Justia White Collar Crime Opinion Summaries

Natalya Shvets was convicted by a jury in 2014 for healthcare fraud and conspiracy to commit healthcare fraud, stemming from her role as a nurse at Home Care Hospice, Inc. (HCH). Evidence showed she and other employees created false records for high-priced “continuous care” services, resulting in fraudulent bills submitted to Medicare. Shvets was ordered to pay $253,196 in restitution, jointly and severally with eight other defendants, for her involvement in 52 false bills. The broader scheme allegedly caused $16.2 million in losses to Medicare, with seventeen individuals ordered to pay varying restitution amounts.After sentencing in the United States District Court for the Eastern District of Pennsylvania, Shvets moved for an accounting and to declare her restitution judgment satisfied, arguing that payments by herself and her jointly liable co-defendants had collectively exceeded $253,196. The District Court, relying on United States v. Sheets, held that Shvets’s judgment would not be satisfied until she personally paid the full amount or until all defendants collectively paid $16.2 million. The Clerk of Court, using a complex allocation method, also reported Shvets’s balance as outstanding, but the District Court did not resolve whether the Clerk’s method was correct.On appeal, the United States Court of Appeals for the Third Circuit affirmed in part, vacated in part, and remanded. The Court held that sentencing judges may issue “hybrid” restitution orders under the Mandatory Victim Restitution Act, combining joint and several liability with apportioned liability. The Court found the District Court erred by applying the Sheets rule, which conflicted with the language of Shvets’s judgment. The Third Circuit directed the District Court to determine whether the Clerk’s accounting method is fair and appropriate, and to decide if Shvets’s restitution judgment has been satisfied. View "United States v. Shvets" on Justia Law

A licensed veterinarian developed and manufactured undetectable performance enhancing drugs (PEDs) for use in professional horse racing, selling them to trainers who administered them to horses to gain a competitive edge. His salesperson assisted in these activities, operating a company that distributed the drugs without prescriptions or FDA approval. The drugs were misbranded or adulterated, and the operation involved deceptive practices such as misleading labeling and falsified customs forms. The PEDs were credited by trainers for their horses’ successes, and evidence showed the drugs could be harmful if misused.The United States District Court for the Southern District of New York presided over two separate trials, resulting in convictions for both the veterinarian and his salesperson for conspiracy to manufacture and distribute misbranded or adulterated drugs with intent to defraud or mislead, in violation of the Food, Drug, and Cosmetic Act. The district court denied motions to dismiss the indictment, admitted evidence from a prior state investigation, and imposed sentences including imprisonment, restitution, and forfeiture. The court calculated loss for sentencing based on the veterinarian’s gains and ordered restitution to racetracks based on winnings by a coconspirator’s doped horses.On appeal, the United States Court of Appeals for the Second Circuit held that the statute’s “intent to defraud or mislead” element is not limited to particular categories of victims; it is sufficient if the intent relates to the underlying violation. The court found no error in the admission of evidence from the 2011 investigation or in the use of gain as a proxy for loss in sentencing. However, it vacated the restitution order to racetracks, finding no evidence they suffered pecuniary loss, and vacated the forfeiture order, holding that the relevant statute is not a civil forfeiture statute subject to criminal forfeiture procedures. The convictions and sentence were otherwise affirmed. View "United States v. Fishman" on Justia Law

