Justia White Collar Crime Opinion Summaries

Sekhar Rao was involved in a scheme to defraud TRICARE, a federal health benefit plan, by ordering medically unnecessary toxicology and DNA cancer screening tests. These tests were billed to TRICARE through a shell company, ADAR Group, LLC, which set up fraudulent testing sites. Rao, a physician, was hired to sign off on these tests without reviewing patient medical information or meeting the patients. He was paid per test ordered. The scheme involved using a signature stamp of Rao’s signature to sign requisition forms, which Rao allegedly knew about and consented to.In the United States District Court for the Northern District of Texas, Rao was acquitted of conspiracy to commit health care fraud but was convicted of two counts of substantive health care fraud related to specific fraudulent claims submitted to TRICARE. The district court sentenced him to 48 months of imprisonment, followed by three years of supervised release, and calculated the loss amount under the United States Sentencing Guidelines based on the intended loss.The United States Court of Appeals for the Fifth Circuit reviewed the case. Rao raised three issues on appeal: the sufficiency of the evidence for his convictions, the exclusion of testimony regarding statements made to him by the scheme’s leader about legal vetting, and the calculation of the loss amount under the Sentencing Guidelines. The Fifth Circuit found no reversible error in the district court’s decisions. The court held that there was sufficient evidence for a reasonable jury to conclude that Rao caused the submission of the fraudulent claims and that he knew about and authorized the use of his signature stamp. The court also held that the district court did not plainly err in excluding the testimony about legal vetting and did not err in calculating the intended loss amount. The Fifth Circuit affirmed Rao’s convictions and sentence. View "United States v. Rao" 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

The case involves Sam Sarkis Solakyan, who owned multiple medical-imaging companies. Solakyan conspired with physicians and medical schedulers to route unsuspecting patients to his companies for unnecessary MRI scans and other medical services, generating $263 million in claims. The scheme involved bribery and kickbacks to physicians who referred patients to Solakyan’s companies, violating California’s anti-kickback statutes.The United States District Court for the Southern District of California presided over the initial trial. Solakyan was charged with conspiracy to commit honest-services mail fraud and health-care fraud, as well as substantive counts of honest-services mail fraud and aiding and abetting. After a seven-day trial, the jury found Solakyan guilty on all counts. The district court sentenced him to 60 months in prison and ordered him to pay $27,937,175 in restitution to the affected insurers.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed Solakyan’s conviction, holding that honest-services mail fraud under 18 U.S.C. §§ 1341 and 1346 includes bribery and kickback schemes that deprive patients of their right to honest services from their physicians. The court also held that actual or intended tangible harm is not an element of honest-services fraud. The indictment was found sufficient in alleging willful misconduct for health-care fraud. The court did not find any abuse of discretion in the jury instructions regarding the mens rea for the conspiracy charges or the use of mails in the fraud scheme. However, the court vacated the restitution order, remanding the case for further proceedings to determine if the restitution amount should be reduced by the cost of medically necessary MRIs that insurers would have paid for absent the fraud. View "USA V. SOLAKYAN" on Justia Law

Artak Ovsepian participated in a healthcare fraud scheme at Manor Medical Imaging, Inc., a sham clinic in Glendale, California. The clinic generated prescriptions for unnecessary medications, which were billed to Medicare and Medi-Cal. Manor employees used the identifying information of Medicare and Medi-Cal beneficiaries, often without their knowledge, to fill these prescriptions. Ovsepian joined the conspiracy in 2010, managing drivers who transported beneficiaries to pharmacies to fill fraudulent prescriptions.The government charged Ovsepian with conspiracy to commit healthcare fraud and aggravated identity theft under 18 U.S.C. § 1028A(a)(1). At trial, the government narrowed the aggravated identity theft charge to the possession of one victim’s identifying information. The jury found Ovsepian guilty on all counts, and he was sentenced to 180 months, including a mandatory 24-month sentence for aggravated identity theft. Ovsepian’s direct appeals were unsuccessful, and the Supreme Court denied his petition for a writ of certiorari.Ovsepian filed a 28 U.S.C. § 2255 motion to vacate his aggravated identity theft conviction, arguing actual innocence. The district court denied the motion, and the Ninth Circuit initially denied a certificate of appealability. However, the Supreme Court remanded the case for reconsideration in light of Dubin v. United States, which clarified the interpretation of the aggravated identity theft statute.The Ninth Circuit reversed the district court’s denial of Ovsepian’s § 2255 motion. The court held that a petitioner convicted under a divisible statute must demonstrate actual innocence only for the prong under which they were convicted. The court found that the jury instructions were erroneous because they did not convey that possession of another’s identifying information must be central to the healthcare fraud to sustain a conviction. Consequently, the Ninth Circuit vacated Ovsepian’s conviction and sentence for aggravated identity theft. View "USA V. OVSEPIAN" on Justia Law

