Justia Government & Administrative Law Opinion Summaries

The plaintiff, a former Senior Reimbursement Manager at a national pharmacy provider, alleged that her employer engaged in a scheme to overcharge government healthcare programs such as Medicare and Medicaid. She claimed the company exploited billing system discrepancies and other tactics to cause overpayments, including billing for deceased patients and miscoding pharmacy types for higher reimbursements. The company allegedly concealed these overpayments in its internal accounting and, after a period, transferred the unreturned funds into its own revenues. The plaintiff reported these practices to management and internal audit, but the issues persisted.After filing a complaint in the United States District Court for the Eastern District of New York, the plaintiff amended her allegations. The District Court dismissed all federal claims with prejudice, finding that the plaintiff did not meet the heightened pleading standards for fraud required under Federal Rule of Civil Procedure 9(b) for “direct” False Claims Act (FCA) claims (those based on submitting fraudulent invoices or statements to the government). The court also denied leave to further amend the complaint, and denied reconsideration.On appeal, the United States Court of Appeals for the Second Circuit reviewed the case de novo. The Second Circuit affirmed the District Court’s dismissal of the plaintiff’s direct FCA claims, holding that she did not identify any specific fraudulent submissions to the government, nor adequately allege that such information was solely within the defendants’ control. However, the Second Circuit vacated the dismissal of the “reverse” FCA claim, which is based on knowingly retaining government overpayments. The court found the plaintiff sufficiently alleged that the company had an obligation to return identified overpayments and knowingly concealed or improperly avoided that obligation. The case was remanded for further proceedings on the reverse FCA claim. View "United States v. Amerisource Bergen Corp." on Justia Law

Two individuals associated with a Russian nonprofit registered the domain name waronfakes.com through a Russian registrar in March 2022. This domain hosted content focused on Russian political issues. In August 2024, the United States government seized the domain and others, alleging violations of the international money laundering statute and the International Emergency Economic Powers Act (IEEPA). The government claimed the domain was used to promote Russian disinformation on behalf of sanctioned individuals and entities, and that the purchase of the domain involved funds transferred for the benefit of a blocked person under U.S. sanctions. Five days after the seizure, the nonprofit and its director were added to the U.S. Treasury’s blocked persons list, which prohibits the transfer or dealing in their U.S.-based property without a license.The applicants, Timofey V and ANO Dialog, moved in the United States District Court for the Eastern District of Pennsylvania for the return of the domain under Federal Rule of Criminal Procedure 41(g). The government opposed the motion, arguing that the applicants were not lawfully entitled to possess the property as they were now blocked persons under U.S. sanctions and lacked the required license from the Office of Foreign Assets Control (OFAC). The District Court denied the motion without an evidentiary hearing, concluding that the applicants could not lawfully receive the domain.On appeal, the United States Court of Appeals for the Third Circuit held that although the applicants had standing due to a sufficient possessory interest, they failed to establish lawful entitlement to the property because transfer to them was blocked by sanctions and no OFAC license had been obtained. The court further found no abuse of discretion in the District Court’s denial of an evidentiary hearing, as the legal impediment to transfer was undisputed. The judgment of the District Court was affirmed. View "Timofey V v. USA" on Justia Law

A company operating as a mortgage lender applied for and received a Paycheck Protection Program (PPP) loan during the COVID-19 pandemic. The company’s PPP loan was later forgiven. A private party, acting as a qui tam relator under the False Claims Act (FCA), alleged that the company and its chief executive officer made several false statements in their loan application and forgiveness process. The key allegations were that the company was ineligible for PPP funds as a financial business primarily engaged in lending, that it misrepresented its use and need for the loan, and that it falsified the number of employees to increase the loan amount. The relator argued that these misrepresentations led the government to approve and forgive the loan improperly.Previously, the United States District Court for the Southern District of California dismissed the relator’s amended complaint. The district court found that the FCA’s public disclosure bar applied, reasoning that the necessary information supporting the ineligibility allegation was already publicly available on a government website, specifically concerning the company’s business classification. The district court also concluded that the relator’s allegations regarding the inflated employee count were speculative. The relator was denied leave to further amend the complaint, on the basis that amendment would be futile.The United States Court of Appeals for the Ninth Circuit reviewed the case and held that the public disclosure bar did not apply because the information on the government website was not “substantially the same” as the relator’s allegations, and the company’s own website did not qualify as “news media” under the statute. The appellate court agreed that the relator’s claim regarding the number of employees was not sufficiently pleaded but found the district court abused its discretion by denying leave to amend. The Ninth Circuit reversed the dismissal and remanded for further proceedings. View "RELATOR, LLC V. ERSKINE" on Justia Law

