Justia Government & Administrative Law Opinion Summaries

The case involves the United States government alleging that Regeneron Pharmaceuticals violated the Anti-Kickback Statute (AKS) by covering copayments for patients prescribed Eylea, a drug used to treat wet age-related macular degeneration. The government contends that this action induced doctors to prescribe Eylea, leading to Medicare claims that were "false or fraudulent" under the False Claims Act (FCA) because they "resulted from" the AKS violation.The United States District Court for the District of Massachusetts reviewed the case and agreed with Regeneron's interpretation that the phrase "resulting from" in the 2010 amendment to the AKS requires a but-for causation standard. This means that the government must prove that the AKS violation was the actual cause of the Medicare claims. The district court noted the conflict in case law and sought interlocutory review, which was granted.The United States Court of Appeals for the First Circuit affirmed the district court's ruling. The court held that the phrase "resulting from" in the 2010 amendment to the AKS imposes a but-for causation requirement. The court reasoned that the ordinary meaning of "resulting from" requires actual causality, typically in the form of but-for causation, unless there are textual or contextual indications to the contrary. The court found no such indications in the 2010 amendment or its legislative history. Therefore, to establish falsity under the FCA based on an AKS violation, the government must prove that the kickback was a but-for cause of the submitted claim. View "United States v. Regeneron Pharmaceuticals, Inc." 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

Kenneth Bryan Ritchey, the defendant, operated Gulf Coast Pharmaceuticals Plus, LLC, a wholesale distributor of pharmaceutical products. During the COVID-19 pandemic, Ritchey directed his employees to acquire large quantities of personal protective equipment (PPE) and resell them at inflated prices to various healthcare providers, including the Department of Veterans Affairs (VA). The VA was charged significantly higher prices than the market value, resulting in Ritchey and his company receiving over $2 million, including more than $270,000 from the VA.Ritchey was charged with six counts, including conspiracy to defraud the United States. He pled guilty to violating 18 U.S.C. § 371, and the remaining counts were dismissed. The United States District Court for the Southern District of Mississippi calculated Ritchey’s offense level based on the estimated pecuniary loss caused by his actions, which included a significant enhancement for the amount of loss. The court determined the fair market value (FMV) of the PPE based on pre-pandemic prices and 3M’s pricing, leading to a higher offense level and a 60-month prison sentence.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court found that the district court erred in calculating the FMV by relying on pre-pandemic prices and 3M’s pricing, which did not reflect the actual market conditions during the pandemic. The appellate court held that the district court’s method of determining the FMV was not based on a realistic economic approach. Consequently, the Fifth Circuit vacated Ritchey’s sentence and remanded the case for resentencing, emphasizing the need for a more accurate calculation of the FMV that reflects the market conditions at the time of the transactions. View "United States v. Ritchey" on Justia Law

Two defendants, Arturo Cuellar ("AC") and Ricardo Quintanilla, were involved in a scheme to bribe city commissioners in Weslaco, Texas, to secure contracts for an infrastructure project. The bribes were intended to influence the awarding of contracts to Camp Dresser & McKee (CDM) and Briones Consulting and Engineering, Ltd. Quintanilla bribed Commissioner Gerardo Tafolla, while AC bribed Commissioner John Cuellar (JC). Leo Lopez, a consultant for CDM and Briones, facilitated the bribes. The scheme involved multiple meetings and payments, with both commissioners taking actions to favor CDM and Briones. The city paid approximately $42.5 million to CDM, Briones, and LeFevre, with Lopez distributing funds to AC and Quintanilla.The United States District Court for the Southern District of Texas convicted Quintanilla and AC of various federal offenses, including conspiracy to commit honest-services wire fraud, honest-services wire fraud, federal program bribery, conspiracy to launder monetary instruments, and money laundering. Quintanilla was sentenced to 200 months in custody, while AC received 240 months. Both were also ordered to pay fines, special assessments, restitution, and forfeiture amounts. The defendants appealed their convictions and sentences.The United States Court of Appeals for the Fifth Circuit reviewed the case and affirmed the convictions and sentences. The court addressed several issues raised by the defendants, including claims of constructive amendment of the indictment, sufficiency of the indictment, recusal of the district judge, and evidentiary rulings. The court found that the government did not constructively amend the indictment and that the evidence supported the convictions. The court also held that the district judge did not need to recuse herself and that the evidentiary rulings were within the court's discretion. The court concluded that the defendants' arguments were either forfeited, not meritorious, or both. View "USA v. Quintanilla" on Justia Law

