The False Claims Tex.) against Laidlaw, Inc., Adventist ...

SETTLEMENT AGREEMENT I. PARTIES

This Settlement Agreement(Agreement)is entered into betweenthe United States America,acting through the United States Departmentof Justice and on-behalf of the Office of Inspector General of the Departmentof Health and HumanServices (OIG-HI-IS)(collectively United States); Adventist Health SystemSunbelt Healthcare Corporation, Adventist Health System/Sunbelt, Inc., Florida Hospital WatermanInc., HuguleyMemorialMedicalCenter, MetropolexAdventist Hospital, Inc. (collectively "Adventist Health"), Regional Emergency Services LP, Florida Regional EmergencyServices (FRES), AmericanMedical Response, Inc., AmericanMedical ResponseManagementI,nc., Florida Emergencypartners, Inc., Laidlaw, Inc. (collectively "RES");KevinMulligan, and AdamWightmati(hereinafter collectively referred as the Parties), throughtheir authorizedrepresentatives.

II. PREAMBLE A. Florida Hospital Watermani,nc., operates as a hospital in Eustis, Florida. Huo-mleyMemorialMedical Center operates as a hospital fia Fort Worth, Texas. Metroplex Adventist Hospital, Inc., operates as a hospital in Killeen, Texas. Eachof these hospitals p~ovidedambulancetransport and related services to.patients covered by the federal Medicare program. RESprovided managemenstervices to each of the hospitals, which included the preparation of Medicareclaims for ambulancetransports, and related services. B. Onor about February11, 2000, KevenP. Mulligantiled a fl_ni tam action titled United States ex rel. KevenMulliganv. Florida Re.~ion~lEmergencyMedicalServices and Florida Hospital WatermanInc., No. 5:00-cv-47-Oc-10B(M.D.Fla.), against Florida Regional

EmergencyMedical Services and Florida Hospital WatermanInc. (the Mulligan ~ t_~_) under

the False ClaimsAct, 31 U.S.C. ?? 3729-3733(the"False Claims Act").

C

Onor about March26, 2001, AdamWightmanfiled a flni tam action

titled United States ex tel. AdamWigAatmavn. Laidlaw, Inc., et al., No. SA01CA0256(EWP.D.

Tex.) against Laidlaw, Inc., Adventist Health System/Sunbelt, Inc. and others (the Wightman

t_.~_) underthe False ClaimsAct.

D The United States contends that RES,operating as an ambulance

managemenot peration, and F1prida Hospital WatermanInc., HuguleyMemorialMedical Center, MetropolexAdventist Hospital, Inc. (collectively "the Hospitals") engagedin the following

conduct ("the CoyeredConduct"). The United States contends that RESand the Hospitals

created false physiciancertifications regardingthe medicalnecessity of the transports by

ambulancesownedor operated by the Hospitals and submitted or caused to be submitted claims

to the MedicareProgram(Medicare), Title XVIIIof the Social Security Act, 42 U.S.C. 1395-1395ggg,for ambulancetransports whichWerenot medically necessary as required by

applicable statutes, regulations, and programguidance, and that the conductoccurred during the follow'rag periods:

i. Withrespect to.Florida Hospital WatermaSnac., the false statements

were created and the associated Mtdicare Claims were submitted for paymentbeginn~g January 1,- 1993 throug~ December31, 2000;

ii. Withrespect to HuguleyMemorialMedicalCenter, the false statements were created and the associated Medicareclaims were

submitted for paymentbegimaing January 1, 1993 through December31,

1997; 2

iii. Withrespect to MetroplexAdventist Hospital, the false statements

were created and the associated Medicareclaims were submitted for

paymentbeginning October 1, 1994 through September30, 2000.

E. The United States contends that the CoveredConductwas in violation of

and gives rise to liability underthe False ClaimsActand other statutes as set forth belowin

paragraphs2 and 3. The United States also contends that it has certa'm adminis~ativeclaims

against the Hospitals and RESfor engagingin the CoveredConduct, as.specified in Paragraph4;

below.

F. RESand the Hospitals contend that they did not engagein the Covered

Conductand that the United States .does not have any claims against thembased on the Covered

Conduct.

G. AmericanMedical Response, Inc., AmericanMedical Response,

ManagemenItn, c., and Laidlaw,Inc. contendfurther that they are not responsible or liable for the

acts or omissionsof any other party to this Settlement Agreement.

H. Toavoid the delay, uncertainty, inconvenience,and expenseof protracted

litigation of any claims based on the CoveredConduct,the Parties have reachedh full and finn

settlement pursuant to the terms spdcified below.

