CORPORATE INTEGRITY AGREEMENT

BETWEEN THE

OFFICE OF INSPECTOR GENERAL

OF THE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

AND

B-EAST,LLC

DBAAMAYA SPRINGS HEALTH CARE CENTER

I. PREAMBLE

B-East, LLC dba Amaya Springs Health Care Center (Amaya Springs) hereby enters into this Corporate Integrity Agreement (CIA) with the Office oflnspector General (OIG) of the United States Department of Health and Human Services (HHS) to promote compliance with the statutes, regulations, and written directives of Medicare, Medicaid, and all other Federal health care programs (as defined in 42 U.S.C. 1320a-7b(f)) (Federal health care program requirements). Contemporaneously with this CIA, Amaya Springs is entering into a Settlement Agreement with the United States.

II. TERM AND SCOPE OF THE CIA

A. The period of the compliance obligations assumed by Amaya Springs under this CIA shall be five years from the effective date of this CIA. The "Effective Date" shall be the date on which the final signatory of this CIA executes this CIA. Each oneyear period, beginning with the one-year period following the Effective Date, shall be refe1Ted to as a "Reporting Period."

B. Sections VII, X, and XI shall expire no later than 120 days after OIG's receipt of: (1) Amaya Springs' final annual report; or (2) any additional materials submitted by Amaya Springs pursuant to OIG' s request, whichever is later.

C. The scope of this CIA shall be governed by the following definitions:

I. "AITangements" shall mean every aITangement or transaction that:

a. involves, directly or indirectly, the offer, payment, solicitation, or receipt of anything of value; and is between

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B-East, LLC dba Amaya Springs Health Care Center Cmporate Integrity Agreement

Amaya Springs and any actual or potential source of health care business or refenals to Amaya Springs or any actual or potential recipient of health care business or referrals from Amaya Springs. The term "source of health care business or refenals" shall mean any individual or entity that refers, recommends, ananges for, orders, leases, or purchases any good, facility, item, or service for which payment may be made in whole or in part by a Federal health care program and the term "recipient of health care business or refe1Tals" shall mean any individual or entity ( 1) to whom Amaya Springs refers an individual for the furnishing or ananging for the furnishing of any item or service, or (2) from whom Amaya Springs purchases, leases or orders or ananges for or recommends the purchasing, leasing, or ordering of any good, facility, item, or service for which payment may be made in whole or in part by a Federal health care program; or

b. is between Amaya Springs and a physician (or a physician's immediate family member (as defined at 42 C.F.R. 411.351)) who makes a refenal (as defined at 42 U.S.C. 1395nn(h)(5)) to Amaya Springs for designated health services (as defined at 42 U.S.C. 1395nn(h)(6)).

2. "Focus Arrangements" means every Anangement that:

a. is between Amaya Springs and any actual source or recipient of health care business or refenals to Amaya Springs and involves, directly or indirectly, the offer, payment, or provision of anything of value; or

b. is between Amaya Springs and any physician (or a physician's immediate family member) (as defined at 42 C.F.R. 411.351)) who makes a refenal (as defined at 42 U.S.C. 1395nn(h)(5)) to Amaya Springs for designated health services (as defined at 42 U.S.C. 1395nn(h))(6)).

Notwithstanding t11e foregoing provisions of Section II.C.2, any Arrangement that satisfies the requirements of 42 C.F.R. 411.356 (ownership or investment interests), 42

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B-East, LLC dba An1aya Springs Health Care Center Co1porale Integrity Agreen1ent

C.F.R. 411.3 57 (g) (remuneration umelated to the provision of designated health services); 42 C.F.R. 41 l.357(i) (payments by a physician for items and services); 42 C.F.R. 41 l.357(k) (non-monetary compensation); 42 C.F.R. 41 l.357(m) (medical staff incidental benefits), 42 C.F.R. 411.357(0) (compliance training), 42 C.F.R. 411.357(q) (refe1Tal services), 42 C.F.R. 411.357(s) (professional comtesy), 42 C.F.R. 357(u) (community-wide health information systems), or any exception to the prohibitions of 42 U.S.C. 1395nn enacted following the Effective Date that does not require a written agreement shall not be considered a Focus Anangement for purposes of this CIA.

