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If one purpose of a payment was to induce referrals, the Antikickback Act has been violated.
In 1984, Doctors Robert and Ronald LaHue approached defendant Ronald Keel, an operations Vice President at Baptist Medical Center ("Baptist"), and proposed moving their patients from the hospitals they were currently using to Baptist in exchange for Baptist's purchase of Blue Valley Medical Group ("BVMG"). Keel brought the proposal to the attention of Baptist's administrative staff, which included McClatchey, Baptist's Chief Operating Officer. McClatchey "supported the idea" of establishing such a relationship. Although Baptist decided not to purchase BVMG, Baptist entered into a one-year agreement with the LaHues to pay each doctor $ 75,000 per year to act as Co-Directors of Gerontology Services at Baptist. The LaHues then began referring their nursing home patients who required hospital care to Baptist. In 1988, a grand jury returned a superseding indictment against seven individual defendants, including McClatchey, charging the latter with one count of conspiracy to offer or pay remuneration to the LaHues in exchange for Medicare and Medicaid patient referrals, in violation of 18 U.S.C. § 2 and 42 U.S.C. § 1320a-7b(b)(2)(A), (B), and one substantive count of offering or paying remuneration to the LaHues to induce such referrals, in violation of 42 U.S.C. § 1320a-7b(b)(2)(A), (B). The jury returned a guilty verdict on both charges against McClatchey. After the verdict, however, the district court granted McClatchey's motion for judgment of acquittal on both counts, concluding that no reasonable jury could find McClatchey deliberately intended to violate the Medicare Antikickback Act (Act) based on the evidence presented at trial. Pursuant to Federal Rule of Criminal Procedure 29(d), the district court ruled alternatively that should its acquittal decision be overturned, McClatchey would be entitled to a new trial due to prejudicial variances between the case presented at trial and the indictment against him. The government appealed.
The court of appeals reversed the district court's judgment. The court found that the district court erred in granting defendant's post-verdict motion for a judgment of acquittal. The court held that the government presented sufficient evidence from which a reasonable jury could infer defendant knowingly, voluntarily, and purposefully entered into an agreement with the specific intent to violate the Act. The court also disagreed with the district court's ruling that prejudicial variances between the indictment and the case presented at trial warranted a new trial. Accordingly, the court reversed the district court's judgment of acquittal and its alternative order for a new trial and remanded with instructions to reinstate the jury's verdict.