Two major airline crashes in 2018 and 2019 involving Boeing 737 MAX aircraft led to the deaths of hundreds of passengers and crew. Investigations revealed that Boeing had concealed important safety information about modifications to the planes’ flight control system, contributing to the crashes. The Department of Justice (DOJ) charged Boeing with conspiracy to defraud the United States but later entered a Deferred Prosecution Agreement (DPA) in 2021, requiring Boeing to pay significant penalties and undertake compliance measures. After Boeing allegedly breached the DPA, the DOJ pursued a Non-Prosecution Agreement (NPA) in 2025, again imposing penalties and compliance obligations in exchange for dismissing the criminal charge. Family members of crash victims challenged both agreements, asserting violations of their rights under the Crime Victims’ Rights Act (CVRA).The United States District Court for the Northern District of Texas found that while the DOJ had originally failed to confer with families before the 2021 DPA due to a legal error, there was no bad faith, and the court lacked authority to modify or review the substance of the DPA or NPA. The district court later granted the DOJ’s motion to dismiss the prosecution against Boeing after the NPA, finding the DOJ’s actions were not in bad faith and were adequately explained.On appeal, the United States Court of Appeals for the Fifth Circuit held that the families’ challenge to the 2021 DPA was moot since the agreement was no longer in effect after Boeing’s breach. Addressing the NPA, the Fifth Circuit concluded the DOJ had fulfilled its obligation to confer with the families and had not misled them. The court also determined it lacked jurisdiction under the CVRA to substantively review the district court’s dismissal of the prosecution. The petitions for writ of mandamus were denied. View "Ryan v. USA" on Justia Law

A longtime Speaker of the Illinois House of Representatives was prosecuted in federal court for engaging in extensive bribery schemes. The first involved a major utility company, Commonwealth Edison (ComEd), which, facing financial difficulties, funneled more than $3 million to the defendant’s political associates through intermediaries and sham contracts in exchange for the defendant’s legislative support of ComEd’s agenda over several years. The government presented evidence that these payments resulted in concrete legislative actions by the defendant that benefitted ComEd, including support for specific bills and regulatory changes. The second scheme involved the defendant’s agreement to recommend a Chicago alderman for a state board appointment in exchange for business referrals and benefits to the defendant’s family.Following a lengthy trial in the United States District Court for the Northern District of Illinois, the jury convicted the defendant on several counts, including conspiracy, federal-program bribery, honest-services wire fraud, and Travel Act violations. The jury acquitted him on some counts and was deadlocked on others. The district court denied the defendant’s motions for acquittal and for a new trial, then imposed a sentence of imprisonment and a substantial fine.On appeal to the United States Court of Appeals for the Seventh Circuit, the defendant challenged the sufficiency of the evidence and the adequacy of the jury instructions. The Court of Appeals held that sufficient evidence supported each conviction and found no prejudicial error in the jury instructions, including those related to the definition of “official act,” “corruptly,” and the intent elements of bribery. The court also concluded that any potential instructional error regarding state law bribery under the Travel Act was harmless beyond a reasonable doubt. The convictions and sentence were affirmed. View "USA v. Madigan" on Justia Law