Marcus Millsap was convicted by a jury of conspiracy to violate the Racketeer Influenced and Corrupt Organizations Act (RICO), aiding and abetting attempted murder in aid of racketeering, and conspiracy to distribute and possess with intent to distribute 500 grams or more of methamphetamine. Millsap was involved with the New Aryan Empire, a white-supremacist organization engaged in drug trafficking. He assisted the organization's president, Wesley Gullett, in drug operations and attempted to retaliate against Bruce Hurley, a police informant, by offering money to have him killed. Gullett attempted to kill Hurley but failed, and Hurley was later murdered by an unknown perpetrator.The United States District Court for the Eastern District of Arkansas sentenced Millsap to life imprisonment. Millsap appealed, arguing that his indictment should have been dismissed due to a violation of the Interstate Agreement on Detainers Act, and that the district court made several errors regarding evidentiary issues and juror intimidation. He also challenged his sentence if the convictions were upheld.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court found that the Interstate Agreement on Detainers Act did not apply because Millsap was transferred to federal custody via a writ of habeas corpus ad prosequendum before a detainer was lodged. The court also held that there was no sufficient showing of juror intimidation to justify a mistrial. The court found the evidence sufficient to support Millsap's convictions on all counts, including his association with the drug-trafficking enterprise and his involvement in the attempted murder of Hurley.The court also ruled that the district court did not err in admitting co-conspirator statements and other evidence, and that any potential errors were harmless. The court upheld the district court's application of sentencing enhancements and the calculation of Millsap's criminal history points. Consequently, the Eighth Circuit affirmed the judgment of the district court. View "United States v. Millsap" on Justia Law

Manish Kumar was involved in a scheme to smuggle misbranded prescription drugs and controlled substances into the United States from March 2015 to August 2019. Kumar, an Indian national, was a partner in Mihu, a New Delhi-based company that sold generic versions of drugs like Viagra, Cialis, Adderall, and tramadol without FDA approval or proper prescriptions. Kumar managed call centers in India where representatives made false statements to U.S. customers, claiming the drugs were FDA-approved and that no prescriptions were needed. Kumar was arrested in August 2019 on unrelated identity theft charges and later charged in Massachusetts with conspiracy to smuggle drugs, distribute controlled substances, and make false statements. He pled guilty to all charges in October 2022.The United States District Court for the District of Massachusetts sentenced Kumar to 87 months in prison. The court applied a fraud cross-reference in the Sentencing Guidelines and accepted the government's estimate of the loss amount involved in the offense, which was approximately $3.8 million. Kumar objected to both the application of the fraud cross-reference and the loss amount calculation, arguing that the evidence was insufficient.The United States Court of Appeals for the First Circuit reviewed the case. The court held that the fraud cross-reference was correctly applied because the false statements made by call center representatives were within the scope of Kumar's conspiracy and were made in furtherance of the criminal activity. The court also found that the sentencing court did not clearly err in its loss amount calculation, as it relied on detailed government estimates and supporting data. The First Circuit affirmed Kumar's 87-month sentence. View "United States v. Kumar" on Justia Law

