Act For Health v. United Energy Workers

CourtCourt of Appeals for the Sixth Circuit
DecidedAugust 9, 2019
Docket18-5900
StatusUnpublished

This text of Act For Health v. United Energy Workers (Act For Health v. United Energy Workers) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Act For Health v. United Energy Workers, (6th Cir. 2019).

Opinion

NOT RECOMMENDED FOR PUBLICATION File Name: 19a0415n.06

No. 18-5900

UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT

ACT FOR HEALTH, dba Professional Case ) Management; PROFESSIONAL CASE ) MANAGEMENT OF KENTUCKY, LLC, ) ) Plaintiffs-Appellants, ) ) v. ) ON APPEAL FROM THE ) UNITED STATES DISTRICT UNITED ENERGY WORKERS HEALTHCARE ) COURT FOR THE WESTERN CORP; KENTUCKY ENERGY WORKERS ) DISTRICT OF KENTUCKY HEALTHCARE, LLC; BRIGHTMORE HOME ) CARE OF KENTUCKY LLC; JOHN FALLS, an ) individual; TRAVIS SHUMWAY, an individual; ) CHAD SHUMWAY, an individual; and ) NICHOLAS BAME, an individual, ) ) Defendants-Appellees )

BEFORE: COOK, McKEAGUE, and WHITE, Circuit Judges.

HELENE N. WHITE, Circuit Judge. Plaintiff Act for Health, dba Professional Case

Management, and its wholly owned subsidiary, Professional Case Management of Kentucky

(“PCMK,” and collectively with Act for Health, “PCM” or “Plaintiffs”), appeal the district court’s

dismissal of their amended complaint for failure to state a claim. Plaintiffs compete with three

affiliated corporate defendants—United Energy Workers Healthcare Corp. (“UEW”), Kentucky

Energy Workers Healthcare, LLC (“KEW”), and Brightmore Home Care of Kentucky

(“Brightmore”)—in providing home-health services. PCM alleges that UEW and KEW were

operating without the required license to provide home-health services and, after the Kentucky No. 18-5900, Act for Health, et al. v. United Energy Workers Healthcare Corp., et al.

Officer of Inspector General investigated them, Defendants John Falls, Travis Shumway, and Chad

Shumway formed Brightmore to continue to illegally service UEW and KEW clients. PCM also

alleges that UEW and KEW solicit PCM’s patients and offer free, unrelated services (such as lawn

care) to induce patients to switch from PCM, and also misclassify their employees as independent

contractors to gain an advantage in the market.

PCM filed this diversity action alleging several state-law claims, including unfair

competition, tortious interference with contract and/or prospective business relations, and civil

conspiracy. Finding no error in the district court’s dismissal of PCM’s First Amended Complaint

for failure to state a claim, we affirm.

I.

The federal Energy Employees Occupational Illness Compensation Program Act

(EEOICPA) of 2000 provides “benefits to individuals or their survivors for illnesses incurred from

exposure to toxic substances while working for the Department of Energy or certain related

entities.” Watson v. Solis, 693 F.3d 620, 622 (6th Cir. 2012); see 42 U.S.C. § 7384, et seq. Eligible

individuals may receive healthcare services, including home-health services and personal-care

services, from designated providers that are reimbursed by the Department of Labor. See 42 U.S.C.

§§ 7384e, 7384t; 20 C.F.R. §§ 30.400, 30.403.

Providers are also subject to state healthcare regulations. Kentucky has different

requirements for providers of home-health services, i.e., “home health agencies,” and providers of

personal-care services, i.e., “personal services agencies.” To establish a home-health agency, an

entity must obtain a “certificate of need” from the Kentucky Cabinet for Health and Family

Services (“KCHFS”). Ky. Rev. Stat. § 216B.061(1)(a); id. § 216B.015(9), (13). Home-health

agencies provide “health and health related services” in a patient’s place of residence “as required

-2- No. 18-5900, Act for Health, et al. v. United Energy Workers Healthcare Corp., et al.

by a plan of care prescribed by a licensed physician.” 902 Ky. Admin. Reg. 20:081, § 2. “Health

services” are defined as “clinically related services provided within the Commonwealth to two . . .

or more persons, including but not limited to diagnostic, treatment, or rehabilitative services.” Ky.

Rev. Stat. § 216B.015(14).

To provide personal-care services, an entity must obtain certification from the KCHFS to

operate a “personal services agency.” Ky. Rev. Stat. § 216.712(1); see also 906 Ky. Admin. Reg.

1:180, § 2. A “personal services agency” is an organization “that directly provides or makes

provision for personal services.” Ky. Rev. Stat. § 216.710(8). The term “personal services” is

defined to include assisting with ambulation and activities of daily living, facilitating the self-

administration of medications, and providing attendant care; but the definition specifically

excludes services “that require the order of a licensed health-care professional to be lawfully

performed in Kentucky” as well as services performed by any “health-care entity or health-care

practitioner otherwise licensed, certified, or regulated by local, state, or federal statutes or

regulations.” Ky. Rev. Stat. § 216.710(7)(b)(6), (9).

Plaintiffs’ amended complaint alleges that since 2002, PCM has been providing home-

health services to EEOICPA-eligible patients in Kentucky. PCM is an enrolled EEOICPA home-

health care provider with the U.S. Department of Labor (DOL), and PCMK is a licensed home-

health agency in Kentucky with a certificate of need to provide home-health services in four

Kentucky counties. To operate this business, PCM locates eligible persons and assists them in

enrolling in and obtaining benefits through the EEOICPA program; it also identifies, recruits and

trains qualified home-health providers to serve patients. These activities require a considerable

investment of time, effort, and money.

-3- No. 18-5900, Act for Health, et al. v. United Energy Workers Healthcare Corp., et al.

PCM’s amended complaint alleges that neither UEW nor KEW has obtained a certificate

of need in any of the four counties where PCM is licensed to operate; therefore they are not licensed

home-health agencies in those counties. Nonetheless, UEW and KEW provide home-health

services in those four counties. UEW and KEW solicit PCM’s patients and offer free, unrelated

services such as lawn care to induce patients to switch from PCM. They also misclassify their

employees by classifying their nurses and other providers as independent contractors, thereby

gaining an economic advantage in the market.

After an investigation, in August 2016 the Kentucky Officer of Inspector General (OIG)

concluded that UEW’s provision of services in Kentucky “exceeded the scope of its Personal

Services Agency certification in connection with six out of six patients sampled by OIG.” (R. 148,

PID 1224.) That month, Falls and the Shumways formed Brightmore, which also lacks the

necessary licensure, and Brightmore began providing home-health services to clients of UEW and

KEW.

PCM’s amended complaint asserts, in relevant part, claims of (1) unfair competition

against UEW, KEW, and Brightmore; (2) tortious interference with contract and/or prospective

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