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As evidenced by its October announcement, we believe that DVA will be further pressured to curtail utilizing AKF as a source of steady stream of “outlier” contracts in the future, for the following reasons. First, the relationship between DVA and AKF is highly suspect because of: (i) the circular donation scheme, whereby AKF predominantly assists patients of own principal donors (including DVA); under the 1997 HHS ruling, donors were required not to track what AKF pays to determine future contributions. And (ii) more importantly, the DVA senior management appears to have orchestrated a campaign to “steer” patients currently enrolled in Medicare and Medicaid to obtain private insurance.

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