Court Opinion

ID: 9905456
Source: CourtListenerOpinion
Date Created: 2023-11-29 16:05:16.105864+00
Date Added: 2024-06-11T09:23:36.293317
License: Public Domain

DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA
                             FOURTH DISTRICT

                          STATE OF FLORIDA,
                              Appellant,

                                     v.

                          MARK A. DESIMONE,
                              Appellee.

                            No. 4D2022-2104

                           [November 29, 2023]

  Appeal from the Circuit Court for the Fifteenth Judicial Circuit, Palm
Beach County; Kirk C. Volker, Judge; L.T. Case No. 2018-CF-005145-
AXXX-MB.

   Ashley Moody, Attorney General, Tallahassee, and Lindsay A. Warner,
Assistant Attorney General, West Palm Beach, for appellant.

   Bruce A. Zimet of Bruce A. Zimet, P.A., West Palm Beach, for appellee.

WARNER, J.

    The State appeals the dismissal of four counts of an information
charging appellee Desimone with violations of section 817.505(1)(a),
Florida Statutes (2016) (The Patient Brokering Act), which prohibits
payments to an entity or person for referring patients to a health care
provider. After an evidentiary hearing, the trial court dismissed the four
counts, finding that while the counts alleged payments to one corporation,
the payments were made for the same tests conducted on the same
patients on the same date as payments made to another entity for those
same patient referrals. Because of this, the trial court determined that the
payments constituted one violation of the statute for each day alleged. We
hold that the trial court erred by holding an evidentiary hearing to
determine disputed issues of fact. We also conclude, based upon the
allegations in the information, that the statute allowed the State to bring
these multiple charges because the unit of prosecution pursuant to section
817.505(1)(a) is each payment made to induce the referral of patients or
patronage. Therefore, we reverse.
                       The Patient Brokering Act

   The State charged appellee Desimone with thirteen counts of violating
section 817.505(1)(a), Florida Statutes (2016) (The Patient Brokering Act).
That section provides:

      (1) It is unlawful for any person, including any health care
      provider or health care facility, to:

      (a) Offer or pay any commission, bonus, rebate, kickback, or
      bribe, directly or indirectly, in cash or in kind, or engage in
      any split-fee arrangement, in any form whatsoever, to induce
      the referral of patients or patronage to or from a health care
      provider or health care facility[.]

Id.

    In State v. Rubio, 967 So. 2d 768 (Fla. 2007), our supreme court
determined the allowable unit of prosecution under section 817.505(1)(b),
which prohibits receiving payment for patient referrals. In Rubio, the
defendant was charged with multiple counts based upon a fee-splitting
agreement with two health care providers. Id. at 770. The defendant
received a percentage of each payment received by the health care
providers from each patient. Id. at 771. Thus, the defendant had a true
fee-splitting agreement with the health care providers, and the charges
against the defendant each involved a different patient on different dates.
The supreme court concluded that the statute did “not simply prohibit
split-fee arrangements but prohibit[ed] engaging in those arrangements . .
. . [I]n accordance with the plain language of the statute, the State is not
limited to prosecuting only the arrangement to refer patients.” Id. at 778.

   The question presented in this case is how the statute should be applied
in section 817.505(1)(a), when a health care provider pays multiple
commissions to different parties for referrals of the same patients on the
same dates.

                                   Facts

   Safe Harbour Recovery Treatment Center (Safe Harbour) was a
substance abuse treatment facility, that regularly sought to have urine
samples of its patients tested. Appellee Desimone was associated with
Impact Q Laboratory, a lab that tested patient urine samples and then
received payment for the tests from the patient’s insurance company.
Impact Q is a health care provider within the meaning of the Act. Another

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individual involved in the alleged patient brokering scheme, John Rizzo,
received commissions from Impact Q/Desimone for bringing patients from
Safe Harbour to Impact Q for testing. Those payments were made to two
entities which Rizzo controlled: Southern Transfer and Idamia.

   Rizzo originally had an agreement in early 2016 with a lab in New
Orleans to provide them with patients’ urine analysis cups from Safe
Harbour, and he received a percentage of insurance claims’ receipts from
that lab. In the spring of 2016, Rizzo met with Desimone, who advised
Rizzo that he was opening a lab, Impact Q. Rizzo agreed to bring the Safe
Harbour urine samples to Impact Q for urine analysis, and in return
Impact Q agreed to pay Rizzo’s two companies from the insurance proceeds
which Impact Q received for the lab services rendered to the Safe Harbour
patients.

