Justia White Collar Crime Opinion Summaries

Two former employees of Coca-Cola claim that they were injured while performing their jobs. They reported their injuries to Coca-Cola’s third-party administrator for worker’s compensation claims, Sedgwick, which denied benefits. Plaintiffs claim that the medical evidence strongly supported their injuries, but that Sedgwick engaged in a fraudulent scheme involving the mail: using Dr. Drouillard as a “cut-off” doctor. They sued alleging that the actions of Sedgwick, Coca-Cola, and Dr. Drouillard violated the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. 1961(1)(B), 1962(c), and 1964(c). The district court dismissed. The Sixth Circuit reversed and remanded, noting that since the dismissal, several of the issues were resolved by its 2012 opinion in another case. The district court misapplied the elements of a RICO cause of action to the plaintiffs’ allegations. The court declined to abstain from exercising jurisdiction pending the outcome of state workers comp proceedings. The alleged acts have the same purpose: to reduce Coca-Cola’s payment obligations towards worker’s compensation benefits by fraudulently denying worker’s compensation benefits to which the employees are lawfully entitled. The allegations suggest that the defendants’ scheme would continue on well past the denial of any individual plaintiff’s benefits View "Jackson v. Segwick Claims Mgmt Serv., Inc." on Justia Law

Stone owned STM, which owed Fifth Third about $1 million, secured by liens on business assets and on Stone’s house. Stone’s attorney, Atherton, introduced Stone to Waldman, a potential investor. Stone did not know that Atherton was indebted to Waldman and had given Waldman STM’s proprietary business data. Atherton filed STM’s Chapter 11 bankruptcy petition to preserve assets so that Waldman could acquire them. Atherton allowed the automatic stay to expire. Fifth Third foreclosed, obtaining judgments and a lien on Stone’s house. Waldman paid Fifth Third $900,000 for the bank’s rights. Waldman and Atherton offered to pay off Stone’s debts and employ him in exchange for STM’s assets and told Stone to sign documents without reading them, to meet a filing deadline. The documents actually transferred all STM assets exchange for a job. Ultimately, Waldman owned all STM assets and Stone’s indebtedness, with no obligation to forgive it. Waldman filed garnishment actions; Stone filed a Chapter 11 bankruptcy petition, alleging that Waldman had fraudulently acquired debts and assets. Atherton was disbarred. The bankruptcy court found that Waldman and Atherton had perpetrated “egregious frauds,” invalidated Stone’s obligations, and awarded Stone $1,191,374 in compensatory and $2,000,000 in punitive damages. The district court affirmed. The Sixth Circuit affirmed the discharge, but vacated the award of damages as unauthorized. View "Waldman v. Stone" on Justia Law

A dialysis provider created a wholly-owned subsidiary, RCGSC, which supplied dialysis equipment for home use, to take advantage of the Medicare reimbursement scheme and increase profits. In 2005 former employees filed a qui tam action under the False Claims Act, 31 U.S.C. 3729-33, alleging that RCGSC was not a legitimate and independent durable medical equipment supply company, but a “billing conduit” used to unlawfully inflate Medicare reimbursements. The United States intervened and the relators’ claim was voluntarily dismissed. The government alleged that defendants submitted claims, knowing that RCGSC was a sham corporation created solely for increasing Medicare reimbursements; knowing that RCGSC was not in compliance with Medicare rules and regulations; knowing that RCGSC was misleading patients over their right to choose between Method I and Method II reimbursements; and for facility support charges for services rendered to home dialysis patients who had selected Method II reimbursements. The government also brought common law theories of payment by mistake and unjust enrichment. The district court granted summary judgment in favor of the United States. The Sixth Circuit reversed on all counts and remanded some. Defendants did not act with reckless disregard of the alleged falsity of their submissions to Medicare.View "United States v. Renal Care Grp., Inc." on Justia Law

