The double billing occurred when the Defendants billed the Federal Medicare, Medicaid, and CHAMPUS Programs [Civilian Health and Medical Program for Uniformed Services] for patient care services that the Government had already provided funds for through the PHS Grant Program [Public Health System] for patients who took part in research trials. This fraudulent double-billing harmed the Treasury of the United States. The number of fraudulent charges for the year 2000 is over 1,000, and upon information and belief, may exceed 10,000 for the past 10 years. The amount of fraudulent charges, at a minimum total approximately $30,000,000 for the year 2000, and based upon information and belief, exceeds $100,000,000 in double billing for the past 10 years.
As we noted earlier, part of the fraud involved a Social Security program for the aged and disabled. And what is CHAMPUS? Now known as TRICARE, it provides civilian health benefits for military personnel, military retirees, and their dependents.
In other words, UAB's scheme involved bilking federal programs designed for the aged, the disabled, veterans, active-duty military personnel, and their dependents.
The University of Kentucky chose a president who was in the midst of all that? Have UK officials ever heard of "doing your homework"?
Actions under the False Claims Act (FCA) are considered "quasi criminal" and often describe misconduct that could be considered criminal under associated statutes. FCA cases are civil in order to encourage whistleblowers to come forward, allowing them to share in any proceeds that are recovered for the government.
An article from justia.com provides an overview of qui tam/whistleblower cases and describes how they are prosecuted:
A whistleblower must file a qui tam suit under seal with a U.S. District Court, and the Justice Department then conducts an investigation of the facts involved in the complaint. When its investigation is complete, the government has the option to take over the case, or intervene. In some cases, the U.S. Attorney will open a criminal investigation based on the qui tam allegations and the civil case will not proceed until the criminal investigation is complete. Whether or not the government takes over the case, the whistleblower is entitled to a share of any successful qui tam action recovery. If the government decides not to participate, the whistleblower may pursue the case on behalf of the government. The filing, investigation, and trial in a qui tam action may take many years to complete.
This paragraph, plus language in the settlement agreement, makes it clear that some UAB officials were in danger of facing criminal prosecution. Given the huge sums allegedly involved, federal prison sentences were a real possibility--if a genuine investigation had been conducted.
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