A pharmaceutical company participated in a federal program that required it to report the average price it received for drugs sold to wholesalers, which in turn affected the rebates it owed the government under Medicaid. From 2005 to 2017, the company sold drugs to wholesalers at an initial price, but if it raised the price before the wholesaler resold the drugs to pharmacies, it required the wholesaler to pay the difference. The company reported only the initial price as the average manufacturer price (AMP), excluding the subsequent price increases, which resulted in lower reported AMPs and thus lower rebate payments to the government. The company justified this exclusion by categorizing the price increases as part of a bona fide service fee to wholesalers, even though the increased value was ultimately paid by pharmacies.The United States District Court for the Northern District of Illinois reviewed the case after a qui tam action was filed by a relator, who alleged that the company’s AMP calculations were false and violated the False Claims Act (FCA). The district court granted summary judgment to the relator on the issue of falsity, finding the AMP calculations and related certifications were factually and legally false. The issues of scienter (knowledge) and materiality were tried before a jury, which found in favor of the relator and awarded substantial damages. The company appealed, challenging the findings on falsity, scienter, and materiality, while the relator cross-appealed on the calculation of the number of FCA violations.The United States Court of Appeals for the Seventh Circuit affirmed the district court’s judgment. The court held that the company’s exclusion of price increase values from AMP was unreasonable and contradicted the plain language and purpose of the relevant statutes, regulations, and agreements. The court also held that the jury reasonably found the company acted knowingly and that the false AMPs were material to the government’s payment decisions. The court rejected the cross-appeal on damages, finding the issue was not properly preserved for appeal. View "Streck v Eli Lilly and Company" on Justia Law

Mathew James, a former nurse and owner of a medical billing business, was convicted after a jury trial for health care fraud, conspiracy to commit health care fraud, wire fraud, and aggravated identity theft. The charges arose from a scheme in which James and his employees falsified insurance claims by “upcoding” and “unbundling” medical procedures, directed patients to emergency rooms for pre-planned surgeries, and impersonated patients in communications with insurance companies. The fraudulent activity spanned several years, involved nearly 150 physicians, and resulted in tens of thousands of claims. While some of James’s business was legitimate, the government’s evidence focused on the fraudulent aspects of his operations.The United States District Court for the Eastern District of New York (Judge Seybert) presided over the trial and sentencing. The jury convicted James on most counts but acquitted him of money laundering conspiracy. During trial, jurors were inadvertently given access to transcripts of two recorded calls not admitted into evidence, but the district court declined to conduct an inquiry into the exposure, instead instructing the jury to disregard any material not in evidence. At sentencing, the court imposed a 144-month prison term, a forfeiture order of over $63 million, and restitution of nearly $337 million. The court applied sentencing enhancements for James’s leadership role and abuse of trust, and increased the sentence after considering James’s potential eligibility for earned time credits and rehabilitation programs.The United States Court of Appeals for the Second Circuit affirmed James’s conviction, finding any jury exposure to extra-record material harmless. However, the court vacated the sentence, including the forfeiture and restitution orders, holding that the district court erred by enhancing the sentence based on potential earned time credits and rehabilitation program eligibility, misapplied sentencing enhancements without adequate findings, and failed to properly calculate forfeiture and restitution by including legitimate business revenue. The case was remanded for resentencing. View "United States v. James" on Justia Law

The case concerns a defendant who, after being excluded from Medicare and Medicaid as part of a civil False Claims Act settlement, purchased a Medicare-participating home healthcare company using an alias and forged documents. The company then submitted hundreds of fraudulent claims to Medicare, resulting in over $2.7 million in payments for services that were never provided. The defendant transferred the proceeds to India, where they remain unrecovered. During the criminal investigation, the defendant also attempted to prevent a former employee from testifying by impersonating another person and making false reports to U.S. authorities, which led to the employee’s visa being denied.A grand jury in the United States District Court for the Eastern District of Michigan indicted the defendant on charges including health care fraud, money laundering, conspiracy, aggravated identity theft, and witness tampering. The trial was delayed, and shortly before it began, the defendant’s counsel experienced internal conflict, leading to motions to withdraw and requests for a mistrial, all of which the district court denied. During trial, the defense sought to call a surprise witness, an unindicted co-conspirator, on the last day. The district court excluded this witness, citing a violation of a discovery order and concerns about delay, prejudice, and the likelihood the witness would invoke the Fifth Amendment.On appeal, the United States Court of Appeals for the Sixth Circuit reviewed whether the district court violated the defendant’s constitutional rights by excluding the witness, denying counsel’s motion to withdraw, and excluding the defendant from an in-chambers conference. The Sixth Circuit held that the exclusion of the witness did not violate the Sixth Amendment, as the district court reasonably balanced the defendant’s right to present a defense against countervailing interests, and the defendant failed to show what exculpatory evidence the witness would have provided. The court also found no abuse of discretion in denying the motion to withdraw and no reversible error in excluding the defendant from the conference. The Sixth Circuit affirmed the district court’s judgment. View "United States v. Pancholi" on Justia Law

