Justia White Collar Crime Opinion Summaries

A healthcare provider operating as a covered entity under the federal Section 340B Drug Pricing Program purchased pharmaceuticals from several drug manufacturers. The provider alleged that these manufacturers engaged in a fraudulent scheme by knowingly charging prices for drugs that exceeded the statutory ceiling, resulting in inflated reimbursement claims submitted to Medicaid, Medicare, and other government-funded programs. The provider did not seek compensation for its own overcharges, but instead brought a qui tam action under the False Claims Act (FCA), seeking to recover losses on behalf of the federal and state governments.The United States District Court for the Central District of California dismissed the complaint with prejudice. It reasoned that, under the Supreme Court’s holding in Astra USA, Inc. v. Santa Clara County, Section 340B does not confer a private right of action for covered entities to sue drug manufacturers over pricing disputes; such claims must instead be pursued through the Section 340B Administrative Dispute Resolution process. The district court concluded that the provider’s FCA claims were essentially attempts to enforce Section 340B and should therefore be barred.On appeal, the United States Court of Appeals for the Ninth Circuit reversed the district court’s dismissal. The appellate court held that the provider’s FCA claims were not barred by the absence of a private right of action under Section 340B or by the Astra decision, because the action was brought to remediate fraud against the government and not to recover personal losses or enforce Section 340B directly. The court further found that the provider had plausibly pleaded falsity under the FCA. The Ninth Circuit remanded the case for further proceedings. View "ADVENTIST HEALTH SYSTEM OF WEST V. ABBVIE INC." on Justia Law

A former employee of a pharmaceutical manufacturer brought a qui tam lawsuit under the False Claims Act, alleging that the company improperly calculated and reported its “Best Price” for certain drugs to the Centers for Medicare and Medicaid Services (CMS), as required under the Medicaid Rebate Statute. The plaintiff claimed that, during a period from 2005 to 2014, the company failed to aggregate multiple rebates and discounts given to different entities on the same drug, resulting in inflated “Best Price” reports and underpayment of rebates owed to Medicaid. The complaint asserted that the company was subjectively aware that CMS interpreted the statute to require aggregation of all such discounts, especially after the company’s communications with CMS during a 2006–2007 rulemaking process and the company’s subsequent internal audit.After the government and several states declined to intervene, the United States District Court for the District of Maryland dismissed the amended complaint, finding that, even under the subjective scienter standard established in United States ex rel. Schutte v. SuperValu Inc., the plaintiff had not plausibly alleged that the company acted with actual knowledge, deliberate ignorance, or reckless disregard as to the truth or falsity of its reports. The district court also suggested that ambiguity in the statute precluded a finding of falsity.On appeal, the United States Court of Appeals for the Fourth Circuit reviewed the dismissal de novo. The Fourth Circuit held that the plaintiff’s allegations—including the company’s awareness of CMS’s interpretation of the rule, its targeted audit and compliance efforts, and its continued use of non-aggregated reporting—plausibly alleged the requisite subjective scienter under the False Claims Act. The court clarified that statutory ambiguity does not, at the pleading stage, negate scienter or falsity, and remanded for the district court to address other elements, including falsity, in the first instance. The Fourth Circuit reversed the dismissal and remanded for further proceedings. View "United States ex rel. Sheldon v. Allergan Sales, LLC" on Justia Law

Several Iraqi citizens detained at Abu Ghraib prison during the U.S. occupation of Iraq alleged that, between October and December 2003, they were subjected to severe abuse by military police. The plaintiffs claimed that employees of CACI Premier Technology, Inc., a contractor providing interrogation services to the U.S. military, conspired with military personnel to “soften up” detainees for interrogation, resulting in torture and cruel, inhuman, and degrading treatment (CIDT). While CACI’s contract required its personnel to operate under military supervision, evidence suggested inadequate oversight and that CACI employees directed some of the abusive tactics. Plaintiffs did not allege direct physical abuse by CACI interrogators, but asserted conspiracy liability.The case was initially filed in the United States District Court for the Eastern District of Virginia, advancing claims under both the Alien Tort Statute (ATS) and state law. Over time, the plaintiffs narrowed their suit to ATS claims for torture, CIDT, and war crimes, proceeding on conspiracy and aiding-and-abetting theories. The district court dismissed some claims and parties, and after two trials—one ending in mistrial—the jury found CACI liable for conspiracy to commit torture and CIDT, awarding significant compensatory and punitive damages.On appeal, the United States Court of Appeals for the Fourth Circuit reviewed multiple legal challenges by CACI, including justiciability, immunity, preemption, and the state secrets privilege. The court held that application of the ATS was proper because the conduct at issue occurred within U.S.-controlled territory (Abu Ghraib during the CPA regime), was actionable under universal jurisdiction principles, and enough domestic conduct was involved. The court found that conspiracy liability and corporate liability are recognized under the ATS, and rejected CACI’s defenses and challenges regarding sovereign immunity, political question doctrine, preemption, and evidentiary rulings. The Fourth Circuit affirmed the judgment against CACI, vacated the district court’s judgment in favor of the United States on third-party claims due to sovereign immunity, and remanded with instructions to dismiss those claims. View "Al Shimari v. CACI Premier Technology, Inc." on Justia Law

