UltraMed had failed for the second time to pay fees for a period of several months. 4 MedCost’s policy is to disfavor coverage provided by coalitions of employees because it believes such arrangements are not legal in some states.

3 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 MedCost’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 the 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 Carolinas, the trial court properly held that MedCost is subject to personal jurisdiction in

Texas, where all the receivership entities are based.

5 Section 101.201(a) reads:

“. . . A person who in any manner assisted directly or indirectly in the procurement of the contract is liable to the insured for the full amount of a claim or loss under the terms of the contract if the unauthorized insurer fails to pay the claim or loss.”

Tex. Ins. Code § 101.201(a) (West Supp. 2004-05).

4 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,

Free access — add to your briefcase to read the full text and ask questions with AI

Related

International Shoe Co. v. Washington
326 U.S. 310 (Supreme Court, 1945)
World-Wide Volkswagen Corp. v. Woodson
444 U.S. 286 (Supreme Court, 1980)
Calder v. Jones
465 U.S. 783 (Supreme Court, 1984)
Helicopteros Nacionales De Colombia, S. A. v. Hall
466 U.S. 408 (Supreme Court, 1984)
Burger King Corp. v. Rudzewicz
471 U.S. 462 (Supreme Court, 1985)
American Type Culture Collection, Inc. v. Coleman
83 S.W.3d 801 (Texas Supreme Court, 2002)
BMC Software Belgium, NV v. Marchand
83 S.W.3d 789 (Texas Supreme Court, 2002)
Morris v. Kohls-York
164 S.W.3d 686 (Court of Appeals of Texas, 2005)
General Electric Co. v. Brown & Ross International Distributors, Inc.
804 S.W.2d 527 (Court of Appeals of Texas, 1991)
Hitachi Shin Din Cable, Ltd. v. Cain
106 S.W.3d 776 (Court of Appeals of Texas, 2003)
Schlobohm v. Schapiro
784 S.W.2d 355 (Texas Supreme Court, 1990)
Memorial Hospital System v. Fisher Insurance Agency, Inc.
835 S.W.2d 645 (Court of Appeals of Texas, 1992)
CSR LTD. v. Link
925 S.W.2d 591 (Texas Supreme Court, 1996)
Blair Communications, Inc. v. Ses Survey Equipment Services, Inc.
80 S.W.3d 723 (Court of Appeals of Texas, 2002)
Botter v. American Dental Ass'n
124 S.W.3d 856 (Court of Appeals of Texas, 2003)
Siskind v. Villa Foundation for Education, Inc.
642 S.W.2d 434 (Texas Supreme Court, 1982)
Pessina v. Rosson
77 S.W.3d 293 (Court of Appeals of Texas, 2001)
Kawasaki Steel Corp. v. Middleton
699 S.W.2d 199 (Texas Supreme Court, 1985)
National Industrial Sand Ass'n v. Gibson
897 S.W.2d 769 (Texas Supreme Court, 1995)

Cite This Page — Counsel Stack

Bluebook (online)
MedCost, L.L.C. v. Robert Loiseau, Special Deputy Receiver of American Benefit Plans, Counsel Stack Legal Research, https://law.counselstack.com/opinion/medcost-llc-v-robert-loiseau-special-deputy-receiv-texapp-2005.