ACA loses Trigon appeal
Could set precedent to shield insurance companies
The American Chiropractic Association (ACA)
suffered a severe defeat on May 6 when the U.S. Fourth Circuit Court of
Appeals ruled against its appeal in the Trigon health care case and affirmed
the lower court's dismissal of all complaints against Trigon.
The case, which along with the ACA's
lawsuit against the Centers for Medicare and Medicaid Services has cost the
chiropractic profession an estimated $5-7 million, was first filed on August
18, 2000.
Alleging eight counts of racketeering,
extortion, mail fraud and antitrust violations and other state and federal
law violations, the complaint initially named Blue Cross & Blue Shield of
America in addition to Trigon but the ACA voluntarily dismissed that company
as a defendant.
On July 19, 2001, a District Court
dismissed two of the counts and, on April 25, 2003, the other counts were
dropped when U.S. Federal Judge James P. Jones ruled in a summary judgment
that there were "no genuine issues of material fact remaining for trial."
The opinion explained that summary judgment is a tool designed for "weeding
out claims and defenses that have no factual basis."
The ACA immediately appealed the case,
despite reservations expressed by numerous organizations, including the
Chiropractic Coalition.
According to the 34‑page Appellate Court
decision, the original District Court judge "was not persuaded by (the)
American Chiropractic (Association's) argument" and "found that (the)
American Chiropractic (Association) had failed to adduce sufficient evidence
of a conspiracy between Trigon and the medical associations who appointed
individuals to the MCAP to survive summary judgment."
The Appellate Court agreed, adding that
the ACA "paints with too broad a brush, and would, in effect, undercut much
of the rationale of the intracorporate immunity doctrine by focusing on form
over substance."
The judge also noted that "the American
Chiropractic (Association) has failed to show that either the reimbursement
policies or the Low Back Guideline was the result of an antitrust
conspiracy. They have pointed to no evidence that Trigon conspired with
any entity in forming its policies. In fact, the only evidence in the record
is that all of the actions in dispute were taken unilaterally by Trigon
employees. In the face of Trigon's affidavits that it acted unilaterally,
(the) American Chiropractic (Association) needed more to create a genuine
issue of material fact."
In one part of the decision, the court
pointed out that the ACA had, in fact, agreed to the provisions of it was
now arguing in court.
In its appeal, the ACA asserted that the
District Court abused its discretion by limiting the scope of discoverable
materials to those created after January 1, 1996, making it impossible for
the ACA to pursue "key avenues of investigation."
The Court of Appeals noted:
"Unfortunately for (the) American Chiropractic (Association) this limitation
was imposed not by judicial fiat, but by the mutual agreement of the
parties. The record shows that (the) American Chiropractic (Association) and
Trigon agreed, in writing, to limit discovery to events arising after
January 1, 1996 unless, in good faith, a more expansive time period was
necessary. (The) American Chiropractic (Association) failed to contact
Trigon to discuss expanding the time period and did not mention the limiting
nature of the agreement to the district court until June 18, 2002, a mere
ten days before the close of discovery."
The Court of Appeals affirmed the lower
court's dismissal of all complaints and wrote a decision that could be cited
as a precedent in any future case alleging conspiracy by an insurer to
discriminate against chiropractors.
