Plaintiffs represented a class of all purchasers of health care services in an eight-county area in central Wisconsin. Their allegations centered around a conspiracy to divide the market, which, in turn, led to supra-competitive prices. Defendant was a "physician-owned, non-profit, multi-specialty clinic based in Marshfield, Wisconsin." The defendant was tied to other health care organizations, ostensibly for the purpose of making an integrated health care system throughout that region of Wisconsin.

One agreement was reached between North Central HMO and Marshfield, which is labeled a free-flow agreement in certain counties. Marshfield and North Central treated each other’s customers and agreed not to market in certain areas. North Central eventually entered into an agreement with two other companies, Rhinelander and Wausau, and marketed in other counties as well. A handful of companies entered several other complicated arrangements throughout the area. In addition, several years previous to the instant case, Blue Cross & Blue Shield United of Wisconsin and Compcare Health Services won a jury trial against Marshfield. On appeal, only the market allocation verdict stood, but, on remand, defendants prevailed "because the plaintiffs were unable to demonstrate any injury tied specifically to the market allocation verdict."

The Court first determined that plaintiffs’ class had sufficient standing to bring the suit, even over defendants’ objections. The defendants had contended that plaintiffs had bought "resold" products, which would ban plaintiffs’ standing, because for plaintiffs to allege an antitrust injury, they must be direct purchasers. The Court held that because plaintiffs had bought products from co-conspirators, the direct-purchaser rule did not apply. Therefore, plaintiffs had standing.

Plaintiffs’ first substantive allegation was the conspiracy to allocate markets, insofar as the relationship between Marshfield and the Rice Clinic, and Marshfield and Wausau Medical Center. This was based on the fact that Marshfield and Rice Clinic did not compete against each other. The Court decided that this was not a violation, because there was no evidence that this was either an express or implied agreement not to compete. Nor did the market allocation allegation survive the Court’s scrutiny; instead, there was evidence of an "affiliation," but not of an agreement to restrict competition. As far as the agreement between Marshfield and Wausau, the Court entered a discussion of "ancillary" versus "naked" restraints on trade. An ancillary restraint triggers rule of reason analysis whereas a naked restraint is a per se violation of the antitrust laws. Although plaintiffs contended that the agreements between Marshfield and Wausau were per se, the Court declined to accept it as such, and stated that it would be subject to rule of reason analysis. The free-flow agreement between Marshfield and Wausau had enough evidence behind it to survive summary judgment.

In terms of causation, plaintiffs must sufficiently assert that they have an injury "of the type the antitrust laws were intended to prevent." A necessary requisite of defendants being able to inflict an antitrust injury on plaintiffs is that the defendants exercised market power. After a discussion of cluster markets, where several products are combined for sale to increase the value of the whole, and a discussion of the geographic markets, the Court concluded that the defendants exercised significant market power (greater than 50% within the given geographic area) and that there was sufficient evidence such that a reasonable jury could conclude that the defendants did indeed exercise market power.

As far as actual injury to plaintiffs, the Court determined that the significant amount of evidence was in conflict and that it seemed to show that the prices charged by defendants were higher. "[The Court] cannot say that a jury would be unreasonable to conclude . . . that plaintiffs paid more for physician services because of defendants’ unlawful conduct."

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