Carecore Settlement w NYS AG

8/7/2019 Carecore Settlement w NYS AG

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Case 2:08-cv-02954-LDW-ETB Document 251-1 Filed 01/25/11 Page 1 of 8

Moses Declaration

Exhibit A


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u~~~~._...~.._-,._.,._,.,......Case 2:08-cv-02954-LDW-ETB Document 251-1 Filed 01/25/11 Page 2 of 8ATTORNEY GENEIlL:Olt tnt.STATEOFNEW YORK

JNRE:CARECORE NATIONAL, LLC . -. Mil * ll)-n)

ASSURANCE pi.' DlSCONTIJl/6NCl'Pu/'iiant to' Article 2L-Aof the New Y Qrk Generiil.BusllieS$ Liw,lIl1dSectlQn 63(15) of

the ExecutIve Law, the Offce of the Attorney General of the Siate of New Yoi'k ("0AO") hasinvesllgiiled eei'tain business praotlces of CaroCfmi Niitlonal, LLC ("CarcCol'e"), Based uponthat investlgatloii, the OAGeollcludeslis. foUows;

FINDlflGS QF' ATTORNEY GItf\lVLI, CareCore js a New York limIted liabilty coiipiiiiywith offces at 169 Myeiw

Corilllfs Road, Wappingers T1illls, NeW York and 400 BUCKwaltel'Pliice Boiileval'd,Slilffon,South Carolina. Cal'eC01'e conlraols with managed cai'o organizations ("MCOs") to provIde

l'adiology-utlllzalloii Jill'llligellelllli NilW YOl'k and tlu'ougbolillhe UliltCd Slales for onimerolallandgovemmeni pl'ogram subscribol's, CareCorc also contracts wlib and i iallages Iletwoi:ks of..radiologIsts (Iho "CMeCol'e MeO Netwol'k,s") that furnish Qutpatlcnt dlagnost1clinaglng sei'vlcesfor certainMCOs hi Ne~ YOlk and New lel'80y.

2, In New York, Cal'eCore cUITonly IlaSCQlitracts (tho "Conti'icls") Wlli four MOOsn Allhia Health hiC, ("Aeiiiall), Oxfoi'd Health Pliiiisand Its liffliii tc -o"foi'd Health Insurance,Ino', ("Oidl'd"), Healtli II1Stlliiice Plaii of Greaei' New York ("Hilt"), and HODllll Nc,l QfN"wYork, Illc. - to provide both iidnnlstrative .sel'l'lces and 10. manage ne.twol'ks of ouipailenl

I'adiolog)' mlclces foi' certain Siibsci'lbers, Uiider ihese Conltacts, CRl'eCOl'll pi'ovldll$ slll'vito toth MCOs fol'lbelt coiiinel'Clill a"d govel'llniClil progl'lni SUbsci'lbers,

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3. In additioh, eacJiot he MeOs BeparaIi~, contraels wlthliospitiils, multispeolaltygroiips aiid Qtliei' prov.lders thaHmlsh o\llpalieiil dagllQs.lic l:(dlQloll sei'v~es. SC!llll MCOsnlso contriiet with coiiii)ehcnsivo provider iitworb thaI selcctllieli' OWn iliiignosll liitilghigii'ovidersiiisleadofpi'()vlders cOlilJacted wiih Cl\l'eCol:o,

4, Stale i'egulatloiis, and Ihe MCOs with which Cal'eCorc conti'aols, iistl\bllsliIirltihliumgcogaphlc acc.iiss rqulicmeiits ror .provldei's. Cal'eCore niist abide by thoserequli'emellts in stiibllshilgiind l'ianaglng tile networks.. As long as those J'equlreinoiits flremet,howevoi, subject to an MeOls diitemiiiiation that Ii particular pro.vlder niuSl be,lniiJuded Iii Itsne!woi'k or does riol !)eet tllllMCO's Qredeiillaiing reqiiiremei~ts, ClreCorell exerelsc Itsdiscretion hi milking recolimendations liS to cOiiltactlng with otherwIse lJulillfied Jifovldel$lo bepart or npll11iciilnr CareCol:e MCO Netwol'k. Eaiih MCO wllh which CareCoie has contractedhils dIrected ClIrliCore to 'Iniliide: pai,tlclllal'olitpiiticJI dial\lIoslic liiiiglng servJc~ providers InIts network. Bach of the MCO'shas siiecilled in Its contract specific pro1lldiil' or diagnosticIUlaglng seivlcs with which CareCol'e must CQltraot Fol' the majorltyor pl'ovldol'$ III thepliitlclilm"CareCore MCO NetwOlk, CnreCore makes the detei'iilnntioiis liS to which provldei'smay be iicluded.