A healthcare provider operating as a covered entity under the federal Section 340B Drug Pricing Program purchased pharmaceuticals from several drug manufacturers. The provider alleged that these manufacturers engaged in a fraudulent scheme by knowingly charging prices for drugs that exceeded the statutory ceiling, resulting in inflated reimbursement claims submitted to Medicaid, Medicare, and other government-funded programs. The provider did not seek compensation for its own overcharges, but instead brought a qui tam action under the False Claims Act (FCA), seeking to recover losses on behalf of the federal and state governments.The United States District Court for the Central District of California dismissed the complaint with prejudice. It reasoned that, under the Supreme Court’s holding in Astra USA, Inc. v. Santa Clara County, Section 340B does not confer a private right of action for covered entities to sue drug manufacturers over pricing disputes; such claims must instead be pursued through the Section 340B Administrative Dispute Resolution process. The district court concluded that the provider’s FCA claims were essentially attempts to enforce Section 340B and should therefore be barred.On appeal, the United States Court of Appeals for the Ninth Circuit reversed the district court’s dismissal. The appellate court held that the provider’s FCA claims were not barred by the absence of a private right of action under Section 340B or by the Astra decision, because the action was brought to remediate fraud against the government and not to recover personal losses or enforce Section 340B directly. The court further found that the provider had plausibly pleaded falsity under the FCA. The Ninth Circuit remanded the case for further proceedings. View "ADVENTIST HEALTH SYSTEM OF WEST V. ABBVIE INC." on Justia Law

A former employee of a pharmaceutical manufacturer brought a qui tam lawsuit under the False Claims Act, alleging that the company improperly calculated and reported its “Best Price” for certain drugs to the Centers for Medicare and Medicaid Services (CMS), as required under the Medicaid Rebate Statute. The plaintiff claimed that, during a period from 2005 to 2014, the company failed to aggregate multiple rebates and discounts given to different entities on the same drug, resulting in inflated “Best Price” reports and underpayment of rebates owed to Medicaid. The complaint asserted that the company was subjectively aware that CMS interpreted the statute to require aggregation of all such discounts, especially after the company’s communications with CMS during a 2006–2007 rulemaking process and the company’s subsequent internal audit.After the government and several states declined to intervene, the United States District Court for the District of Maryland dismissed the amended complaint, finding that, even under the subjective scienter standard established in United States ex rel. Schutte v. SuperValu Inc., the plaintiff had not plausibly alleged that the company acted with actual knowledge, deliberate ignorance, or reckless disregard as to the truth or falsity of its reports. The district court also suggested that ambiguity in the statute precluded a finding of falsity.On appeal, the United States Court of Appeals for the Fourth Circuit reviewed the dismissal de novo. The Fourth Circuit held that the plaintiff’s allegations—including the company’s awareness of CMS’s interpretation of the rule, its targeted audit and compliance efforts, and its continued use of non-aggregated reporting—plausibly alleged the requisite subjective scienter under the False Claims Act. The court clarified that statutory ambiguity does not, at the pleading stage, negate scienter or falsity, and remanded for the district court to address other elements, including falsity, in the first instance. The Fourth Circuit reversed the dismissal and remanded for further proceedings. View "United States ex rel. Sheldon v. Allergan Sales, LLC" on Justia Law

Several Iraqi citizens detained at Abu Ghraib prison during the U.S. occupation of Iraq alleged that, between October and December 2003, they were subjected to severe abuse by military police. The plaintiffs claimed that employees of CACI Premier Technology, Inc., a contractor providing interrogation services to the U.S. military, conspired with military personnel to “soften up” detainees for interrogation, resulting in torture and cruel, inhuman, and degrading treatment (CIDT). While CACI’s contract required its personnel to operate under military supervision, evidence suggested inadequate oversight and that CACI employees directed some of the abusive tactics. Plaintiffs did not allege direct physical abuse by CACI interrogators, but asserted conspiracy liability.The case was initially filed in the United States District Court for the Eastern District of Virginia, advancing claims under both the Alien Tort Statute (ATS) and state law. Over time, the plaintiffs narrowed their suit to ATS claims for torture, CIDT, and war crimes, proceeding on conspiracy and aiding-and-abetting theories. The district court dismissed some claims and parties, and after two trials—one ending in mistrial—the jury found CACI liable for conspiracy to commit torture and CIDT, awarding significant compensatory and punitive damages.On appeal, the United States Court of Appeals for the Fourth Circuit reviewed multiple legal challenges by CACI, including justiciability, immunity, preemption, and the state secrets privilege. The court held that application of the ATS was proper because the conduct at issue occurred within U.S.-controlled territory (Abu Ghraib during the CPA regime), was actionable under universal jurisdiction principles, and enough domestic conduct was involved. The court found that conspiracy liability and corporate liability are recognized under the ATS, and rejected CACI’s defenses and challenges regarding sovereign immunity, political question doctrine, preemption, and evidentiary rulings. The Fourth Circuit affirmed the judgment against CACI, vacated the district court’s judgment in favor of the United States on third-party claims due to sovereign immunity, and remanded with instructions to dismiss those claims. View "Al Shimari v. CACI Premier Technology, Inc." on Justia Law