I.

During September2003, Florida Hospital:Watermanpaid funds to

Medicarepursuant to Notice(s) of ProgramReimbursemenbtased on the-finN settlement of cost

reports for fiscal years ending 12/31/1995through and inclusive of 12/31/2000. rg. TERMS AND CONDITIONS

1. Adventist Health and RESagree to pay to the United States $20,340,000(the "Settlement Amount")plus simple interes( as described belowwhichshall be immediatelydue

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and owingon the Effective Date, to be discharged as follows. Oft,he funds paid to Medicare described in Preambleparagraph. I, $1,033,281shall be deemeda paymentof part of the Settlement Amounthat Adventist Health madRESagree to pay to the United States under the terms of this Agreement.Accord~gly, the total amountto be paid by Adventist Health and RES uponexecution of this agreementshall be reduced to $19,306,719(the "Net Settlement Amount") plus interest on the Net Settlement Amounct alculated at the Federal Reserve's prime rate which shall accrue fromJune 15, 2003to the date of payment.RESshall pay $5,000,000of the Net Settlement Amountand Adventist Health shall pay the remainder of the Net Settlement Amount, with neither party being responsible for the other party's share. Adventist Health and RESagree to makesuch paymenst to the.United States within 10 business days after the Effective Date of this agreementvia an electronic transfer of lands that will be madeaccordingto written instructions to be providedby the Departmenot f Justice.

2. Subject to the exceptions in paragraph5 of this Agreementi,n consideration of the obligations set forth in this Agreementa~nd conditioned uponpaymentin full of the Settlement Amountt,he United States releases Adventist Health, and its respective predecessor, successor, and parent corporations and its present and formerofficers, trustees, directors, and employees, from any civil or administrative monetaryclaim the United States has or mayhave under the FalseClaims Act, 31 U.S.C. ?? 3729-3733;the Civil MonetaryPenalties Law,42 U.S.C. ? 1320a-7a; the ProgramFraud Civil RemediesAct, 31 U.S.C. ?? 3801-3812; or the commonlaw theories of paymentby mistake, unjust enrichment,breae~hofdontract, and fraud, for the submissionof any and all claims for ambulancetransports (including the creatiofl of the documentationmadcertifications qf any kind, if any, required for such claims to be paid and the services referenced therein to be covered) provided and billed by Florida Hospital Waterman

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Inc., HuguleyMemorialMedicalCenter, and MetroplexAdventist Hospital, Inc., to Medicarefor the respective periods referenced in the CoveredConduct,~Sectitn II, ParagraphC, above), and for the inclusion of ambulanceservice related expenseson Medicarecost reports filed by the Hospitals for the respective periods referenced in the CoveredConduct.

3. Subject to the exceptions in paragraph5 of this Agreementi,n consideration of the obligations set forth in this Agreement,and conditioned uponpaymentin full of the Settlement Amountt,he United States releases RESand their respective predecessor, successor, and parent .corporations madtheir present and formerofficers, trustees, directors, and employees,fromany civil or administrative monetaryclaim the United States has or mayhave under the False Claims Act, 31 U.S.C. ?? 3729-3733;the Civil Monetary.Penalties Law,42 U.S.C. ? 1320a-7a; the ProgramFraud Civil RemediesAct, 31 U.S.C. ?? 3801-3812; or the commonlaw theories of paymentby mistake, unjust enrichment, breach of contract, and fraud, for the CoveredConduct.

4. In consideration of the obligations of Adventist Health set forth in this Agreement and conditioned uponfull paymentof the Settlement Amountt,he OIG-I-1I-ISagrees to release and refrain frominstituting, directing, or maintainingany administrative action seeking exclusion from the Medicare, Medicaid,or other Federal heaith care programs(as defined in 42 U.S.C. 1320a-7b(f)) againstAdventistHealthunder 42 U.S.C. ? 1320a-7a (Civil MunetaryPenalties Law),or 42 U.S.C. ? 1320a-7(b)(7) (parmissive exclusion for fraud, kickbacks, and prohibited activities) for the Co,/eredConduct;provided,however,that this release (i) shall ? becomeeffective until receipt by the United States of the Settlement Amounstpecified in Paragraph1, and (ii) is subject to the exceptionsspecified in Paragraph5, below. Notwithstandingthe foregoing ~elease, the OIG-HHeSxpressly reserves all fights to complywith any statutory obligations to exclude Adventist Health from the Medicare,Medicaid, or Other

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