Justia Antitrust & Trade Regulation Opinion Summaries

In this dispute in which Plaintiffs sought reimbursement for healthcare costs based upon claims for restraint of trade and monopolization pursuant to N.C. Gen. Stat. Chapter 75 and N.C. Const. art. I, 34, the Supreme Court affirmed in part and reversed in part the order of the trial court deciding issues arising from the Charlotte-Mecklenburg Hospital Authority's motion for judgment on the pleadings, holding that the trial court erred in part.Plaintiffs were a group of current and former North Carolina residents who were covered under the commercial health insurance obtained through the Hospital Authority, a non-profit corporation providing healthcare services with a principal place of business in Charlotte. The trial court granted the Hospital Authority's motion for judgment on the pleadings with respect to Plaintiffs' restraint of trade and monopolization claims but denied the motion with respect to Plaintiffs' monopolization claim. The Supreme Court affirmed in part and reversed in part, holding that the trial court (1) did not err in granting judgment on the pleadings with respect to Plaintiffs' Chapter 75 restraint of trade and monopolization claims; but (2) erred by denying the motion for judgment on the pleadings with respect to Plaintiffs' claim pursuant to article I, section 34. View "DiCesare v. Charlotte-Mecklenburg Hosp. Auth" on Justia Law

SmileDirect filed suit against the Georgia Board of Dentistry, including the Board’s members in their individual capacities, alleging inter alia, antitrust, Equal Protection, and Due Process violations related to the amendment of Ga. Bd. of Dentistry R. 150-9-.02. On appeal, the Board members challenged the denial of their motion to dismiss the complaint with respect to the alleged antitrust violations.After determining that it does have appellate jurisdiction under the collateral order doctrine, the Eleventh Circuit affirmed, holding that, based on the facts alleged in SmileDirect's complaint, the Board members are not entitled to state-action immunity under Parker v. Brown, 317 U.S. 341 (1943), at this point in the litigation, and the district court properly denied their motion to dismiss. In this case, the Board members have failed to satisfy the Midcal test by failing to meet the "active supervision" prong of the test and both prongs are necessary to satisfy the test. Furthermore, the court rejected the Board members' argument that ipso facto state-action immunity is available merely because of the Governor's power and duty, and without regard to his actual exercise thereof. The court explained that the Board members have established no more than the mere potential for active supervision on the part of the Governor, and thus they have fallen far short of establishing that the amended rule was "in reality" the action of the Governor. View "SmileDirectClub, LLC v. Battle" on Justia Law

The State and City of New York filed suit charging UPS with violating the Contraband Cigarette Trafficking Act (CCTA), the Prevent All Cigarette Trafficking Act (PACT Act), and New York Public Health Law 1399-ll (PHL 1399-ll), as well as breaching its settlement agreement, the Assurance of Discontinuance (AOD), with the New York State Attorney General.The court held that UPS did not honor the AOD and was therefore subject to liability under the PACT Act and PHL 139-ll; UPS was liable for violations of the AOD's audit requirement; and UPS violated the CCTA by knowingly transporting more than 10,000 unstamped cigarettes. In regard to damages and penalties awards, the court held that the district court did not abuse its discretion in allowing plaintiffs to present their damages case nor did it clearly err in making factual findings based on record evidence; the district court erred in awarding plaintiffs only half of the unpaid taxes on cigarettes UPS unlawfully shipped; and the district court abused its discretion in awarding per-violation penalties under both the PACT Act and PHL 1399-ll.Therefore, the court affirmed the judgment of liability and attendant penalties under PHL 1399-ll; affirmed the judgment of liability, but vacated the imposition of the penalties under the PACT Act; affirmed the judgment of liability, but modified the award of damages under the CCTA; affirmed the judgment of liability, but modified the award of penalties under the AOD; and affirmed the judgment as modified. View "New York v. United Parcel Service, Inc." on Justia Law

