Source: cases/15usc1/f3d-922-713-med-ctr-v-atrium-health.case
Case source: https://www.neochart.com/catalog/cases/f3d/volume_922/0713_01/index.html
There is a presumption against applying the per se rule "[u]nless the restraint falls squarely into a per se category."
If, in spite of the plaintiff's efforts, the record indicates that the challenged restraint is plausibly procompetitive, then summary judgment for the defendants is appropriate.
Because Judge Rice was correct to find that the challenged restraints do not fall within the circumscribed categories of per se condemnation, we AFFIRM the district court's grant of summary judgment.
We follow the majority of Circuits and hold that a joint venture's restraint is ancillary and therefore inappropriate for per se categorization when, viewed at the time it was adopted, the restraint "may contribute to the success of a cooperative venture."
It is plausible that panel limitations, by lowering the cost of Hospital Defendants' services, contribute to the efficiency-enhancing purposes of the joint venture, specifically improving "cost effectiveness and efficiencies in the delivery of health care services."
Preventing such a misalignment of incentives is plausibly related to Hospital Defendants' goal of "integrat[ing] physicians and other health care providers with the JOC Network."
This opinion likewise reaches no decision on the ultimate economic merits of Premier's actions because to do so would go beyond our charge.
There is no "rim" conspiracy without alleged agreement among the parties at the rim (among the payers and physicians, respectively).
Because the Amended Complaint lacks an essential element for MCEP's "rim" conspiracy claims, the Amended Complaint does not include those claims.
casedsl 1.2
# author: Flash1 (gemini-3.8-flash-high)
# triaged-by: Fable (2026-11-10)
case /f3d/922/0713-01
name Med. Ctr. At Elizabeth Place, LLC v. Atrium Health Sys.
cite 922 F.3d 713 (2019)
# IR court field says: United States Court of Appeals for the Six Circuit
court United States Court of Appeals for the Sixth Circuit
date 2019-04-25
url catalog/cases/f3d/volume_922/0713_01/index.html
source ir/caselaw/f3d_922.jsonl sha1=0c381acd42ccb00276b9082bea4ae886d4d4a0c9 chars=59999
opinion op : majority by Batchelder @0..48026, @48038..55751 controlling
opinion conc : concurrence by Sutton @55752..59999
? opinion: the IR text is capped at 59999 chars. The majority body ends at 48026; its footnotes follow a stray "CONCURRENCE" heading (48038..55751). Judge Sutton's concurrence (he would hold Premier a single entity) is cut off, and Judge White's partial dissent is not in the text at all, so it was not read.
party p1 : Medical Center at Elizabeth Place (MCEP; physician-owned hospital, plaintiff) v. the Premier Health Partners hospitals ("Hospital Defendants", a joint operating company and its four member hospitals)
theory t1 : per se group boycott by the Hospital Defendants (the "hub" claim): payer panel limitations, physician non-competes and lease terminations, the "Dear Physician" letter
theory rim : "rim" conspiracies among payers and among physicians, orchestrated by the Hospital Defendants
law 15usc1
role applied
posture civil; physician-owned hospital sued a hospital joint venture under ยง 1, pleading only a per se group-boycott claim (no rule-of-reason claim); after an earlier appeal on single-entity status, a successor district judge reconsidered and granted summary judgment for defendants; CA6 affirmed
result claimant-lost
element restraint.per-se : not-satisfied [law]
party p1
theory t1
route cooperative-or-novel-arrangement
pattern hospital joint venture's payer panel limitations, physician non-competes and opposition letter; plausibly procompetitive, so no per se category
rule @17289..17408 | There is a presumption against applying the per se rule "[u]nless the restraint falls squarely into a per se category."
rule @18578..18755 | If, in spite of the plaintiff's efforts, the record indicates that the challenged restraint is plausibly procompetitive, then summary judgment for the defendants is appropriate.
fact @4441..4590 [supports] | Executives from Premier told an MCEP shareholder that Hospital Defendants "would do whatever they needed to do in order to stop [MCEP] from opening."
fact @39581..39903 [supports] | As characterized by MCEP, a condition of the purchase by Good Samaritan Hospital was that individual owners of Dayton Heart Hospital were paid in full only if they agreed "(i) not to invest in MCEP, and (ii) if they already owned shares, they would divest if MCEP began to offer cardiac services" over the next five years.
