Alan C. Hancock, M.D., a Kansas Citizen v. Blue Cross-Blue Shield of Kansas, Inc., a Missouri Corporation

Citations: 21 F.3d 373; 1994 U.S. App. LEXIS 7077; 1994 WL 117194Docket: 93-3054

Court: Court of Appeals for the Tenth Circuit; April 11, 1994; Federal Appellate Court

SummaryOriginalCytator Case TreatmentBackward CitatorAnalysis

EnglishEspañolSimplified EnglishEspañol Fácil

Alan C. Hancock, M.D., a Kansas resident, filed an appeal against Blue Cross and Blue Shield of Kansas, Inc., following a decredentialing procedure that aimed to terminate his contract as a participating physician. He claimed that the procedure violated his rights under the Health Care Quality Improvement Act of 1986 (HCQIA), specifically the provision allowing for legal representation during the hearing. Hancock sought declaratory and injunctive relief in federal court, asserting federal question jurisdiction under the HCQIA. The trial court dismissed the case, ruling that the HCQIA does not provide a private cause of action, thus lacking subject matter jurisdiction. The appellate court affirmed this decision, stating that while the HCQIA mandates certain due process protections during peer review, it does not create a direct right for physicians to sue based on violations of these requirements. The HCQIA aims to improve healthcare quality through professional peer review, providing immunity to such groups, contingent on their adherence to due process and reasonable actions to improve healthcare quality.

To survive the motion to dismiss, the plaintiff's action must be supported by the Health Care Quality Improvement Act (HCQIA). The Supreme Court case Cort v. Ash outlines four factors for determining if a private cause of action can be implied from a statute lacking an express provision: 

1. Whether the plaintiff is part of the class intended to benefit from the statute.
2. Any evidence of legislative intent to create or deny a remedy.
3. Consistency with the legislative scheme's underlying purposes to imply a remedy.
4. Whether the cause of action traditionally falls under state law, making it inappropriate to infer a federal cause of action.

After evaluating these factors, the court determined that Congress did not intend to create a cause of action for physicians under the HCQIA. The HCQIA's purpose is to facilitate effective peer review of physician competence by granting immunity to compliant peer review groups, rather than benefiting physicians subjected to peer review. Consequently, the court concluded that no implied cause of action exists for the plaintiff under the HCQIA, a conclusion supported by similar findings in other cases. The district court's judgment was affirmed.