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Brown, the manager of a company that provided home physician visits, and Talaga, who handled the company’s billing, were convicted of conspiracy to commit health-care fraud, 18 U.S.C. 1349; six counts of health-care fraud, 18 U.S.C. 1347; and three counts of falsifying a matter or providing false statements, 18 U.S.C. 1035(a). The district court sentenced Mr. Brown to 87 months’ imprisonment, 34 months below the Guidelines’ range, stating that a significant sentence was warranted because of the duration of the scheme, the amount of the fraud, the need for general deterrence, and Brown’s failure to accept responsibility. Ms. Talaga was sentenced to 45 months. The Seventh Circuit affirmed, rejecting Brown’s argument that the court’s assumptions about the need for general deterrence were unfounded and constituted procedural error and Talaga’s arguments that the court calculated the amount of loss for which she was responsible by impermissibly including losses that occurred before she joined the conspiracy. The district court was under no obligation to accept or to comment further on Brown’s deterrence argument. Talaga, as a trained Medicare biller, knew that that the high-volume billings were fraudulent. View "United States v. Talaga" on Justia Law

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Accredo delivers clotting medication and provides nursing assistance for hemophilia patients. Accredo makes donations to charities concerned with hemophilia, including HSI and HANJ, which allegedly recommended Accredo as an approved provider for hemophilia patients. Greenfield, a former Accredo area vice president, sued, alleging violations of the Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), and the False Claims Act, 31 U.S.C. 3729(a)(1)(A)-(B). If Greenfield prevailed, he would get at least 25% of any civil penalty or damages award. The government did not intervene. The district court, following discovery, granted Accredo summary judgment, finding that Greenfield failed to provide evidence of even a single federal claim for reimbursement that was linked to the alleged kickback scheme. The Third Circuit affirmed. The Anti-Kickback Statute prohibits kickbacks regardless of their effect on patients’ medical decisions. Because any kickback violation is not eligible for reimbursement, to certify otherwise violates the False Claims Act but there must be some connection between a kickback and the reimbursement claim. It is not enough to show temporal proximity. Greenfield was required to show that at least one of the 24 federally-insured patients for whom Accredo provided services and submitted reimbursement claims was exposed to a referral or recommendation by HSI/HANJ in violation of the Anti-Kickback Statute. View "Greenfield v. Medco Health Solutions Inc" on Justia Law

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The Idaho Supreme Court answered a certified question of Idaho law from the United States District Court for the District of Idaho. The question certified centered on whether, for purposes of the dispute in this lawsuit, the terms ‘state board of correction’ as used in Idaho Code 20-237B(1) and ‘department of correction’ as used in Idaho Code § 20-237B(2), included privatized correctional medical providers under contract with the Idaho Department of Correction. The Court answered the question certified in the negative. View "In Re: Pocatello Hospital, LLC v. Corazon, LLC" on Justia Law

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Securiforce entered into a requirements contract with the government to deliver fuel to eight sites in Iraq. The government terminated the contract for convenience with respect to two sites because Securiforce intended to supply fuel from Kuwait, reasoning that delivery to those sites would violate the Trade Agreements Act, 19 U.S.C. 2501, and that obtaining a waiver would take too long. Weeks later, the government ordered small deliveries to two sites, to occur by October 24. Securiforce indicated that it could not deliver until November. The government notified Securiforce that it should offer justifiable excuses or risk termination. Securiforce responded that the late deliveries were excused by improper termination for convenience, failure to provide required security escorts, small orders, and other alleged irregularities. The government terminated the contract for default. Securiforce filed suit (Tucker Act, 28 U.S.C. 1491; Contract Disputes Act, 41 U.S.C. 7101-09). The Claims Court found that it had jurisdiction to review both terminations; that the Contracting Officer abused her discretion in partially terminating the contract for convenience; and that the termination for default was proper. The Federal Circuit affirmed in part. The court lacked jurisdiction over the termination for convenience; a contractor’s request for a declaratory judgment that the government materially breached a contract violates the rule that courts will not grant equitable relief when money damages are adequate. The government did not breach the contract by terminating for convenience or with respect to providing security. View "Securiforce International America, LLC v. United States" on Justia Law

