[PUBLISH]

In the

United States Court of Appeals For the Eleventh Circuit

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No. 23-13979 ____________________

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, et al., Plaintiffs-Appellants, versus MICHAEL LAROCCA, et al., Defendants-Appellees.

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Appeal from the United States District Court for the Middle District of Florida D.C. Docket No. 8:21-cv-02536-SCB-AEP ____________________ USCA11 Case: 23-13979 Document: 70-1 Date Filed: 04/30/2025 Page: 2 of 15

2 Opinion of the Court 23-13979

Before JORDAN, LAGOA, and TJOFLAT, Circuit Judges. LAGOA, Circuit Judge: Florida’s Health Care Clinic Act requires medical clinics op- erating in the state of Florida to be licensed by the Florida Agency for Health Care Administration (“AHCA”), subject to several ex- emptions. See FLA. STAT. § 400.991. As relevant here, the Clinic Act exempts from licensure clinics that are “wholly owned by one or more licensed health care practitioners . . . if one of the owners who is a licensed health care practitioner is supervising the business activities and is legally responsible for the entity’s compliance with all federal and state laws.” Id. § 400.9905(4)(g). This exemption is known as the “wholly owned exemption.” On appeal in this case, the Appellants argue that the phrase “legally responsible” imposes an “affirmative duty” on clinic own- ers seeking exemption under the wholly owned provision to “en- sure” that their clinics are “substantially complying” with all federal and state laws. According to the Appellants, a clinic owner’s failure to achieve substantial compliance with all federal and state laws au- tomatically renders any charges submitted by his clinics void and noncompensable under a different provision of the Clinic Act, which provides that a “charge or reimbursement claim made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed . . . is an unlawful charge and is noncom- pensable and unenforceable.” FLA. STAT. § 400.9935(3). The Appel- lees, on the other hand, argue that the wholly owned exemption USCA11 Case: 23-13979 Document: 70-1 Date Filed: 04/30/2025 Page: 3 of 15

23-13979 Opinion of the Court 3

imposes no such affirmative duty on an owner; on their interpreta- tion of the exemption, a clinic owner is simply monetarily liable for any violations of law by his clinics. This appeal thus turns on the meaning of the phrase “legally responsible” within § 400.9905(4)(g), Florida Statutes. The Florida Supreme Court, which is the final arbiter of Florida law, has not published a decision interpreting the statutory language at issue. 1 Given the impact on insurance law that our de- cision may have, principles of comity and federalism counsel that the Florida Supreme Court should decide this issue before we do. See Steele v. Comm’r of Soc. Sec., 51 F.4th 1059, 1061 (11th Cir. 2022) (citing WM Mobile Bay Env’t Ctr., Inc. v. City of Mobile Solid Waste Auth., 972 F.3d 1240, 1242 (11th Cir. 2020)). Thus, rather than pre- dicting