Engaging in one predicate act, such as accepting a bribe, is not enough to trigger RICO. The defendant must engage in a pattern of racketeering. The risk of physicians’ being charged with RICO violations was increased by the 1989 ruling in H. J. Inc. v. Northwestern Bell Telephone Company, [ H.J. Inc. v. Northwestern Bell Tel. Co., 492 U.S. 229 (1989) ] in which the Supreme Court completed the expansion of RICO that began with the 1985 decision in Sedima, S.P.R.L. v. Imrex Co. [Sedima, S.P.R.L. v. Imrex Co., 473 U.S. 479 (1985) ] In Sedima, the Court held that RICO defendants need not be convicted of the underlying predicate acts that were used to charge a pattern of racketeering. This ruling greatly simplified criminal prosecutions and private civil actions brought under RICO because the prosecutors or plaintiffs were no longer compelled to wait until the defendants were tried for the underlying predicate acts. The Sedima ruling left open the definition of a pattern of racketeering, allowing some courts to limit the application of RICO by defining a pattern of racketeering as sustained criminal activity involving many, even hundreds, of predicate acts.

The Supreme Court in Northwestern Bell held that the RICO pattern requirements were meant to have a broad reach. In particular, the Court stressed that RICO was meant to apply to situations “in which persons engaged in long-term criminal activity often operate wholly within legitimate enterprises.” The Court also reiterated that a pattern might be as few as three predicate acts. This ruling makes clear that a legitimate business, such as a medical care enterprise, that commits three or more predicate acts can be charged with the requisite pattern of racketeering for a RICO action.