   Operatives from Safe Harbour then sought payments for steering Safe
Harbour’s business to Impact Q. Rizzo put the operators in touch with
Desimone to make a deal for payments from Desimone/Impact Q for the
urine analysis business from Safe Harbour. After considering different
methods to receive compensation, Safe Harbour operatives set up an entity
called United Recovery Consultants, LLC (United) to receive payments.
Impact Q made several payments to United as well as to Rizzo’s companies.
These arrangements led to the charges against Desimone.

   The State alleged in thirteen counts that Desimone violated the Patient
Brokering Act, for paying fees to Rizzo’s companies and United Recovery
Consultants on five different dates. For several of the dates, the State
charged one count for a Rizzo company, and another count on the same
date for a payment to the other Rizzo company or United. Desimone moved
to dismiss the counts for multiplicity as to Rizzo’s two corporations. The
State agreed to consolidate the counts alleging payments to Rizzo’s two
corporations on the same dates.

   Ultimately the State’s amended information charged Desimone with
nine counts: four for payments to United and five for payments to Rizzo’s
two corporations. The four payments to United were made on the same
dates as four of the payments to Rizzo’s corporations.

   Desimone also moved to dismiss as multiplicitous the counts alleging
payments to United, where payment to United was made for the same
patients and on the same dates that payment was made to one of Rizzo’s
corporations, which were the subject of other counts of the information.
Although the payments were for the same group of patient samples tested
by Impact Q, the State claimed that Impact Q’s payments to different

                                    3
corporations for the same referrals should constitute separate patient
brokering violations. Thus, the State argued it could charge Desimone for
each payment to United, a separate entity, from the Rizzo corporations.

   The trial court agreed with Desimone and granted the motion to dismiss
as to multiplicity, finding persuasive that the payments were for the same
patients and same tests. The court described the payments as “payments
that are issued on the same date, for the same patients or patronage, but
are allocated to different corporations, or are in essence, ‘installment
payments[.]’” Pursuant to Rubio, the court found that only one violation
could be charged for payments made for the same date of service.

   In moving for rehearing, the State claimed that the court went beyond
the four corners of the information to evaluate the arrangements between
the parties. The State argued that this was an issue for trial as to the type
of arrangements between Impact Q, Rizzo, and United, because the State
contended that each entity had a separate agreement with Impact Q and
received separate payments.

   Over the State’s objection, the court determined that it could hear
evidence outside the four corners of the information regarding the
arrangements between Impact Q and the corporations. At the evidentiary
hearing, various agreements between Impact Q and the corporations were
introduced, and a United representative as well as Rizzo testified regarding
their respective arrangements with Impact Q. Each corporation had a
separate “marketing” agreement with Impact Q, which set different
compensation for each company. Rizzo’s corporations received an annual
fee, with monthly installments plus a potential for incentive compensation.
United’s agreement did not state any annual compensation but permitted
United to receive up to $75,000 in “discretionary incentive compensation.”
The witness from United described the arrangement as getting a “cut” of
the Impact Q monies. The United witness also testified that Rizzo was
separate from United and never got part of United’s payments, as each
entity had its own arrangement with Impact Q.

   At the end of the evidentiary hearing, the trial court determined:

      It is clear that a global split fee arrangement existed between
      Safe Harbour, John Rizzo and Impact Q for the referral of Safe
      Harbour patient urine samples to Impact Q for testing . . . .
      [O]n the four occasions that Impact Q made payments for Safe
      Harbour referrals, both Safe Harbour operatives and John
      Rizzo received their “cut” for the referral and brokering the
      referral of Safe Harbour patient urine tests to Impact Q. It is

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      the Court’s finding that the “allowable unit of prosecution”
      does not permit separate prosecutions based on Impact Q
      payments made to the source of the urine sample referrals
      and the broker or middleman of the urine sample referrals
      when the payments are made on the same date, for the same
      urine samples, and the same urine testing.

The court then dismissed the four counts alleging payments to United
Recovery, thus leaving five counts against Desimone for payments to
Rizzo’s corporations. From this order, the State appeals.

                                 Analysis

   The State first contends that the trial court erred by holding an
evidentiary hearing on Desimone’s motion to dismiss to determine the unit
of prosecution for section 817.505(1)(a), Florida Statutes (2016).
Desimone filed a motion to dismiss pursuant to Florida Rule of Criminal
Procedure 3.190(b), arguing that the court should dismiss for multiplicity
the several counts of the information. Desimone did not bring a motion
pursuant to Florida Rule of Criminal Procedure 3.190(c)(4), and the motion
was not sworn. As a result, the State made no traverse to the motion.

