Source: https://law.justia.com/cases/federal/appellate-courts/F3/170/1026/503084/
Timestamp: 2020-05-28 19:00:30
Document Index: 170647701

Matched Legal Cases: ['§ 371', '§ 666', '§ 286', '§ 1512', '§ 666', '§ 666', '§ 666', '§ 794', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666', '§ 666']

United States of America, Plaintiff-appellant, v. Robert C. Lahue, Doing Business As Robert C. Lahue, D.o.,chartered, Doing Business As Blue Valley Medicalgroup; Ronald H. Lahue, Defendants-appellees,, 170 F.3d 1026 (10th Cir. 1999) :: Justia
Justia › US Law › Case Law › Federal Courts › Courts of Appeals › Tenth Circuit › 1999 › United States of America, Plaintiff-appellant, v. Robert C. Lahue, Doing Business As Robert C. Lahue...
United States of America, Plaintiff-appellant, v. Robert C. Lahue, Doing Business As Robert C. Lahue, D.o.,chartered, Doing Business As Blue Valley Medicalgroup; Ronald H. Lahue, Defendants-appellees,, 170 F.3d 1026 (10th Cir. 1999)
US Court of Appeals for the Tenth Circuit - 170 F.3d 1026 (10th Cir. 1999) March 23, 1999
Defendants Dr. Ronald LaHue and Dr. Robert LaHue, agents of Blue Valley Medical Group (BVMG), were indicted on one count of conspiracy under 18 U.S.C. § 371 (count 1), seven counts of Medicare fraud under the Anti-Bribery Act, 18 U.S.C. § 666(b) (counts 2 through 8), one count of conspiracy under 18 U.S.C. § 286 (count 9), and one count of witness tampering under 18 U.S.C. § 1512 (count 10). The district court granted defendants' motion to dismiss counts 2 through 8 on the theory that BVMG did not receive federal benefits as required by section 666(b) and therefore was not within the ambit of the statute.1 United States v. LaHue, 998 F. Supp. 1182, 1184 (D. Kan. 1998). The government appeals, arguing that the alleged fraud falls within section 666(b) because BVMG was a recipient of Medicare reimbursements assigned to it by its patients. We affirm the district court.
In reviewing the district court's determination, we must decide whether providers of medical services to Medicare Part B patients fall within the statutory jurisdiction of 18 U.S.C. § 666(b). In other words, are the LaHues agents of an organization, BVMG, that "receive [d] benefits in excess of $10,000 under a Federal Program." Id. (emphasis added) In making this determination, we look first at the nature of the Medicare program, and then assess section 666 in light of that program.
We review legal issues of statutory construction de novo. United States v. Oberle, 136 F.3d 1414, 1423 (10th Cir. 1998). In interpreting section 666, we recognize that the Supreme Court directs us to use restraint in interpreting federal criminal statutes. Dowling v. United States, 473 U.S. 207, 214, 105 S. Ct. 3127, 87 L. Ed. 2d 152 (1985). "Courts in applying criminal laws generally must follow the plain and unambiguous meaning of the statutory language." Salinas v. United States, 522 U.S. 52, ----, 118 S. Ct. 469, 474, 139 L. Ed. 2d 352 (1997) (quoting United States v. Albertini, 472 U.S. 675, 680, 105 S. Ct. 2897, 86 L. Ed. 2d 536 (1985)). Where the statute is ambiguous, we look to the legislative history and the underlying public policy of the statute. See United States v. Simmonds, 111 F.3d 737, 742 (10th Cir. 1997).
18 U.S.C. § 666(b). The district court acknowledged the superficial appeal of the government's contention that the plain language of section 666(b) includes the patient assignments to BVMG. See LaHue, 998 F. Supp. at 1187. The scope of section 666(b) jurisdiction reaches any organization that "receives ... benefits" from a federal program in an amount over $10,000. 18 U.S.C. § 666(b). Medicare is indisputably a federal program and BVMG did receive reimbursements in any one year in excess of $10,000 for its physicians' services to Medicare recipients.
