Justia White Collar Crime Opinion Summaries

The case involves the United States government alleging that Regeneron Pharmaceuticals violated the Anti-Kickback Statute (AKS) by covering copayments for patients prescribed Eylea, a drug used to treat wet age-related macular degeneration. The government contends that this action induced doctors to prescribe Eylea, leading to Medicare claims that were "false or fraudulent" under the False Claims Act (FCA) because they "resulted from" the AKS violation.The United States District Court for the District of Massachusetts reviewed the case and agreed with Regeneron's interpretation that the phrase "resulting from" in the 2010 amendment to the AKS requires a but-for causation standard. This means that the government must prove that the AKS violation was the actual cause of the Medicare claims. The district court noted the conflict in case law and sought interlocutory review, which was granted.The United States Court of Appeals for the First Circuit affirmed the district court's ruling. The court held that the phrase "resulting from" in the 2010 amendment to the AKS imposes a but-for causation requirement. The court reasoned that the ordinary meaning of "resulting from" requires actual causality, typically in the form of but-for causation, unless there are textual or contextual indications to the contrary. The court found no such indications in the 2010 amendment or its legislative history. Therefore, to establish falsity under the FCA based on an AKS violation, the government must prove that the kickback was a but-for cause of the submitted claim. View "United States v. Regeneron Pharmaceuticals, Inc." on Justia Law

Edward Mangano, the former County Executive of Nassau County, New York, and his wife, Linda Mangano, were involved in a public corruption case. Edward Mangano was accused of accepting bribes from Harendra Singh, a businessman, in exchange for using his influence to secure loan guarantees from the Town of Oyster Bay for Singh's businesses. Singh provided various gifts and a no-show job for Linda Mangano, paying her approximately $100,000 annually. The Manganos were also accused of conspiring to obstruct a federal grand jury investigation into these bribes by fabricating stories about Linda's employment.In the United States District Court for the Eastern District of New York, Edward Mangano was convicted of conspiracy to commit federal programs bribery, honest services fraud, and related substantive offenses. Linda Mangano was convicted of conspiracy to obstruct justice, obstruction of justice, and making false statements to federal officials. The district court sentenced Edward Mangano to 12 years in prison and Linda Mangano to 15 months.On appeal, the United States Court of Appeals for the Second Circuit reviewed the case. The court found that the district court properly instructed the jury on the conspiracies to commit honest services fraud and obstruction of justice, and that the evidence was sufficient to convict the Manganos on those charges. However, the court concluded that the evidence was insufficient to convict Edward Mangano of conspiracy to commit federal programs bribery or the related substantive offense. Consequently, the Second Circuit reversed the district court's judgment in part, affirming the convictions related to honest services fraud and obstruction of justice, but reversing the convictions related to federal programs bribery. The case was remanded for further proceedings consistent with the appellate court's opinion. View "United States v. Mangano" on Justia Law

Rojay Lawson was involved in a telemarketing sweepstakes scheme based in Jamaica that targeted elderly individuals in the United States. Lawson, operating from South Carolina, collected and laundered the fraudulent proceeds, keeping a portion for himself and sending the rest to his co-conspirators in Jamaica. The scheme defrauded at least 179 victims, most of whom were elderly, out of approximately $720,000. Lawson pleaded guilty to multiple counts, including wire fraud conspiracy, money laundering conspiracy, wire fraud, and mail fraud.The United States District Court for the District of South Carolina sentenced Lawson to 78 months in prison and ordered him to pay $405,401 in restitution. Lawson challenged his sentence, arguing against the application of a vulnerable victim enhancement, the denial of a minor role reduction, and the calculation of the loss amount. The district court overruled his objections, finding that the scheme specifically targeted elderly victims and that Lawson played a significant role in the conspiracy.The United States Court of Appeals for the Fourth Circuit reviewed the case and affirmed the district court's decision. The appellate court held that the vulnerable victim enhancement was appropriate because the elderly victims were particularly susceptible to the telemarketing fraud, and Lawson knew or should have known about their vulnerability. The court also upheld the denial of a minor role reduction, noting that Lawson's involvement in collecting and laundering the funds was substantial and essential to the scheme. Additionally, the court found no error in the calculation of the loss amount, which was based on actual losses suffered by the victims. The appellate court concluded that Lawson's sentence was both procedurally and substantively reasonable. View "United States v. Lawson" on Justia Law

