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Brookdale employed Prather to review Medicare claims before their submission for payment. Many of these claims were missing required certifications from physicians attesting to the need for the medical services provided. Certifications must “be obtained at the time the plan of care is established or as soon thereafter as possible.” 42 C.F.R. 424.22(a)(2).Prather filed a complaint under the False Claims Act, 31 U.S.C. 3729, alleging an implied false certification theory. The district court dismissed her complaint. The Sixth Circuit reversed in part, holding that Prather had pleaded two claims with the required particularity and that the claims submitted were false. On remand, the district court dismissed Prather's Third Amended Complaint in light of the Supreme Court’s 2016 clarification of the materiality element of an FCA claim. The Sixth Circuit reversed. Prather sufficiently alleged the required materiality element; the timing requirement in section 424.22(a)(2) is an express condition of payment and Prather alleges that the government paid the claims submitted by the defendants without knowledge of the non-compliance, making those payments irrelevant to the question of materiality. Section 424.22(a)(2) is a mechanism of fraud prevention, which the government has consistently emphasized in guidance regarding physician certifications and Prather adequately alleged “reckless disregard” of compliance and whether this requirement was material. View "Prather v. Brookdale Senior Living Community" on Justia Law

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Brookdale employed Prather to review Medicare claims before their submission for payment. Many of these claims were missing required certifications from physicians attesting to the need for the medical services provided. Certifications must “be obtained at the time the plan of care is established or as soon thereafter as possible.” 42 C.F.R. 424.22(a)(2).Prather filed a complaint under the False Claims Act, 31 U.S.C. 3729, alleging an implied false certification theory. The district court dismissed her complaint. The Sixth Circuit reversed in part, holding that Prather had pleaded two claims with the required particularity and that the claims submitted were false. On remand, the district court dismissed Prather's Third Amended Complaint in light of the Supreme Court’s 2016 clarification of the materiality element of an FCA claim. The Sixth Circuit reversed. Prather sufficiently alleged the required materiality element; the timing requirement in section 424.22(a)(2) is an express condition of payment and Prather alleges that the government paid the claims submitted by the defendants without knowledge of the non-compliance, making those payments irrelevant to the question of materiality. Section 424.22(a)(2) is a mechanism of fraud prevention, which the government has consistently emphasized in guidance regarding physician certifications and Prather adequately alleged “reckless disregard” of compliance and whether this requirement was material. View "Prather v. Brookdale Senior Living Community" on Justia Law

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On the facts of the case, the constitutional speedy trial clock began to run from the date of the original indictment rather than from the date of an additional charge first brought in a superseding indictment. A federal grand jury indicted Defendant on twelve counts of wire fraud. Approximately six years later, the government filed a superseding indictment containing the same twelve wire-fraud counts as the original indictment and adding a new count for bank fraud. The district court granted Defendant’s motion to dismiss the original indictment and the added bank-fraud count on Sixth Amendment speedy trial grounds. The government appealed, arguing that, with respect to the bank-fraud charge, the district court should have measured the period of delay from the filing of the superseding indictment, not from the filing of the initial indictment. The First Circuit disagreed, holding that the bringing of an additional charge does not reset the Sixth Amendment speedy trial clock to the date of the superseding indictment where the additional charge and the charge for which the defendant was previously accused are based on the same act or transaction, or common scheme or plan, and where the government could have, with diligence, brought the additional charge at the time of the prior accusation. View "United States v. Handa" on Justia Law

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In 2003, Williams, behind on paying SCCA condominium association fees, filed the first of five, Chapter 13 Bankruptcy petitions so that creditors were stayed from initiating collection. Her scheme was to not make payments required by her Chapter 13 plan so that the court would dismiss the case; SCCA would file eviction and collection suits; Williams would then file a new Chapter 13 petition. After voluntarily dismissing her second bankruptcy petition, Williams signed a deed transferring the condominium to Wilke. A deed recorded weeks later returned title to Williams. Wilke paid nothing and never occupied the condominium but obtained loans secured by the condominium. In her subsequent bankruptcy petitions, Williams failed to disclose the transfers but stated, falsely, that Wilke was a co‐debtor and would contribute toward the mortgage. After dismissing Williams’s fifth petition, the court barred Williams from filing a new petition for 180 days. She again deeded the condominium to Wilke, who filed a bankruptcy petition stating it was his property. The court dismissed the case. Both were charged with bankruptcy fraud, 18 U.S.C. 157. Wilke pled guilty and cooperated. The court limited the defense’s cross-examination of SCCA's board member and attorney about a class action lawsuit Williams had filed against SCCA and about SCCA’s treatment of Williams relative to other tenants, reasoning that the topics were an irrelevant attack on the underlying debt. Williams was convicted. With enhancements for causing a loss of $193, 291 and because the offense involved 10 or more victims, her Guidelines Range was 51–63 months’ imprisonment. The court sentenced her to 46 months. The Seventh Circuit affirmed, rejecting challenges to the court’s limitation on cross-examination and to the sentencing enhancements. View "United States v. Williams" on Justia Law