In support of this argument, the government offers an analogy to anti-discrimination statutes, contending that "section 666 'expressly equates "benefits" with "Federal assistance." ' " Br. of Aplt. at 15 (quoting United States v. Rooney, 986 F.2d 31, 34 (2d Cir. 1993)). The government then directs us to cases holding that providers who accept Medicare funds receive "federal assistance" under an anti-discrimination statute. Id. at 16 (citing United States v. Baylor Univ. Med. Ctr., 736 F.2d 1039, 1042-48 (5th Cir. 1984)). The government concludes by analogy that a health care provider who accepts Medicare funds thereby receives federal benefits and accordingly falls within the scope of section 666.
We are not persuaded by the analogy to anti-discrimination statutes, which are civil rather than criminal. We must exercise particular restraint in interpreting federal criminal statutes. Dowling, 473 U.S. at 214, 105 S. Ct. 3127. Moreover, there are inherent policy differences between these criminal and civil statutes.4 Section 666 was designed to prevent diversions of federal funds enroute to their intended beneficiaries, whereas the anti-discrimination statutes were enacted to prevent the use of federal funds to support discrimination. See United States v. Wyncoop, 11 F.3d 119, 123 (9th Cir. 1993) (Title IX anti-discrimination provision different in purpose and language from section 666).
Finally, like the district court, we believe that a closer look at the government's position reveals ambiguity in the plain meaning of section 666. Under the government's interpretation of section 666(b), any organization that is assigned $10,000 in a year in funds initially disbursed under a federal program source would fall within the statute. Thus, when funds have passed to the beneficiary and she assigns the funds further to any number of organizations which may assign them even further, the government's theory suggests that these monies are all considered benefits as long as they originated under a federal benefits program. Presumably under this interpretation, if the recipient physician endorsed Medicare checks to pay a supplier of medical goods, the supplier would be receiving benefits from a federal program. As the district court aptly noted, this construction creates almost a limitless statutory reach beyond a plain commonsense interpretation of the statute. See LaHue, 998 F. Supp. at 1187.5 Even in the context of anti-discrimination statutes, the Supreme Court has distinguished between direct and indirect beneficiaries, holding that "federal coverage [does not follow] the aid past the recipient to those who merely benefit from the aid." United States Dept. of Trans. v. Paralyzed Veterans of America, 477 U.S. 597, 607, 106 S. Ct. 2705, 91 L. Ed. 2d 494 (1986) (construing 29 U.S.C. § 794 prohibition against subjecting handicapped individuals "to discrimination under any program or activity receiving Federal financial assistance."). In so holding, the Court pointed out that if the statutes were construed to extend to all those who receive an indirect economic benefit from the federal assistance, " [t]he statutory 'limitation' on [the anti-discrimination statute's] coverage would virtually disappear, a result Congress surely did not intend."6 Id. at 609, 106 S. Ct. 2705. Similarly, in our judgment, the implausibility that Congress intended this limitless result in a criminal statute creates an ambiguity regarding the meaning of just who "receives ... benefits ... under a Federal Program," within the meaning of section 666(b).
Like other courts that have wrestled with an interpretation of section 666(b), we look to the legislative history and the underlying purpose of the statute for guidance. See United States v. Copeland, 143 F.3d 1439, 1441 (11th Cir. 1998); United States v. Rooney, 37 F.3d 847, 850-51 (2d Cir. 1994); United States v. Wyncoop, 11 F.3d 119, 121 (9th Cir. 1993). The legislative history reveals that although Congress intended "federal programs" to be broadly construed, Congress also intended to limit the statute to be consistent with its underlying purpose to "protect the integrity of the vast sums of money distributed through federal programs from theft, fraud, and undue influence by bribery." S.Rep. No. 95-225, at 370 (1984), reprinted in 1984 U.S.C.C.A.N. 3182, 3511. As further explained by our sister circuit, the purpose of section 666 is
to prevent diversions of federal funds not only by agents of organizations that are direct beneficiaries of federal benefits funds, but by agents of organizations to whom such funds are 'disbursed' for further 'distribut [ion]' to or for the benefit of the individual beneficiaries.
