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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision

People v. Wolf

This case examines the legal requirements for establishing economic harm in first-degree commercial bribing under New York law. The defendant, an attorney, was accused of paying kickbacks to insurance adjusters at Aetna Life and Casualty Company and Commercial Union Insurance Company to expedite client settlements. The central issue was whether the payment of a kickback alone constitutes sufficient proof of economic harm exceeding $250 to the employer, as mandated by the 1983 felony commercial bribery statute. The Court, drawing parallels with federal mail fraud cases, ruled that concrete economic loss, not merely the kickback itself, must be demonstrated. Consequently, the conviction related to Commercial Union was reduced to a misdemeanor due to inadequate proof that the company would have secured a better settlement in the absence of the bribery. However, the conviction concerning Aetna was upheld, as evidence indicated that Aetna was deprived of the opportunity for a reduced settlement due to the corrupt arrangement. Additionally, the Court affirmed the first-degree scheme to defraud conviction and addressed procedural challenges concerning co-conspirator statements and Rosario rule violations.

Commercial BriberyEconomic HarmKickbacksInsurance FraudFelony CrimeStatutory InterpretationSufficiency of EvidenceMail Fraud AnalogyConspiracyHearsay Exception
References
17
Case No. MISSING
Regular Panel Decision
Oct 12, 2016

Waldmann v. Fulp

The court denied motions for summary judgment filed by McAllen Medical Center (MMC) Defendants, RedMed Defendants, Dr. Ray Fulp, III, and Alex Santos. Plaintiffs and qui tam Relators Keith Waldmann and Adan Ponce alleged two schemes: a Surgery Delegation Scheme, where Dr. Fulp improperly delegated surgical duties to unlicensed personnel (Alex Santos and Eberardo Martinez), leading to false claims to government healthcare programs (Medicare, Medicaid, TriCare), and a Device Scheme, involving illegal kickback payments to Alex Santos from RedMed/AOS for using their medical devices, violating the Federal Fraud and Abuse Anti-Kickback Statute (AKS) and the Stark Law. The court found genuine disputes of material fact regarding factual and legal falsity, scienter, materiality, and the existence of actual false claims under the False Claims Act (FCA) and the Texas Medicaid Fraud Prevention Act (TMFPA), as well as a conspiracy to violate the FCA. It rejected various affirmative defenses and evidentiary objections raised by the defendants.

False Claims ActTexas Medicaid Fraud Prevention ActAnti-Kickback StatuteStark LawMedicare fraudMedicaid fraudsurgical delegationmedical device fraudqui tamsummary judgment
References
57
Case No. 14-cv-9662
Regular Panel Decision
Jul 09, 2015

In re Petrobras Securities Litigation

This case involves a putative class action where Lead Plaintiff Universities Superannuation Scheme Ltd. (USS), along with Union Asset Management Holding AG and Employees' Retirement System of the State of Hawaii, sued Petróleo Brasileiro S.A. — Petrobras, its subsidiaries, former officers and directors, independent auditor PwC, and several underwriters. Plaintiffs allege a multi-year, multi-billion dollar bribery and kickback scheme at Petrobras, leading to false and misleading statements in violation of the Securities Exchange Act of 1934, the Securities Act of 1933, and Brazilian law. The alleged scheme involved inflated contracts and kickbacks, causing overvaluation of Petrobras's assets and a decline in its securities' price. The Court largely denied defendants' motion to dismiss Exchange Act claims for failure to plead materiality and scienter. However, some Securities Act claims were dismissed due to the statute of repose or lack of reliance, while others related to standing were granted leave to amend. Brazilian law claims were dismissed due to a mandatory arbitration provision in Petrobras's bylaws, found valid under Brazilian law, but this provision was not applied to the Exchange Act claims.

Securities LitigationClass ActionBriberyKickbacksCorporate FraudFinancial MisstatementsSecurities Exchange ActSecurities ActBrazilian LawMotion to Dismiss
References
40
Case No. MISSING
Regular Panel Decision

Maussner v. McCormick

Plaintiffs alleged that the defendant, their general contractor, violated RICO by demanding "kickback" commissions from subcontractors, leading to overcharges. The defendant moved for summary judgment, arguing the plaintiffs failed to show a "pattern of racketeering activity." The court granted the defendant's motion, concluding that the alleged acts, which revolved around a single construction contract over a limited period, did not satisfy RICO's "pattern" requirement of "continuity plus relationship." Consequently, the federal RICO claim was dismissed, and the remaining state law claims were dismissed without prejudice due to the absence of federal jurisdiction.

RICORacketeering ActivityPattern RequirementContinuity Plus RelationshipSummary JudgmentBreach of ContractKickbacksSubcontractorsFederal JurisdictionState Law Claims
References
14
Case No. 14-13-00824-CV
Regular Panel Decision
Nov 23, 2015

Tamimi Global Company, LTD v. Kellogg Brown & Root, L.L.C., Kellogg Brown & Root International, Inc., and Kellogg Brown & Root Services, Inc.