fact @38201..38405 [cuts-against absent] | MCEP has not shown that Hospital Defendants' "Dear Physician" letter was untrue, and MCEP countered the "Dear Physician" letter, without any apparent difficulty, with a "Dear Colleague" letter of its own.
fact @39904..40052 [cuts-against absent] | MCEP cites no case law holding that vertical non-compete contracts entered into by joint ventures qualify as conduct that is anticompetitive per se.
held @47577..47776 | Because Judge Rice was correct to find that the challenged restraints do not fall within the circumscribed categories of per se condemnation, we AFFIRM the district court's grant of summary judgment.
gloss Because MCEP pleaded only a per se claim, rejecting the per se mode ends the case; the court stresses that it decides nothing about whether the conduct was on balance anticompetitive.
element x-ancillary-restraints : satisfied [law]
party p1
theory t1
route _whole
pattern joint venture's payer panel limitations and physician lease/non-compete terms plausibly related to the venture's efficiency goals
rule @26941..27197 | We follow the majority of Circuits and hold that a joint venture's restraint is ancillary and therefore inappropriate for per se categorization when, viewed at the time it was adopted, the restraint "may contribute to the success of a cooperative venture."
fact @32583..32821 [neutral] | First, MCEP argues that Hospital Defendants restrained trade through "panel limitations," wherein Hospital Defendants stipulated to payers that if they added MCEP to their networks, Hospital Defendants would be able to renegotiate prices.
fact @34548..34774 [cuts-against] | In support of this claim, MCEP points to evidence showing that Premier's contract with insurer Aetna had a volume-based discount that automatically lowered Premier's rates when billing volume increased past certain benchmarks.
fact @22314..22471 [cuts-against] | Hospital Defendants continue to operate as a joint venture today even though the panel limitation clauses have been removed from their contracts with payers.
fact @38897..39159 [supports] | Hospital Defendants had a plausible concern that, without these contracts, physicians who invested in MCEP could rent office space at a Premier-associated hospital, free ride on the reputation and facilities of that hospital, and then refer patients out to MCEP.
held @35741..36007 | It is plausible that panel limitations, by lowering the cost of Hospital Defendants' services, contribute to the efficiency-enhancing purposes of the joint venture, specifically improving "cost effectiveness and efficiencies in the delivery of health care services."
held @39160..39338 | Preventing such a misalignment of incentives is plausibly related to Hospital Defendants' goal of "integrat[ing] physicians and other health care providers with the JOC Network."
gloss The court rejects both the "core activity" label for the panel limitations (Dagher) and the Eleventh Circuit's requirement that an ancillary restraint be necessary; the defendant need not prove procompetitive effect, a plausible relationship to the venture suffices.
? route: the menu has no route for x-ancillary-restraints; missing: the standard for ancillarity (reasonably related / "may contribute" versus necessary) and who bears the burden.
element restraint.rule-of-reason : not-reached
party p1
theory t1
fact @6590..6691 [neutral] | In its Amended Complaint, MCEP made only a per se claim; MCEP made no claim under the rule of reason.
held @2325..2464 | This opinion likewise reaches no decision on the ultimate economic merits of Premier's actions because to do so would go beyond our charge.
element agreement : not-satisfied [pleaded]
scope procedural
party p1
theory rim
route hub-and-spoke
pattern rim agreements among payers and among physicians raised only in summary-judgment opposition; not in the complaint, and leave to amend denied
fact @44142..44273 [cuts-against absent] | But MCEP's Amended Complaint includes neither an allegation of an agreement among the payers nor an agreement among the physicians.
fact @44274..44416 [supports] | Instead, the Amended Complaint alleges an agreement among the Hospital Defendants to financially induce payers and physicians to boycott MCEP.
rule @44417..44549 | There is no "rim" conspiracy without alleged agreement among the parties at the rim (among the payers and physicians, respectively).
held @44663..44808 | Because the Amended Complaint lacks an essential element for MCEP's "rim" conspiracy claims, the Amended Complaint does not include those claims.
gloss The ruling is that the rim claims were never pleaded and that denying a second amendment was no abuse of discretion; it is not a merits ruling that no rim agreement existed. Whether the Hospital Defendants themselves are separate actors capable of conspiring was settled as triable in the earlier appeal (MCEP I, 817 F.3d 934) and is not revisited by the majority.