Three former employees are suing the nation's largest provider of HIV/AIDS medical care, alleging it illegally paid for patient referrals in violation of the anti-kickback statute and the False Claims Act.
The lawsuit against the AIDS Healthcare Foundation was unsealed in U.S. District Court in Fort Lauderdale, Fla., in February. An amended complaint was filed this month after the federal government and the state of Florida declined to join the case.
Attempts to reach the foundation for comment were not immediately successful Wednesday morning.
The whistle-blowers, three former managers at the not-for-profit foundation, allege that the foundation started rewarding patients for using its services and paying employees for referring patients to the foundation's testing, clinical, pharmacy and insurance service centers. The whistle-blowers allege these illegal incentives started in California and spread to 11 other states.
The illegal referrals then led to false and fraudulent claims to federal healthcare programs including Medicare, Medicaid and HIV/AIDS assistance programs, according to the complaint. The whistle-blowers allege federal healthcare programs doled out tens of millions of dollars in payments because of the fraudulent claims.
The whistle-blowers are Jack Carrel, former director of public health at the foundation's Southern bureau; Mauricio Ferrer, a former senior program manager at the Southern bureau; and Shawn Loftis, a former grants manager at the Southern bureau.
Under the False Claims Act, whistle-blowers may sue on behalf of the government and receive a portion of whatever money is recovered if the lawsuit is successful. Cases joined by the U.S. Justice Department are far more likely to lead to settlements and judgments against the defendants.