Connecticut Podiatric Medical Ass'n v. Health Net of Connecticut, Inc.
Connecticut Podiatric Medical Ass'n v. Health Net of Connecticut, Inc.
Opinion of the Court
Opinion
The plaintiff podiatrists, Jeffrey F. Yale, Anthony R. lorio, and R. Daniel Davis (individual podiatrists), and the named plaintiff, the Connecticut Podiatric Medical Association (association), appeal
The trial court set forth the following relevant facts in its memorandum of decision rendering summary judgment in favor of the defendant. The defendant issues health care insurance policies to provide coverage for medical services and enters into contracts with practitioners of the healing arts to provide those services. The individual podiatrists are licensed to practice in the state of Connecticut and are network providers of services pursuant to provider agreements with the defendant. Pursuant to those agreements, the individual podiatrists administer podiatric care to patients who are members of a health care insurance plan that is issued or administered by the defendant. The defendant has entered into agreements with its insureds to provide health insurance coverage for a variety of medical services, and for each service, the defendant has designated a specific current procedural terminology code (code). In order to receive payment for services that they provide to the defendant’s insureds, the individual podiatrists inform the defendant of the type of service provided by using the code that has been assigned to that particular service. Pursuant to its provider agreements with the individual podiatrists, the defendant reimburses them for the services that they have provided by paying a set amount for each code.
The plaintiffs brought the present action, alleging that the defendant’s practice of reimbursing the individual podiatrists at a lower rate than medical doctors for the same service, designated by the identical code, constitutes an unfair trade practice in violation of CUTPA and CUIPA. The plaintiffs sought both monetary and injunctive relief. The trial court granted the defendant’s motion to dismiss the association’s claims for monetary relief, concluding that it lacked representational standing because the claim for monetary damages would require the participation of the individual podiatrists.
“[Notwithstanding the broad language and remedial purpose of CUTPA, we have applied traditional common-law principles of remoteness and proximate causation to determine whether a party has standing to bring an action under CUTPA.” Vacco v. Microsoft Corp., 260 Conn. 59, 88, 793 A.2d 1048 (2002). “It is axiomatic that a party must have standing to assert a claim in order for the court to have subject matter jurisdiction over the claim. . . . Our standing jurisprudence consistently has embodied the notion that there must be a colorable claim of a direct injury to the plaintiff, in an individual or representative capacity. . . . The requirement of directness between the injuries claimed by the plaintiff and the conduct of the defendant also is expressed, in our standing jurisprudence, by the focus on whether the plaintiff is the proper party to assert the claim at issue. . . . Thus, to state these basic propositions another way, if the injuries claimed by the plaintiff are remote, indirect or derivative with respect to the defendant’s conduct, the plaintiff is not the proper party to assert them and lacks standing to do so. [When], for example, the harms asserted to have been suffered directly by a plaintiff are in reality derivative of injuries to a third party, the injuries are not direct but are indirect, and the plaintiff has no standing to assert them.” (Citations omitted.) Ganim v. Smith & Wesson Corp., 258 Conn. 313, 346-48, 780 A.2d 98 (2001).
We employ “a three part policy analysis ... [in applying] the general principle that plaintiffs with indi
The right to reimbursement is derived from the provider agreements. The individual podiatrists, not their practice groups, are the parties to the provider agreements. Because only the individual podiatrists can enforce their contractual rights under the provider agreements, there is no party that is more directly injured or in a better position to remedy the alleged harm. The mere fact that, for the sake of convenience, the practice groups rather than the individual podiatrists directly received the reimbursement that was due pursuant to the provider agreements does not render the injury too remote. Accordingly, the individual podiatrists have standing.
We next address the plaintiffs’ claim that the trial court improperly concluded that, as a matter of law, the defendant’s practice of reimbursing the individual podiatrists at a lesser rate than medical doctors, for the same procedures, does not constitute “unfair discrimination” in violation of § 38a-816 (10). The plaintiffs contend that the term “unfair discrimination” in § 38a-816 (10), includes setting different reimbursement rates solely on the basis of license. In other words, the plaintiffs argue that the statute prohibits discrimination
The question of whether the term “unfair discrimination” in § 38a-816 (10) precludes setting different reimbursement rates solely on the basis of license presents a question of statutory interpretation, over which we exercise plenary review, guided by well established principles regarding legislative intent. See Hartford/ Windsor Healthcare Properties, LLC v. Hartford, 298 Conn. 191, 197-98, 3 A.3d 56 (2010) (explaining plain meaning rule under General Statutes § l-2z and setting forth process for ascertaining legislative intent).