Tasis and his brother ran a sham medical clinic, recruited homeless Medicare recipients who had tested positive for HIV, hepatitis or asthma, paid the “patients” small sums in exchange for their insurance identification, then billed Medicare for infusion therapies that were never provided. During four months in 2006, the Center billed Medicare $2,855,785 and received $827,000 in return. The scheme lasted 15 months, during which Tasis and his collaborators submitted $9,122,159.35 in Medicare claims. An auditor notified the FBI. After an investigation, prosecutors indicted Tasis on fraud and conspiracy claims. Over Tasis’s objection, co-conspirator Martinez testified that she and Tasis had orchestrated a a similar scam in Florida. The court instructed the jury to consider Martinez’s testimony about the Florida conspiracy only as it related to Tasis’s “intent, plan and knowledge.” The jury found Tasis guilty, and the trial judge sentenced him to 78 months in prison and required him to pay $6,079,445.93 in restitution. The Sixth Circuit affirmed, rejecting various challenges to evidentiary rulings. View "United States v. Tasis" on Justia Law

Lesley and Fogg presented the Benistar 419 Plan to the Ouwingas, their accountant, and their attorney, providing a legal opinion that contributions were tax-deductible and that the Ouwingas could take money out tax-free. The Ouwingas made substantial contributions, which were used to purchase John Hancock life insurance policies. In 2003, Lesley and Fogg told the Ouwingas that the IRS had changed the rules; that the Ouwingas would need to contribute additional money; and that, while this might signal closing of the “loophole,” there was no concern about tax benefits already claimed. In 2006, the Ouwingas decided to transfer out of the Plans. John Hancock again advised that there would be no taxable consequences and that the Plan met IRS requirements for tax deductible treatment. The Ouwingas signed a purported liability release. In 2008, the IRS notified the Ouwingas that it was disallowing deductions, deeming the Plan an “abusive tax shelter.” The Ouwingas filed a class action against Benistar Defendants, John Hancock entities, lawyers, Lesley, and Fogg, alleging conspiracy to defraud (RICO, 18 U.S.C. 1962(c), (d)), negligent misrepresentation, fraudulent misrepresentation, unjust enrichment, breach of fiduciary duty, breach of contract, and violations of consumer protection laws. The district court dismissed. The Sixth Circuit reversed, View "Ouwinga v. Benistar 419 Plan Servs., Inc." on Justia Law

Plaintiffs delivered artifacts from a famous shipwreck to Debtor for display and, according to Debtor, sale in Debtor’s jewelry store. The store went out of business. When Debtor returned the artifacts, an emerald pendant and musket balls were missing. Plaintiffs filed a complaint alleging breach of fiduciary duty, common law conversion, and statutory conversion or negligence. A Michigan state court found that Debtor’s failure to respond to any written discovery requests, file a response to the Motion for Summary Disposition, and appear at the hearing were sufficient basis for entry of summary disposition and awarded $42,706.10. The judgment did not specify the claim upon which it was based. Debtor filed a voluntary Chapter 7 bankruptcy petition. Plaintiffs filed an adversary complaint seeking to have the debt declared nondischargeable under 11 U.S.C. 523(a)(4), stating that Debtor’s actions constituted “fraud or defalcation while acting in a fiduciary capacity, embezzlement, or larceny.” The bankruptcy court granted Plaintiffs summary judgment. The Sixth Circuit reversed. The bankruptcy court erred when it held that the issue of fraud was “necessarily determined” by the state court; the state court judgment cannot have issue preclusive effect as to this element for nondischargeability under the embezzlement portion of section 523(a)(4). View "In re: Dantone" on Justia Law