Charles Cui was charged with bribery and related offenses after he attempted to secure the assistance of Edward Burke, a powerful Chicago alderman, in reversing a permit denial by the Chicago Department of Buildings (CDOB) regarding a pole sign at his commercial property. Cui’s financial interests were jeopardized by the permit denial, which threatened both a lucrative lease with Binny’s Beverage Depot and tax increment financing from the City. To influence Burke, Cui offered to retain Burke’s law firm for property tax appeal work, explicitly seeking Burke’s intervention in the CDOB matter.The United States District Court for the Northern District of Illinois, Eastern Division, presided over a six-week trial in which a jury convicted Cui on all counts: bribery under 18 U.S.C. § 666(a)(2), violations of the Travel Act, and making false statements to the government. The district court admitted evidence over Cui’s objections, including a photoshopped photograph sent to the CDOB, and denied Cui’s post-trial motions for acquittal and a new trial. The court sentenced Cui to 32 months’ imprisonment and applied an obstruction-of-justice enhancement for failing to produce key emails in response to a grand jury subpoena.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed Cui’s challenges to the sufficiency of evidence, jury instructions, evidentiary rulings under Federal Rule of Evidence 404(b), and sentencing. The court held that sufficient evidence supported the convictions, that the jury instructions correctly conveyed the law’s requirements—including the quid pro quo element and the definition of “corruptly”—and that the admission of the photoshopped photograph was not an abuse of discretion. The court also found that the sentencing enhancement and the disparity between Cui’s and Burke’s sentences were justified. The Seventh Circuit affirmed the judgment of the district court. View "USA v Cui" on Justia Law

A government agency responsible for marketing hydroelectric power operated a warehouse in Colorado, where an employee, Jared Newman, orchestrated a fraudulent procurement scheme from 2014 to 2017. Newman arranged for the agency to purchase supplies from vendors owned by friends and family, including the defendant, who owned two such companies. The vendors submitted invoices for goods that were never delivered, received payments from the agency, and then funneled most of the money back to Newman, keeping a portion as a commission. The defendant received nearly $180,000 through 59 fraudulent payments, writing checks back to Newman and taking steps to conceal the scheme.A grand jury indicted the defendant in the United States District Court for the District of Colorado on six counts of wire fraud, each corresponding to a specific transfer, and sought forfeiture of all proceeds. At trial, the government introduced evidence of a co-participant’s guilty plea and the district court instructed the jury that it could infer the defendant’s knowledge of the fraud if he was deliberately ignorant. The defendant was convicted on all counts. The district court limited forfeiture to the six charged transfers, totaling about $20,000, but ordered restitution for the full amount received, for which the defendant and Newman were jointly and severally liable.The United States Court of Appeals for the Tenth Circuit reviewed the case. It held that the district court did not abuse its discretion in admitting evidence of the co-participant’s guilty plea, as it was used to assess credibility and not as substantive evidence of guilt, and the jury was properly instructed on its limited use. The court also held that, because there was sufficient evidence of the defendant’s actual knowledge, any error in the deliberate ignorance instruction did not warrant reversal. On the government’s cross-appeal, the Tenth Circuit vacated the forfeiture order, holding that forfeiture should include all proceeds obtained through the fraudulent scheme, not just the charged transactions, and remanded for further proceedings. View "United States v. Cline" on Justia Law

Derrick Clark and Shawn Mesner worked for Didion Milling, Inc., a corn milling company. In May 2017, Didion’s grain mill exploded, killing five employees. The Occupational Health and Safety Administration (OSHA) investigated and referred Didion for criminal prosecution. The government charged Didion and several employees with federal crimes related to their work at the mill. Clark and Mesner proceeded to trial, challenging the district court’s evidentiary rulings, jury instructions, the indictment, the sufficiency of the evidence, and the constitutionality of their convictions.The United States District Court for the Western District of Wisconsin convicted Clark on four counts and Mesner on two counts. Clark was found guilty of conspiracy to commit federal offenses, false entries in records, using false documents within the EPA’s jurisdiction, and obstruction of agency proceedings. Mesner was found guilty of conspiracy to commit mail and wire fraud and conspiracy to commit federal offenses. Both defendants were sentenced to 24 months’ imprisonment and one year of supervised release.The United States Court of Appeals for the Seventh Circuit reviewed the case. The court vacated Mesner’s conviction on Count 4, remanding for an entry of judgment of acquittal and further proceedings consistent with the opinion. The court affirmed the district court’s evidentiary rulings and jury instructions, as well as Clark’s convictions and Mesner’s conviction on Count 1. The court found sufficient evidence to support the convictions and determined that the jury instructions, when considered as a whole, accurately reflected the law. The court also rejected challenges to the constitutionality of the OSHA regulation involved. View "USA v Mesner" on Justia Law