As directed by § l-2z, we begin with the text of § 38a-816, which provides in relevant part: “The following are defined as unfair methods of competition and unfair and deceptive acts or practices in the business of insurance . . . (10) Notwithstanding any provision of any policy of insurance, certificate or service contract, whenever such insurance policy or certificate or service contract provides for reimbursement for any services which may be legally performed by any practitioner of the healing arts licensed to practice in this state, reimbursement under such insurance policy, certificate or service contract shall not be denied because of race, color or creed nor shall any insurer make or permit any unfair discrimination against particular individuals or persons so licensed. ...”
Subdivision (10) of § 38a-816 may be divided into four clauses. The first clause, “[notwithstanding any provision of any policy of insurance, certificate or ser
The final two clauses of § 38a-816 (10) define the protection provided by the statute, setting forth the prohibited practices. Whereas the scope of the third clause is easy to discern—it is expressly limited to decisions denying reimbursement and its protection extends to denials made on the basis of race, color or creed—the fourth clause simply prohibits insurers from making or permitting “unfair discrimination,” without expressly limiting that prohibition to a particular context.
We observe preliminarily that the scope of the third and fourth clauses differs in that the third clause expresses a categorical prohibition—“reimbursement . . . shall not be denied because of race, color or creed”—whereas the prohibition in the fourth clause is conditional. That is, the fourth clause prohibits only discrimination that is “unfair.” It follows that “fair” discrimination within the meaning of the fourth clause would be permitted under the statute. Keeping that distinction in mind, we turn to the first question of statutory interpretation before us: to whom does the protection of the fourth clause extend. The fourth clause prohibits insurers from making or permitting “any unfair discrimination against particular individuals
Although “discrimination” is not defined in § 38a-816 (10), the term is used throughout title 38a of the General Statutes, which deals with insurance practices. With respect to health insurance, the insurance commissioner (commissioner) is empowered to prescribe regulations to ensure that rates set for individual health insurance policies “shall not be excessive, inadequate or unfairly discriminatory. . . .” General Statutes § 38a-481 (b). Various health care centers, insurance
From these related statutes, it appears that “discrimination” is used in § 38a-816 (10) in a broad manner to mean disparate treatment. Moreover, consistent with General Statutes § 1-1 (a), which directs that in the construction of statutes, “words and phrases shall be construed according to the commonly approved usage of the language; and technical words and phrases . . . shall be construed and understood accordingly,” we construe “unfair discrimination,” as used in § 38a-816 (10), to refer generally to “[a] failure to treat all persons
In addressing the second question of whether the prohibition against “unfair discrimination” applies to all reimbursement decisions, including the setting of reimbursement rates, or is restricted to denials of reimbursement, we first turn to the statutory language of § 38a-816 (10). The fact that the third clause is expressly limited to “denials” of reimbursement at least suggests that the legislature intended the same limitation to apply to the fourth clause. It certainly would be incongruous to extend the protection against other forms of discrimination to reimbursement rates, but to limit the protection against discrimination on the basis of race, color or creed to reimbursement denials. Although that suggestion provides strong evidence, it does not resolve the ambiguity. Accordingly, we look to related statutes. None of the other subdivisions within § 38a-816 prove helpful. Several subdivisions of § 38a-816 prohibit charging an individual a different rate for the same coverage because of various conditions, including “physical disability or mental retardation”; General Statutes § 38a-816 (12); “blindness or partial blindness”; General Statutes § 38a-816 (13); and having been