Charles Cui was charged with bribery and related offenses after he attempted to secure the assistance of Edward Burke, a powerful Chicago alderman, in reversing a permit denial by the Chicago Department of Buildings (CDOB) regarding a pole sign at his commercial property. Cui’s financial interests were jeopardized by the permit denial, which threatened both a lucrative lease with Binny’s Beverage Depot and tax increment financing from the City. To influence Burke, Cui offered to retain Burke’s law firm for property tax appeal work, explicitly seeking Burke’s intervention in the CDOB matter.The United States District Court for the Northern District of Illinois, Eastern Division, presided over a six-week trial in which a jury convicted Cui on all counts: bribery under 18 U.S.C. § 666(a)(2), violations of the Travel Act, and making false statements to the government. The district court admitted evidence over Cui’s objections, including a photoshopped photograph sent to the CDOB, and denied Cui’s post-trial motions for acquittal and a new trial. The court sentenced Cui to 32 months’ imprisonment and applied an obstruction-of-justice enhancement for failing to produce key emails in response to a grand jury subpoena.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed Cui’s challenges to the sufficiency of evidence, jury instructions, evidentiary rulings under Federal Rule of Evidence 404(b), and sentencing. The court held that sufficient evidence supported the convictions, that the jury instructions correctly conveyed the law’s requirements—including the quid pro quo element and the definition of “corruptly”—and that the admission of the photoshopped photograph was not an abuse of discretion. The court also found that the sentencing enhancement and the disparity between Cui’s and Burke’s sentences were justified. The Seventh Circuit affirmed the judgment of the district court. View "USA v Cui" on Justia Law

A government agency responsible for marketing hydroelectric power operated a warehouse in Colorado, where an employee, Jared Newman, orchestrated a fraudulent procurement scheme from 2014 to 2017. Newman arranged for the agency to purchase supplies from vendors owned by friends and family, including the defendant, who owned two such companies. The vendors submitted invoices for goods that were never delivered, received payments from the agency, and then funneled most of the money back to Newman, keeping a portion as a commission. The defendant received nearly $180,000 through 59 fraudulent payments, writing checks back to Newman and taking steps to conceal the scheme.A grand jury indicted the defendant in the United States District Court for the District of Colorado on six counts of wire fraud, each corresponding to a specific transfer, and sought forfeiture of all proceeds. At trial, the government introduced evidence of a co-participant’s guilty plea and the district court instructed the jury that it could infer the defendant’s knowledge of the fraud if he was deliberately ignorant. The defendant was convicted on all counts. The district court limited forfeiture to the six charged transfers, totaling about $20,000, but ordered restitution for the full amount received, for which the defendant and Newman were jointly and severally liable.The United States Court of Appeals for the Tenth Circuit reviewed the case. It held that the district court did not abuse its discretion in admitting evidence of the co-participant’s guilty plea, as it was used to assess credibility and not as substantive evidence of guilt, and the jury was properly instructed on its limited use. The court also held that, because there was sufficient evidence of the defendant’s actual knowledge, any error in the deliberate ignorance instruction did not warrant reversal. On the government’s cross-appeal, the Tenth Circuit vacated the forfeiture order, holding that forfeiture should include all proceeds obtained through the fraudulent scheme, not just the charged transactions, and remanded for further proceedings. View "United States v. Cline" on Justia Law