In this case, defendant Charles Yeager-Reiman, a veteran, pleaded guilty to misdemeanor grand theft in connection with fraudulent activities related to veterans' benefits from the United States Department of Veterans Affairs (VA). Yeager-Reiman appealed his conviction, arguing that his prosecution was preempted by federal law, as his offenses concerned the theft of benefits from the VA.The Court of Appeal of the State of California Second Appellate District Division Five disagreed with Yeager-Reiman's contention, and affirmed the lower court's judgement. The court ruled that federal preemption did not apply in this case. While federal law establishes the guidelines and regulations for VA benefits, it does not prohibit state-level criminal prosecutions for fraudulent activities related to these benefits.In terms of field preemption, the court determined that the provisions of the federal law did not indicate an intent by Congress to occupy the field of criminal prosecution of veterans in connection with the theft of VA benefits. As for obstacle preemption, the court found that allowing state-level prosecutions for theft of VA benefits actually promotes Congress's purpose of aiding veterans by preserving funds for veterans' benefits through deterrence.Therefore, the court concluded that neither field preemption nor obstacle preemption deprived the trial court of jurisdiction to hear Yeager-Reiman's case. View "People v. Yeager-Reiman" on Justia Law

This appeal related to "electronic-bingo" operations conducted by the Department of Alabama Veterans of Foreign Wars of the United States ("the VFW") at some of its Alabama posts. Travis Whaley and Randall Lovvorn contracted with the VFW to superintend and promote its electronic-bingo operations. Between 1997 and 2013, Whaley served the VFW as adjutant, commander, and quartermaster at different times. For his part, Lovvorn served as the VFW's accountant. The VFW contracted with G2 Operations, Inc. ("G2"), to conduct its electronic-bingo operations. Under contract, G2 agreed to conduct electronic-bingo operations at VFW posts throughout Alabama, and the VFW would receive 10% of the gross revenue. All the proceeds from electronic bingo were deposited into a VFW bank account. The VFW also entered into contracts with Whaley and Lovvorn, assigning them specific roles in its electronic-bingo operations. Several years later, after being notified of a tax penalty from the IRS, the VFW discovered a shortfall of $1,782,368.88 from what it should have received under its contracts with G2. The VFW filed a complaint asserting claims against G2 as well as additional claims against other parties, which were eventually whittled down throughout litigation until only claims against Whaley and Lovvorn remained. A jury reached a verdict against Whaley and Lovvorn on VFW's claims of breach of contract, fraudulent suppression, and conversion, awarding $1,782,368.88 in compensatory damages and $2,000,000 in punitive damages. Because the VFW's claims rely upon its own involvement in illegal transactions, the Alabama Supreme Court reversed the trial court's judgment and rendered judgment in favor of Whaley and Lovvorn. View "Whaley, et al. v. Dept. of Alabama Veterans of Foreign Wars of the United States" on Justia Law

The Penal Code authorizes but does not require, county sheriffs to issue licenses to carry concealed weapons. The Santa Clara County Sheriff’s Office rarely issued CCW licenses; the office would not even process a CCW application absent a special instruction Sung, who apparently ran Sheriff Smith’s 2018 re-election campaign and subsequently became the undersheriff, could issue such instructions and could place applications on hold even after licenses were signed by the sheriff. Sung abused that authority to extract favors.Apple executives, concerned about serious threats, met with Sung, who asked whether they would support Sheriff Smith’s re-election. Apple would not give anything of value in exchange for CCW licenses but two executives personally donated $1,000, the maximum allowable amount, to Smith’s campaign. After the election, the applicants were fingerprinted and completed their firearm range qualification tests. Sheriff Smith signed the CCW licenses but they were not handed over. Although Apple had no program for donating products to law enforcement agencies, after a meeting with Sung, an Apple executive (Moyer) emailed an inquiry about donating iPads or computers to the sheriff’s office's “new training facility,” not mentioning Apple’s pending CCW applications. The Office was not setting up a new training center but asked for 200 iPads, worth $50,0000-$80,000. Apple’s team then received their CCW licenses, Apple terminated the promised donation.The court of appeal reversed the dismissal of a bribery charge against Moyer. A public official may be bribed with a promise to donate to the official’s office. View "People v. Moyer" on Justia Law