Other statutes in the insurance chapter of the General Statutes do, however, address discriminatory rate setting. For example, § 38a-236 provides in relevant part: “No nonprofit legal service corporation, as defined in section 38a-230, shall enter into any contract with subscribers unless and until it has filed with the . . . [c]ommissioner a full schedule of the rates to be paid by the subscriber and has obtained said commissioner’s approval thereof. The commissioner may refuse such approval if he finds such rates are excessive, inadequate or unfairly discriminatory. ...” (Emphasis added.) General Statutes § 38a-418 (a), which sets standards for premium rates, expressly provides that such rates “shall not be inadequate, excessive, or unfairly discriminatory.” Section 38a-481 (b) establishes procedures for approval of individual health insurance policies and requires the commissioner to adopt regulations to set standards to ensure that the rates set in such policies “shall not be excessive, inadequate or unfairly discriminatory. . . .” See also General Statutes § 38a-582 (commissioner may disapprove schedule of charges for enrollee coverage for dental services if commissioner finds that charges are “excessive, inadequate or unfairly discriminatory”); General Statutes § 38a-623 (prohibiting “unfair discrimination” in setting rates for life insurance premiums); General Statutes § 38a-665 (a) (rates for commercial risk insurance may not be “excessive or inadequate . . . nor shall they be unfairly discriminatory”); General Statutes § 38a-688 (a)
Because our analysis of the text of § 38a-816 (10) and related statutes does not resolve either of the two questions presented, we turn to extratextual sources. In 1967, the legislature amended § 38a-816, then codified at General Statutes § 38-61, by adding the following antidiscrimination provision: “Notwithstanding any provision of any policy of insurance, certificate or service contract, whenever such insurance policy or certificate or service contract provides for reimbursement for any services which may be legally performed by any person licensed under the provisions of chapter 372, reimbursement under such insurance policy, certificate or service contract shall not be denied because of race, color or creed nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under said chapter.” (Emphasis added.) Public Acts 1967, No. 852, § 1. The discussion of the amendment, both in the House of Representatives and Senate, clarifies that the legislature’s dual purpose was to benefit both chiropractors, who are licensed pursuant to chapter 372, and their patients by ensuring that individuals who chose to seek treatment from chiropractors would receive insurance
In 1969, the legislature replaced the phrase “person licensed under the provisions of chapter 372” with the phrase “practitioner of the healing arts licensed to practice in this state.” Public Acts 1969, No. 651, § 1. At that time, § 20-1 defined the “practice of the healing arts” as the practice of medicine, chiropractic, naturopathy and osteopathy. The purpose of the 1969 amendment was to extend the antidiscrimination protection to naturopathic and osteopathic physicians. See 13 S. Proc., Pt. 6,1969 Sess., pp. 3039-40, remarks of Senator George L. Gunther. Senator Gunther described the scope of the protection afforded to practitioners of the healing arts by the amendment, which is now codified at § 38a-816 (10), as eliminating “any insurance reimbursement being denied anyone based on race, color, creed, or healing art.'’' (Emphasis added.) Conn. Joint Standing Committee Hearings, Insurance, 1969 Sess., p. 1. In 1981, the legislature amended § 20-1 to include podiatry among the healing arts—thus extending the protection against “unfair discrimination” in § 38a-816 (10) to podiatrists. Public Acts 1981, No. 81-471, § 4.
The judgment is affirmed.
In this opinion NORCOTT, ZARELLA, HARPER, VER-TEFEUILLE and BEAR, Js., concurred.
The plaintiffs appealed from the decision ofthe trial court to the Appellate Court and we transferred the appeal to this court pursuant to General Statutes § 51-199 (c) and Practice Book § 65-1.
The plaintiffs also contend that the trial court abused its discretion in denying their motion to strike or to respond to the defendant’s argument, raised for the first time in its reply brief in support of its motion for summary judgment, that nondiscriminatory “market forces” justify the defendant’s conduct. Because the trial court did not render summary judgment on the basis of “market forces,” and because we do not affirm the trial court’s judgment on that basis, we do not address that claim.
Although the defendant’s preliminary statement of the issues raised as an alternate ground for affirmance the claim that the action was federally preempted, the defendant expressly abandoned that argument in its brief.
General Statutes § 38a-816 provides in relevant part: “The following are defined as unfair methods of competition and unfair and deceptive acts or practices in the business of insurance . . .
“(10) Notwithstanding any provision of any policy of insurance, certificate or service contract, whenever such insurance policy or certificate or service contract provides for reimbursement for any services which may be legally performed by any practitioner of the healing arts licensed to practice in this state, reimbursement under such insurance policy, certificate or service contract shall not be denied because of race, color or creed nor shall any insurer make or permit any unfair discrimination against particular individuals or persons so licensed. . . .”
