Conspiracy to commit Fraud
False Claims Actions
U.S. ex rel. Freedman v. Suarez-Hoyos, M.D.Fla.2011, 781 F.Supp.2d 1270.Government's amended complaint, alleging violations of False Claims Act (FCA) based on agreement between physician, pathologist, and medical laboratory, which allegedly violated Anti Kickback Statute (AKS).
Ayala v. Department of Professional Regulation, 478 So.2d 1116 (Fla.App.1.Dist.,1985) Appellant, a physician, challenged an order of appellee, which suspended his medical license for three months and placed him on probation for five years because of his nolo contendere plea to submitting a false and fraudulent insurance claim and grand theft for unperformed medical services. Doctor rebutted presumption and assert his innocence of underlying criminal charges convinced the board he was not guilty of crime in violation of provisions of section 458.331(1)(c).
U.S. ex rel. Badr v. Triple Canopy, Inc., 2013 WL 3120204 (E.D.Va.,2013). While an individual suing on behalf of the Government is the assignee of an False Claims Act (FCA) action, intervention by the Government on a claim that is identical to the individual's claim precludes the individual from maintaining the same. 31 U.S.C.A. § 3730(b)(4).
Burke v. Record Press, Inc., 2013 WL 2631323 (D.D.C.,2013). In order to prevail on a claim brought pursuant to the False Claims Act (FCA), a plaintiff must prove all elements of the cause of action by a preponderance of the evidence. 31 U.S.C.A. § 3729(a)(1).
Kickbacks
State v. Harden 938 So. 2d 480 (Fla. 2006): Employees of dental services corporation charged with conspiracy, racketeering, and Medicaid fraud moved to dismiss information. The Circuit Court, Dade County, granted motion, and state appealed. The Supreme Court held that state Medicaid anti-kickback statute was preempted by federal anti-kickback statute and was thus unconstitutional under the Supremacy Clause.
Florida Med. Center of Clearwater, Inc. v. Sebelius 614 F.3d 1276 (11th Cir., 2010). Medicare services provider appealed decision of the Medical Appeals Council which denied review of claim that the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) improperly subjected provider to recoupment of allegedly overpaid Medicarereimbursements. The court held that: provider was not excluded, under the mandatory exclusion section of the Social Security Act, from the Medicare Part B program during period when its majority owner and president was subject to an exclusion letter.
U.S. v. Hooshmand 931 F.2d 725 (11thCir., 1991).Defendant was convicted in the United States District Court for the Southern District of Florida of submitting fraudulent Medicare claims to the DHHS and fraudulent claims for medical services to private insurers. Defendant appealed. The Court of Appeals, Johnson held that: (1) indictment was sufficient under McNally ; (2) evidence was sufficient to sustain convictions; (3) extrinsic act evidence was admissible; and (4) district court was not required to make findings before imposing fine.
U.S. v. Suba 132 F.3d 662 (11thCir., 1998). Defendants were convicted of various offenses in connection with complex Medicare fraud scheme. Defendants appealed. The Court of Appealsheld that, except as to two counts, evidence supported convictions.
U.S. v. Isley , 369 Fed. Appx. 80 (11thCir., 2010). A jury convicted defendant on fourteen counts relating to a scheme to defraud the Medicare program, under 18 U.S.C.S. § 1347; thirty-five counts of honest services mail fraud, under 18 U.S.C.S. §§ 1341 and 1346; and three counts of money laundering, under 18 U.S.C.S. § 1957. Defendant filed a motion for a new trial. The United States District Court for the Northern District of Georgia denied the motion.Defendant appealed. The judgment of the district court was affirmed.
U.S. v. Mateos, 623 F.3d 1350 (11th Cir., 2010). Defendants, a doctor and a nurse, were indicted for: (1) conspiracy to defraud the United States, cause the submission of false claims, and pay health care kickbacks, in violation of 18 U.S.C.S. § 371; and (2) conspiracy to commit health care fraud, in violation of 18 U.S.C.S. §§ 1347 and 1349. A jury found defendants guilty; they appealed. The appellate court affirmed the convictions and sentences of both defendants.
U.S. v. Mitchell 165 Fed.Appx. 821 (11thCir., 2010). Following his conviction by a jury of conspiracy to commit fraud, defendant filed motion for judgment of acquittal, or, in alternative, for new trial. The United States District Court for the Northern District of Georgia granted judgment of acquittal, and, in alternative, granted new trial. Government appealed.
U.S. v. Rodriguez , 427 Fed. Appx. 784 (11th Cir., 2011): Defendants were convicted in the United States District Court for the Southern District of Florida, on counts related to their participation in a kickback scheme to defraud the federal Medicare program. Their convictions and sentences were affirmed.
U.S. v. Hernandez , 490 Fed. Appx. 250 (11th Cir., 2012): Defendant appealed his convictions from the U.S. District Court for the Southern District of Florida for money laundering under 18 U.S.C.S. §§ 1956(a)(1)(B)(i), 1957, and attempting to cause a bank to fail to file a report required while he violated another federal law as part of a pattern of illegal activity involving more than $100,000 in 12 months under 31 U.S.C.S. § 5324(a)(1), (d)(2).