,5. The OAO hils i'cceivedcomplnluts assei'ling 1I11! Cai'cCol'll hils refused to conti'actwllhquiillfled physlclmis iind physIcian groups Coi'some 01' all modalities that they offer, for oneor inoi:e networks thaI CareCore manages for MCOs, Hie OAO also has receivcd,cbmplaintsabou,t Cl\reCore's preference for Its ~wniii's In ne(w~l'k decisIons. Ca~eCore hnsiissol'lcd ihat It Is11.01 required to cOllll'acl with lIny paltlciiliil' provider soong as'the networks it maiiiiges meetaiicess i'cquirelllnts of stiite law iilidls ol\trMts with MCOs.

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~~~~~~~~.,__...._""om~~.__._.___.,~Case 2:08-cv-02954-LDW-ETB Document 251-1 Filed 01/25/11 Page 4 of 86. 1'heOAO has Iil1eged thai CiireCore's business pl'ctices constitue n violation of

New York Ja\v.1.'llre OAQ diislres locollthid.e Ihis illVi:sUgiillon bi\sed 011 Cal'eCOI''S Iigreelnel1

to imdc,i.tlike the actions'set forth h~low.. The OAO is willhlg 10 iiccepiihis Assurance In lieu or. coimnencliig n speohil pl'ceedhlg. \\ifhl~glll'dto Ihe matters ii?dres~od hel'en,Th OAOfiods ,

theiigi'cenients conll.ed III IhlsAssul'uii:CeapPl'opl'ale mid In lhepubllcliilel'es.t.II, The pai'tios agi'ee to cnleriiilo this Assullcc of Discolitliiuance, 11Irsiiant to

BxcoutlveLiw 63 (15), liS follows:ACImEMENT

IT IS HERnBY UNDERSTOOD AND AGJiD, byaiid belwciiii the parties thnl;9. ThIs Assl/i'mtee or DlscontillllinCC shall apply to CllleColc Nnilolliil, LLC

whether acilng lhi'oiighlis pl'iiolpaJs, dlrectos, offcers; shlll'elilders,.cl1ployees,l'cprescotiitlves, lIgCJ\ts, assigns, siiccessins, parents, subsIdiaries, iiffllates, 01' oihei' busli1essI'Jilities wIrosoiie.ts, pl'llCile~1 oi'ponole~ lire dll'ecled, fQlinulaled, 01' contl'olled by Cal'eCOi'e,

10. CftreCoro shall uiidei'tiike besl efforts to ptii,nhase lit fll!I'Jlnrkel viilue, wlililn twohiindi'ed ten (210) days from the date of exceution .o'fJiis Assuranoe, iho full owiiei'shlp Interestot each CareC1'(l Ownei'. lor purposes of this ASBurancii,"ireCore Owner" shull 1U.1'1I1I 1\CiireCol'e Menibei' ("Cal'eCol'e Menibei'" Shiiil mean llypel'snoi' eiitlty with ah 'owliel'liip

Interest III CareCoro) that conll'lIols with CsreCore 01' an affllftte of CareeOl'e to pi'ovde seivieespU~uaiilto tlieColitrl\cts or II,oy f\ilure shnlhil' COnl\Ilels, ii10ludlng liiiy CareCoro Member who Isa l'adioJogist aotively pmetlolng In New York, .f11 nil parimls, subsidiaries, pl'UCipiils, atliliiies,sharoholders, partners, inembol', and iniinediile fnmllymembel'sofsi\cli Carceorii Members.