Robert Kennedy was convicted of possessing a firearm as a convicted felon, possessing heroin with the intent to distribute, and possessing a firearm in furtherance of a drug trafficking crime. The convictions were based on evidence found during a search of his apartment, including drugs, scales, and a firearm. Kennedy's prior convictions for burglary and drug offenses led to his classification as an armed career criminal and a career offender, resulting in a guidelines range of 420 months to life imprisonment. He received a below-guidelines sentence of 360 months.The United States District Court for the Middle District of Georgia admitted text messages and expert testimony over Kennedy's objections and found sufficient evidence to support his convictions. The court also determined that Kennedy's prior convictions qualified him for the ACCA and career offender enhancements, despite his arguments to the contrary.The United States Court of Appeals for the Eleventh Circuit reviewed the case and affirmed the district court's decisions. The appellate court held that the text messages were admissible as they were directly related to the charged offense and not subject to Rule 404(b). The expert testimony was also deemed appropriate as it did not violate Rule 704(b). The court found sufficient evidence to support Kennedy's convictions, including testimony linking him to the drugs and firearm.The appellate court also upheld the ACCA enhancement, finding that Kennedy's prior burglary convictions qualified as predicate offenses. The court rejected Kennedy's arguments against the career offender enhancement, affirming that his prior drug convictions met the criteria. Finally, the court found Kennedy's sentence to be both procedurally and substantively reasonable, given the circumstances and the guidelines range. The sentence was affirmed. View "United States v. Kennedy" on Justia Law

Donald Booker owned and operated United Youth Care Services, which billed North Carolina’s Medicaid program for millions of dollars’ worth of medically unnecessary drug tests. Booker was involved in a scheme where his company, along with United Diagnostic Laboratories, recruited individuals to submit to drug testing, which was then billed to Medicaid. The company used several medical providers to certify the testing as medically necessary, even though these providers often did not meet with the beneficiaries. Booker directed the testing protocols, which included testing all participants twice per week regardless of medical need. He also arranged kickback schemes with other entities to recruit Medicaid beneficiaries for the drug tests.The United States District Court for the Western District of North Carolina convicted Booker on ten counts, including conspiracy to defraud the United States, commit health care fraud, pay illegal kickbacks, and money laundering. Booker represented himself at trial, and the jury found him guilty on all counts. The district court denied his motion for judgment of acquittal and sentenced him to 200 months in prison, considering a loss amount exceeding $9.5 million.The United States Court of Appeals for the Fourth Circuit reviewed the case and affirmed the district court’s judgment. The appellate court found that there was substantial evidence to support Booker’s convictions, including testimony from co-conspirators and evidence of kickback payments. The court also rejected Booker’s arguments regarding the nondelegation doctrine, the sufficiency of the evidence for his money-laundering convictions, and the alleged Confrontation Clause violations. The court upheld the district court’s loss-amount calculation and found Booker’s sentence to be substantively reasonable, noting that his co-defendants were not similarly situated and had cooperated with the government. View "United States v. Booker" on Justia Law

