Justia White Collar Crime Opinion Summaries

Humana, a health insurance company and Medicare Part C and Part D sponsor, filed a lawsuit against Biogen, a drug manufacturer, and Advanced Care Scripts, Inc. (ACS), a specialty pharmacy, in the District of Massachusetts. Humana alleged that Biogen and ACS engaged in fraudulent schemes involving three multiple sclerosis drugs, violating the civil RICO statute. Humana claimed that Biogen "seeded" the market with these drugs, funneled patients into Medicare, and indirectly funded patient copays through third-party patient-assistance programs (PAPs). Humana also alleged that ACS aided Biogen's scheme by steering patients and acting as an intermediary between Biogen and the PAPs, causing the submission of false certifications to Humana.The district court dismissed the case, ruling that Humana lacked standing to bring RICO claims because it was an indirect purchaser and failed to plead the RICO claims with particularity as required by Federal Rule of Civil Procedure 9(b). The court found that Humana did not specify the time, place, and content of the alleged fraudulent communications and failed to detail the false certifications' language, timing, and context. Humana's motion for leave to amend the complaint was also denied.The United States Court of Appeals for the First Circuit reviewed the case. The court affirmed the district court's dismissal, agreeing that Humana failed to meet the heightened pleading standard of Rule 9(b) for its RICO claim. The court held that Humana did not provide specific details about the fraudulent certifications or the use of mail or wire communications in furtherance of the scheme. The court also upheld the denial of leave to amend, citing undue delay and the inefficiency of seeking amendment after dismissal. View "Humana Inc. v. Biogen, Inc." on Justia Law

In this case, the defendant, a local attorney, was contracted by Theory Wellness, a marijuana dispensary operator, to assist in obtaining a host community agreement from the City of Medford, Massachusetts. Instead of legitimate lobbying, the defendant attempted to bribe Medford's chief of police through the chief's brother. This led to the defendant's convictions on two counts of honest-services wire fraud and one count of federal programs bribery.The United States District Court for the District of Massachusetts presided over the trial, where a jury convicted the defendant on all counts. The defendant was sentenced to concurrent twenty-four-month terms of imprisonment. The defendant appealed, challenging the sufficiency of the evidence, the admission of certain testimony, and the jury instructions.The United States Court of Appeals for the First Circuit reviewed the case. The court vacated the honest-services wire fraud convictions, finding that the district court erroneously admitted the only evidence establishing the jurisdictional element of those counts. However, the court affirmed the federal programs bribery conviction, concluding that the evidence was sufficient to support the jury's finding that the defendant intended to bribe the chief of police.The court held that the defendant's actions constituted a bribery scheme under 18 U.S.C. § 666, even if the defendant did not believe the chief had accepted the bribe. The court also found that the district court's failure to instruct the jury on the requirement of an "official act" was harmless, as the evidence overwhelmingly supported the conclusion that the defendant sought official acts from the chief. The court rejected the defendant's entrapment defense, finding no improper inducement by the government and that the defendant was predisposed to commit the crime. View "United States v. O'Donovan" on Justia Law

When the five defendants in this case failed to pass the required exams to obtain their medical licenses, they gained certification by obtaining falsified scores. All five defendants were indicted for conspiracy to commit honest-services mail fraud, money or property mail fraud, and aggravated identity theft. The First Circuit affirmed Defendants’ convictions for honest-services mail fraud conspiracy but reversed the convictions for money or property mail fraud and aggravated identity theft, holding that there was sufficient evidence to support the convictions for conspiracy to commit honest-services mail fraud but insufficient evidence to support both Defendants’ convictions for money or property mail fraud and the identity theft convictions. View "United States v. Berroa" on Justia Law

Defendant divorced his wife in order to transfer assets fraudulently and avoid some tax liability. The district court set aside the separation agreement as a fraudulent transfer and proceeded to redivide and reallocate certain assets applying Massachusetts law. The government’s tax liens attached directly to any assets allocated to Defendant, but the government argued that its tax liens also attached indirectly to certain assets allocated to Defendant’s wife. This appeal concerned the district court’s allocation of two assets that the district court divided more or less evenly. The First Circuit vacated in part and affirmed in part, holding (1) with regard to funds that were directly traceable to the tax shelter that Defendant used to reduce his taxable income for several years, it was not clear whether the district court considered fourteen factors required by Massachusetts law in order to arrive at an equitable division of the parties’ assets; and (2) the government was not entitled to Defendant’s wife’s half of the proceeds from the sale of property owned by Defendant and his wife in Massachusetts on a lien-tracing theory. Remanded. View "United States v. Baker" on Justia Law