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~~.__~'~M-~'lM~m.lli!i~_a..iill__'''''-'-'._~''''-~---,--Case 2:08-cv-02954-LDW-ETB, Document 251-1 Filed 01/25/11 Page 5 of 8i 1 (n) For II period of five yeftu fi'oin the date of exeouiion of this AssUlftnce, 110

CareCoTe Owner shall be eligible to inolude wiJhliithcsoope of its Ooii.traot wllh CareCl)re ornny CoreCi'C affliate i'eJatiilg to the Ci\tl'iClsally e;pliSloli or addlloillli site or location ofservieethat snot liicliidcd within the contl'act as of the date hereof, exoept silo relocations thatInvolve no material chaiige In size 01' cll)lchy fmii that existing i\s of the .effective date of thisAgleeinollt.

(b) Theliniltatioiisset fOi'lh iii. sl1bpnragraph(li) of this pai'al'lIl)h shall not apply toeidsting CnreCore Owllers thal-ai'e IiOSIIl!IiJs. hosiiitlil faculty practice pliins 01' that are otherwisecontl'lled by hospitals 01'10 CareCol'e Owners who hav6triilisfOl'redtlieli'full ownorshlp liilerosl,

12. Wl1hili sixty (60) dysofthe ()xccliliOIl ofllils Assuf~lico,CllleColo shall adopt nniiiiendnioiit to its operating agreement aiid aiiy othei' noocssl\iy documents toprohlbltinlllliigemellt COllll'.lttee .lleliibel'sfrol1 being Ciii-eCol'e Owiicrs and to provide that the inteJ'e~isof the CilIeCoro OWi1I'.s twe non-voting,

)3, CareCore shalllIiikedetcl'ilnaiions l'eg81'dliig Its New York neiwoi'k contractlng

in the following miilnel':(8) adinlnlstmlvc pei'sonnel will'cvlew applicfttlons submitted by pi'oviders and provide

lnfol'l)ll!ioii !o.CnreCore's inftiigement persoiinl(b) CareCore's iuanogeineni pei'soniiel, who shall notlnclud.eiiny incmbei' of any

CateCore Netwoi'k, wl inRke decisions regarding whothei' to coiili'1ct wi1i 01' recommend thatMCOslionlract wlih providers, based on the needs ortis MCO cUslomcir-s iind all upjiJleliblest\teregulations Including regu(iilions rtigardlllguecesSi and

(c) network pi'Qvldel's wUl nol Ii~vc any coi)sJihlg ol'decison-inaking 1'01e in thcploees~,

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14 ,Cai'eCl'c shall slabllsh ali Jlppeals process for ptoYidei'8 that htive been deniedmeinbcrshipliiii CareCore Network,

15, Wllhiii two Imndi'cd teii (2\ 0) days ofthe execution dille of this Assiminee, theChief EXillIlive Offcer of CarCtire shall provide 10 Ihe OAG' n sworn statement conflrmlngthat CareCore has adopted praclices !llId proccduros aiid has takcn all necessary sleps to complywllh this Assllrance mid setting foi'h the miniilor 81d extell\ of Stich stips,S,lich eUflcatlolishall iil~o bc provided by Cal'eCol'e lllll1laUy for thl'ee years from the date of execuilon 0& thisAssul'nce,

16, Nothing coiltaliied In this AssUl'aiice ~halJ be constnied to altoi', change, iiodliy 01'enhance aiiy ex:ls.tlng legal rIGhts of liiiy COI\SIiiier 01' to deprive any twl'Soll 01' entity or I\nyeidsthig )j1'lvle l'lght under the law, . Nothing iii this Assul'~noe shall in IIny way lime , restde..

. 01' therwise gQvel'l) lin)' rights of rilOUl'SC Caj'i:COl'e lIay hiive 01' seck 10 Assert agaInst allY thli'dparty. or defend aiiy olahl1 iigaliislli,

17, The OAO has lIgl'Ced to the terlls oftlils Assul'ance based on, 8nlon8 o.tliel' things,the ~flpre.seiitiitlol\s made to the OAG by ClirflCol'e and its couriselarid the OAO's own factual. .nvestigation. To thecxtcnt that allY inati'lalreprosiiiitations are latei' foiind to ))0 lnaceuratl 01'misleadIng, this .AsS\lrlmCe is voidable by the OAO In iis sole dlscl'etlon, III Rddition, in Uieeveiit of aiiy lIcllon by thii OAG for ~iQintlon of t.hisAs,8uranco, any ClIrciCol'o OWl1cr \lint has

sold its ownci'shlp hitci'csl shall 001 be.8 party to any siich action.\8, No I'cpresentiiilon, induccment, pl'inlse. undersiiiiiding, condltloli, or wal'ally

not set fOi1h iii this Assii:ance has been mnde to or relied upon by CureCo'e II) agi'Cllng to thisAssnrinc,

