SUPREME COURT OF THE UNITED STATES
Between 1985 and 1988, plaintiffs-respondents, beneficiaries of group health
insurance policies issued by defendant-petitioner Humana Health Insurance of
Nevada, Inc. (Humana Insurance), received medical care at a hospital owned by
defendant-petitioner Humana Inc.
Humana Insurance agreed to pay 80% of the
beneficiaries’ hospital charges over a designated deductible. The beneficiaries
bore responsibility for payment of the remaining 20%.
But pursuant to a
concealed agreement, the complaint in this action alleged, the hospital gave
Humana Insurance large discounts on the insurer’s portion of the hospital’s
charges for care provided to the beneficiaries. As a result, Humana Insurance
paid significantly less than 80% of the hospital’s actual charges for the care
that beneficiaries received, and the beneficiaries paid significantly more than
20%.
The beneficiaries brought suit in Federal District Court, alleging that
Humana Insurance and Humana Inc. had violated the federal Racketeer Influenced
and Corrupt Organizations Act (RICO) through a pattern of racketeering activity
consisting of mail, wire, radio, and television fraud.
The Humana defendants
moved for summary judgment, citing §2(b) of the McCarran-Ferguson Act, which
provides: “No Act of Congress shall be construed to invalidate, impair, or
supersede any law enacted by any State for the purpose of regulating the
business of insurance, or which imposes a fee or tax upon such business, unless
such Act specifically relates to the business of insurance.”
RICO does not
proscribe conduct that Nevada’s laws governing insurance permit. But the federal
and state remedial regimes differ. Both provide a private right of action. RICO
authorizes treble damages; Nevada law permits recovery of compensatory and
punitive damages.
The District Court granted summary judgment for the Humana
defendants. The Ninth Circuit reversed in relevant part.
In its Merchants
Home decision, handed down after the District Court rejected the
beneficiaries’ right to sue under RICO in this case, the Ninth Circuit adopted a
“direct conflict” test for determining when a federal law “invalidate[s],
impair[s], or supersede[s]” a state insurance law. As declared in Merchants
Home, the McCarran-Ferguson Act does not preclude application of a federal
statute prohibiting acts that are also prohibited under state insurance laws.
Guided by Merchants Home, and assuming, inaccurately, that Nevada law
provided for administrative remedies only, the Ninth Circuit held that the
McCarran-Ferguson Act did not bar the policy beneficiaries’ suit under RICO.
Held:
Because RICO advances the State’s interest in combating insurance fraud, and does not frustrate any articulated Nevada policy or disturb the State’s administrative regime, the McCarran-Ferguson Act does not block the respondent policy beneficiaries’ recourse to RICO in this case. Pp. 5—13.
(a) The McCarran-Ferguson Act precludes
application of a federal statute in face of state law “enacted … for the purpose
of regulating the business of insurance,” if the federal measure does not
“specifically relat[e] to the business of insurance,” and would “invalidate,
impair, or supersede” the State’s law.
RICO is not a law that “specifically
relates to the business of insurance.”
This case therefore turns on the question
whether RICO’s application to the employee beneficiaries’ claims would
“invalidate, impair, or supersede” Nevada’s laws regulating insurance.
Under the
standard definitions, RICO’s application in this action would neither
“invalidate”–i.e., render ineffective without providing a replacement
rule–nor “supersede”–i.e., displace while providing a substitute
rule–Nevada’s insurance laws.
The key question, then, is whether RICO’s
application here would “impair” Nevada’s law.
The Court rejects the Humana
petitioners’ suggestion that the word “impair,” in the McCarran-Ferguson Act
context, signals Congress’ intent to cede the field of insurance regulation to
the States, saving only instances in which Congress expressly orders otherwise.
If Congress had meant generally to preempt the field for the States, Congress
could have said either that “no federal statute [that does not say so
explicitly] shall be construed to apply to the business of insurance” or
that federal legislation generally, or RICO in particular, would be “applicable
to the business of insurance [only] to the extent that such business
is not regulated by state law.”
Moreover, §2(b)’s second prohibition,
barring construction of federal statutes to “invalidate, impair, or supersede”
“any [state] law … which imposes a fee or tax upon [the business of insurance],”
belies any congressional intent to preclude federal regulation merely because
the regulation imposes liability additional to, or greater than, state law. Were
this not so, federal law would “impair” state insurance laws imposing fees or
taxes whenever federal law imposed additional fees or greater tax liability.
Under the federal system of dual taxation, however, it is scarcely in doubt that
generally applicable federal fees and taxes do not “invalidate, impair, or
supersede” state insurance taxes and fees within the meaning of §2(b) where
nothing precludes insurers from paying both.
On the other hand, the Court is not
persuaded that Congress intended a green light for federal regulation whenever
the federal law does not collide head on with state regulation. The dictionary
defines “impair” as to weaken, make worse, lessen in power, diminish, relax, or
otherwise affect in an injurious manner. The following formulation seems to
capture that meaning and to construe, most sensibly, the text of §2(b):
When federal law does not directly conflict with state regulation, and when
application of the federal law would not frustrate any declared state policy or
interfere with a State’s administrative regime, the McCarran-Ferguson Act does
not preclude its application.
Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 101—103,
supports the view that to “impair” a law is to hinder its operation or “frustrate [a] goal” of that law.
The Court’s standard also accords with SEC v. National Securities, Inc., 393 U.S.
453, 463, where, as here, federal law did not “directly conflict with state
regulation,” application of federal law did not “frustrate any declare [sic]
(b) Applying the foregoing standard to the
facts of this case, the Court concludes that suit under RICO by policy
beneficiaries would not “impair” Nevada law and therefore is not precluded by
the McCarran-Ferguson Act.
Nevada provides both statutory and common-law
remedies to check insurance fraud. The Nevada Unfair Insurance Practices Act is
a comprehensive administrative scheme that prohibits various forms of insurance
fraud and misrepresentation; gives Nevada’s Insurance Commissioner the authority
to issue charges if there is reason to believe the Act has been violated, to
issue cease and desist orders, and to administer fees; and authorizes victims of
insurance fraud to pursue private actions under Nevada law for violations of a
number of unfair insurance practices, including misrepresentation of pertinent
facts or insurance policy provisions relating to coverage. Moreover, the Act is
not hermetically sealed; it does not exclude application of other state laws,
statutory or decisional. Specifically, Nevada case law recognizes tort actions
against insurers for breach of a common-law duty to negotiate with insureds in
good faith and to deal with them fairly. Furthermore, aggrieved insureds may be
awarded punitive damages if a jury finds clear and convincing evidence that the
insurer is guilty of oppression, fraud, or malice, and those damages may exceed
the treble damages available under RICO.
In sum, there is no frustration of
Nevada policy in the RICO litigation at issue. RICO’s private right of action
and treble damages provision appears to complement Nevada’s statutory and
common-law claims for relief. The Court notes both that Nevada filed no brief at
any stage of this lawsuit urging that application of RICO would frustrate any
state policy, or interfere with the State’s administrative regime, and that
insurers, too, have relied on RICO when they were the fraud victims. Pp. 10—13.
Ginsburg, J., delivered the opinion for a unanimous Court.