The plaintiffs, a group of consumers, filed a lawsuit against General Motors (GM) and Robert Bosch LLC, alleging that the companies misled consumers about the emissions produced by certain Chevrolet Cruze vehicles. They claimed that the vehicles emitted higher levels of nitrogen oxides (NOx) than advertised and that the emissions control systems were manipulated to pass regulatory tests. The plaintiffs sought damages under various state fraud laws and the Racketeer Influenced and Corrupt Organizations (RICO) Act.The United States District Court for the Eastern District of Michigan initially dismissed some of the plaintiffs' claims, ruling that those based on the Environmental Protection Agency (EPA) standards were preempted by the Clean Air Act. The court allowed other claims to proceed, particularly those alleging that GM's advertising misled consumers about the vehicles' emissions. However, after the Sixth Circuit's decision in a similar case (In re Ford Motor Company F-150 and Ranger Truck Fuel Economy Marketing and Sales Practices Litigation), the district court revisited its decision and dismissed the remaining fraud claims, concluding they were preempted by federal law. The court also granted summary judgment to the defendants on the RICO claims.The United States Court of Appeals for the Sixth Circuit reviewed the case. The court held that the district court should determine whether the plaintiffs' remaining claims could proceed without relying on a disagreement with the EPA's determinations. The court remanded the case for the district court to decide if the claims were preempted under the analysis described. The court affirmed the dismissal of the RICO claims and the denial of the plaintiffs' post-judgment motion to vacate the judgment in part and approve a preliminary settlement agreement. The case was remanded for further proceedings consistent with the opinion. View "Counts v. General Motors, LLC" on Justia Law

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

The case involves Amaka Oji and Oji Fit World, LLC (OFW), who were approved as Medicaid providers by the D.C. Department of Health Care Finance (DHCF) in 2011. Between 2012 and 2015, they submitted over 24,000 claims for reimbursement for wellness services provided to Medicaid beneficiaries. Investigations by DHCF, the Office of the Inspector General for the Centers for Medicare and Medicaid Services, and the FBI revealed that Oji and OFW regularly overbilled Medicaid, often charging for a full hour of service regardless of the actual time spent or whether the service was provided at all.The District of Columbia filed a lawsuit in April 2021 under the D.C. False Claims Act and the common law doctrine of unjust enrichment. The Superior Court of the District of Columbia granted summary judgment in favor of the District, finding that Oji and OFW had submitted false claims and falsified records. The court awarded the District $1,001,362.50 in treble damages and $497,000 in civil penalties. Oji and OFW's various procedural defenses, including claims of laches and statute of limitations, were deemed waived due to their failure to raise them in a timely manner.The District of Columbia Court of Appeals reviewed the case and affirmed the summary judgment order. However, the court remanded the case for further consideration of the damages and penalties. The appellate court found that the Superior Court had not provided sufficient explanation or analysis for the awarded amounts, making it difficult to review the decision. The appellate court emphasized the need for the trial court to explain its reasoning in detail to permit adequate appellate review. View "Oji Fit World, LLC v. District of Columbia" on Justia Law

Kenneth Bryan Ritchey, the defendant, operated Gulf Coast Pharmaceuticals Plus, LLC, a wholesale distributor of pharmaceutical products. During the COVID-19 pandemic, Ritchey directed his employees to acquire large quantities of personal protective equipment (PPE) and resell them at inflated prices to various healthcare providers, including the Department of Veterans Affairs (VA). The VA was charged significantly higher prices than the market value, resulting in Ritchey and his company receiving over $2 million, including more than $270,000 from the VA.Ritchey was charged with six counts, including conspiracy to defraud the United States. He pled guilty to violating 18 U.S.C. § 371, and the remaining counts were dismissed. The United States District Court for the Southern District of Mississippi calculated Ritchey’s offense level based on the estimated pecuniary loss caused by his actions, which included a significant enhancement for the amount of loss. The court determined the fair market value (FMV) of the PPE based on pre-pandemic prices and 3M’s pricing, leading to a higher offense level and a 60-month prison sentence.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court found that the district court erred in calculating the FMV by relying on pre-pandemic prices and 3M’s pricing, which did not reflect the actual market conditions during the pandemic. The appellate court held that the district court’s method of determining the FMV was not based on a realistic economic approach. Consequently, the Fifth Circuit vacated Ritchey’s sentence and remanded the case for resentencing, emphasizing the need for a more accurate calculation of the FMV that reflects the market conditions at the time of the transactions. View "United States v. Ritchey" on Justia Law