United States ex rel. Carrel v. Aids Healthcare Foundation, Inc.

262 F. Supp. 3d 1353
CourtDistrict Court, S.D. Florida
DecidedJune 9, 2017
DocketCASE NO. 14-CV-61301-KMW
StatusPublished
Cited by2 cases

This text of 262 F. Supp. 3d 1353 (United States ex rel. Carrel v. Aids Healthcare Foundation, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States ex rel. Carrel v. Aids Healthcare Foundation, Inc., 262 F. Supp. 3d 1353 (S.D. Fla. 2017).

Opinion

SEALED ORDER GRANTING MOTION FOR, SUMMARY JUDGMENT

KATHLEEN M. WILLIAMS, UNITED STATES DISTRICT JUDGE

THIS MATTER is before the Court on Defendant AIDS Healthcare Foundation, Inc.’s (“AHF”) motion for summary judgment based on the employee safe harbor exception to Anti-Kickback Statute- liability. (Sealed motion, DE 171; Sealed exhibits to motion, DE 172; Redacted public motion, DE 174). Relators Jack Carrel, Mauricio Ferrer, and Shawn Loftis have filed a response in opposition to the motion (Response to motion, DE 183; Redacted public responsive facts, DE 184; Sealed responsive facts, DE 186) and -AHF has filed a reply in support of the motion (Reply in support of motion, DE 188; Sealed reply in support of-statement of material facts, DE 190).

' The Relators, three former AHF' employees, filed the operative Third Amended Complaint (“TAC”) on July 10, 2015. (DE 59). They allege that AHF pays bonuses to employee “Linkage Coordinators” for referring'patients who have tested positive for HIV at an AHF facility to other HIV/ AIDS-related services that AHF provides, Relators argue these bonuses are kickbacks prohibited by the federal Anti-Kickback Statute (“AKS”), 42 U.S.C. § 1320(a)-7b(b). And because reimbursement claims for services provided to patients referred through AKS violations are deemed “false or fraudulent” as a matter of law, 42 U.S.C. § 1320(a)-7b(g), Relators assert that AHF’s claims for federal funds in return for services provided following the purported kickbacks to Linkage Coordinators violate-the False- Claims Act (“FCA”), 31 U.S.C. § 3729(a), and Florida False Claims Act (“FFCA”), Fla. Stát. § 68.082(2). . ...

Although Relators alleged several broad-ranging kickback schemes, the TAC described in sufficient detail only two “Representative False Claims” in which AHF sought federal funds—through the [1356]*1356Ryan White Comprehensive AIDS Resources Emergency Act (“Ryan White”)— in connection with services provided following bonuses to Linkage Coordinators. Accordingly, the Court entered an order on June 27, 2016 granting in part AHF’s motion to dismiss and limiting the focus of this case to Relators’ claims “regarding the Ryan White program only as they relate to the two Representative False Claims.” (DE 95 at 36). Additionally, because the TAC alleged the Linkage Coordinators who were paid bonuses in connection with the Representative False Claims were AHF employees, the Court entered a Scheduling Order permitting an early round of dispositive motions as to the applicability of the AKs’s employee safe harbor provision, 42 U.S.C. § 1320a-7b(b)(3)(B), to the facts of this case. (DE 106).

AHF’s motion for summary judgment on the employee safe harbor is now before the Court. Because the undisputed facts demonstrate that AHF paid the bonuses connected to the two Representative False Claims to an AHF employee engaged in the provision of covered services, AHF’s motion for summary judgment (DE 171; DE 174) is GRANTED.