When Congress enacted section 666, it cited three cases that represent the types of situations section 666 was intended to cover. See S.Rep. No. 95-225, at 370 nn. 2 & 3, reprinted in 1984 U.S.C.C.A.N. at 3182, 3511 nn. 2 & 3; see also Salinas, 552 U.S. at ----, 118 S. Ct. at 474 (discussing legislative history). In all three cases, the organization in question received federal program funds as the intended recipient, and each was charged with the responsibility for administering or spending the federal grant monies to benefit the intended beneficiaries. In United States v. Del Toro, 513 F.2d 656, 661 (2d Cir. 1975), the Harlem-East Harlem Model Cities Program (Model Cities) received funds for revitalization projects in inner city areas. Model Cities had the responsibility to administer and disburse funds to benefit the communities. In United States v. Hinton, 683 F.2d 195, 196 (7th Cir. 1982), United Neighborhoods, Inc. (UNI) entered into contracts with the city of Peoria, Illinois, to administer federal funds under a Community Development Block Grant from HUD. The intended beneficiary, again, was the community and UNI was charged with the administration and disbursement of federal funds to benefit that community. In United States v. Mosley, 659 F.2d 812, 813 (7th Cir. 1981), the State of Illinois Bureau of Employment Security as part of the Comprehensive Employment and Training Program administered employment and training programs for the unemployed, the intended beneficiaries. The Bureau received the funds and had the responsibility to administer them to benefit the unemployed. None of the cases represent a situation where the beneficiary had already received the benefits.
We note in this regard that in United States v. Baylor Univ. Med. Ctr., 736 F.2d 1039 (5th Cir. 1984), the court expressly grounded its holding on the legislative history of the anti-discrimination statutes, judicial decisions construing them, and regulations adopted under them. See id. at 1042
We note that § 666(c) refines § 666(b) by carving out certain transactions in the ordinary course of business: "This section does not apply to bona fide salary, wages, fees, or other compensation paid, or expenses paid or reimbursed, in the usual course of business." 18 U.S.C. § 666(c). Cf. United States v. Copeland, 143 F.3d 1439 (11th Cir. 1998) (holding § 666(b) inapplicable to defense contractor without referencing § 666(c)). Neither the parties nor the district court addressed § 666(c), however. Since there are no circuit cases addressing § 666(c)'s application to § 666(b), we leave that analysis for another day. See United States v. Grossi, 143 F.3d 348, 350-51 (7th Cir. 1998) (declining to decide whether certain payments have met § 666(c) requirements where the parties did not argue the issue below); United States v. Mills, 140 F.3d 630 (6th Cir. 1998) (determining that § 666(c) applies to § 666(a)). We merely introduce § 666(c) as an additional legal wrinkle that contributes to the ambiguity of § 666(b)
In New York Conference of Blue Cross v. Travelers Ins. Co., 514 U.S. 645, 115 S. Ct. 1671, 131 L. Ed. 2d 695 (1995), the Supreme Court similarly refused to extend a statutory phrase to its full expansive meaning
The governing text of ERISA is clearly expansive. Section 514(a) marks for pre-emption "all state laws insofar as they ... relate to any employee benefit plan" covered by ERISA, and one might be excused for wondering, at first blush, whether the words of limitation ("insofar as they ... relate") do much limiting. If "relate to" were taken to extend to the furthest stretch of its indeterminancy, then for all practical purposes pre-emption would never run its course, for " [r]eally, universally, relations stop nowhere," H. James, Roderick Hudson xli (New York ed., World's Classics 1980). But that, of course, would be to read Congress's words of limitation as mere sham....
Id. at 655, 115 S. Ct. 1671 (emphasis added).