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19. Care Core r~lmiseits and wai'l'lits; i1im\1gh Ili~ slgnaliinis below, thiit the Hmnsllud conditions of ihis AS5uriincc are duly npJlrov~d, and that executloii or this AssUl'ance Is .duly

ftiithoi'iied, Cal'Core shall notliike nnYotion ni' make iiiiy 811ltement denying, dlredy orIiidlreilly, Ibe ptojil'lety oftls MSIU1\fice 01' expl'esshig the view Ihattlis ASS\ll'illieels wl1houtractiial ot' legal bftsls. Nothing ithls pamgraih affects CareCorc's: (I) testlmonlal obllgiitloiisl'(ll) l'ight to hike legft! 61' fachiiil p:osl1l(!ls iii defel!Se ofl1Ugal\oii,tlietlegaJ proedlntis, 01' iiiaiiy othei' govel'IUiiental Investlgatlon to whlchtlie OAG Is not a iai1y. This Assuranoe is notIntended for uiie by iiny third pl\l'ly III aiiy Cilherpro'eeedlng, !lnd hi not iiiended, aiid sllPuld notbe eOi\sttucd,'iis.t\ admIssIon ofwlongdoij)g 01' liabilty by Cill'eCore,

20. This Assurance may not be amended ex.ocj)t by iin insiriinent In wl'tJngslgned onbiihA'.oC nU tlie pni1ies to this AsslImnce,Cill'eCore lIaY at any time llpply to ihe OAO fol' amodlficai Ion of this ASSUI'IUICe, based on oliiiiged oondltlons, 01' other reasoiis.

2J, ThIs Assurance shaU liiure 10 the benefit oflhe parties to this Assurance and shallbe bInding iipoii iheli' agents, tepreseiiatives. employees, successors and assigns, Inohidlng any'cOliioratlon, subsidiary or division through whieh ,they lIel or hereafter act, provided that nopii1y, olher ihiiii the OAO. l1a)ilissigii, delegiite, 01' othel'Wlse tl'lOsfer miy of its I'glits 01'oblignUons under ihis Assyraiice Without the prior w~ltten conseiit of the OAG,

22. Iii the event thnl liiiy one 01' more of Uie provisions oiitained in tliIs Ass\1l1nco

shall for liiiy I'cason be held to be invalid, illegal, or uneiitorceiible III aiiy respect,in the solediscretion of the OAG such iiwalidityi lIegallly, or uncnforiioabllity shall nlitiiffel. ally (llhei'provision ofihls ASSlll'l\IlOe,

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23. T iht extent iot already provided uiidcr ihls Assul'lInc, CatCore sball, \lpC)/l

reasonable written reqliest .bythe OAO, provld all.docUinGllliltioil and infriatloii necessary fortliO OAOIo vcd/y coinplitUlce with this ASSllllice.

24, No.ilijng .cQnlallied herein shiillbe eonstl'lcd as relieving CareCore of theobligation to coiiply wlh aU state and fedel' laws, regitlatloiis or. rUles, nor shall any or tIieJli'ovlslons ofhis ASSIIl\ncil be dCCliic.d pCl'lissioli by lhe Altol'l1ey GOili'al (0 engage III any actor pract!cc prohibited by such law, rcgullilIon 01' rule.

2S. TIls Assul'lIlice shall be govel'od by the laws of iite Stiite of New York wlthaiitreglll'd toily conflct of laws prlnoiples, . fit-IN WITNESS WIllREOF, this Assurance Is execlIled by the parties thls-J dayorDeceiiibci', 20 I O.

Aiidi'ew M, CiiomoAr'1:;fd.I\~.S(nl~ ofNcw Yol'K

By: .. ..' Jt~Mlil'hl T. Vulloxecutl'lc Deputy Atiomcy eneralFoi' Ec.oiiomlc.u.slice

By:Donald R. Ryall .Chali'man lIi,d Chief Bxecutlve Offeer

1.'119,IISvS

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Documents

Carecore Settlement w NYS AG