In this case concerning civil liability based on insurer conduct affecting chiropractic services, the Supreme Court affirmed the order of the trial court dismissing all claims in this case, relying on and incorporating its reasoning in a companion case, Sykes v. Health Network Solutions, Inc., __ S.E.2d __ (N.C. 2019)(Sykes I), in holding that the decision in Sykes I met the criteria for collateral estoppel.This case was one of two putative class actions alleging that defendant insurers contracted with Health Network Solutions, Inc. (HNS) to provide or restrict insured chiropractic services in violation of state insurance and antitrust laws. Plaintiffs chose to bring this action against insurers separately from their claims against against HNS and its individual owners in Sykes I, but both actions presented essentially the same claims and relied on the same theories. The trial court dismissed Plaintiffs' claims in this case. The Supreme Court affirmed, holding that collateral estoppel barred Plaintiffs from litigating these matters given the Court's resolution of the issues in Sykes I. View "Sykes v. Blue Cross & Blue Shield of North Carolina" on Justia Law

The Supreme Court affirmed the Business Court's dismissal of Plaintiffs' claims against Defendants Health Network Solutions, Inc. (HNS) and HNS's individual owners alleging that HNS committed antitrust and other violations in its role as intermediary between individual chiropractors and several insurance companies and third-party administrators, holding that the Business Court did not err in dismissing Plaintiffs' entire complaint.Plaintiffs were licensed chiropractic providers in North Carolina who alleged that Defendants engaged in unlawful price fixing resulting in a reduction of output of chiropractic services in North Carolina. The Business Court granted in part and denied in part Defendants' motions to dismiss and for partial summary judgment and then dismissed Plaintiffs' remaining claims under N.C. R. Civ. P. 12(b)(6). The Supreme Court affirmed, holding that the Business Court did not err in dismissing each of Plaintiffs' substantive claims and their derivative claims. The Business Court's dismissal of Plaintiffs' antitrust claims, including the derivative claim of civil conspiracy, stands without presidential value because the members of the Court were equally divided as to these claims. View "Sykes v. Health Network Solutions, Inc." on Justia Law

MCEP, an acute care, for-profit hospital owned by 60 physicians and one corporate shareholder, opened in 2006. By 2009, MCEP’s existence as a physician-owned enterprise ended when it sold an ownership interest to Kettering Health Network, a competitor in the Dayton healthcare market. MCEP alleges that it failed because of the anticompetitive actions of Premier, a dominant healthcare network in the Dayton area. MCEP alleges that Premier contracted with area physicians and payers (insurers and managed-care plan providers) on the condition that they did not do business with MCEP. MCEP claims that Premier engaged in a conspiracy so devoid of benefit to the market as to be per se illegal under the Sherman Act, 15 U.S.C. 1. The Sixth Circuit affirmed summary judgment in favor of the defendants. To be per se illegal, a defendant’s conduct has to be so obviously anticompetitive that it has no plausibly procompetitive features. Premier’s contracts with payers and physicians had plausibly procompetitive features. It is plausible that panel limitations, which prohibited referrals to MCEP, lower the cost of defendants’ services and improve “cost effectiveness and efficiencies in the delivery of health care services.” View "Medical Center at Elizabeth Place, LLC v. Atrium Health System" on Justia Law

LifeWatch is one of the two largest sellers of telemetry monitors, a type of outpatient cardiac monitoring devices used to diagnose and treat heart arrhythmias, which may signal or lead to more serious medical complications. An arrhythmia can be without noticeable symptoms. Other outpatient cardiac monitors also record the electrical activity of a patient’s heart to catch any instance of an arrhythmia but they vary in price, method of data capture, and mechanism by which the data are transmitted for diagnosis. LifeWatch sued the Blue Cross Blue Shield Association and five of its member insurance plan administrators under the Sherman Act, 15 U.S.C. 1, claiming they impermissibly conspired to deny coverage of telemetry monitors as “not medically necessary” or “investigational,” although the medical community, other insurers, and independent arbiters viewed it as befitting the standard of care. The Third Circuit reversed the dismissal of the complaint. LifeWatch plausibly stated a claim and has antitrust standing. That so many sophisticated third parties allegedly view telemetry monitors as medically necessary or meeting the standard of care undercuts Blue Cross’s theory that nearly three dozen Plans independently made the opposite determination for 10 consecutive years. Read in the light most favorable to LifeWatch, the complaint alleges competition among all outpatient cardiac monitors such that they are plausibly within the same product market. LifeWatch has alleged actual anticompetitive effects in the relevant market. View "Lifewatch Services Inc. v. Highmark, Inc." on Justia Law

