Blue Cross & Blue Shield United of Wisconsin v. Marshfield Clinic’s Empirical Analysis

Citation profile

32 federal appellate · 17 district · 4 state decisions

Most-quoted passages

The sentences later courts lift from this opinion, ranked by how many decisions quote each — the parts of the opinion doing the work. These counts are smaller than the citation total above because most of the 94 citing decisions cite the case generally; a passage count includes only decisions quoting that exact language verbatim.

1. “the money went directly from Blue Cross to the Clinic, and although the two entities were not linked by any overarching contract, each payment and acceptance was a separate and completed contract. We do not think more is required to establish Blue Cross's right to sue to collect these overcharges.”

   2 later decisions quote this exact passage
   e.g. 295 F. Supp. 2d 30 - In Re Lorazepam & Clorazepate Antitrust Litigation · International Brotherhood of Teamsters v. Philip Morris Incorporated, et al.

2. “shows, what is anyway well known, that individuals, and their employers, and medical insurers (the real “buyers” of medical services, according to the plaintiffs) regard HMOs as competitive not only with each other but also with the various types of fee-for-service provider, including “preferred provider” plans (generally referred to as “PPOs,” for “preferred provider organization”) under which the insurer offers more generous reimbursement if the insured patronizes physicians who have contracts with the insurer to provide service at low cost to its insureds. [PPOs] are particularly close substitutes for HMOs, since they use the insurer’s clout with physicians to drive down price. And if, as the record shows, they are feasible even in areas supposedly dominated by the Marshfield Clinic, and even without including any physicians employed by the Clinic, it is impossible to understand what barrier there could be to the formation of HMOs. All that is needed is an array of physicians who among them provide a broad range of medical services, and the same thing is needed for a preferred provider plan. Ability to create a preferred-provider plan therefore implies ability to create an HMO, and so implies in turn that if Security raised its prices above competitive levels, and if people had a strong preference for HMOs over preferred-provider plans despite the similarities between the two systems for providing medical care, the operators of those plans would convert them to HMOs. If so”

   1 later decision quote this exact passage
   e.g. 176 F. Supp. 2d 1207 - Coventry Health Care of Kansas, Inc. v. VIA Christi Health System, Inc.

3. “Compcare persuaded the jury that HMOs constitute a separate market, much as banks are a separate market from currency exchanges; and if there is a reasonable basis for this finding in the evidence, we are bound to accept it regardless of what we might think as an original matter. But we have searched the record in vain for evidence that under contemporary principles of antitrust law would justify such a finding. An HMO is not a distinctive organizational form or assemblage of skills, as is plain from the fact that the physicians retained by Security, whether they are employees of the Marshfield Clinic or completely independent, to serve its subscribers serve other patients on a fee for-service basis. An HMO is basically a method of pricing medical services. Instead of having the patient pay separately for each medical procedure, the patient pays a fixed annual fee for all the services he needs and the HMO undertakes to provide those services with the physicians with whom it has contracts.”

   1 later decision quote this exact passage
   e.g. 176 F. Supp. 2d 1207 - Coventry Health Care of Kansas, Inc. v. VIA Christi Health System, Inc.