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Criminal Anti-Kickback Trial

 Employee Exception is a Jury Issue in Criminal Anti-Kickback Trial

In United States v. Novak, Case No. 13-CR-00312 (June 30, 2014), the district court’s recent denial of defendants’ motions to dismiss the government’s superseding indictment reinforces that as long as the four corners of the indictment adequately allege a violation of a federal criminal statute, a motion to dismiss will likely be denied. In Novak, this was true even though defendants argued that they were entitled to an affirmative defense (statutory bona fide employee exception) to a violation of the Federal Anti-Kickback Statute.

Facts

More specifically, in Novak, government filed a superseding against several medical doctors and a podiatrist alleging that, among other things, they violated the Federal Anti-Kickback Statute. The crux of one of the government’s kickback allegations against one of the co-defendants, Dr. Venkateswara Kuchipudi (“Dr. Kuchipudi”), is that a physician assistant (listed as Employee A and likely a government witness) working for Sacred Heart hospital received checks which were, indirectly, paid to Dr. Kuchipudi in return for Dr. Kuchipudi referring patients, i.e., Medicaid and Medicare business, back to Sacred Heart.

In response to the kickback allegations in the indictment, Dr. Kuchipudi and his co-defendants filed motions to dismiss the indictment contending that the Counts in the indictment alleging violations of the Federal Anti-Kickback Statute fail to state an offense because any remuneration (including the checks) received by the physicians constitutes remuneration received by employees. Therefore, as employees, they are entitled to the protections provided by the statutory exception to the Federal Anti-Kickback statute, which states that violations of the Federal Anti-Kickback Statute “shall not apply to …any amount paid by an employer to an employee (who has a bona fide employment relationship with such employer) for employment in the provision of covered items or services. . . .” See 42 U.S.C. § 1320a-7b(b)(3)(B).

District judge Matthew F. Kennelly of the Northern District of Illinois, however, was not convinced and underscored:

Their [Defendants’] contention is that the indictment fails to negate, or affirmatively concedes, the application of the safe harbor [Note: the district judge is mistakenly referring to the regulatory safe-harbor for employees found at 42 C.F.R. § 1001.951(i) as opposed to the statutory exception for employees found at 42 U.S.C. § 1320a-7b(b)(3)(B)]. A great deal of ink has been spilled on these motions, but their resolution, in the Court’s view, is fairly simple.

It is settled law that an indictment is sufficient if it states all the elements of the crime charged, adequately informs the defendant of the nature of the charges so that he may prepare a defense, and allows him to plead the judgment as a bar to future prosecutions. (other citation omitted). The offense charged in the counts at issue is violation of the anti-kickback statute. There is no question that the government has alleged each of the elements of an offense under the pertinent provision and that it has done so by essentially adopting the language of the statute itself

Takeaway

Affirmative Defense in Pre-Trial Motion to Dismiss. While defendants will very likely raise the employee exception or employee safe-harbor as an affirmative defense at trial, the district court in Novak further demonstrates that an indictment that ‘parrot[s] the language of a federal criminal statute’ is sufficient except in extraordinary circumstances.

Comparison to False Claims Act.In a civil False Claims Act action, defendants would have an opportunity to depose witnesses and to develop their affirmative defense that defendants are bona fide employees to position themselves to potentially prevail on a motion for summary judgment pursuant to Federal Rule of Civil Procedure 56. Here, however, as the district court strongly emphasized, “for better or worse there is no such thing as a motion for summary judgment in a criminal case” and the employee defense raised in the motion was premature.

Jury Instructions. In light of the recent Halifax trial where the jury was permitted to extensively analyzed the employee exception to Stark, defense counsel should be granted substantial flexibility in fashioning jury instructions that concisely convey what constitutes a bona fide employee so that the jury may properly render a verdict. Also, two questions remain: (i) whether, and to what extent, the court will permit the jurors to methodically review each and every factor relevant to a determination of whether a person is a bona fide employee and (ii) whether defense counsel will also request an alternative instruction with respect to the employee safe harbor. 

