Bristow Endeavor Healthcare, LLC v. Blue Cross & Blue Shield Ass'n
691 F. App'x 515
| 10th Cir. | 2017Background
- Bristow Endeavor Healthcare operates three NE Oklahoma facilities: BMC (in-network with HCSC), Cimarron, and CORE (new facility denied in-network status).
- In 2014 Bristow and HCSC executed a Provider Agreement covering BMC and Cimarron; agreement expressly required HCSC consent to add additional entities.
- Bristow alleges HCSC/BCBSA refused to add CORE to the network as part of a concerted scheme with Hillcrest/Ardent (competitors) to restrain competition and preserve Hillcrest’s market share.
- Allegations include meetings among Hillcrest/Ardent/Tulsa Spine personnel, hiring of a private investigator, and statements attributed to an Ardent rep (Gwock) and an unidentified Blue Cross Blue Shield rep indicating CORE would be kept out of network.
- Bristow asserted four claims: Sherman Act §1 conspiracy; Oklahoma state conspiracy; attempted monopolization under Oklahoma law; and tortious interference. HCSC and BCBSA moved to dismiss; district court granted dismissal and Bristow appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sherman Act §1 — conspiracy to restrain trade | Bristow: HCSC/BCBSA conspired with Hillcrest/Ardent to keep CORE out of network to limit competition | HCSC/BCBSA: No plausible agreement pleaded; acting against economic self-interest; conduct as consistent with unilateral decisions | Dismissed — complaint fails to plead plausible conspiracy or facts excluding independent action |
| Oklahoma state-law conspiracy | Bristow: State law conspiracy parallel to Sherman Act claim | Defendants: Same defenses; insufficient factual pleading | Dismissed — district court applied same reasoning as federal claim; Bristow does not contest dismissal on appeal |
| Attempted monopolization (OK) | Bristow: Defendants trying to monopolize inpatient/outpatient healthcare market in NE Oklahoma; points to HCSC’s 64% insurance market share | Defendants: Complaint fails to define relevant healthcare services market or allege market power/dangerous probability of success; 64% insurer share not proof of provider-market monopoly | Dismissed — insufficient allegations of relevant market and dangerous probability of monopolization; monopsony theory not fairly pled |
| Tortious interference with business relations | Bristow: Defendants maliciously interfered with business/contractual rights of Bristow entities | Defendants: Pleading is conclusory and fails to identify specific contracts/relationships harmed | Dismissed — allegations are formulaic recitation of elements and give inadequate notice |
Key Cases Cited
- Smith v. United States, 561 F.3d 1090 (10th Cir.) (standard of review for Rule 12(b)(6) dismissals)
- Ashcroft v. Iqbal, 556 U.S. 662 (2009) (pleading must contain factual content showing plausible entitlement to relief)
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007) (conspiracy claims require factual enhancement to be plausible)
- Copperweld Corp. v. Indep. Tube Corp., 467 U.S. 752 (1984) (Sherman Act targets restraints arising from agreement, not independent action)
- Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574 (1986) (conspiracy inference impermissible when defendants lacked rational economic motive to conspire)
- Monsanto Co. v. Spray-Rite Serv. Corp., 465 U.S. 752 (1984) (companies generally may refuse to deal unilaterally)
- Kan. Penn Gaming, LLC v. Collins, 656 F.3d 1210 (10th Cir.) (importance of particularized allegations identifying who did what)
- Robbins v. Oklahoma ex rel. Dep’t of Human Servs., 519 F.3d 1242 (10th Cir.) (Twombly criticized complaints lacking specifics on time/place/person)
- Buccaneer Energy (USA) Inc. v. Gunnison Energy Corp., 846 F.3d 1297 (10th Cir.) (showing market power requires market share and barriers to entry evidence)
- TV Commc’ns Network, Inc. v. Turner Network Television, Inc., 964 F.2d 1022 (10th Cir.) (elements for attempted monopolization)
- Maldonado v. City of Altus, 433 F.3d 1294 (10th Cir.) (court may decline theories not fairly pled in the complaint)
- Tuffy’s, Inc. v. City of Oklahoma City, 212 P.3d 1158 (Okla.) (elements of tortious interference under Oklahoma law)