Physician Care, P.C. v. Caremark, Inc.

16 F. Supp. 2d 806, 50 Fed. R. Serv. 640, 1998 U.S. Dist. LEXIS 12934, 1998 WL 518357
CourtDistrict Court, E.D. Michigan
DecidedAugust 20, 1998
Docket96-70039, 96-73598
StatusPublished
Cited by1 cases

This text of 16 F. Supp. 2d 806 (Physician Care, P.C. v. Caremark, Inc.) 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
Physician Care, P.C. v. Caremark, Inc., 16 F. Supp. 2d 806, 50 Fed. R. Serv. 640, 1998 U.S. Dist. LEXIS 12934, 1998 WL 518357 (E.D. Mich. 1998).

Opinion

MEMORANDUM OPINION & ORDER

GILMORE, District Judge.

I.

The present case, which has been before this Court on several prior motions, is basically about a joint business enterprise gone very wrong. The facts follow.

A.

Dr. Bruce Margulis (“Margulis”) is the sole shareholder, sole officer, and sole director of Physician Care, P.C. (“Physician Care”), a Michigan professional corporation. In the 1980s, Physician Care formed two Michigan general partnerships in conjunction with Caremark, Inc. (“Caremark”), a California corporation. The partnerships were known as: (1) Home Infusion Resources (“HIR Partnership”) and (2) Physician Health Resources (“PHR Partnership”)(jointly, the “Partnerships”). The business purpose of the Partnerships was to provide in-home medical supplies and care (i.e., home infusion services) in the state of Michigan. Physician Care was responsible for marketing and supervising the home infusion services. Care-mark, on the other hand, was responsible for the Partnerships’ billing and administrative activities. Caremark’s responsibilities included making payments to participating physicians, who were paid on a fee-for-service basis.

In 1986, Caremark entered into a Prescription Drug Program Agreement (“Prescription Agreement”) with Blue Cross Blue Shield of Michigan (“BCBSM”). The Prescription Agreement governed the Partnerships’ claims for pharmaceutical reimbursement for its BCBSM-insured clients. Under its terms, Caremark was to submit claims for pharmaceutical reimbursement at “net acquisition cost.”

B.

On April 1, 1991, Physician Care and Caremark entered into an agreement under which Physician Care sold its interest in the HIR Partnership to Caremark (“HIR Purchase Agreement”). 1 The PHR Partnership, 2 however, remained in existence until December 30, 1992, when the parties executed three agreements: (1) a Partnership Retirement Agreement (“PHR Retirement Agreement”); (2) an Employment Agreement (“Employment Agreement”); and (3) a Non-Competition Covenant (“Non-Competition Covenant”). Under the PHR Retirement Agreement, Physician Care agreed to retire from the PHR Partnership and Mar-gulis agreed to retire as its President. However, under the Employment Agreement, Margulis and Caremark agreed that Margu-lis would work for five years beginning January 1, 1993, as Caremark’s Director of Marketing of home infusion services in Michigan. In this capacity, Margulis was to earn an annual salary of $100,000, plus an annual award of 28,829 shares of Caremark stock. While Caremark reserved the right to terminate Margulis during the five-year term, the Employment Agreement provided that if such termination was without cause, the balance of Margulis’ salary and stock awards for the five-year term would immediately vest. Finally, under the Non-Competition Covenant, Caremark was to pay Physician Care $50,000 per year for five years not to compete with Caremark. Similarly, Care-mark was to pay Margulis $586,022.20 per year for five years not to compete with Care-mark.

*808 In April 1995, over two years after the dissolution of the PHR Partnership, Care-mark sold its home infusion business to Co-ram Health Care Corporation (“Coram”). It then entered into negotiations to terminate the Employment Agreement with Margulis, as his skills in marketing and supervising home infusion services were no longer required. However, as described below, those negotiations never came to fruition.

C.

In 1991, prior to the dissolution of the Partnerships, the Office of Inspector General (“OIG”) of the United States Department of Health and Human Services began a criminal investigation of Caremark’s health care enterprises nationwide, including the HIR and PHR Partnerships in Michigan. 3 As part of this investigation, the OIG investigated whether Caremark’s fee-for-serviee system disguised an elaborate kick-back scheme by which physicians were paid for patient referrals. In addition, it investigated whether Caremark, and the HIR and PHR Partnerships in particular, were seeking pharmaceutical reimbursement from BCBSM at “average wholesale price” rather than net acquisition cost, as required under the Prescription Agreement. 4

As a result of the OIG investigation, on June 15, 1995, Caremark pled guilty to two counts of mail fraud pursuant to a Rule 11 plea agreement. One count was brought by Information in the District of Minnesota and the second was brought by Information in the Southern District of Ohio. 5 In the combined Plea Agreement (“Caremark Plea”), 6 Caremark admitted making payments to doctors — under the guise of consulting agreements, research grants, joint venture and partnership agreements, supply agreements, marketing agreements, and professional services agreements — for and to induce patient referrals. It also pled guilty to defrauding the Federal Employees Health Benefits Program (“FEHBP”) and the Civilian Health and Medical Program of the Uniformed Services (“CHAMPUS”), to which it had submitted bills for the treatment of the illegally referred patients. Pursuant to Caremark’s Rule 11 plea agreement, Caremark paid $29 million in fines, $132 in civil penalties, and an additional $2 million to the Health Resources and Services Administration (“HRSA”). In exchange, Caremark received immunity from further prosecution for related wrongdoing nationwide. It is of particular relevance to the case at hand that in Attachment A to Caremark’s Rule 11 plea agreement, Care-mark specifically received immunity from prosecution for the “related offense” of its manner of billing BCBSM.

It is important to note that while Care-mark received immunity from prosecution for its billing practices, this immunity did not extend to Physician Care or Margulis. Rather, under Caremark’s Rule 11 plea agreement, the government expressly preserved its right to prosecute Caremark’s partners, employees, and physicians. In addition, Caremark agreed to cooperate with the ongoing OIG investigation.

D.

Margulis claims that the entry of the Care-mark Plea effectively ended an agreement between Caremark and Physician Care to respond cooperatively to the OIG investigation and to jointly defend the legality of their *809 business practices. Given the fact that Care-mark’s Rule 11 plea agreement did not extend immunity to Physician Care, Margulis states that he was left with “no choice” but to negotiate and authorize a Rule 11 plea agreement for Physician Care.

On August 10, 1995, Physician Care notified Caremark that it was negotiating a plea agreement with the United States Attorney for the Eastern District of Michigan. In addition, it notified Caremark that it was also negotiating a settlement agreement with BCBSM. Following a series of inquiries by Caremark, the essential elements of the proposed agreements were communicated to Caremark in a letter of September 22, 1995. Specifically, Physician Care informed Care-mark that

negotiations for a potential corporate plea for Physician Care ...

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16 F. Supp. 2d 806, 50 Fed. R. Serv. 640, 1998 U.S. Dist. LEXIS 12934, 1998 WL 518357, Counsel Stack Legal Research, https://law.counselstack.com/opinion/physician-care-pc-v-caremark-inc-mied-1998.