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Two nurses and a licensed physical therapist (PT) originally from the Philippines have filed a proposed class action lawsuit against an Ohio staffing firm, claiming its contracts and practices amount to trafficking and fraud, among other allegations.

The claims that Cincinnati-based Health Carousel, which recruits and hires healthcare workers primarily from the Philippines to work in the U.S., employs its workers in "essentially indentured servitude."

"Health Carousel mandates that its workers not leave the company for years unless they pay the company tens of thousands of dollars," a complaint filed on behalf of Novie Carmen, RN, Kersteen Flores, RN, and licensed PT Jerlin Amistoso states. "And the company follows through on its threats by suing workers who dare to leave anyway."

Earlier this month, a first shed light on the case and Carmen, the original nurse behind it.

"I was basically trapped," Carmen told Bloomberg. "Duped."

According to the Bloomberg report, Carmen borrowed money from her boyfriend to help pay the $20,000 "quitting fee" and break ties with Health Carousel.

Carmen, Flores, and Amistoso now claim in their lawsuit that Health Carousel knows its workers must partake in lengthy orientation sessions and work overtime, but that the company doesn't count those hours toward their required commitment period. The lawsuit adds that, "to make these workers feel even more vulnerable," Health Carousel isolates them and prohibits them from discussing their pay and working conditions with others.

According to the complaint, Health Carousel maintains its scheme through defrauding the federal government, which approves its visa petitions without knowing it routinely fails to pay workers the wage it promises, and defrauding the workers themselves -- who are unexpectedly subject to harsh employment terms, difficult workplace conditions, long work requirements, and stringent rules.

The complaint adds that Health Carousel continues to profit from its alleged scheme because healthcare facilities at which workers are placed pay the company more than what it pays its workers, and the company recoups even more money from workers who leave before the company determines they have completed their commitment period.

The lawsuit seeks to end what it claims are Health Carousel's illegal practices and to compensate victims through forced labor claims under federal and state law, claims under the Racketeer Influenced and Corrupt Organizations Act and Ohio's Corrupt Practices Act, and claims under the Fair Labor Standards Act.

Ultimately, Carmen, Flores, and Amistoso allege their circumstances aren't unique. The reported that at least 20 nurses in Pennsylvania alone, where Carmen was placed at a hospital by Health Carousel in 2018, have paid high financial penalties in recent years, according to the lawsuit.

Of Health Carousel, the Enquirer reported that the staffing firm has of the region's largest privately held companies for the past 5 years. "In the latest ranking, the company dropped from 39 to 45 on the list, reporting a revenue of $288 million in 2020," the Enquirer wrote. "It hauled in $301 million in 2019."

Legal counsel for Carmen, Flores, and Amistoso did not immediately provide additional comment on the case.

A spokesperson for Health Carousel, which has denied the allegations against it in court documents, told MedPage Today in an email that, "Unfortunately, we cannot comment on the specifics of ongoing litigation, but we are confident we will be successful in this matter."

The spokesperson also pointed to a posted on the company's website that includes the following: "For our part, ensuring the health, safety and well-being of every one of our nurses is the core of our business. To imply otherwise, based on activists intent on exploiting and twisting the experiences of a few, is disheartening and damaging. But more than that, it is simply inaccurate and a grave insult to the millions of people worldwide who continue to be victimized by traffickers."

The company also posted a list of answers to frequently asked questions, one of which includes information on why nurses have to reimburse expenses when they break a contract. To that end, Health Carousel states in part that, "Requiring repayment of invested expenses and other damages if an employee does not fulfill a service obligation is not a 'quitting fee' or a penalty. Rather, it is a customary, reasonable and fair practice that many employers use in a range of industries and occupations to recoup investment in tuition reimbursement, relocation expenses, signing bonuses and more."

Health Carousel added that the expenses it expects healthcare professionals to reimburse should they not complete their contracts "approximates or underestimates" its upfront investment on their behalf. "For example, when healthcare professionals do not complete the commitment period in the contract, the nurse retains his or her permanent resident visa to work in the United States, but Health Carousel suffers a financial loss because it cannot earn back the money it had advanced for their recruitment, credentialing, sponsorship, relocation and resettlement, and employment," the company stated.

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