Because the association’s claims for injunctive relief were not the subject of the motion to dismiss, the association remains a plaintiff in this action.
The dissent asserts that our reading of the statutory language, which construes the express limitation of the third clause to denials of reimbursement to mean what it says, that is, to limit the scope of the third clause to denials of reimbursement, is “simply . . . inconceivable . . . ." The dissent contends that the literal language of § 38a-816 (10), so construed, permits discrimination on the basis of race, color or creed in setting reimbursement rates. Section 38a-816 (10) does not, however, sanction any discriminatory actions; it provides a civil remedy for discriminatory denials of reimbursement.
As explained in this opinion, the text and legislative history of this statute reflect that the legislature had a particular issue in mind in drafting this legislation-—namely, preventing discriminatory denials of reimbursement, in the interest of both practitioners of the healing arts and patients, who have a right to have broad access to health care. All of the evidence supports our conclusion that the legislature crafted the statute to address that specific issue.
In addition, the issue of discrimination on the basis of race, color or creed is not before us in this appeal. The present case does not involve such a
We believe that the proper approach, rather than inferring that the only options are to rewrite the statute or to leave certain discrimination without a remedy, is to recognize that the legislature simply did not anticipate the problem, and to give the legislature the opportunity to address it.
Accordingly, we will not overreach to decide an issue that is not before us. Judicial restraint counsels us to commend the issue to the attention of the legislature for further review, as is appropriate. We consistently have held that “the task of changing the law lies with the legislature, and not with the judiciary. In construing a statute, the cardinal principle of construction is to ascertain the intent of the legislature. If an act passed by the legislature is within its constitutional power, it is not the business of the court to attempt to twist the interpretation of the law to conform to the ideas of the judges as to what the law ought to be or to attempt to make the law coincide with their ideas of social justice. The judicial function should not invade the province of the legislature.” (Internal quotation marks omitted.) Director of Health Affairs Policy Planning v. Freedom of Information Commission, 293 Conn. 164, 182, 977 A.2d 148 (2009).
The plaintiffs contend that reimbursement at different levels could implicate coverage. By way of illustration, the plaintiffs offer a hypothetical example of a podiatrist being reimbursed $1 for the same service for which a medical doctor is reimbursed $100. Nothing in the record substantiates the likelihood of such an extreme discrepancy in reimbursement rates. Indeed, such a discrepancy would require insurers to act against their own best interest by in effect discouraging lower cost providers from participating in the insurance network, which would force subscribers to seek treatment with the higher cost providers. At a time when society is concerned with the high costs of health care in general, it would make no sense to adopt rules that would discourage the lowest cost provider from performing the required treatment. Moreover, if an insurer were to act in such a manner, we express no opinion as to whether such an action could be deemed tantamount to a denial and abad faith act to make an end run around the law.
The plaintiffs claim that other states and federal statutes require that doctors of podiatric medicine and medical doctors be paid equally for administering the same services. They contend that these statutes support their claim that § 38a-816 (10) requires pay parity. We confine our analysis to our state statutes and applicable precedent.
Dissenting Opinion
dissenting.
Under General Statutes § 38a-816 (10), whenever an insurer enters into a service contract that provides for reimbursement for services performed by any practitioner of the healing arts licensed to practice in this state, including podiatrists, “reimbursement under such . . . service contract shall
In my view, the majority is wrong in its interpretation of the scope of the statutory prohibition against “any unfair discrimination” on the basis of licensure because, among other reasons, it is wrong in its predicate interpretation of the scope of the statutory protection barring discrimination on the basis of race, color or creed. Under that interpretation, the defendant is free to discriminate on the basis of race, color or creed, and also on the basis of licensure, unless the defendant refuses altogether to reimburse a licensed medical professional for covered services rendered. In other words, in reaching its conclusion that it is permissible under § 38a-816 (10) for an insurer to discriminate on the basis of licensure with respect to the amount it reimburses a
1 would conclude, rather, that § 38a-816 (10) bars discrimination on the basis of race, color, creed or licensure both with respect to the outright denial of reimbursement and to the amount of reimbursement. Accordingly, I also would conclude that the named plaintiff, the Connecticut Podiatric Medical Association (association), and the individual plaintiffs, podiatrists Jeffrey F. Yale, Anthony R. lorio, and R. Daniel Davis,
Before turning to the issue of statutory interpretation raised by the plaintiffs’ appeal, it bears emphasis that
The majority commences its statutory analysis by construing the language of § 38a-816 (10) that immediately precedes the language at issue in the present case. Specifically, the majority construes the phrase “reimbursement . . . shall not be denied because of race, color or creed,” as follows: “[T]he scope of [that] . . . clause is easy to discern—it is expressly limited to decisions denying reimbursement and its protection extends to denials made on the basis of race, color or creed . . . .” (Emphasis in original.) Having concluded that the scope of that language is “limited to decisions denying reimbursement,” the majority then states that the issue presented by this appeal is whether the scope of the language that follows, namely, “nor shall any insurer make or permit any unfair discrimination against particular individuals or persons so licensed”; General Statutes § 38a-816 (10); also is limited to decisions denying reimbursement, or whether the prohibition against unfair discrimination extends to all decisions concerning reimbursement, including rate setting.