Mark Schena operated Arrayit, a medical testing laboratory in Northern California, which focused on blood tests for allergies. Schena marketed these tests as superior to skin tests, despite their limitations, and billed insurance providers up to $10,000 per test. To maintain a steady flow of patient samples, Schena paid marketers a percentage of the revenue they generated by pitching Arrayit’s services to medical professionals, often misleading them about the tests' efficacy. During the COVID-19 pandemic, Schena transitioned to COVID testing, using similar deceptive marketing practices to bundle allergy tests with COVID tests.The United States District Court for the Northern District of California denied Schena’s motion to dismiss the EKRA counts, arguing that his conduct did not violate the statute as a matter of law. The jury convicted Schena on all counts, including conspiracy to commit healthcare fraud, healthcare fraud, conspiracy to violate EKRA, EKRA violations, and securities fraud. The district court sentenced Schena to 96 months in prison and ordered him to pay over $24 million in restitution.The United States Court of Appeals for the Ninth Circuit reviewed the case and affirmed Schena’s convictions. The court held that 18 U.S.C. § 220(a)(2)(A) of EKRA covers payments to marketing intermediaries who interface with those who do the referrals, and there is no requirement that the payments be made to a person who interfaces directly with patients. The court also concluded that a percentage-based compensation structure for marketing agents does not violate EKRA per se, but the evidence showed wrongful inducement when Schena paid marketers to unduly influence doctors’ referrals through false or fraudulent representations. The court affirmed Schena’s EKRA and other convictions, vacated in part the restitution order, and remanded in part. View "United States v. Schena" on Justia Law

Quintan Cockerell, a marketer for two compounding pharmacies, was convicted for receiving illegal kickbacks as part of a conspiracy to induce physicians to prescribe highly lucrative prescriptions. These pharmacies, including Xpress Compounding, focused on formulating expensive topical creams, resulting in significant reimbursements from federal insurers like TRICARE. Cockerell was involved in recruiting physicians, developing new formulas, and receiving commissions disguised as payments to his then-wife. He also provided financial incentives to physicians, including lavish vacations and investment opportunities, to encourage them to prescribe these creams.The United States District Court for the Northern District of Texas convicted Cockerell of violating the Anti-Kickback Statute, conspiracy, and money laundering. He was sentenced to 29 months of imprisonment, two years of supervised release, and ordered to pay $59,879,871 in restitution. Cockerell appealed, challenging the sufficiency of the evidence, alleged misstatements of law by the Government during trial, and the restitution order.The United States Court of Appeals for the Fifth Circuit reviewed the case and found that a reasonable jury could have convicted Cockerell based on the evidence presented. The court held that the Government provided sufficient evidence of Cockerell's involvement in the illegal kickback scheme and his intent to influence physicians. The court also found no reversible error in the Government's statements during closing arguments and upheld the restitution order, noting that Cockerell failed to provide evidence of legitimate services to offset the loss amount. Consequently, the Fifth Circuit affirmed the district court's judgment. View "United States v. Cockerell" on Justia Law

Richard Hall and his partners established a pharmacy business to capitalize on the market for compounded drugs, targeting federal insurers for high reimbursements. They created two pharmacies, Rxpress and Xpress Compounding, to handle private and federal insurance claims, respectively. The business model involved paying marketers commissions to secure prescriptions from physicians, which led to over $59 million in federal healthcare reimbursements. Hall and his partners were indicted for conspiracy to defraud the United States, paying and receiving illegal kickbacks, and money laundering.The United States District Court for the Northern District of Texas tried the case. The jury found Hall guilty on multiple counts, including conspiracy to defraud the United States and paying illegal kickbacks. The district court sentenced Hall to 52 months in prison, three years of supervised release, and ordered him to pay over $59 million in restitution. Hall's motion for release pending appeal was denied by both the district court and the appellate court.The United States Court of Appeals for the Fifth Circuit reviewed the case. Hall raised four arguments on appeal: improper jury instructions regarding the burden of proof for the safe-harbor defense under the Anti-Kickback Statute (AKS), the definition of "employee" in the jury instructions, the exclusion of his proposed jury instruction on kickback recipients, and the imposition of restitution. The Fifth Circuit held that the district court correctly placed the burden of persuasion for the safe-harbor defense on Hall, properly defined "employee" in the jury instructions, and did not err in excluding Hall's proposed instruction on kickback recipients. The court also upheld the restitution order, finding it appropriate based on the total loss to the government. Consequently, the Fifth Circuit affirmed Hall's convictions and the district court's restitution order. View "United States v. Hall" on Justia Law