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

ATTORNEY 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") has

invesllgiiled eei'tain business praotlces of CaroCfmi Niitlonal, LLC ("CarcCol'e"), Based upon

that investlgatloii, the OAGeollcludeslis. foUows;

FINDlflGS QF' ATTORNEY GItf\lVL

I, 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'llligellelïllli NilW YOl'k and tlu'ougbolillhe UliltCd Slales for èonimerolal
l

andgovemmeni pl'ogram subscribol's, CareCorc also contracts wlib and iiallages Iletwoi:ks of
..
radiologIsts (Iho "CMeCol'e MeO Netwol'k,s") that furnish Qutpatlcnt dlagnost1clinaglng sei'vlces

for certainMCOs hi Ne~ YOlk and New lel'80y.

2, In New York, Cal'eCore cUITonìly IlaSCQlitracts (tho "Conti'icls") Wlli four MOOs

n Allhia Health hiC,

("Aeiiiall), Oxfoi'd Health Pliiiisand Its liffliiitc -o"foi'd Health Insurance,

Ino', ("Oidl'd"), Healtli II1Stlliiice Plaii of Greaíei' New York ("Hilt"), and HODllll Nc,l QfN"w

York, Illc. - to provide both iidnùnlstrative .sel'l'lces and 10. manage ne.twol'ks of ouipailenl

I'adiolog)' ¡mlclÎces foi' certain Siibsci'lbers, Uiider ihese Conltacts, CRl'eCOl'll pi'ovldll$ slll'vito to

thó MCOs fol'lbelt coiiïinel'Clill a"d govel'llniClil progl'lni SUbsci'lbers,

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Case 2:08-cv-02954-LDW-ETB Document 251-1 Filed 01r25í11 Page 3 of 8

3. In additioh, eacJiot ¡he MeOs BeparaIßi~, contraels wlthliospitiils, multispeolalty

groiips aiid Qtliei' prov.lders thaHùmlsh o\llpalieiil dìagllQs.lic l:(dlQloll sei'v¡~es. SC!llll MCOs

nlso contriiet with coiiii)¡ehcnsivo provider iiètworb thaI selcctllieli' OWn iliiignosllë liitilghig

¡ii'ovidersiiisleadofpi'()vlders cOlilJacted wiih Cl\l'eCol:o,

4, Stale i'egulatloiis, and Ihe MCOs with which Cal'eCorc conti'aols, iistl\bllsli

Iirltihliumgcogaphlc acc.iiss rèqulicmeiits ror .provldei's. Cal'eCore niist abide by those

requli'emellts inestiibllshilgiind 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 Its

ne!woi'k or does riol !)eet tllllMCO's Qredeiillaiing reqiiiremei~ts, ClreCoreç¡ll exerelsc Its

discretion hi milking recolimendations liS to cOiiltactlng with otherwIse lJulillfied Jifovldel$lo be

part or npll11iciilnr CareCol:e MCO Netwol'k. Eaiih MCO wllh which CareCoie has contracted

hils dIrected ClIrliCore to 'In¡iliide: pai,tlclllal'olitpiitic¡JI dial\lIoslic liiiiglng servJc~ providers In

Its network. Bach of the MCO'shas siiecilled in Its contract specific pro1lldiil' or diagnostic

IUlaglng seivlcès with which CareCol'e must CQltraot Fol' the majorltyor pl'ovldol'$ III the

pliitlclilm"CareCore MCO NetwOlk, CnreCore makes the detei'ìiilnntioiis liS to which provldei's

may be iicluded.

,5. The OAO hils i'cceivedcomplnluts assei'ling 1I11! Cai'cCol'll hils refused to conti'act

wllhquiillfled physlclmis iind physIcian groups Coi'some 01' all modalities that they offer, for one

or inoi:e networks thaI CareCore manages for MCOs, Hie OAO also has receivcd,cbmplaints

abou,t Cl\reCore's preference for Its ~wniii's In ne(w~l'k decisIons. Ca~eCore hnsiissol'lcd ihat It Is

11.01 required to cOllll'acl with lIny paltlciiliil' provider so long as'the networks it maiiiiges meet

aiicess i'cquirelllênts of stiite law iilidÌls èol\trMts with MCOs.