Johnson was the councilman in Cleveland’s Buckeye-Shaker neighborhood for 41 years. Jamison was his executive assistant. For years, Johnson used his position to fraudulently claim federal reimbursements for payments he never made. He also secured employment for his children in federally funded programs, although they were not legally eligible to work in such positions. Johnson deposited their earnings into his own account. In addition, Johnson fraudulently claimed a series of tax deductions. He encouraged and assisted his son Elijah in submitting falsified records for Elijah’s grand-jury testimony. Jamison assisted Johnson in these crimes. Johnson and Jamison were convicted on 15 charges, including federal program theft under 18 U.S.C. 371, 666(a)(1)(A) and (2); tax fraud, 26 U.S.C. 7206(2); and obstruction of justice, 18 U.S.C. 1512(b) and 1519. Johnson was sentenced to 72 months in prison. Jamison was sentenced to 60 months.The Sixth Circuit affirmed, rejecting challenges to the district court’s loss calculations and to sentencing enhancements for being an organizer or leader of a criminal activity involving five or more participants, for using a minor, and for obstructing justice. The district court properly admitted “other acts” evidence of prior misuse of campaign funds. Any other errors in evidentiary rulings were harmless. View "United States v. Jamison" on Justia Law

Arroyo served in the Illinois House of Representatives from 2006-2019, while also managing a lobbying firm. In 2018-2019, Arroyo’s firm received $32,500 in checks from Weiss’s sweepstakes-gaming company in exchange for his official support for the sweepstakes industry in the General Assembly. Despite never previously expressing a view on sweepstakes gaming, Arroyo began pushing for sweepstakes-friendly legislation and encouraging other legislators and executive-branch officials to support the same. Arroyo concealed his financial arrangement with Weiss.When the government uncovered the bribery scheme, Arroyo pleaded guilty to wire fraud, 18 U.S.C. 666(a)(2). The court sentenced him to 57 months’ imprisonment and ordered that he forfeit $32,500 in bribe money. The Seventh Circuit affirmed, rejecting Arroyo’s contention that the judge erred by finding his 57-month sentence necessary to deter public corruption. District judges need not marshal empirical data on deterrent effects before considering whether a sentence adequately deters criminal conduct. The judge presumed that public officials are rational actors who pay attention when one of their own is sentenced. That presumption that sentences influence behavior at the margins was reasonable. The court also rejected arguments that the judge erred by deeming several of his allocution statements aggravating and ordering him to forfeit too much money. View "United States v. Arroyo" on Justia Law

Vepuri is the de facto director of KVK-Tech, a generic drug manufacturer. He employed Panchal as its director of quality assurance. KVK-Tech manufactured and sold Hydroxyzine, a prescription generic drug used to treat anxiety and tension. The government alleges that Vepuri, Panchal, and KVK-Tech sourced active ingredient for the Hydroxyzine from a facility (DRL) that was not included in the approvals that they obtained from the FDA and that they misled the FDA about their practices.An indictment charged all three defendants with conspiracy to defraud and to commit offenses against the United States and charged KVK-Tech with an additional count of mail fraud. The district court dismissed the portion of the conspiracy charge that alleges that the three conspired to violate the Food, Drug, and Cosmetic Act (FDCA), which prohibits introducing a “new drug” into interstate commerce unless an FDA approval “is effective with respect to such drug,” 21 U.S.C. 355(a).The Third Circuit affirmed, rejecting an argument that a deviation from the approved drug application means that the approval is no longer effective. The approval ceases being effective only when it has been withdrawn or suspended. The indictment does not include any allegations that the KVK-Tech Hydroxyzine manufactured with active ingredients from DRL had a different composition or labeling than the KVK-Tech Hydroxyzine with the effective approval. View "United States v. Vepuri" on Justia Law