    No provision of the Rules of Criminal Procedure allow for an evidentiary
hearing without compliance with these preliminary steps, although the
trial court may hold an evidentiary hearing to establish certain facts in
determining a rule 3.190(c)(4) motion. See Fla. R. Crim. P. 3.190(d).
Therefore, the court erred in conducting an evidentiary hearing on the
issue over the objection of the State.

   Additionally, the evidentiary hearing showed a dispute as to the type
and nature of the arrangements between the corporations and Impact Q.
Because disputed issues of fact were present, those fact questions should
have been decided at trial and not in a hearing prior to trial. The court
erred in making the factual determinations in a pretrial evidentiary
hearing where the motion to dismiss was based on rule 3.190(b) and not
rule 3.190(c)(4).

    Nevertheless, the State’s briefs do not dispute that the payments from
Impact Q to United and Rizzo were for referral of the same Safe Harbour
patients on the same four days. Nor is there any dispute that United and
Rizzo separately negotiated their agreements for payment with Impact Q.
See Rubio, 967 So. 2d at 776 (determining the unit of prosecution while
noting that no evidence had been presented or considered as the case was
at the motion to dismiss stage).

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   Thus, we are able to address the question presented in this appeal:
whether payments paid to different entities for referrals of the same
patients on the same days can be charged as different violations of the
Patient Brokering Act, or whether such payments constitute only one
violation for each day. We conclude that such payments may be separately
charged, because the correct unit of prosecution pursuant to section
817.505(1)(a) is each payment made to induce the referral of patients or
patronage.

    The Fifth Amendment double jeopardy clause protects against multiple
punishments for the same offense. State v. Losada, 175 So. 3d 911, 912
(Fla. 4th DCA 2015) (citing Ohio v. Johnson, 467 U.S. 493, 498, 104 S. Ct.
2536, 81 L. Ed. 2d 425 (1984)). “If a defendant is charged with more than
one count of the same statutory offense, the ‘allowable unit of prosecution’
standard applies” to determine if the charges are multiplicitous. Id.; State
v. Johnson, 343 So. 3d 46, 47–48 (Fla. 2022). When the court is faced with
the question of whether charges under one statute are multiplicitous, like
in the instant case, the court must first determine the permissible unit of
prosecution. Johnson, 343 So. 3d at 47; Rubio, 967 So. 2d at 777. “Unit
of prosecution” refers to “the aspect of criminal activity that the legislature
intended to punish.” Rubio, 967 So. 2d at 777 (quoting McKnight v. State,
906 So. 2d 368, 371 (Fla. 5th DCA 2005)); Johnson, 343 So. 3d at 48
(same). “[I]t is a distinguishable discrete act that is a separate violation of
the statute.” McKnight, 906 So. 2d at 371.

     In Rubio, the supreme court addressed the question of the unit of
prosecution and multiplicity in connection with section 817.505(1)(b)
which makes it unlawful for a person to solicit or receive “any commission
. . . or engage in any split-fee arrangement” for patient referrals. 967 So.
2d at 776. The court noted that the State charged defendants “every single
time” “they did any act in furtherance of the arrangement to refer patients.”
Id. The court considered the application of the “a/any” test to determine
whether the Legislature intended to allow multiple offenses or a singular
unit of prosecution. Id. at 777. The use of the word “any” in section
817.505(1)(b) had led the Fifth District to affirm the trial court’s dismissal
of charges because the Fifth District held it could “discern no intent by the
Legislature to criminalize each and every act done pursuant to the
agreement.” Id. at 776 (quoting State v. Rubio, 917 So. 2d 383, 398 (Fla.
5th DCA 2005)). The supreme court disagreed, noting that the “a/any
test” to determine legislative intent should not be applied mechanically.
Instead, the court stated a “common-sense approach” should be followed
to discern the intended unit of prosecution. Rubio, 967 So. 2d at 777
(quoting Bautista v. State, 863 So. 2d 1180, 1183 (Fla. 2003)). Rubio

                                      6
concluded that to determine the intended unit of prosecution for section
817.505, it had to “look at the overall statutory scheme and language of
the statute.” Id. at 778.

    The supreme court then observed that the statute made it unlawful to
“‘[s]olicit or receive any commission, bonus, rebate, kickback, or bribe’ or
to ‘engage in any split-fee arrangement,’ in return for referring patients.”
Id. “The statute’s express words indicate[d] that it is the engaging in fee-
splitting in return for referrals of patients that is prohibited.” Id. The
supreme court concluded that the appropriate unit of prosecution was not
the arrangement to refer patients, but “engaging in those arrangements.”
Id.