Second, it cannot be disputed that the language of § 38a-816 (10) barring “any unfair discrimination” on the basis of licensure is worded in much broader terms than the statutory prohibition against the denial of reimbursement due to race, color or creed. Because the
The majority acknowledges that, under its interpretation of § 38a-816 (10), that provision does not prohibit insurers from discriminating on the basis of race, color or creed with respect to the amount that those insurers reimburse medical professionals. The majority nevertheless seeks to justify its construction of § 38a-816 (10) by asserting, first, that, contrary to my statement that invidious discrimination is permitted under the majority’s construction of § 38a-816 (10), that provision “does not . . . sanction any discriminatory actions; [rather] it provides a civil remedy for discriminatory denials of reimbursement”; footnote 6 of the majority opinion; and, second, that “the issue of discrimination on the basis of race, color or creed is not before us in this appeal” because “[t]he present case does not involve such a claim . . . .” Id. The majority’s reliance on these semantical distinctions is unconvincing. With respect to the majority’s first point, CUIPA represents a legislative determination that certain insurance practices are unfair and, therefore, must be prohibited. Under the majority’s interpretation of CUIPA, discrimination in the amount of reimbursement on the basis of race, color or creed is not an unfair insurance practice. In light of the majority’s express conclusion that such discrimination is not prohibited under CUIPA, it necessarily is permitted under CUIPA. See, e.g., Mead v. Burns, supra, 199 Conn. 666-66 (CUIPA establishes certain “regula
With respect to its second point, the majority’s attempt to minimize the import of its interpretation of § 38a-816 (10) also is unavailing. Contrary to the majority’s assertion, the issue of discrimination on the basis of race, color and creed most certainly is before this court in this appeal because the majority has elected to place it before the court by virtue of its statutory analysis. This is so because the majority’s statutory interpretation is expressly predicated on its determination that § 38a-816 (10) bars only complete denials of reimbursement on the basis of race, color or creed, and not other discriminatory reimbursement practices based on race, color or creed. Thus, far from “overreach[ing] to decide an issue that is not before [this court]”; footnote 6 of the majority opinion; I am merely pointing out a necessary, and untenable, consequence of the majority’s interpretive analysis.
Indeed, under the majority’s narrow construction of § 38a-816 (10) as prohibiting only the complete denial of reimbursement on the basis of race, color or creed, an insurer readily could defeat that prohibition. Specifically, if an insurer wished to prevent a medical professional from participating in its network because of his
Even if the majority were correct in its interpretation of the language of § 38a-816 (10) as barring only denials of reimbursement on the basis of race, color and creed, its construction of the statutory bar against “any unfair discrimination” on the basis of licensure is unpersuasive. Under the majority’s construction, the scope of the two provisions of § 38a-816 (10) is precisely the same: the first clause bars the denial of reimbursement on account of race, color and creed, and the second clause bars the denial of reimbursement on account of licensure. The majority, however, does not explain why the legislature would have elected to use entirely different language in the two clauses if it had intended for those provisions to have identical meanings. “Ordinarily, when the legislature uses different language, the legislature intends a different meaning.” (Internal quo
To support its conclusion, the majority relies on the scant legislative history of § 38a-816 (10). That legislative history is, at best, unhelpful in determining the scope of that provision. For example, in commenting on Public Acts 1967, No. 852, § 1, which is now codified as amended at § 38a-816 (10), and which applied only to chiropractors,
In sum, the majority’s interpretation of § 38a-816 (10) finds insufficient support in the statutory language or in the pertinent legislative history. In view of the fact that the provision’s broad prohibition against “any unfair discrimination” on the basis of licensure surely encompasses disparate reimbursement rates based solely on the license held by a medical professional and not on the nature or quality of the care provided by that professional, as the plaintiffs allege, the plaintiffs are entitled to their day in court.
