Qui Tam Lawyers of Florida, For the Injured Worker announce Pensacola Doctors have been accused of a Governement fraud scheme under the Qui Tam or Government Fraud Program that protects the tax payers.
A company or individual that has made a false claim may be liable for triple damages, a civil fine of $5,500 to $11,000 per false claim, and the attorney's fees of the citizen whistle-blower (called the "relator"). Individuals or companies that cause someone else to submit a false claim can also be found liable under the False Claims Act.
The standard of proof in a False Claims Act case is "preponderance of the evidence", i.e., the claim is more likely true than not. This is the same burden of proof ordinarily applicable in most civil cases, and is easier to meet than the "beyond a reasonable doubt" standard used in criminal cases.
Two doctors accused of fraud scheme
lawsuit against Sacred Heart Health Systems, the Medical Center Clinic and two radiation oncologists is known as qui tam litigation, filed under the federal False Claims Act.
Designed to combat fraud against the government, the act allows private individuals who have knowledge of fraud to sue on behalf of the federal government.
Once such a suit is filed, federal or state law enforcement agencies investigate the claims to determine whether the Department of Justice will join in the suit as a plaintiff.
The details of the lawsuit remain a secret until the investigation is complete.
Once an investigation is complete, the government can either join the suit as a plaintiff, decline to join the suit but allow the whistleblower and the whistleblower's attorney to pursue the case or dismiss the suit for lack of evidence.
Fewer than 25 percent of filed qui tam actions result in an intervention by the Department of Justice, as occurred in Koch's suit.
WellCare health Plans
The U.S. Attorney for the Middle District of Florida and the Civil Division of the U.S. Department of Justice announced yesterday that WellCare Health Plans had agreed to pay $137.5 million to settle a qui tam/ False Claims Act case pending against it, primarily in the Middle District of Florida, that has been pending for years.
Qui Tam lawyers of for the Injured worker are accepting cases from Florida Whistleblowers for Qui Tam cases.
The suit, originally filed by Koch under seal and made public when the federal government became a plaintiff in late March, alleges 6,450 fraudulent claims totaling $3.5 million between December 2007 and October 2011.
The potential damages from the suit could top $75 million, because it seeks to recoup triple the $3.5 million in alleged false claims, a penalty of as much as $10,000 for each of the claims, and attorney's fees.
Sacred Heart and Medical Center Clinic spokespersons both denied the allegations.
"We certainly do not believe we participated in any fraud scheme or any intentional improper billings and intend to defend against the allegations accordingly," said Lester Perling, a Fort Lauderdale attorney representing the Medical Center.
Lowrey and Krentel were employed by the Medical Center and were the only two doctors at Gulf Region Radiation Oncology Centers. Under a contractual arrangement, the oncology centers paid Sacred Heart and the Medical Center a percentage of its revenue.
Lowrey continues to work in the same capacity at Radiation Oncology Centers; Krentel is no longer there.
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