Jeffery Henson was convicted of federal fraud, including aggravated identity theft, money laundering, and wire fraud, for diverting nearly $330,000 from his employer to his personal account. He was ordered to pay $436,495.93 in restitution. Following his arrest, Illinois police found $17,390 in cash in his car. The government sought to apply this cash towards Henson's restitution, but Henson argued that the money was obtained through an illegal search and seizure, as the warrant was issued nine hours after the search.The United States District Court for the Central District of Illinois, through a magistrate judge, granted the government's motion to turn over the cash. Henson appealed, contending that the magistrate judge lacked the authority to issue a final decision on the matter.The United States Court of Appeals for the Seventh Circuit reviewed the case. The court determined that the magistrate judge acted outside of his authority, as there was no final decision in the case. The Federal Magistrates Act and the local rules of the Central District of Illinois did not authorize the magistrate judge to issue a final decision on the turnover motion without the district court's explicit assignment. Consequently, the Seventh Circuit dismissed the appeal for lack of appellate jurisdiction, as the magistrate judge's order was not an appealable final decision. View "USA v Henson" on Justia Law

Eric Kyereme was indicted on five counts of wire fraud for misleading investors in his company, Sika Capital Management, LLC. He solicited $200,000 for the "Alpha Fund," which he lost through poor trading. Instead of informing investors, he created fake account statements to show positive returns. Kyereme pleaded guilty to one count but disputed his dealings with Da Zhou, a business associate who invested $133,000, allegedly for shares in RestoreFlow Allografts (RFA). The government claimed Kyereme used Zhou's money to cover Alpha Fund losses, while Kyereme argued it was a legitimate transaction.The United States District Court for the Northern District of Illinois held an evidentiary hearing and found that Kyereme defrauded Zhou. The court determined that Zhou's $133,000 investment was part of the wire fraud scheme, increasing the total loss amount to $335,500. This led to a higher offense level and a sentencing range of 41 to 51 months. The court sentenced Kyereme to 36 months in prison, three years of supervised release, and ordered $185,500 in restitution, including $135,500 to Zhou.The United States Court of Appeals for the Seventh Circuit reviewed the case. The court found no clear error in the district court's determination that the Zhou transaction was part of the wire fraud scheme. The court noted that the evidence, including the membership agreement and the Primrose operating agreement, supported the finding that Kyereme defrauded Zhou. The appellate court also held that Kyereme had sufficient notice that the district court would rule on the Zhou transaction at the final sentencing hearing. Consequently, the Seventh Circuit affirmed Kyereme's sentence. View "United States v. Kyereme" on Justia Law

Conduent State Healthcare, LLC (Conduent) was hired by the State of Texas to administer its Medicaid program. In 2012, Texas began investigating Conduent for allegedly helping orthodontics offices overbill for services. Texas sued several orthodontic providers in 2014, and the providers sued Conduent. Texas terminated its contract with Conduent and sued Conduent under the Texas Medicaid Fraud Prevention Act. Conduent was insured by AIG Specialty Insurance Company, ACE American Insurance Company, and Lexington Insurance Company, among others. The insurers provided defense coverage for the provider actions but denied coverage for the state action, claiming it involved fraudulent conduct excluded by the policies.The Superior Court of Delaware found that the insurers breached their duty to defend Conduent in the state action. The court also ruled that Conduent was relieved of its duties to cooperate and seek consent before settling with Texas due to the insurers' breach. The jury found that Conduent acted in bad faith and fraudulently arranged the settlement but did not collude with Texas or settle unreasonably. The Superior Court granted a new trial due to evidentiary issues and the jury's inconsistent verdicts.The Supreme Court of Delaware affirmed the Superior Court's rulings. It held that the insurers' breach of their duty to defend excused Conduent from its duties to cooperate and seek consent. The court also ruled that the policy's fraud exclusion did not bar indemnity coverage because the settlement was allocated to breach of contract damages. The court found that the evidentiary issues and the jury's inconsistent verdicts justified a new trial to prevent manifest injustice. View "AIG Specialty Insurance Company v. Conduent State Healthcare, LLC" on Justia Law

Oladayo Oladokun was convicted in the United States District Court for the Southern District of New York after pleading guilty to conspiracy to commit bank fraud and conspiracy to commit money laundering. His involvement included directing others to open bank accounts to receive stolen or forged checks and launder money. He was sentenced to 125 months in prison followed by three years of supervised release.Oladokun appealed, challenging the district court's calculation of his offense level under the United States Sentencing Guidelines. He argued against the application of an eighteen-level enhancement based on the loss amount, a two-level enhancement for ten or more victims, and a four-level enhancement for his role in an offense involving five or more participants. Additionally, he claimed ineffective assistance of counsel for not requesting a Franks hearing to suppress evidence obtained from his residence.The United States Court of Appeals for the Second Circuit reviewed the case. The court found that the district court did not err in its factual basis for the Guidelines enhancements. It upheld the eighteen-level enhancement for the intended loss amount, the two-level enhancement for ten or more victims, and the four-level enhancement for Oladokun's role in the offense. The court also rejected Oladokun's ineffective assistance claim, noting that even if his counsel had been ineffective, Oladokun failed to show the requisite prejudice because the warrant application was supported by probable cause without the challenged evidence.The Second Circuit affirmed the judgment of the district court. View "United States v. Oladokun" on Justia Law