The Appellees/Cross-Appellants, Kellogg Brown & Root (KBR), filed a Motion for Rehearing with the Fourteenth Court of Appeals in Houston, Texas. KBR seeks reconsideration of the court's affirmation of the district court's denial of KBR's breach of contract counterclaim. KBR's counterclaim sought recovery of $930,000 in attorneys' fees and costs from Tamimi Global Company, Ltd. (Tamimi) due to third-party litigation arising from Tamimi's payment of illegal kickbacks. KBR argues that Tamimi's actions were a substantial and foreseeable cause of their damages, challenging the trial and appeals courts' causation analysis.

Breach of contractAttorneys' feesKickbacksCausation analysisAppellate procedureForeseeabilityCollateral litigationGovernment contractsSubcontractor liabilityFraud
References
36
Case No. MISSING
Regular Panel Decision

Texas Farm Bureau Insurance Companies v. Sears

James Sears, an insurance agent, reported a 'kickback' scheme involving Texas Farm Bureau. After being implicated, investigated, and fired, Farm Bureau continued punitive actions against him, including involving federal agencies and attempting to revoke his license. Sears and his wife sued for defamation, negligent investigation, and intentional infliction of emotional distress. A jury awarded damages for all claims. On appeal, the court reversed the findings for negligent and gross negligent investigation due to factually insufficient evidence. However, the court affirmed the judgment for intentional infliction of emotional distress, citing the company's extreme and outrageous post-termination conduct.

Negligent InvestigationIntentional Infliction of Emotional DistressAt-Will EmploymentEmployee TerminationWhistleblower ProtectionInsurance FraudAppellate ReviewJury VerdictCompensatory DamagesPunitive Damages
References
35
Case No. 2022 NY Slip Op 03956 [206 AD3d 1322]
Regular Panel Decision
Jun 16, 2022

Matter of Habif v. New York State Workers' Compensation Bd.

Marc Lawrence Habif, a licensed chiropractor, appealed the denial of his application to renew his authorization to treat injured workers by the New York State Workers' Compensation Board. The Board's denial was based on an investigation that revealed Habif accepted $27,500 in payments from Elite Medical Supply for prescribing their durable medical equipment (DME), which constituted impermissible kickbacks. Habif contended he was improperly denied a hearing and that the payments were for services outside of medical treatment. The Appellate Division, Third Department, affirmed the Supreme Court's judgment dismissing Habif's petition, concluding he was not entitled to a hearing, the denial was adequately explained, and the Board's determination was rational.

ChiropractorMedical Provider AuthorizationDurable Medical EquipmentKickbacksProfessional MisconductRenewal ApplicationAdministrative ReviewAppellate DivisionThird-Party PaymentsJudicial Review
References
9
Case No. MISSING
Regular Panel Decision
Dec 30, 1997

Sullivan v. International Fidelity Insurance

This case concerns an action to recover prevailing wages and benefits on a payment bond, initiated under Labor Law §§ 220 and 220-g. The defendant-appellant surety appealed the denial of its motion for summary judgment to dismiss the complaint. The appellate court unanimously affirmed this denial. The court reasoned that the public policy of Labor Law article 8, which mandates the payment of prevailing wages on public construction contracts, takes precedence over the surety’s desire to avoid liability, even if the plaintiffs were involved in an employer’s payroll kickback scheme. Furthermore, the plaintiffs were not obliged to pursue administrative remedies first, as there was no allegation that the payment bonds had not been filed.

prevailing wagespayment bondsummary judgment denialsurety liabilitypayroll kickback schemepublic policyLabor Law complianceappellate reviewwage benefitscontractual obligations
References
2
Case No. MISSING
Regular Panel Decision

Rodriguez v. State

This is an appeal from jury convictions for two counts of engaging in organized criminal activity, specifically bribery and aggravated theft. The Appellant, Albert Rodriguez, owner of Lamco, was found guilty of orchestrating a kickback scheme involving fraudulent invoices with the El Paso Independent School District (EPISD) and bribing EPISD employees. The appellate court affirmed the conviction, addressing numerous legal issues raised by Rodriguez, including the sufficiency of accomplice witness testimony, the denial of severance for the criminal counts, issues with subpoenas, indictment defects, jury charge instructions, and the admissibility of evidence summaries. The court found no reversible error in the trial court's proceedings.

Criminal appealOrganized crimeBriberyAggravated theftFraudKickbacksAccomplice testimonySufficiency of evidenceJury chargeTrial procedure
References
91
Case No. MISSING
Regular Panel Decision
Jan 28, 2015

In re Bioscrip, Inc. Securities Litigation

This is a securities class action where lead plaintiffs, Fresno County Employees’ Retirement Association and West Palm Beach Police Pension Fund, allege that BioScrip, its officers, directors, and underwriters engaged in deception. The plaintiffs claim BioScrip failed to disclose a government investigation into alleged Anti-Kickback Statute and False Claims Act violations related to its specialty pharmacy division. They also allege the company concealed the rapid decline of its PBM Services segment, misleading investors. The court partially grants and partially denies the defendants' motions to dismiss, allowing claims related to the government investigation and certain PBM Services misstatements to proceed, while dismissing others.

Securities FraudClass ActionFinancial MisrepresentationCorporate GovernanceAnti-Kickback StatuteFalse Claims ActGovernment InvestigationPBM ServicesStock DropEarnings Guidance
References
104
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