   As to the defendants’ claim that only one charge could be brought per
fee splitting arrangement because the statute used the term “any” fee split
arrangement, the supreme court stated:

      [T]he underlying information in the instant case did not
      charge crimes occurring in a single event. Rather, each count
      references a different date. These different dates reflect that
      the State has brought charges for different patient brokering
      activities. Whether on those dates the defendants actually did
      take part in a split-fee arrangement in return for the referral
      of patients is a question for the trier of fact.

Id. at 779. The court then held that the unit of prosecution under section
817.505(1)(b) constituted each time the patients were referred to the
health care providers. Id.

   In this case, the trial court looked to this language in Rubio and
concluded that the State was precluded from charging Desimone for the
separate payments to the Rizzo corporations and United for the same
patient referrals on the same dates.

   We find that the trial court, however, applied a mechanistic analysis,
rather than Rubio’s “common sense” analysis. The trial court focused on
the word “engage” with respect to a split-fee arrangement as used in both
sections 817.505(a) and (b) as the Rubio court did. However, the statutory
analysis required by Rubio to determine the unit of prosecution requires
consideration of the “whole subsection” and “look[ing] at the overall
statutory scheme and language of the statute.” 967 So. 2d at. at 778.
Here, if the payments are considered commissions or kickbacks, rather
than a split fee arrangement, then section 817.505(a) provides that it is a
violation to pay “any commission” or “kickback.” See 817.505(1)(a), Fla.

                                     7
Stat. (2016) (emphasis added). If the payment is truly a split fee
arrangement, then the health care provider violates the statute any time it
“engage[s] in any split-fee arrangement.”

    “To discern legislative intent, courts must consider the statute as a
whole, including the evil to be corrected, the language, title, and history of
its enactment, and the state of law already in existence on the statute.”
McKnight, 906 So. 2d at 371 (quoting Bautista, 863 So. 2d at 1186). When
determining the “unit of prosecution,” the focus is directed to “the aspect
of criminal activity that the Legislature intended to punish.” Rubio, 967
So. 2d at 777 (quoting McKnight, 906 So. 2d at 371).

   Section 817.505(1)(a), unlike section 817.505(1)(b) at issue in Rubio, is
directed at the payer or offeror who “induce[s]” the referral of patients or
patronage. The overall evil is patient brokering, but specifically as to
Desimone, as a health care provider, the evil to be corrected pursuant to
section 817.505(a) is paying third parties to refer patients to the health
care provider. Focusing on the act of paying commissions, Desimone’s
payments to Rizzo and separately to United induced both to be players in
the referral of patients or patronage to Impact Q. A definition of “pay” is
“to make due return to for services rendered or property delivered” and
another for “pay” is “to give in return for goods or service.” See Pay,
Merriam-Webster’s              Dictionary,         https://www.merriam-
webster.com/dictionary/pay (last visited on Nov. 1, 2023).             Here,
Desimone was charged with specific payments by separate checks to Rizzo
and to United in return for referrals.

   Thus, even though the State conceded that the payments were for the
same patients, Desimone paid each player, Rizzo and United, to induce
each player to refer to Desimone/Impact Q patients for lab testing. Section
817.505(1)(a) prohibits Desimone from inducing referral or patronage,
which inducement is made by each payment, on each date, to Rizzo or
United.

   Because the focus is on the payor in section 817.505(1)(a), not the
payee as in Rubio, the fact that the payments are for the referral of the
same patients for the same lab tests is not material. If a provider has to
pay two parties to obtain patient referrals, the provider is twice entering
into deals to broker the patients. Logically, any person, health care
provider, or facility making several deals to induce the same referrals or
patronage is engaging in more prohibited behavior pursuant to section
817.505(1)(a) than the person, health care provider, or facility which
makes only one deal to induce referrals or patronage. For that reason, the

                                      8
“common sense” unit of prosecution under section 817.505(1)(a) is each
payment made to induce the referral of patients or patronage.

                               Conclusion

   For the foregoing reasons, the unit of prosecution under section
817.505(1)(a), Florida Statutes (2016), is each payment made to induce
the referral of patients or patronage. Thus, the State properly charged
Desimone for the separate payments to Rizzo and to United, as each
payment was used to induce the referral of patients or patronage.
Accordingly, the trial court erred in granting the motion to dismiss as to
Counts 1, 4, 6, and 9 as multiplicitous. We reverse and remand for
reinstatement of the charges.

   Reversed and remanded.

MAY and FORST, JJ., concur.

                           *        *        *

   Not final until disposition of timely filed motion for rehearing.

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