## Facts

- Drs. Shawky A. Hassan and Fikria Hassan, allergists in the Flint, Michigan area, provided services through their medical practice and participated in Independent Practice Associates, P.C. (IPA), a physician network.
- Health Plus of Michigan operated as an HMO in the area, covering about 20% of local health-care needs and competing with other HMOs and insurers.
- IPA contracted with Health Plus to furnish medical services to Health Plus subscribers; a substantial portion of area physicians belonged to IPA, while also remaining free to treat non-Health Plus patients and participate in other arrangements.
- Plaintiffs joined IPA in 1979 and, until October 1981, were the only allergy specialists serving Health Plus subscribers through the IPA network.
- IPA reviewed billing/utilization patterns and concluded plaintiffs ordered a high volume of laboratory tests compared to other allergists and that the tests were not justified, increasing Health Plus costs.
- IPA terminated plaintiffs’ membership as part of a cost-containment/utilization-review policy, which prevented plaintiffs from treating Health Plus subscribers through the network.
- Plaintiffs sued IPA, Health Plus, and associated physicians alleging federal antitrust violations (price fixing and group boycott), a Michigan antitrust claim, and tortious interference with economic advantage.

## Issues

1. Whether plaintiffs showed antitrust standing and antitrust injury (harm to competition rather than harm to a competitor).
2. Whether the IPA–Health Plus arrangement constituted unlawful price fixing or an unreasonable restraint of trade under Sherman Act § 1.
3. Whether plaintiffs’ termination from IPA was an unlawful group boycott/concerted refusal to deal under Sherman Act § 1.
4. Whether the Michigan antitrust claim survived if the federal antitrust claims failed.
5. Whether defendants committed tortious interference with economic advantage under Michigan law by acting unlawfully or improperly.

## Decision

- The court granted defendants’ motion for summary judgment on all counts and denied plaintiffs’ motion in limine as moot.
- The price-fixing theory failed because plaintiffs lacked antitrust injury/standing and because IPA was treated as a legitimate joint venture imposing no unreasonable restraint of trade.
- The group-boycott theory failed because the termination was based on a procompetitive cost-containment rationale, defendants lacked market power, and plaintiffs did not show reduced market-wide availability of allergy care.
- The Michigan antitrust claim failed for the same reasons as the federal antitrust claims.
- The tortious-interference claim failed because plaintiffs did not show defendants engaged in illegal conduct, a required element of the claim.

## Legal Principles

- A Sherman Act plaintiff must show antitrust injury: harm to competition (e.g., higher prices, reduced output, diminished quality or access), not merely lost income or lost access to a customer base.
- Physician networks integrated with an HMO may be analyzed as joint ventures under the rule of reason when they plausibly serve legitimate purposes such as coordinated delivery and cost control.
- A group-boycott claim generally requires proof of market power and actual anticompetitive effects; exclusion from a single network, without market foreclosure or reduced consumer access, is insufficient.
- Parallel state antitrust claims commonly fail when premised on the same conduct and the plaintiff cannot show unreasonable restraint or competitive harm under federal standards.
- Tortious interference with economic advantage under Michigan law requires a showing of improper or illegal conduct; a lawful termination decision does not satisfy that predicate requirement.

## Conclusion

The court held that terminating a physician from an HMO-affiliated network for utilization and cost-control reasons, absent market power and demonstrable harm to competition or consumer access, does not establish federal or state antitrust liability and cannot supply the illegality required for tortious interference.


Hassan v. Indep. Prac. Assocs., P.C., 698 F. Supp. 679 (E.D. Mich. 1988)