After a jury trial, Defendant was convicted of illegal insider trading. The conviction arose from Defendant’s act of receiving material, nonpublic information about a local bank from a fellow member of the Oakley Country Club and then using that information to make a substantial trading profit. Defendant appealed, arguing, in part, that the district court wrongly instructed the jury on the mens rea element of his offense. Defendant did not object to these instructions at trial. The First Circuit affirmed, holding (1) the government presented sufficient evidence to support the jury’s verdict; and (2) the trial court erred in its instructions to the jury regarding the mens rea element of Defendant’s offense, but Defendant failed to establish that the error was plain error. View "United States v. Bray" on Justia Law

After a bench trial, Defendant was convicted of both conspiracy to commit healthcare fraud and healthcare fraud. The convictions arose from Defendant’s role in an extensive scheme to defraud Medicare by billing the program for services provided to patients falsely presented as eligible to receive them. Defendant was sentenced to thirty-six months of imprisonment to be followed by three years of supervised release. Defendant appealed, arguing that there was insufficient evidence to prove beyond a reasonable doubt that she acted with the required culpable state of mind. The First Circuit affirmed, holding that the evidence was sufficient to permit a reasonable fact-finder to conclude, beyond a reasonable doubt, that Defendant conspired to commit, and committed, healthcare fraud. View "United States v. Troisi" on Justia Law

After a jury trial, Defendant was convicted of conspiracy to commit healthcare fraud, healthcare fraud, and money laundering. Defendant appealed, alleging trial error. The First Circuit affirmed, holding that the district court did not err by (1) failing to sua sponte give a limiting instruction as to testimony by Defendant’s associate that the associate had pled guilty to one count of healthcare fraud arising from the same scheme; (2) permitting witness testimony about Medicare regulations; and (3) denying Defendant’s preferred jury instruction as to the meaning of a particular certification requirement in the relevant Medicare provisions. View "United States v. Galatis" on Justia Law

Defendants, who previously served as high-ranking officials in the Massachusetts Office of the Commissioner of Probation (OCP), were convicted for Racketeer Influenced and Corrupt Organizations (RICO) violations, RICO conspiracy, and mail fraud based on their roles in a hiring scheme at the OCP. The First Circuit reversed the convictions and ordered the entry of judgments of acquittal, holding that the evidence was insufficient to support the convictions because the Government failed to demonstrate the the conduct of these Massachusetts state officials satisfied the appropriate criminal statutes. Specifically, the Government overstepped its authority in using federal criminal statutes to police the hiring practices of Defendants. View "United States v. Tavares" on Justia Law

Defendant, a tile salesman, received material, nonpublic information from a corporate inside and then passed that information along to friends, who used it to obtain substantial trading gains. After a jury trial, Defendant was convicted of committing securities fraud and conspiring to commit securities fraud. Defendant appealed, arguing that there was insufficient evidence in the record to support his conviction, where he was neither a corporate insider nor a trader of securities. The First Circuit affirmed, holding (1) the evidence was sufficient to show that Defendant knowingly breached a duty of confidence; (2) the district court’s instructions did not improperly shift the burden of proof or misstate the state of mind element of the securities fraud offense; and (3) the evidence was sufficient to show that Defendant anticipated receiving a benefit as a result of his disclosure. View "United States v. McPhail" on Justia Law

Acting on “obviously nonpublic information” that a golfing buddy, McPhail, received from a corporate insider, Parigian made more than $200,000 trading in securities. A federal criminal securities fraud indictment alleged a “misappropriation theory” against Parigian, arguing that Parigian knew or should have known that, by providing the inside information to Parigian, McPhail breached a duty of trust and confidence and personally benefited by doing so. He pled guilty to the charges conditionally. The First Circuit rejected Parigian's preserved challenges to the indictment, following the circuit’s controlling precedent: allegations of a friendship between McPhail and Parigian plus an expectation that the tippees would treat McPhail to a golf outing and assorted luxury entertainment is enough to allege a benefit if a benefit is required. The court rejected an argument that the government was obligated to allege that the insider was also expecting a benefit when passing along confidential information to McPhail in the first instance. View "United States v. Parigian" on Justia Law