Steven A. Mueller, Bradley J. Brown, Mark A. Kruse, Kevin D. Miller, and Larry E. Phipps, on Behalf of Themselves and Those Like Situated v. Wellmark, Inc. D/B/A Wellmark Blue Cross and Blue Shield of Iowa, an Iowa Corporation and Wellmark Health Plan of Iowa, Inc., an Iowa Corporation
2012 Iowa Sup. LEXIS 83
| Iowa | 2012Background
- Chiropractors sue Wellmark alleging discriminatory and anticompetitive practices in provider contracts and payment rates.
- Claims span Iowa insurance statutes and Iowa Competition Law; district court dismissed statutory claims for lack of private action and granted summary judgment on antitrust claims under state action exemption.
- Court held: statutory claims lack private right of action; state action exemption may not bar all antitrust claims; some antitrust claims dismissed while remanding remaining issues.
- District court allowed administrative-remedies path via Iowa Insurance Commissioner; the Love settlement and related practices were scrutinized for antitrust implications; Love settlement not shown to discriminate against chiropractors.
- Record shows Wellmark’s use of preferred-provider arrangements, RVU-based reimbursements, and regulatory approvals; appellate review focuses on whether these are immunized or actionable under state law.
- Result: affirm in part, reverse in part, and remand for further proceedings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Iowa HF 2219 statutory provisions implicitly create a private right of action. | Seeman factors support private action for regulatory provisions. | Statutes regulatory in nature; no implied private action. | No private action implied; district court proper. |
| Whether the state action exemption applies to Wellmark’s provider arrangements. | Exemption should apply under state policy supervision. | Exemption not satisfied; lack of active state supervision. | State action exemption does not foreclose antitrust claims. |
| Whether the Love settlement was implemented in a discriminatory manner against chiropractors. | Settlement terms favor MDs/DOs and discriminate against chiropractors. | Evidence shows nondiscriminatory implementation; no contractor bias shown. | No genuine issue of material fact; Love settlement not discriminatory as implemented. |
| Whether the district court properly dismissed claims seeking relief under Iowa Competition Law for unilateral pricing decisions. | Antitrust injury and conspiracy alleged; monopsony/monopoly concerns. | Unilateral pricing decisions do not violate antitrust law absent conspiracy. | Summary judgment affirmed for unilateral pricing claims; no antitrust violation shown. |
Key Cases Cited
- Seeman v. Liberty Mutual Insurance Co., 322 N.W.2d 35 (Iowa 1982) (four-factor test for implied private action in regulatory statutes)
- Nw. Bell Tel. Co. v. Iowa Utils. Bd., 477 N.W.2d 678 (Iowa 1991) (state action immunity framework; need active supervision)
- Neyens v. Roth, 326 N.W.2d 294 (Iowa 1982) (state action immunities and uniformity considerations)
- Comes v. Microsoft Corp., 646 N.W.2d 440 (Iowa 2002) (dissenting/analytical context on antitrust and state action exemptions)
- Patrick v. Burget, 486 U.S. 94 (U.S. 1988) (state-mandated peer review not automatically immunizing antitrust claims)
- Health Care Equalization Committee of the Iowa Chiropractic Society v. Iowa Medical Society, 851 F.2d 1020 (8th Cir. 1988) (state action considerations in chiropractic coverage history)
- Cal. Retail Liquor Dealers Ass’n v. Midcal Aluminum, Inc., 445 U.S. 97 (U.S. 1980) (establishes state action immunity framework)