This matter stemmed from a lawsuit filed by the State of Mississippi against the defendant pharmacies. The State alleged deceptive trade practices and fraudulent reporting of inflated “usual and customary” prices in the defendant’s reimbursement requests to the Mississippi Department of Medicaid. The State argued that Walgreens, CVS, and Fred’s pharmacies purposefully misrepresented these prices to obtain higher prescription drug reimbursements from the State. Finding that the circuit court was better equipped to preside over this action, the DeSoto County Chancery Court transferred the matter to the DeSoto County Circuit Court in response to the defendants’ request. Aggrieved, the State timely filed an interlocutory appeal disputing the chancellor’s decision to transfer the case. After a thorough review of the parties’ positions, the Mississippi Supreme Court found that though the chancery court properly could have retained the action, the chancellor correctly used his discretion to transfer the case, allowing the issues to proceed in front of a circuit-court jury. As a result, the Supreme Court affirmed the chancellor’s decision. View "Mississippi v. Walgreen Co." on Justia Law

In 2017, Maryland enacted “An Act concerning Public Health – Essential Off-Patent or Generic Drugs – Price Gouging – Prohibition.” The Act, Md. Code, Health–General 2-802(a), prohibits manufacturers or wholesale distributors from “engag[ing] in price gouging in the sale of an essential off-patent or generic drug,” defines “price gouging” as “an unconscionable increase in the price of a prescription drug,” and “unconscionable increase” as “excessive and not justified by the cost of producing the drug or the cost of appropriate expansion of access to the drug to promote public health” that results in consumers having no meaningful choice about whether to purchase the drug at an excessive price due to the drug’s importance to their health and insufficient competition. The “essential” medications are “made available for sale in [Maryland]” and either appear on the Model List of Essential Medicines most recently adopted by the World Health Organization or are “designated . . . as an essential medicine due to [their] efficacy in treating a life-threatening health condition or a chronic health condition that substantially impairs an individual’s ability to engage in activities of daily living.” The Fourth Circuit reversed the dismissal of a “dormant commerce clause” challenge to the Act, finding that it directly regulates the price of transactions that occur outside Maryland. View "Association for Accessible Medicine v. Frosh" on Justia Law

Methodist and Saint Francis are the two largest hospitals in Peoria, Illinois. Saint Francis is considerably larger and more profitable. Methodist filed suit, charging Saint Francis with violating the Sherman Act by entering into exclusive contracts with insurance companies, covering more than half of all commercially-insured patients in the area. Methodist argued that it could not obtain a sufficiently high volume of patients to enable it to invest in improvements. The Seventh Circuit affirmed summary judgment in favor of Saint Francis, noting that health insurers regard Saint Francis as a “must have” hospital, because it provides certain services that the other hospitals in the area do not provide, such as solid-organ transplants, neonatal intensive care, and a Level 1 trauma center. The contracts are a form of requirements contract; an insurance company may get better rates from a hospital by agreeing to an exclusive contract, which will drive more business to the hospital. The contracts are of fixed duration; when they terminate, the insurance companies are free to contract with other hospitals. Competition-for-the-contract is protected by the antitrust laws and is common. The court noted that none of the other four area hospitals had joined the case and the Department of Justice declined to file a case. View "Methodist Health Services Corp v. OSF Healthcare System" on Justia Law