Total Benefit Services, Inc. v. Group Insurance Administration, Inc.

875 F. Supp. 1228, 1995 U.S. Dist. LEXIS 1611
CourtDistrict Court, E.D. Louisiana
DecidedFebruary 8, 1995
DocketCiv. A. 92-2386
StatusPublished
Cited by3 cases

This text of 875 F. Supp. 1228 (Total Benefit Services, Inc. v. Group Insurance Administration, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Total Benefit Services, Inc. v. Group Insurance Administration, Inc., 875 F. Supp. 1228, 1995 U.S. Dist. LEXIS 1611 (E.D. La. 1995).

Opinion

MEMORANDUM AND ORDER

VANCE, District Judge.

This is an action asserting claims under the federal antitrust laws and various state law theories by Total Benefit Services, Inc. (“TBS”), a provider of health care financing services. Defendants are Robert H. Carter, III (“Carter”) and two entities affiliated with Carter, Group Insurance Administration of Louisiana, Inc. (“GIA-LA”), and Group Insurance Administration, Inc. (“GIA”). These entities likewise provide health care financing services. This matter is now before the Court on defendants’ motions for partial summary judgment on the antitrust claims, voluntary dismissal of their counterclaim, and dismissal for lack of subject matter jurisdiction of the state law claims. The Court heard oral argument on the motions. Following the arguments, the Court granted the motions, with written reasons to follow. The following reasons underlie the Court’s decision.

I. Factual Background

TBS is a Louisiana corporation that engages in various aspects of the health care financing business. Its principals, A. Michael Lawrence and Sandra DeBlanc, purchased the business in 1989 for $60,000. TBS provides claims administration and reinsurance brokerage services primarily to entities that provide self-insured health benefit plans to their employees. Through subcontractors, TBS also offers preferred provider organization (“PPO”) networks to its customers.

Defendant GIA-LA is likewise a Louisiana corporation that provides various' forms of health care financing services, including its own PPO. GIA-LA markets claims administration services alone and in conjunction with its PPO services. GIA-LA also offers a health maintenance organization (“HMO”) through a subcontractor and indemnity-style health insurance through a joint venture.

Defendant GIA is an Illinois corporation that provides health care financing services in several parts of the United States. Carter is the president of both GIA and GIA-LA. At the time this lawsuit was filed, Carter owned 100% of GIA-LA and 95% of GIA. In a January 1993 reorganization, Carter formed a holding company, GIA-USA, which owns 100% of GIA-LA and 95% of GIA. Carter owns 95% of the voting stock of the holding company.

*1232 This lawsuit arises out of the parties’ involvement in the City of New Orleans’ employee health benefit plan. TBS was the successful low bidder on a contract to serve as the third party administrator of the city’s self-funded health care plan. As a third party administrator (“TPA”), TBS receives claims, determines whether and to what extent charges are reimbursable by the city, and writes checks on a city bank account in payment of claims. In January 1992, the city also hired GIA-LA to provide discounted health care services to city employees through its PPO network. Under the system adopted, TBS and GIA-LA were required to work together to administer claims under the city’s health care plan. Claims went first to GIA-LA for repricing based on the city’s discount, then to TBS for eligibility determination. TBS then paid GIA-LA for claims due its PPO providers, from which GIA-LA deducted fees due it as administrator of the PPO. The dual system of administration proved cumbersome, and it was plagued by mistakes and delays. Both parties blamed these administrative problems on each other.

Indeed, the gravamen of plaintiffs claims in this case is that defendants and co-conspirators, including former Mayor Sidney Bartholemy and Cheryl Cramer, a member of the Orleans Parish School Board, conspired to create delays and other difficulties in the administration of the city’s plan to make plaintiff look bad. Plaintiff further alleges that the conspirators spread false information about plaintiffs services and generated adverse publicity about its business in order to eliminate plaintiff as a competitor for third party administration services to be provided to governmental and quasi-governmental health plans in the New Orleans area. Plaintiff claims that this alleged conspiracy violated Section 1 of the Sherman Act. See 15 U.S.C. § 1. Additionally, plaintiff relies on the same conduct as the basis of its claims that defendants attempted to monopolize and conspired to monopolize the market under Section 2 of the Sherman Act. See id. § 2. Finally, plaintiff asserts that this conduct amounts to defamation, tortious interference with contractual relations, and unfair trade practices under state law.

Defendants challenge plaintiffs antitrust claims on a number of grounds. First, defendants contend that plaintiffs Section 1 and Section 2 claims must fail because plaintiff cannot prove a valid relevant market and defendants’ power in that market. Second, defendants attack plaintiffs conspiracy claims as legally and factually deficient. Third, defendants claim that plaintiff cannot prove “antitrust injury,” an element of antitrust standing under Section 4 of the Clayton Act. Because the Court has determined that defendants’ first two arguments are legally sufficient to warrant the entry of summary judgment on the antitrust claims, the Court need not reach the third argument.

II. Legal Analysis

The standard for the entry of summary judgment is a familiar one. The moving party must demonstrate that there is no genuine issue of material fact and that it is entitled to summary judgment as a matter of law. Fed.R.Civ.Pro. 56(c). Summary judgment is warranted when a party fails to prove an essential element of its case as to which that party has the burden of proof. Celotex Corp. v. Catrett, 477 U.S. 317, 322-23, 106 S.Ct. 2548, 2552-53, 91 L.Ed.2d 265 (1986). In antitrust conspiracy cases, plaintiff must prove more than conduct that is as consistent with permissible competition as with illegal conspiracy in order to create a triable issue of conspiracy under the antitrust laws. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 597 n. 21, 106 S.Ct. 1348, 1361 n. 21, 89 L.Ed.2d 538 (1986); Monsanto Co. v. Spray-Rite Serv. Corp., 465 U.S. 752, 763-64, 104 S.Ct. 1464, 1470-71, 79 L.Ed.2d 775 (1984). Rather, plaintiff must proffer evidence that tends to negate the possibility that defendants were acting lawfully.

A. The Relevance of the Market.

The Court agrees with defendants that plaintiffs antitrust claims under both Section 1 and Section 2 of the Sherman Act for the most part rise or fall with the issue of the relevant market and defendants’ power in that market. Plaintiffs Section 1 claim in essence alleges that defendants conspired to *1233 eliminate TBS as a competitor by using unfair competitive practices. Such conduct does not amount to a per se violation of the Sherman Act. See Union City Barge Line, Inc. v. Union Carbide Corp.,

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Bluebook (online)
875 F. Supp. 1228, 1995 U.S. Dist. LEXIS 1611, Counsel Stack Legal Research, https://law.counselstack.com/opinion/total-benefit-services-inc-v-group-insurance-administration-inc-laed-1995.