 

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Charge Bargaining in AntiKickback Case Involving Bribes for Test Referrals

Charge Bargaining in Anti-Kickback Case Involving Bribes for Test Referrals to Clinical Laboratory

The headline in the case of United States v. Dennis Aponte, (D.N.J. 2014) is nothing new: a physician received illegal kickbacks in exchange for referring patient blood specimens to a diagnostic laboratory, Biodiagnostic Laboratory Services, LLC, which were ultimately billed to government payers – Medicare and Medicaid. The lab earned more than $200 million in illegal revenue from a kickback scheme involving sham lease agreements, sham services agreements, and other kickback arrangements with physicians. In fact, the lab used a sales and marketing entity, in many cases, as a “middle man” or “consultant” to deliver cash payments to physicians. Some of those discussions were intercepted by audio recordings or were provided to the government in the form of text messages. Thus far, there is nothing atypical about this case.[1]

What is interesting and impressive about this case, however, is that government never charged the defendant-physician with a violation of the health care fraud statute or the Anti-Kickback statute. Instead, counsel for the defendant-physician negotiated a plea to a one count Information alleging a violation of the Travel Act. (18 U.S.C. Section 1952).

But, why would the parties agree to a Travel Act plea?

The government resurrected the use of the Travel Act as an alternative method of prosecuting certain forms of commercial bribery not covered by the anti-bribery provisions of the Foreign Corrupt Practices Act (FCPA). Yetthe government seldom uses the Travel Act to prosecute violations of the Federal Anti-Kickback Statute.

Stated simply, defense counsel successfully negotiated a sweet-heart deal.

First, the arrangement permitted the physician to plea to a Travel Act charge and to avoid a plea to a more serious criminal charge of health care fraud with a statutory maximum of 20 years.

Second, the physician avoided mandatory exclusion under the health care fraud statute.

Third, although there are at least 16 grounds for exclusion, including a violation of the Anti-Kickback Statute, or a “criminal offense relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct” pursuant to OIG’s permissive exclusion authorities, OIG-HHS may encounter some difficulties showing that the Travel Act violation in this case constitutes an offense triggering permissive exclusion. [2] Even if they did, the physician might be able to negotiate an Integrity Agreement with OIG.

In sum, the plea agreement in Aponte reinforces that, whenever possible, clients should take advantage of charge-bargaining in health care fraud cases to minimize the likelihood of a potentially lengthy sentence and to avoid automatic exclusion from federal health care programs.

 

 

 

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West Palm Beach, Florida based Hedge Fund Charged with Fraud

The Securities and Exchange Commission (SEC) Recently Charged a West Palm Beach, Florida based Hedge Fund with Fraud

The Securities and Exchange Commission (SEC) recently charged a West Palm Beach, Florida based hedge fund with fraud. According to the complaint, Weston Capital Asset Management LLC, and its founder and president Albert Hallac engaged in fraud by illegally draining more than $17 million from a hedge fund they managed and transferred the money to a consulting and investment firm known as Swartz IP Services Group Inc.  The transaction went against the hedge fund’s stated investment strategy and wasn’t disclosed to investors, who received account statements falsely portraying that their investment was performing as well or even better than before.  Weston Capital’s former general counsel Keith Wellner assisted the activities. The SEC further alleges that out of the transferred investor proceeds, Hallac, Wellner, and Hallac’s son collectively received $750,000.00 in payments from Swartz IP.  Weston Capital and Hallac also wrongfully used $3.5 million to pay down a portion of a loan from another fund managed by the firm.

“Investment advisers owe their clients a fiduciary duty of utmost good faith and full disclosure about what they’re doing with their money,” said Eric I. Bustillo, director of the SEC’s Miami Regional Office.  “Weston and Hallac dishonored that duty with Wellner’s assistance by secretly steering investor proceeds to a third party and then pocketing some of those funds.”

Weston Capital, Hallac, and Wellner agreed to settle the SEC’s charges along with Hallac’s son Jeffrey Hallac, who is named as a relief defendant in the SEC’s complaint for the purposes of recovering ill-gotten gains in his possession.  Wellner and Jeffrey Hallac each also agreed to pay $120,000 in disgorgement.

Takeaway

While this settlement is by no means a large settlement in financial terms – especially given some of the recent SEC settlements involving fraud, FCPA violations, and other egregious conduct – the settlement is a strong reminder that the SEC will continue to examine more registered investment advisers, including advisers attached to private equity and hedge funds.

Further, in this case, the fund’s general counsel appears to have been actively involved in the fraud.  In fact, indictments of general counsels are becoming increasingly common-place, e.g.,  general counsel’s of GlaxoSmith Kline and Detroit’s Pension Fund. Indeed, Laura Stevens, the assistant general counsel for GlaxoSmith Kline, was acquitted after suffering through two separate indictments, but after resigning from GSK Ms. Stevens cautioned: “I think the criminalization of the practice of law is here, and I don’t think it’s necessarily going away…The government will continue to be aggressive in looking at in-house counsel.” Recognizing that this case did not involve allegations of criminal conduct, the message is the same: general counsels may wind up in the cross-hairs of a civil enforcement action or a criminal investigation.

The SEC press release is available here

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