2
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Case 2:08-cv-02954-LDW-ETB Document 251-1 Filed 01/25/11 Page 4 of 8

6. 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'é'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'eìn,Thé OAOfiods ,

theiigi'cenients conlâl.ed III IhlsAssul'uii:CeapPl'opl'ale mid In lhepubllcliilel'es.t.

II, The pai'tios agi'ee to cnleriiilo this Assulàlcc 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' busli1ess

I'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 two

hiindi'ed ten (210) days from the date of exceution .o'fJiis Assuranoe, iho full owiiei'shlp Interest

ot each CareCÓ1'(l Ownei'. ¡lor purposes of this ASBurancii,"èiïreCore Owner" shull 1U.1'1I1I 1\

CiireCol'e Menibei' ("Cal'eCol'e Menibei'" Shiiil mean llypel'sònoi' eiitlty with ah 'owliel'liip

Interest III CareCoro) that conll'lIols with CsreCore 01' an affllftte of CareeOl'e to pi'ov¡de seiviees

pU~uaiilto tlieColitrl\cts or II,oy f\ilure shnlhil' COnl\Ilels, ii10ludlng liiiy CareCoro Member who Is

a l'adioJogist aotively pmetlolng In New York, .f11 nil parimls, subsidiaries, pl'UCipiils, atliliiies,

sharoholders, partners, inembol', and iniinedìiile fnmllymembel'sofsi\cli Carceorii Members.

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Case 2:08-cv-02954-LDW-ETB, Document 251-1 Filed 01/25/11 Page 5 of 8

i 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 or

nny CoreCôi'C affliate i'eJatiilg to the CÖi\tl'iClsally e;¡pàliSloli or addílloillli site or location of

servieethat ¡snot liicliidcd within the contl'act as of the date hereof, exoept silo relocations that

Involve no material chaiige In size 01' cll)lßchy fmii that existing i\s of the .effective date of this

Agleeinollt.

(b) Theliniltatioiisset fOi'lh iii. sl1bpnragraph(li) of this pai'aßl'lIl)h shall not apply to

eidsting CnreCore Owllers thal-ai'e IiOSIIl!IiJs. hosiiitlil faculty practice pliins 01' that are otherwise

contl'lled by hospitals 01'10 CareCol'e Owners who hav6triilisfOl'redtlieli'full ownorshlp liilerosl,

12. Wl1hili sixty (60) dàysofthe ()xccliliOIl ofllils Assuf~lico,CllleColo shall adopt nn

iiiiendnioiit to its operating agreement aiid aiiy othei' noocssl\iy documents toprohlblt

inlllliigemellt COllll'.lttee .lleliibel'sfrol1 being Ciii-eCol'e Owiicrs and to provide that the inteJ'e~is

of 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) adinlnlstmlÎvc pei'sonnel will'cvlew applicfttlons submitted by pi'oviders and provide

lnfol'l)ll!ioii !o.CnreCore's inftiigement persoiinøl¡

(b) CareCore's iuanogeineni pei'soniiel, who shall notlnclud.eiiny incmbei' of any

CateCore Netwoi'k, wíl inRke decisions regarding whothei' to coiili'Í1ct wìi1i 01' recommend that

MCOslionlract wlih providers, based on the needs ortis MCO cUslomcir-s iind all upjiJleliblestí\te

regulations Including regu(iilions rtigardlllguecesSi and

(c) network pi'Qvldel's wUl nol Ii~vc any coi)sùJihlg ol'decisìon-inaking 1'01e in thc

ploees~,

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Case 2:08-cv-02954-LDW-ETB Document 251-1 Filed 01/25/11 Page 6 of 8

14 ,Cai'eCöl'c shall öslabllsh ali Jlppeals process for ptoYidei'8 that htive been denied

meinbcrshipliiii CareCore Network,

15, Wllhiii two Imndi'cd teii (2\ 0) days ofthe execution dille of this Assiminee, the

Chief EXillIlive Offcer of CaréCtire shall provide 10 Ihe OAG' n sworn statement conflrmlng

that CareCore has adopted praclices !llId proccduros aiid has takcn all necessary sleps to comply

wllh this Assllrance mid setting foi'h the miniilor 81d extell\ of Stich stiìps,S,lich eÚUflcatloli

shall iil~o bc provided by Cal'eCol'e lllll1laUy for thl'ee years from the date of execuilon 0& this

Assul'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\SI¡iiier 01' to deprive any twl'Soll 01' entity or I\ny

eidsthig )j1'lvále l'lght under the law, . Nothing iii this Assul'~noe shall in IIny way limeI, restde..

