Two of Florida’s largest health care providers are engaged in a bitter lawsuit in which the plaintiff, Omni HealthCare, has accused the defendant, Health First, of providing illegal incentives to doctors to influence their referral of patients. The intensity of the litigation is demonstrated by Omni’s recent decision to invoke a rarely used statute that is intended to punish businesses that use fraud in their dealings with the state.
What is a qui tam law?
Omni recently amended its complaint to include a charge that Health First’s conduct in dealing with the state of Florida is fraudulent. The claim is based upon what is commonly known as a “qui tam” statute. Both the United States and Florida (as well as other states) have enacted qui tam statutes. The federal act is known as the False Claims Act, and Florida’s statute is called the Florida False Claims Acts. Both statutes were significantly amended in 2013 to clarify certain provisions about the mechanics of asserting a qui tam claim.
The basic idea of the statute is simple. The state can of course sue a party for fraud whenever it believes that it has been the victim of a fraudulent act; the qui tam statute makes it possible for private parties to bring similar actions. The state has the option of joining a private qui tam case or remaining on the sidelines. Thus far in the dispute between Omni HealthCare and Health First, both the state of Florida and the United States have declined to enter the litigation, although either one can do so at a later date.
The allegations of fraud
Omni is alleging that Health First made illegal payments to physicians to refer patients to its facilities instead of other providers, including Omni. According to the complaint, these payments violate the FFCA, the Anti-Kickback Act, and a federal statute that forbids physicians from referring Medicare and Medicaid patients to an entity with which the physician has a financial connection. Health First has denied all allegations and has accused Omni of using the legal system for financial gain.
The outcome of this dispute is difficult to predict. If it prevails, Omni stands to recover treble damages plus its attorneys’ fees. Thus, settlement may be difficult.
Any business that is considering suing a competitor for fraud may wish to consult an experienced business trial lawyer for advice on invoking Florida’s qui tam law.