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As CEO of the Chicago Public Schools, Byrd-Bennett worked behind the scenes to assure that companies headed by Solomon and Vranas received lucrative contracts. In exchange, Solomon and Vranas agreed that they would pay Byrd-Bennett a percentage of the revenue generated by those contracts when she came to work for them at the end of her tenure with CPS. After the fraudulent scheme was exposed, each participant pleaded guilty to committing wire fraud, 18 U.S.C. 1343 and 1346. Solomon was sentenced to 84 months’ imprisonment, 30 months more than Byrd-Bennett received. Solomon argued that the district court erred by incorporating the value of a contract unrelated to the criminal agreement into his advisory sentencing guidelines calculation, resulting in an offense score that was four levels higher than Solomon believes it should have been and claimed that the disparity between Byrd-Bennett’s sentence and his sentence is unwarranted, making his sentence substantively unreasonable. The Seventh Circuit affirmed. The record supports the court’s decision to include the contested contract in the offense level calculation, and dissimilar cooperation is a reasonable basis for a sentencing disparity. View "United States v. Solomon" on Justia Law

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As CEO of the Chicago Public Schools, Byrd-Bennett worked behind the scenes to assure that companies headed by Solomon and Vranas received lucrative contracts. In exchange, Solomon and Vranas agreed that they would pay Byrd-Bennett a percentage of the revenue generated by those contracts when she came to work for them at the end of her tenure with CPS. After the fraudulent scheme was exposed, each participant pleaded guilty to committing wire fraud, 18 U.S.C. 1343 and 1346. Solomon was sentenced to 84 months’ imprisonment, 30 months more than Byrd-Bennett received. Solomon argued that the district court erred by incorporating the value of a contract unrelated to the criminal agreement into his advisory sentencing guidelines calculation, resulting in an offense score that was four levels higher than Solomon believes it should have been and claimed that the disparity between Byrd-Bennett’s sentence and his sentence is unwarranted, making his sentence substantively unreasonable. The Seventh Circuit affirmed. The record supports the court’s decision to include the contested contract in the offense level calculation, and dissimilar cooperation is a reasonable basis for a sentencing disparity. View "United States v. Solomon" on Justia Law

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The First Circuit affirmed Defendants’ convictions for wire fraud, embezzlement of public money, and conspiracy, holding that there was no merit in any of Defendants’ claims of error. Defendants, members of the United States Army National Guard in Puerto Rico, were convicted for carrying out a fraudulent scheme to obtain recruitment bonuses. The First Circuit affirmed, holding (1) the district court did not err in denying Defendants’ pretrial motion to dismiss the indictment as untimely; (2) the court’s rulings as to military dress in the courtroom were not an abuse of discretion; (3) the evidence was sufficient to support the convictions; (4) Defendants’ evidentiary challenges failed; and (5) one of the Defendant’s challenge to his sentence was unavailing. View "United States v. Melendez-Gonzalez" on Justia Law

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The Second Circuit denied a petition for a writ of error coram nobis where petitioner sought vacatur of his prior conviction and sentence for conspiracy to commit mail and wire fraud, as well as 21 counts of mail fraud, based on his conduct in the rare-coins business. Petitioner contended that newly discovered evidence would undermine the reliability of expert testimony submitted against him at trial. The court held that, given the strength of evidence of defendant's fraudulent activity in support of his sale of coins, the issue he raised as to the government expert's method of valuation did not show circumstances compelling grant of the writ to achieve justice. View "Du Purton v. United States" on Justia Law

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Schock resigned from Congress in 2015, after disclosures about trips he took at public expense, the expense of his elaborate office furnishings, and how he had applied campaign funds. Schock was charged with mail and wire fraud, theft of government funds, making false statements to Congress and the Federal Elections Commission, and filing false tax returns. Schock moved to dismiss the indictment, arguing that the charges are inconsistent with the Constitution’s Speech or Debate Clause and with the House of Representatives’ constitutional authority to determine the rules of its proceedings. The Seventh Circuit affirmed the denial of the motion. The indictment arises out of applications for reimbursements, which are not speeches, debates, or any other part of the legislative process. Submitting a claim under established rules differs from the formulation of those rules. The foundation for Schock’s rule-making” argument—the proposition that if Body A has sole power to make a rule, then Body A has sole power to interpret that rule—does not represent established doctrine. “ Judges regularly interpret, apply, and occasionally nullify rules promulgated by the President or another part of the Executive Branch, as well as statutes enacted by the Legislative Branch; why would reimbursement rules be different?” View "United States v. Schock" on Justia Law

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Lagos was convicted of using a company he controlled to defraud a lender of millions of dollars. After Lagos’ company went bankrupt, the lender conducted a private investigation and participated as a party in the company’s bankruptcy proceedings, spending nearly $5 million in legal, accounting, and consulting fees. When Lagos pleaded guilty to federal wire fraud charges, the court ordered him to pay the lender restitution for those fees. The Fifth Circuit affirmed, citing the Mandatory Victims Restitution Act of 1996, which requires defendants convicted of certain federal offenses, including wire fraud, to “reimburse the victim for lost income and necessary child care, transportation, and other expenses incurred during participation in the investigation or prosecution of the offense or attendance at proceedings related to the offense,” 18 U.S.C. 3663A(b)(4). The Supreme Court, acting unanimously, reversed. The words “investigation” and “proceedings” are limited to government investigations and criminal proceedings and do not include private investigations and civil or bankruptcy proceedings. A broader reading would require courts to resolve difficult, fact-intensive disputes about whether particular expenses “incurred during” participation in a private investigation were actually “necessary,” and about whether proceedings such as a licensing proceeding or a Consumer Products Safety Commission hearing were sufficiently “related to the offense.” The Court acknowledged that its interpretation means that some victims will not receive restitution for all of their losses, but reasoned that is consistent with the Act’s enumeration of limited categories. View "Lagos v. United States" on Justia Law