I hereinafter refer to the association and the individual plaintiffs collectively as the plaintiffs.
As the majority explains, the individual plaintiffs seek both damages and injunctive relief. The trial court dismissed the association’s claim for damages, and the association has not appealed from the dismissal of that claim. Consequently, the association’s claim is limited to injunctive relief. I agree with the majority that the plaintiffs have standing to pursue their respective claims.
I note that the defendant is the only private insurer that reimburses podiatrists in this state at a lower rate than medical doctors for the performance of the same medical services.
For purposes of this appeal, I accept the majority’s assertion that the scope of the “unfair discrimination” language of § 38a-816 (10) “is limited to an insurer’s actions with respect to reimbursement.” I also agree that that language prohibits any such discrimination on the basis of licensure.
In Mead, this court explained that, because “ [t]he definition of unacceptable insurer conduct [under CUIPA requires proof that the conduct at issue constitutes a general business practice, that definition] reflects the legislative determination that isolated instances of unfair insurance settlement practices are not so violative of the public policy of this state as to warrant statutory intervention.” Mead v. Burns, 199 Conn. 661, 666, 609 A.2d 11 (1986). Thus, in Mead, we held that, although CUTPA applies to unfair or unethical insurance practices, the plaintiff in Mead had not raised a viable claim under CUTPA merely by alleging a single instance of an alleged unfair settlement practice because to conclude otherwise would be contrary to the public policy reflected in the legislature’s definition of unacceptable insurer conduct. See id., 666-66. In other words, the fact that the legislature has limited the reach of CUIPA to a certain category of insurance practices represents a legislative policy decision that conduct by an insurer that does not fall within that category is not prohibited.
With respect to the provision of § 38a-816 (10) barring the denial of reimbursement on the basis of race, color or creed, the defendant states that the plaintiffs malee no claim that the defendant has violated that provision.
Although such discrimination by an insurer on the basis of race, color or creed might not be in that insurer’s best financial interest, undoubtedly, an insurer bent on discriminating in (hat manner would not be deterred from doing so by economic considerations. Indeed, if it were otherwise, there would have been little need for the provision barring discrimination on the basis of race, color or creed.
The majority appears to suggest that construing § 38a-816 (10) to include unfair discrimination in the setting of reimbursement rates on the basis of licensure somehow renders superfluous the preceding clause barring discrimination on the basis of race, color or creed. Specifically, the majority states that it “cannot interpret” the clause prohibiting unfair discrimination “so broadly that it completely encompasses the meaning of the . . . clause” prohibiting discrimination on the basis of race, color or creed. Because the two clauses target discrimination involving different groups, neither clause renders the other superfluous.
1 also note that, as the plaintiffs contend, if § 38a-816 (10) does not prohibit unfair discrimination in the setting of rates, then the protections of the provision are largely, if not entirely, illusory. Under the majority’s interpretation, an insurer could reimburse podiatrists at very low rates, thereby effectively denying podiatrists the opportunity to participate in the defendant’s network and thwarting the purpose of the statute.
Podiatrists were not included in the protected class of “practitioners] of the healing arts”; General Statutes § 38a-816 (10); until 1981. See Public Acts 1981, No. 81-471, § 4 (amending General Statutes [Bev. to 1981] § 20-1 to include podiatry in definition of “[t]he practice of the healing arts”).
In support of its contention that the trial court properly granted its motion for summary judgment, the defendant asserts that the different reimbursement rates that it pays to medical doctors and podiatrists cannot constitute unfair discrimination because, as a matter of law, medical doctors and podiatrists are not similarly situated. This argument lacks merit because the plaintiffs have raised a statutory claim, not a claim under the equal protection clause of the fourteenth amendment. See, e.g., Stuart v. Commis
Reference
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- Connecticut Podiatric Medical Association Et Al. v. Health Net of Connecticut, Inc.
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