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Cincinnati ordinances provide guidelines for selecting the “lowest and best bidder” on Department of Sewers projects to “ensure efficient use of taxpayer dollars, minimize waste, and promote worker safety and fair treatment of workers” and for bids for “Greater Cincinnati Water Works and the stormwater management utility division,” to employ skilled contractors, committed to the city’s “safety, quality, time, and budgetary concerns.” Allied alleged that the Employee Retirement Income Security Act (ERISA) preempted: a requirement that the bidder certify whether it contributes to a health care plan for employees working on the project as part of the employee’s regular compensation; a requirement that the bidder similarly certify whether it contributes to an employee pension or retirement program; and imposition of an apprenticeship standard. Allied asserts that the only apprenticeship program that meets that requirement is the Union’s apprenticeship program, which is not available to non-Union contractors. The ordinances also require the winning contractor to pay $.10 per hour per worker into a city-managed pre-apprenticeship training fund, not to be taken from fringe benefits. The district court granted Allied summary judgment. The Sixth Circuit reversed. Where a state or municipality acts as a proprietor rather than a regulator, it is not subject to ERISA preemption. The city was a market participant here: the benefit-certification requirements and the apprenticeship requirements reflect its interests in the efficient procurement of goods and services. View "Allied Construction Industries v. City of Cincinnati" on Justia Law

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DiFiore, working for CSL since 2008, became concerned about CSL marketing drugs for off-label uses not approved by the FDA and including off-label use in sales forecasts. DiFiore expressed her concerns to her supervisors and alleges that as a consequence of that protected conduct, she suffered adverse employment actions: a warning letter, after which CSL hired an employment coach to help DiFiore develop her leadership skills; a mid-year performance review with “needing improvement” evaluations in several areas; a second warning letter regarding her nonpayment of her company credit card; her deteriorating relationships with supervisors and management; and her removal from a committee and certain meetings. In May 2012, DiFiore was placed on a Performance Improvement Plan, requiring improvement within 45 days. Within a week, DiFiore resigned. DiFiore sued, claiming unlawful discharge under Pennsylvania law and retaliation in violation of the False Claims Act, 31 U.S.C. 3730(h). The district court granted summary judgment on the wrongful discharge claim and held that DiFiore could not rely upon constructive discharge as an adverse action in her FCA claim. The judge instructed the jury that the FCA retaliation provision required that protected activity be the “but-for” cause of adverse actions. The jury found in favor of CSL. The Third Circuit affirmed. An employee’s protected activity must be the “but for” cause of adverse actions to support a claim of retaliation under the FCA. View "DiFiore v. CSL Behring LLC" on Justia Law

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In 1996, the Federal Communications Commission awarded spectrum licenses to Alpine, for use in the provision of wireless telecommunications services. Alpine bid approximately $8.9 million for one license and $17.3 million for the other. As a small business, Alpine was eligible to pay in installments over the 10-year term of the licenses. Alpine’s failure to make required payments in 2002 triggered automatic cancellation under FCC regulations. In addition to taking other steps in response, Alpine sought relief from the FCC and, on review under the Communications Act, 47 U.S.C. 402(b)(5), from the District of Columbia Circuit. In 2016, Alpine filed this action against the United States under the Tucker Act, 28 U.S.C. 1491(a)(1), arguing that the FCC breached contractual obligations in canceling the licenses and that the cancellation was a taking for which Alpine was entitled to just compensation. The Federal Circuit affirmed dismissal by the Claims Court for lack of jurisdiction under the Tucker Act. The Communications Act provides a comprehensive statutory scheme through which Alpine could raise its contract claims and could challenge the alleged taking and receive a remedy that could have provided just compensation in this case, foreclosing jurisdiction under the Tucker Act. View "Alpine PCS, Inc. v. United States" on Justia Law