Elizabeth Peters Young was convicted of conspiring to pay and receive kickbacks from federal reimbursements for medical creams and lotions dispensed by pharmacies she worked with. The district court sentenced her to 57 months in prison and ordered her to pay $1.5 million in restitution and forfeiture, representing the gross proceeds she controlled during the conspiracy.The United States District Court for the Southern District of Florida initially reviewed the case. Young challenged her conviction, restitution order, and forfeiture judgment, arguing insufficient evidence for her conspiracy conviction, improper calculation of restitution, and errors in the forfeiture amount. The district court denied her motion to set aside the verdict and sentenced her, including the contested financial penalties.The United States Court of Appeals for the Eleventh Circuit reviewed the case. The court affirmed Young’s conspiracy conviction, finding sufficient evidence that she conspired with others, including a pharmacy, to receive kickbacks. The court also upheld the forfeiture judgment, ruling that Young was liable for the gross proceeds she controlled, even if she distributed some to co-conspirators. However, the court vacated the restitution order, agreeing with Young that the government did not prove the amount of loss it experienced due to her conduct. The court remanded the case for further proceedings to determine the correct restitution amount. View "USA v. Young" on Justia Law

The United States Court of Appeals for the Ninth Circuit upheld the drug-trafficking and money-laundering convictions of Benjamin Galecki and Charles Burton Ritchie for their distribution of "spice," a synthetic cannabinoid product. The defendants were found guilty of manufacturing and distributing spice through their company, Zencense Incenseworks, LLC. The drug-trafficking charges were based on the premise that the cannabinoid used, XLR-11, was treated as a controlled substance because it was an "analogue" of a listed substance. The court rejected the defendants' arguments that their convictions should be set aside due to Fourth Amendment violations, insufficient evidence, and vagueness of the Controlled Substance Analogue Enforcement Act of 1986. However, the court reversed their mail and wire fraud convictions due to insufficient evidence. The case was remanded for further proceedings. View "USA V. GALECKI" on Justia Law

Defendant ended up at a Twin Cities chiropractic clinic after an automobile accident. The visit resulted in a job: the clinic hired him to recruit patients. And then another one did too. Defendant’s role was to bring in as many accident victims as possible. Each new patient could undergo treatment up to $20,000, the limit of basic economic benefits available under most Minnesota automobile insurance policies. After a jury trial, the district court ordered Defendant to pay $187,277 in restitution to the insurance companies he defrauded. On remand, the amount of restitution decreased. This time, the district court concluded that Defendant qualified as a runner for only 53 of the 65 victims, which dropped the award to $155,864. Defendant, for his part, has adopted an all-or-nothing strategy: he does not believe he owes a single penny of restitution.   The Eighth Circuit affirmed. The court explained that Defendant received up to $1,500 per patient he recruited, which satisfies the pecuniary-gain requirement. A series of text messages establishes the remaining elements. When the clinic owner later said she was “praying for some ice and snow” to bring in more clients, Defendant replied that he had “been praying for [the] last four weeks.” It was reasonable to conclude from these messages that Hussein “directly procure[d]” these patients with at least a “reason to know,” if not actual knowledge, that the provider’s purpose was to obtain benefits under an automobile-insurance contract. View "United States v. Abdisalan Hussein" on Justia Law

Defendants Gladden and Linton were convicted of conspiracy to commit health care fraud and mail fraud, and the substantive offenses of health care fraud, mail fraud, and aggravated identity theft, for their roles in a multi-year scheme to defraud insurance companies. The government alleged Defendants received inflated reimbursement payments by billing for medically unnecessary and fraudulent prescriptions.The Eleventh Circuit found that the evidence presented at trial was sufficient to support the jury’s verdict as to all of Linton’s convictions and as to Gladden’s convictions for conspiracy, health care fraud, and mail fraud. In addition, the Eleventh Circuit found that the district court did not clearly err in calculating Gladden’s restitution and forfeiture amounts. The Court also vacated Galdden's conviction for aggravated identity theft and remanded for further proceedings consistent with this opinion. View "USA v. John Gladden, et al" on Justia Law