Nixon worked at a law office, doing clerical and bookkeeping work. While the attorney was out of the office for medical reasons, his bank informed him that he was delinquent in paying back his line of credit. An investigation by a forensic accountant uncovered that Nixon had made thousands of dollars of personal charges on the firm’s credit card and had borrowed thousands more, all of which was unauthorized according to the testimony of the attorneys. The FBI charged, and Nixon was convicted of,11 counts of wire fraud, 18 U.S.C. 1343; two counts of bank fraud, 18 U.S.C. 1344; three counts of aggravated identity theft, 18 U.S.C. 1028A; and one count of using an unauthorized access device, 18 U.S.C. 1029(a)(2). She was sentenced to 54 months of imprisonment and ordered to pay $55,236.30 in restitution. The Sixth Circuit affirmed with respect to 16 counts, rejecting assertions concerning evidentiary rulings, but reversed as to the final count. The government conceded that it failed to present evidence at trial that the card was an “unauthorized access device.” The term is defined under the statute as “any access device that is lost, stolen, expired, revoked, cancelled, or obtained with intent to defraud.” View "United States v. Nixon" on Justia Law

Semrau, a Ph.D. in clinical psychology, owned companies that provided psychiatric care to nursing home patients in Tennessee and Mississippi, using contracting psychiatrists who submitted records describing their work. The companies then billed the services to Medicare or Medicaid through private insurance carriers. Services are categorized into five-digit Current Procedural Terminology Codes, published by the American Medical Association. The Centers for Medicare and Medicaid Services sets reimbursement levels for each code as well as “relative value units” corresponding to the amount of work typically required for each service. After audits indicated that the companies had been billing at a higher rate than could be justified by the services actually performed, “upcoding,” Semrau was convicted of healthcare fraud, 18 U.S.C. 1347, and was sentenced to 18 months of imprisonment and ordered to pay $245,435 in restitution. The Sixth Circuit affirmed, rejecting Semrau’s claim that results from a functional magnetic resonance imaging lie detection test should have been admitted to prove the veracity of his denials of wrongdoing. There was ample evidence that Semrau was aware of accepted definitions of the CPT codes; he expressly agreed not to “submit claims with deliberate ignorance or reckless disregard of their truth or falsity.” View "United States v. Semrau" on Justia Law

McAllister, a former FBI agent, was charged with making material misrepresentations on loan documents to obtain real estate loans for rental properties, and making material misrepresentations on official documents during bankruptcy proceedings. At trial he raised a Batson challenge to the government’s peremptory strike of two African-Americans in the jury pool. The government offered race-neutral reasons for striking the jurors: one had a conviction; the other was unemployed and had a military background so that he might be sympathetic to the defendant. The district court summarily accepted those reasons, by stating, “All right.” The court also excused a defense witness who had notified the court of his intention to invoke the Fifth Amendment in response to all questions asked by the defense. McAllister was convicted of 15 counts of wire fraud, 18 U.S.C. 1343, and three counts of bankruptcy fraud, 18 U.S.C. 151(3). The Sixth Circuit affirmed in part, rejecting claims of prosecutorial and judicial misconduct and challenges to evidentiary rulings, but remanding for findings concerning racial animosity that might entitle McAllister to a new trial. View "United States v. McAllister" on Justia Law

Federal officers applied for a warrant to search the offices of Fair Finance in Akron, as part of an investigation into its owner, Durham, who was suspected of employing the company to engage in a Ponzi scheme. A Magistrate granted a warrant and, at the government’s request, sealed the file. Officers executed the search. The warrant and inventory of seized items were placed in the sealed file. Newspapers requested an order unsealing the files, arguing that they had a right of access under common law and the First Amendment. The district court denied the motion. After an indictment issued, the court granted the government’s motion to unseal the face sheet of the warrant, the form application (excluding the affidavit in support of the application), the inventory, two attachments to the warrant and application, the motion to seal the documents, and the order granting that motion. The affidavit filed in support of the warrant application and the docket sheet remained sealed. The newspapers are no longer contesting the sealing of the affidavit. The Sixth Circuit affirmed. The First Amendment right of access does not permit the newspapers to obtain the documents filed in connection with these warrant proceedings.View "In re: Search of Fair Finance " on Justia Law