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Henderson was a VA Program Analyst. Veterans may, under certain circumstances, obtain medical care from private physicians and facilities after obtaining preauthorization from a VA supervisory physician. An “unresolved authorized consult” means that a veteran’s medical appointment with an outside provider has not been scheduled or completed, or the completed appointment has not been memorialized. Henderson was charged with 50 counts of making false statements related to health care matters, 18 U.S.C. 1035, for ordering VA employees under his direction to close 2700 unresolved authorized consults by falsely declaring the consults were completed or refused by the patients. The VA informed Henderson that it proposed to suspend him for an indefinite period, noting that if convicted, he would face a maximum sentence of five years in prison on each count. Henderson, through counsel, denied the allegations, requested documentary evidence from the VA regarding his alleged wrongdoing, and asked that the proposed suspension be stayed pending the outcome of the criminal proceedings. The VA indefinitely suspended Henderson. A Merit Systems Protection Board administrative judge found, and the Board, and Federal Circuit affirmed, that the indictment provided the VA with reasonable cause to believe that he had committed a crime for which imprisonment could be imposed. The VA established a nexus between the criminal charges and the efficiency of the service. View "Henderson v. Department of Veterans Affairs" on Justia Law

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The Fifth Circuit affirmed the district court's holding that it lacked jurisdiction over relator's claims based on the public disclosure bar of the False Claims Act (FCA). Relator filed suit against his employer Northrop Grumman and against Lockheed Martin for making false claims against the government. The court held that it lacked jurisdiction to hear relator's claims because he failed to demonstrate that he was the original source of the Systems Design and Development contract. In this case, the record made clear that relator derived his knowledge about the connection between cost performance and award fees from portions of the contract that were publicly disclosed before he filed his complaint. View "Solomon v. Lockheed Martin Corp." on Justia Law

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In this redevelopment case, the city of Anaheim, acting in its capacity as successor to the former Anaheim Redevelopment Agency, sought approval from the California Department of Finance (the department) to obtain money from the Redevelopment Property Tax Trust Fund (the fund or, the RPTTF) to pay back the city of Anaheim for payments the City of Anaheim made to a construction company to complete certain real property improvements that the former Anaheim Redevelopment Agency was obligated to provide on a particular redevelopment project (the packing district project). The city and the city-as-successor characterized the transaction between themselves as a loan, but the department ultimately denied the claim for money from the fund because the city did not disburse the loan proceeds to the city-as-successor, but instead paid the construction company directly, and because the city-as-successor did not obtain prior approval for the “loan” agreement with the city from the oversight board. Around the same time, the city-as-successor sought approval from the department to obtain money from the fund to make payments to the Anaheim Housing Authority (the authority) under a cooperation agreement between the agency and the authority, the purpose of which was to provide funding for the Avon/Dakota revitalization project, which was being carried out by a private developer -- The Related Companies of California, LLC (Related) -- pursuant to a contract with the authority. The department denied that claim because the 2011 law that dissolved the former redevelopment agencies rendered agreements between a former redevelopment agency and the city that created that agency (or, a closely affiliated entity like the authority) unenforceable. The city, the city-as-successor, and the authority sought mandamus, declaratory, and injunctive relief on both issues in the superior court, but the trial court denied the writ petition and dismissed the complaint for declaratory and injunctive relief. The Court of Appeal reversed, finding: (1) with respect to the packing district project, the fact that the city contracted directly with the construction company to construct the improvements the agency was legally obligated to provide at that project, and the fact that the city paid the company directly for its work, did not mean the agreement between the city and the city-as-successor with respect to the transaction was not a loan, as the department and the trial court concluded, also, the fact that the city-as-successor did not obtain prior approval from the oversight board to enter into a loan agreement with the city did not give the department a valid reason to deny the city as successor’s request for money from the fund to pay off the loan; and (2) as for the money from the fund claimed for the Avon/Dakota revitalization project, enforcing the provision of the dissolution law that renders unenforceable an agreement between a former redevelopment agency and the city that created it (or an affiliated entity like the authority) would, in this case, unconstitutionally impair Related’s contractual rights under its agreement with the authority. View "City of Anaheim v. Cohen" on Justia Law