在 美国诉弗农,第十一巡回上诉法院推翻了阿拉巴马州地方法院’陪审团作出无罪判决’对某药店高管被控违反反回扣法规的有罪判决。在发表意见时,第十一巡回法庭确认了一些有关反回扣法令适用的重要原则。

反回扣法令收费

弗农在阿拉巴马州被联邦大陪审团起诉,罪名是根据反回扣法规定支付非法报酬的几项指控。起诉书指控弗农故意并故意向血友病管理专家(HMS)支付钱款,诱使HMS将个人转介给Medfusion来提供血友病,从而违反了该法规。“factor”由Medicaid支付的药物。起诉书确定了弗农支付给HMS的三张支票,这些支票是根据Medfusion和HMS之间的佣金协议支付的。根据协议,Medfusion向HMS支付了HMS因上述转介而产生的利润的45%至50%。除弗农外,大陪审团还对HMS的所有者洛里·布里尔(Lori Brill)提出起诉,指控其多次违反反回扣法令,理由是他们收取了非法佣金,以换取患者转介Medfusion。联邦陪审团随后对弗农,布里尔和其他在此案中被指控的人作出有罪判决。

弗农审判后无罪释放

作出有罪判决后,弗农根据联邦刑事诉讼程序规则29宣布无罪判决。地区法院批准弗农’s motion, finding that the government had presented insufficient evidence to show that 弗农 knowingly and 故意地 made payments to HMS for the 参考ral of individuals to Medfusion for the furnishing of 因子 medication paid for by 医疗补助. The government appealed.

第十一巡回上诉

上诉争议在于政府是否提供足够的证据证明(1)Vernon支付了HMS,(2)支付该费用是为了促使HMS“refer”Medfusion和(3)Vernon的患者“willfully”在反回扣法规的含义内。

在发现弗农已付款后,法院接着向弗农致词’关于政府提供的证据不足以证明付款是诱使HMS向Medfusion推荐的论点。最初,弗农(Vernon)辩称,布里尔(Brill)不是医生,因此不能“refer”患者必须通过Medfusion填写处方。但是,法院评论说,反回扣法的明文不仅仅限于向医生付款。相反,根据法院,该法规适用于“whoever knowingly and 故意地 . . . pays any remuneration” to “any person to induce such person . . . to 参考 an individual”用于由Medicaid支付的商品或服务。

此外,弗农认为,患者只能“referred” to Medfusion if he was not already a Medfusion customer and that, at the times in 2008 and 2009 that the three checks alleged in the indictment were issued, the patients already had been Medfusion customers for a period of time. The court stated that whether the patients already were existing customers was irrelevant. The court pointed to evidence in the record that, at any time, HMS could have moved its business to other specialty pharmacies. The court noted that payments made for the continuing 参考ral of patients violate the statute just as would a payment for an initial 参考ral.

最后,关于弗农是否有作为“willfully”在该法规所指的范围内,弗农认为,反回扣法规是一项“specific intent”犯罪,要求提供证明他知道他所违反的实际法律。法院不同意,认为反回扣法是一项“general intent”犯罪,只要求政府证明弗农知道委员会的安排通常是非法的。与大多数其他巡回法院的先例一样,第十一巡回法院在此裁定,反回扣法令并不是具有很高技术性的税法或金融法,因此“specific intent”犯罪状况。法院进一步指出了审判记录的许多部分—包括政府’Medfusion的介绍’自己的合规计划,其中包含有关转介付款不当的部分—这提供了充分的证据,弗农知道付款是违法的。

得到教训

有很多外卖 美国诉弗农。如先前在 卫生法更新, commission arrangements related to the 参考ral of federal healthcare program recipients should be viewed with substantial scrutiny. 在 the last two years, there have been opinions in the Fifth, Tenth and now Eleventh Circuit affirming anti-kickback statute convictions involving commission arrangements. While there is a safe harbor under the statute for payments to a bona fide employee, the burden to establish the safe harbor is 上 the defendant. Furthermore, 弗农 证明了维持“active,” not “paper,”合规计划。在这里,政府通过将遵守程序作为提供者的证据来针对提供者使用’s knowledge about improper 参考rals.