U.S. ex rel. St. Joseph's Hosp., Inc. v. United Distributors, Inc. 2012 WL 5511729. This case involves claims brought by the United States under the False Claims Act ("FCA"), 31 U.S.C. § 3729, and common law theories of unjust enrichment and payment by mistake of fact. The Government's complaint asserts five causes of action: Count One alleges violations of the FCA under 31 U.S.C. § 3729(a)(1); Count Two alleges violations of the FCA under 31 U.S.C. § 3729(a)(2); Count Three alleges violations of the FCA under 31 U.S.C. § 3729(a)(3); Count Four presents a claim for unjust enrichment; and Count Five alleges payment by mistake of fact.
U.S. v. Medina, 485 F.3d 1291 (C.A.11.Fla.,2007). Mere fact that prescriptions which Medicare providers submitted to Medicare contained forged signatures was insufficient to establish any health care fraud on providers' part, without some evidence that any agents of providers knew of these forgeries or forged prescriptions themselves. 18 U.S.C.A. § 1347.
U.S. v. Morris, 376 Fed.Appx. 281 (C.A.3.Pa.,2010). The number and egregiousness of false Medicare claims submitted by defendant who ran health care services company was sufficient evidence that defendant acted knowingly and willfully, as required to support conviction for health care fraud; defendant obtained Medicare provider numbers for herself as an individual and for company by submitting false social security number, false clinical social worker license, then defendant submitted claims totaling 964,454.17 for which Medicare paid $278,507.05 for services that were never provided, including services that defendant claimed were provided to dead people. 18 U.S.C.A. § 1347.
U.S. v. Palazzo (C.A.5.La.,2010). Evidence was sufficient to sustain conviction for Medicare fraud; defendant, a psychiatrist and hospital medical director, did not meet with patients for whom she billed Medicare, and she knowingly billed for services that were either not performed or that did not qualify for reimbursement. 18 U.S.C.A. § 1347.
Fischer v. United States, 529 U.S. 667: Petitioner, who had been convicted under 18 U.S.C.S. § 666(a)(1)(A) for defrauding a hospital that received Medicare benefits in excess of $ 10,000 per year, sought review of the judgment of the United States Court of Appeals for the Eleventh Circuit, which affirmed the conviction despite petitioner's argument that Medicareprovided no benefits to the hospital, as required under the statute. The judgment was affirmed.
U.S. ex rel. Heineman-Guta v. Guidant Corp., 2013 WL 2364172 (C.A.1.Mass.,2013). Qui tam complaint alleging that medical device manufacturers engaged in scheme of illegal kickbacks to promote sales of their cardiac rhythm management devices alleged same material elements of fraud as prior qui tam case against manufacturers, and thus was barred by False Claims Act's (FCA) first-to-file rule, even if prior action did not provide enough detail to satisfy heightened pleading requirements for fraud claims, where prior complaint described same types of kickbacks as disclosed in current complaint, and alleged the same essential facts. 31 U.S.C.A. § 3730(b)(5); Fed.Rules Civ.Proc.Rule 9(b), 28 U.S.C.A.
U.S. v. De Oleo, 697 F.3d 338 (C.A.6.Mich.,2012). Evidence of other prior sham clinics in which defendant was involved was admissible, at his trial on charges of Medicare fraud, conspiracy to commit Medicare fraud, and money laundering, where government admitted evidence for permissible purpose of showing defendant's intent, knowledge, or plan to commit Medicare fraud at sham medical clinic that gave rise to his charges. Fed.Rules Evid.Rule 404(b), 28 U.S.C.A.
Fraud
Kickbacks
U.S. v. Job, 387 Fed.Appx. 445 (C.A.5.Tex.,2010). Physician defendant's conviction for violating Medicare Anti-Kickback Statute was supported by sufficient evidence that he knowingly and willfully received cash payments intended to induce referrals of Medicare beneficiaries for whom defendant wrote prescriptions for medically unnecessary power wheelchairs. He was paid only for beneficiaries for whom he wrote prescriptions, and he wrote prescriptions for every beneficiary that he assessed. Social Security Act, § 1128B(b)(2)(A), 42 U.S.C.A. § 1320a-7b(b)(2)(A).
U.S. v. Job, 387 Fed.Appx. 445 (C.A.5.Tex.,2010). Defendants, a medical equipment provider and a physician, sought review of judgments from the U.S. District Court for the Western District of Texas, which convicted the provider of conspiring to violate, and violating, 18 U.S.C.S. § 371 and 42 U.S.C.S. § 1320a-7b(b)(2)(A), as well as of health-care fraud under 18 U.S.C.S. § 1347, and convicted the physician of violating 42 U.S.C.S. § 1320a-7b(b)(2)(A). Affirmed.