I. BACKGROUND1

AHF is a 30-year-old nonprofit corporation that provides HIV/AIDS-related services across the United States. (Defendant’s statement of material facts DE 171-1 ¶¶ 1-2).2 To obtain reimbursements for providing these services in Broward County, Florida, AHF entered agreements with the State of Florida Department of Health (“FDOH”). (DE 171-1 ¶¶ 4, 5). These agreements with FDOH required AHF to take efforts to ensure that patients testing positive for HIV received appropriate follow-up medical care. (DE 171-1 ¶¶ 4-5). For instance, Contract # BW266 between AHF and FDOH — which AHF “understands” FDOH to be funding through Ryan White Part B 3 grant funds (DE 171 at 10) — required AHF to “refer all individ[1357]*1357uals newly diagnosed with HIV or those currently not in care to a healthcare Provider.” (DE 172-8 at 11). A second agreement between AHF and FDOH, Contract # BW265 — which AHF “understands” FDOH to be funding through the federal Centers for Disease Control and Prevention (“CDC”) (DE 171 at 10) — required AHF to “implement a high-impact, comprehensive HIV prevention program” that would “[ljink at least eighty percent (80%) of clients with a positive test result to medical care within ninety (90) days of their diagnosis.” (DE 172-10 at 12). Under Contract #BW265, AHF was also required to “[pjrovide referrals to clients with preliminary or confirmed HIV-positive test results.” (DE 172-10 at 13) (emphasis added). This contract also specifically defined the term “[linkage” as the “act of confirming that a client offered a voluntary service is successful in accessing that service” and the term “[l]inkage-to-care” as “[ajssisting an individual in receiving medical care for HIV infection from a physician, physician’s assistant, or nurse practitioner, usually within ninety (90) days of diagnosis. Linkage is the post-referral verification that the individual being referred to care accessed medical services. Linkage to medical care is the outcome of the referral.” (DE 172-10 at 11).

Separately, AHF also entered Agreement Number 11-CP-HCS-8515-RW for fiscal year 2011 with Broward County, Florida, to receive federal Ryan White Part A funding for providing HIV/AIDS-related services. (DE 171-1 ¶ 7). Pursuant to this agreement, AHF was responsible for “directing individuals to ... primary care, counseling and testing,, clinical diagnostic services, and referrals to appropriate providers of health and support services” and “creat[ing] and imple-mentEing] policies for referring clients to ambulatory/medical care services as requested by [the patient] if [the patient] is not in medical care.” (DE 172-11 at 70) (emphasis added). AHF renewed this agreement for fiscal year 2012-2013 and fiscal year 2013-2014 and, as part of the renewal process during fiscal year 2013-2014, submitted a “line item budget justification” that disclosed the means by which it had chosen to provide these services: employing Linkage Coordinators .who are “responsible for linking newly diagnosed HIV positive individuals' to care and identifying] patient[s] who have been out of care back into care.” (DE 172-14 at 18).

One of those Linkage Coordinators— and the individual who worked as the Linkage Coordinator for the two HIV-positive patients at the center of the allegations in this case, John Doe # 1 and John Doe # 2 — was Julio Rodriguez. (DE 171-1 ¶ 10). After John Doe # 1 tested positive for HIV and attended two follow-up appointments with AHF healthcare providers, AHF paid Rodriguez a $100 bonus. (DE 171-1 ¶ 32; see also DE 172-47). Similarly, after John Doe #2 attended two follow-up appointments with an AHF healthcare provider following his positive HIV test, AHF paid Rodriguez another $100 bonus. (DE 171-1 ¶ 33; see also DE 172-48). Indeed, around the time ’of the events involving John Doe # 1 and John Doe #2, on every. occasion an HIV-positive patient with whom Rodriguez worked as a Linkage Coordinator attended two [1358]*1358follow-up appointments with AHF healthr care providers, AHF paid Rodriguez a $100 bonus. (DE 171-1 ¶ 31).

AHF disclosed these bonus payments to FDOH.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

TULSA AMBULATORY PROCEDURE CENTER v. OLMSTEAD
2024 OK 57 (Supreme Court of Oklahoma, 2024)

Cite This Page — Counsel Stack

Bluebook (online)
262 F. Supp. 3d 1353, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-carrel-v-aids-healthcare-foundation-inc-flsd-2017.