. 01'otherwise gQvel'l) lin)' rights of rilOUl'SC Caj'i:COl'e lIay hiive 01' seck 10 Assert agaInst allY thli'd

party. 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

Investigation. To thecxtcnt that allY inatèi'lalreprosiiiitations are latei' foiind to ))0 lnaceuratìl 01'

misleadIng, this .AsS\lrlmCe is voidable by the OAO In iis sole dlscl'etlon, III Rddition, in Uie

eveiit 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 CureCoÌ'e II) agi'Cllng to this

Assnrincç,

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Case 2:08-cv-02954-LDW-ETB Document 251-1 Filed 01/25/11 Pa'ge 7 of 8

19. Care Core r~lmiseits and wai'l'lits; i1im\1gh Ili~ slgnaliinis below, thiit the Hmns

llud conditions of ihis AS5uriincc are duly npJlrov~d, and that executloii or this AssUl'ance Is .duly

ftiithoi'iied, Cal'Core shall notliike nnYßotion ni' make iiiiy 811ltement denying, dlredy or

Iiidlreilly, Ibe ptojil'lety oftläs MSIU1\fice 01' expl'esshig the view Ihattlis ASS\ll'illieels wl1hout

ractiial ot' legal bftsls. Nothing ùithls pamgra¡ih affects CareCorc's: (I) testlmonlal obllgiitloiis¡

èl'(ll) l'ight to hike legft! 61' fachiiil p:osl1l(!ls iii defel!Se ofl1Ugal\oii,òtlietlegaJ proòëedlntis, 01' iii

aiiy othei' govel'IUiiental Investlgatlon to whlchtlie OAG Is not a ¡iai1y. This Assuranoe is not

Intended for uiie by iiny third pl\l'ly III aiiy Cilherpro'eeedlng, !lnd hi not iiiended, aiid sllPuld not

be 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 on

biihA'.íoC nU tlie pni1ies to this AsslImnce,Cill'eCore lIaY at any time llpply to ihe OAO fol' a

modlficai 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 shall

be bInding iipoii iheli' agents, tepreseiiatives. employees, successors and assigns, Inohidlng any'

cOliioratlon, subsidiary or division through whieh ,they lIel or hereafter act, provided that no

pii1y, 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 çoiitained in tliIs Ass\1l1nco

shall for liiiy I'cason be held to be invalid, illegal, or uneiitorceiible III aiiy respect,in the sole

discretion of the OAG such iiwalidityi lIegallly, or uncnforiioabllity shall nlitiiffeòl. ally (llhei'

provision ofihls ASSlll'l\IlOe,

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

23. Tò iht extent ¡iot already provided uiidcr ihls Assul'lIncø, CatèCore sball, \lpC)/l

reasonable written reqliest .bythe OAO, provldß all.docUinGllliltioil and infòriatloii necessary for

tliO OAOIo vcd/y coinplitUlce with this ASSllllice.

24, No.ilijng .cQnlallied herein shiillbe eonstl'lcd as relieving CareCore of the

obligation to coiiply wÍlh aU state and fedel'ß ¡laws, regitlatloiis or. rUles, nor shall any or tIie

Jli'ovlslons ofthis ASSIIl\ncil be dCCliic.d pCl'lissioli by lhe Altol'l1ey GOili'al (0 engage III any act

or pract!cc prohibited by such law, rcgullilIon 01' rule.

2S. TIìls Assul'lIlice shall be govel'od by the laws of iite Stiite of New York wlthaiit

reglll'd to
iily conflct of laws prlnoiples,
. fit-
IN WITNESS WIllREOF, this Assurance Is execlIled by the parties thls-J dayor

Deceiiibci', 20 I O.

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

By:
Donald R. Ryall .
By: .. ..' Jt~
Mlil'hl T. Vullo
Chali'man lIi,d Chief Bxecutlve Offeer ßxecutl'lc Deputy Atiomcy úeneral
Foi' Ec.oiiomlc.u.slice

1.'119,IISvS

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