3. "Covered Persons" includes:

a. all owners, officers, directors, and employees of Amaya Springs; and

b. all contractors, subcontractors, agents, and other persons who furnish patient care items or services or who perfmm billing or coding functions on behalf ofAmaya Springs excluding vendors whose sole connection with Amaya Springs is selling or otherwise providing medical supplies or equipment to Amaya Springs; and

c. all physicians and other non-physician practitioners who are members of Amaya Springs' active medical staff.

4. "Atrnngements Covered Persons" includes each Covered Person who is involved with the development, approval, management, or review of Amaya Springs' Arrangements.

III. CORPORATE INTEGRITY OBLIGATIONS

Amaya Springs shall establish and maintain a Compliance Program that includes the following elements:

A. Compliance Officer and Committee, Governing Body, and Management Compliance Obligations

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B-E'ast, LLC dba A111aya Springs Health Care Center Co1porate Integrity Agree111ent

1. Compliance Officer. Within 90 days after the Effective Date, Amaya Springs shall appoint a Compliance Officer and shall maintain a Compliance Officer for the term of the CIA. The Compliance Officer shall be an employee and a member of senior management of Amaya Springs, shall report directly to the Chief Executive Officer of Amaya Springs, and shall not be or be subordinate to the General Counsel or Chief Financial Officer or have any responsibilities that involve acting in any capacity as legal counsel or supervising legal counsel functions for Amaya Springs. The Compliance Officer shall be responsible for, without limitation:

a. developing and implementing policies, procedures, and practices designed to ensure compliance with the requirements set forth in this CIA and with Federal health care program requirements;

b. making periodic (at least quarterly) reports regarding compliance matters directly to the Governing Body of Amaya Springs, and shall be authorized to report on such matters to the Governing Body at any time. Written documentation of the Compliance Officer's reports to the Governing Body shall be made available to OIG upon request; and

c. monitoring the day-to-day compliance activities engaged in by Amaya Springs as well as any reporting obligations created under this CIA.

Any noncompliance job responsibilities of the Compliance Officer shall be limited and must not interfere with the Compliance Officer's ability to perform the duties outlined in this CIA.

Amaya Springs shall report to OIG, in writing, any changes in the identity of the Compliance Officer, or any actions or changes that would affect the Compliance Officer's ability to perform the duties necessary to meet the obligations in this CIA, within five days after such a change.

2. Compliance Committee. Within 90 days after the Effective Date, Amaya Springs shall appoint a Compliance Committee. The Compliance Committee shall, at a minimum, include the Compliance Officer and other members of senior management necessary to meet the requirements of this CIA (~, senior executives of

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B-East, LLC dba A111aya Springs Health Care Center Co1porate Integrity Agree111ent

relevant departments, such as billing, clinical, human resources, audit, and operations). The Compliance Officer shall chair the Compliance Committee and the Committee shall support the Compliance Officer in fulfilling his/her responsibilities &&, shall assist in the analysis of Amaya Springs' risk areas and shall oversee monitoring of internal and external audits and investigations). The Compliance Committee shall meet at least quarterly. The minutes of the Compliance Committee meetings shall be made available to OIG upon request.

Amaya Springs shall report to OIG, in writing, any changes in the composition of the Compliance Committee, or any actions or changes that would affect the Compliance Committee's ability to perform the duties necessary to meet the obligations in this CIA, within 15 days after such a change.

3. Governing Body Compliance Obligations. The Governing Body (or a committee of the Governing Body) of Amaya Springs Governing Body shall be responsible for the review and oversight of matters related to compliance with Federal health cam program requirements and the obligations of this CIA. The Governing Body must include independent (i.e., non-executive) members.

The Governing Body shall, at a minimum, be responsible for the following:

a. meeting at least quarterly to review and oversee Amaya Springs' compliance program, including but not limited to the performance of the Compliance Officer and Compliance Committee;

b. submitting to the OIG a description of the documents and other materials it reviewed, as well as any additional steps taken, such as the engagement of an independent advisor or other third party resources, in its oversight of the compliance program and in support of making the resolution below during each Reporting Period; and

c. for each Reporting Period of the CIA, adopting a resolution, signed by each member of the Governing Body summarizing its review and oversight of Amaya Springs' compli