Fraud and False Claims

U.S. v. Calhoon, 97 F.3d 518 (11th Cir. 1996)

What statutes was the defendant charged and convicted under?

Who is the defendant and who did he work for?

What was his job?

What is a fiscal intermediary?

When is the hospital paid for its Medicare costs?

What is a Medicare cost report and what must be included in it?

What does the hospital have to do if it wants to contest the disallowance of a cost?

What is filing "under protest?"

Where are the rules for this process set out?

What does the intermediary do when it first receives the cost report?

What can the provider do when it received notice of program reimbursement?

What are the elements of a charge of making false statements?

What are the elements of a wire fraud charge?

What did the government charge where the false statements and the scheme to defraud by mail?

What is defendant's defense?

What is the standard of review and what inferences are accepted when reviewing a criminal conviction?

What are the two ways to show falsity?

What is CMCI and why was it set up?

What were the royalty fee paid for?

How did the interest payments arise?

Did defendant believe that the royalty fee and interest were reimbursable?

How did he tell the accountant to list these charges on the cost report?

Why would he list them this way?

Why were the royalty and interest payments not reimbursable?

Why was the royalty payment not an actual expense?

What was not disclosed about the royalty payment?

What is defendant's argument for claiming that the royalty payment is a proper charge?

Why were they really charges?

What is the theory behind defendant's claim that his conviction on the charges related to the royalty payment is unconstitutional?

What is the standard for determining the appropriate amount that would be reimbursable for the royalty payment?

What happened to the government's case on whether the amount of the charge was proper?

How did the government get defendant anyway on the royalty payment?

Why does defendant not have any grounds for arguing that he did not know he had to provide this information?

Where did the money come from that CMCI loaned to the hospitals?

What is the standard for determining the proper charge for the interest?

Why did the government fail to do on this charge?

How did the government nail defendant on the interest charges?

What are allowable advertising costs?

What not allow costs for increasing the census?

Why did the term "outreach" get defendant in trouble?

What did a witness testify was the reason defendant called advertising "outreach?"

How did defendant argue that Medicare reimbursement can never support criminal charges?

What is wrong with the "I get to ask" approach?

What is the evidence that defendant understood the proper way to contest reimbursement decisions?

Who has to decide materiality and why is this a problem in this case?

What kind of review does the court do in this circumstance?

Was the judge's determination of materiality proper?

What is the standard for deciding if the case should be remanded?

What is the standard for materiality in a false statement case based on a claim to the federal government?

What if the government did not rely on the false statements?

How did defendant use the intermediary's review as a defense?

Why is this an unrealistic view of the intermediary?

Are intermediaries agents of the government?

What are the sentencing guidelines?

Why didn't defendant get credit for accepting responsibility?