Antitrust Enforcement and State-Action Immunity
Antitrust Enforcement and State-Action Immunity
Court: United States District Court for the District of Arizona
Issue: Anticompetitive Effects and Board Supervision
Citation: Collision Chiropractors LLC v. State of Arizona, No. CV-24-03625-PHX-SHD (D. Ariz. Sept. 15, 2026)
In a September 15, 2026, decision, the United States District Court for the District of Arizona considered issues concerning anticompetitive effects and board supervision.
Collision Chiropractors LLC (“Collision”) is an Arizona chiropractic services company specializing in treating accident-related injuries, primarily through medical liens. It employs chiropractors and contracts with independent practitioners who provide services under its business model. Collision sued the State of Arizona, the Arizona Board of Chiropractic Examiners, and the Board’s Chairman. It alleged that the enforcement of Arizona’s fee-splitting regulations constituted anticompetitive conduct in violation of Section 1 of the Sherman Antitrust Act, 15 U.S.C. § 1. It also alleged that the Board targeted its business model by investigating independent-contractor compensation arrangements, questioning the legality of deferred compensation tied to personal-injury recoveries, and communicating enforcement threats to Arizona chiropractors. Collision maintained that these actions discouraged chiropractors from participating in its network and interfered with competition in the chiropractic services market.
Although Collision alleged that the Board’s actions caused chiropractors to terminate contracts and discouraged others from joining its network, the Court found its allegations insufficient to establish a properly defined relevant market or anticompetitive effects. Collision failed to adequately demonstrate that the challenged conduct harmed competition rather than primarily affecting its particular business model.
Applying North Carolina State Board of Dental Examiners v. FTC, 574 U.S. 494 (2015), the Court explained that a regulatory board controlled by active market participants must demonstrate both a clearly articulated state policy authorizing the challenged anticompetitive conduct and active state supervision.
The Court found that Collision plausibly alleged that practicing chiropractors participated in the Board’s challenged actions and that Arizona officials did not actively supervise those actions. Although Arizona Administrative Code R4-7-902(34) regulates fee-splitting arrangements, the Court could not conclude that the challenged enforcement campaign was necessarily authorized by that regulation. Consequently, the Court rejected the defendants’ state-action immunity argument at the pleading stage.
The District Court granted the defendants’ motion to dismiss the First Amended Complaint, with leave to amend. Although Collision sufficiently alleged an interstate-commerce connection and plausible collective conduct, it failed to establish a legally adequate relevant market or plausible injury to competition under Section 1 of the Sherman Act.
The Court distinguished injury to an individual business from harm to competition and explained that professional boards controlled by active market participants may be subject to antitrust scrutiny without active state supervision.