Dr. Anita Jackson, an otolaryngologist, was convicted of various offenses related to her private medical practice in North Carolina. She was the leading Medicare biller for balloon sinuplasty surgery, a procedure treating chronic sinusitis. Jackson reused single-use medical devices, specifically the Entellus XprESS Multi-Sinus Dilation Tool, on multiple patients without proper sterilization, leading to potential contamination. She also incentivized employees to recruit Medicare patients for the procedure, often bypassing proper medical assessments. Additionally, Jackson falsified documents and patient signatures in response to Medicare audits.The United States District Court for the Eastern District of North Carolina convicted Jackson on all counts, including violating the Food, Drug, and Cosmetics Act (FDCA) by holding for resale adulterated medical devices, violating the federal anti-kickback statute, making materially false statements, committing aggravated identity theft, mail fraud, and conspiracy. Jackson was sentenced to twenty-five years in prison and ordered to pay over $5.7 million in restitution. She moved for a judgment of acquittal and a new trial, which the district court denied.The United States Court of Appeals for the Fourth Circuit reviewed the case. Jackson argued that the devices were not "held for sale" under the FDCA, that her actions were protected under 21 U.S.C. § 396, and that the Government relied on a defective theory of per se adulteration. She also challenged the exclusion of certain evidence and jury instructions. The Fourth Circuit found no reversible error in the district court's rulings, holding that the devices were indeed "held for sale," that § 396 did not protect her conduct, and that the Government's theory was valid. The court also upheld the exclusion of evidence and the jury instructions. Consequently, the Fourth Circuit affirmed all of Jackson's convictions. View "United States v. Jackson" on Justia Law

Humana, a health insurance company and Medicare Part C and Part D sponsor, filed a lawsuit against Biogen, a drug manufacturer, and Advanced Care Scripts, Inc. (ACS), a specialty pharmacy, in the District of Massachusetts. Humana alleged that Biogen and ACS engaged in fraudulent schemes involving three multiple sclerosis drugs, violating the civil RICO statute. Humana claimed that Biogen "seeded" the market with these drugs, funneled patients into Medicare, and indirectly funded patient copays through third-party patient-assistance programs (PAPs). Humana also alleged that ACS aided Biogen's scheme by steering patients and acting as an intermediary between Biogen and the PAPs, causing the submission of false certifications to Humana.The district court dismissed the case, ruling that Humana lacked standing to bring RICO claims because it was an indirect purchaser and failed to plead the RICO claims with particularity as required by Federal Rule of Civil Procedure 9(b). The court found that Humana did not specify the time, place, and content of the alleged fraudulent communications and failed to detail the false certifications' language, timing, and context. Humana's motion for leave to amend the complaint was also denied.The United States Court of Appeals for the First Circuit reviewed the case. The court affirmed the district court's dismissal, agreeing that Humana failed to meet the heightened pleading standard of Rule 9(b) for its RICO claim. The court held that Humana did not provide specific details about the fraudulent certifications or the use of mail or wire communications in furtherance of the scheme. The court also upheld the denial of leave to amend, citing undue delay and the inefficiency of seeking amendment after dismissal. View "Humana Inc. v. Biogen, Inc." on Justia Law

Julian Omidi and his business, Surgery Center Management, LLC (SCM), were involved in a fraudulent scheme called "Get Thin," which promised weight loss through Lap-Band surgery and other medical procedures. Omidi and SCM defrauded insurance companies by submitting false claims for reimbursement, including fabricated patient data and misrepresented physician involvement. The scheme recruited patients through a call center, pushing them towards expensive medical tests and procedures regardless of medical necessity.A grand jury indicted Omidi and SCM for mail fraud, wire fraud, money laundering, and related charges. After extensive pretrial litigation and a lengthy jury trial, both were convicted on all charges. The district court sentenced Omidi to 84 months in prison and fined SCM over $22 million. The government sought forfeiture of nearly $100 million, arguing that all proceeds from the Get Thin scheme were derived from fraud. The district court agreed, finding that even proceeds from legitimate procedures were indirectly the result of the fraudulent scheme.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed the district court's forfeiture judgment, holding that under 18 U.S.C. § 981(a)(1)(C), all proceeds directly or indirectly derived from a health care fraud scheme must be forfeited. The court rejected the argument that only proceeds from fraudulent transactions should be forfeited, noting that the entire business was permeated with fraud. The court concluded that there is no "100% Fraud Rule" in forfeiture cases seeking proceeds of a fraud scheme, and all proceeds from the Get Thin scheme were subject to forfeiture. View "United States V. Surgery Center Management, LLC" on Justia Law