Despite the group's protestations of wrongdoing, AIDS Healthcare Foundation has continued taking criticism since a group of three whistleblowers who filed complaints in Florida last week, alleging the foundation had defrauded the federal government and state of Florida.
According to one of the plaintiffs in the case, Jack Carrel, AHF knowingly broke the law when it started its Linkage to Care Program in 2010, a system that rewarded employees for referring patients to AHF services centers. In addition, the program offered monetary awards to clinic staff for exceeding an expected number of HIV tests and gave money to patients who self-referred to AHF centers.
Carrel, an HIV-positive activist with over 30 years of experience in HIV and AIDS service work, says the referral program broke anti-kickback laws at federal and state levels. When he brought his concerns about the program to his supervisors, he claimed that they ignored or did not address them at all.
His big tip off that something was wrong, Carrel alleges, was when he began attending meetings with funders. The funders, according to Carrel, expressed concern about the Linkage to Care Program and told AHF that they needed to be sure to give patients referrals not just to AHF centers, but to all other centers they could receive care at.
“I realized that, one we were not one following what we had agreed to do and two the people above me were basically lying to our funders,” said Carrel. “They said that when someone was referred to us we would give them an option of going to any clinic they want to and then most of the time they chose AHF but we always offered them options which is part of the law.”
Carrel said that he tried to follow up on these concerns, telling his supervisors that they at least needed a list of all options for patients, but that this list was never put together. In addition, grantees tried to initiate new systems so a neutral third party would meet and counsel patients. Carrel said AHF was able to bypass this by telling grantees that patients were given a choice in providers but that they simply preferred to go to AHF.
And then Carrel, whose department dealt with public health and HIV testing, started getting return on investment reports, he alleges.
“I thought my goal was to identify new positives, or previous positives, who had fallen out of care,” he said. “But in fact, from my return on investment sheet, my success, or my department’s success, was based on how many people we found who were positive that we linked to AHF pharmacies.
“There was a dollar amount based on that. And that’s how we were judged whether our program was successful or not,” he said. After receiving the ROI reports, Carrel became even more suspicious that something was not right. His suspicions were confirmed, he says, after a site visit in Jacksonville, Fla., attended by four people from the main office in Los Angeles.
“Shawn [Loftis], who’s one of the other relators, and I had identified a number of, kind of, irregularities, nothing’s reported and being billed and we had actually talked to our project officer about those things because that’s what I’m used to doing,” he said, alleging that both he and Loftis got in trouble with the attendees from the head office. “Several times we were told, when the project officer was out of the room, ‘You two need to shut up. We’ll do the talking here. We understand this better than you do.’”
Shortly after this site visit, Carrel said, he and his assistant were laid off, and since then Carrel has said he’s suffered professional backlash from AHF even before he filed the whistleblower complaint.
“When AHF first came here [to Baton Rouge] they asked to meet with all the providers and it was through a city meeting,” he said. “And because this is my area, my supervisor asked me to represent our agency and the message that came back from the city was that AHF would not allow us at the meeting if I was the representative.”
Since bringing the case against AHF, Carrel said there have been further retaliations against him.
“I’m part of the Louisiana AIDS Network here in Louisiana and AHF had agreed to work with us to rent some buses to bring people with HIV from around the state to the capital," Carrel says. "And I was just informed, actually about 30 minutes ago, the national [representative] had told the local rep that they would not be doing that and that AHF could not participate in any activities that I was associated with or anyone who worked [with me or I] was associated with.”
AHF has fired back against the plaintiffs in the media, saying in a statement last week that they had done nothing illegal and that they looked forward to proving these allegations wrong in court.
It is difficult though to determine how prevalent AHF's business model, including its Linkage to Care Program, is among HIV and AIDS organizations and other nonprofits. Organizations like amFAR, the Gay Men's Health Center, Planned Parenthood, the Stigma Project, and Equality Florida either declined to comment or requests to do so this week went unanswered.
Ted Leopold, head counsel for the plaintiffs, said that they had a while to go, estimating that a trial wouldn’t happen for at least several months, maybe even a year from now.
Leopold said he believed they had a strong case against AHF and that the fact that both the federal government and the state of Florida declined to intervene did not mean the case had no merit. Leopold clarified that the government could still chose to participate any time they wished and would still remain involved in the case. (The U.S. Department of Justice also declined to comment on the case.)
“There is a lot of precedent in a case like this, which is why there is a federal statute directly on point that you cannot incentivize patients or your own employees,” said Leopold. “And there is good reasons for that, especially in cases like this where to do so is going to create a lot of competitive behavior. It’s going to create overutilization of services, and essentially corrupt the system. That’s why we have statutes that make this in violation of the law.”
AHF has 21 days to file a response to the pleading and then the case will enter discovery.