Opinion ID: 2967751
Heading Depth: 3
Heading Rank: 4

Heading: The False Claims Evidence

Text: Ms. Bolden challenges eighteen of her twenty convictions for violating the false claims statute (Counts Three through Eleven, Thirteen through Nineteen, Twenty-One, and Twenty-Four).27 She contends that the evidence was insufficient on the essential element of her knowledge that the claims submitted to Medicaid were false. Her convictions resulted from eighteen separate Medicaid Bills, between December 1993 and April 1995, for Emerald Health’s supposed care of patients who had died, had been hospitalized, or had been discharged. The false claims statute, codified at § 287 of Title 18, criminalizes the submission of a false claim to the United States, or any department or agency thereof, if the defendant knows that such claim is 27 Ms. Bolden was convicted on 20 counts of filing false claims. Two of those counts related to her submission of false Cost Reports to Medicaid, while the other 18 counts were connected to her submission of Medicaid Bills for patient services not rendered. Ms. Bolden only appeals her convictions on the latter 18 counts. When we refer to her false claims convictions, we are referring to those on appeal. UNITED STATES v. BOLDEN 29 28 false, fictitious, or fraudulent. Thus, we must uphold such a conviction if the evidence shows the submission of a false claim and if the defendant acted with knowledge that the claim was false . . . and with a consciousness that he was either doing something which was wrong, or which violated the law. United States v. Maher, 582 F.2d 842, 847 (4th Cir. 1978) (internal citations omitted); see also United States v. Blecker, 657 F.2d 629, 634 (4th Cir. 1981) (upholding false claim conviction even though there was evidence that the government got its money’s worth). Although the jury was required to find, in order to convict Ms. Bolden, that she had knowingly submitted the eighteen false claims to Medicaid, it was entitled to do so on the basis of circumstantial evidence. Indeed, [t]he question of one’s intent is not measured by a psychic reading of [the defendant’s] mind but by the surrounding facts and circumstances; i.e., circumstantial evidence. United States v. Larson, 581 F.2d 664, 667 (7th Cir. 1978). On the evidence presented, the jury could conclude that Ms. Bolden knowingly submitted the eighteen false claims to Medicaid. She controlled Emerald Health’s Medicaid Bills, and Emerald Health was strapped for funds. Ms. Bolden was aware that Emerald Health’s patient census was incorrect, and she nonetheless instructed Emerald Health’s employees to submit the Medicaid Bills.29 According to Ms. Cox, the accounts 28 The false claims statute, 18 U.S.C. § 287, provides in pertinent part that: Whoever makes or presents to any person or officer in the civil, military, or naval service of the United States, or to any department or agency thereof, any claim upon or against the United States, or any department or agency thereof, knowing such claim to be false, fictitious, or fraudulent, shall be imprisoned not more than five years and shall be subject to a fine in the amount provided in this title. 18 U.S.C. § 287 (emphasis added). Importantly, the submission of a false claim to a state agency to obtain federal funds that were provided to the state falls within the parameters of § 287. See United States v. Littlefield, 840 F.2d 143, 151 (1st Cir. 1988) (submission of false claims to state agency violated § 287 because federal monies were used to fund state program). 29 In order to bill Medicaid, Emerald Health maintained a daily patient census, which identified patients residing in the nursing facility and specified the levels of care they were receiving. 30 UNITED STATES v. BOLDEN receivable clerk, many times [Emerald Health] would get behind on the census and most of the time [they] would go ahead and . . . submit a bill to Medicaid. Ms. Cox informed Ms. Bolden that Emerald Health’s patient census was inaccurate, yet Ms. Bolden instructed her to go ahead and bill Medicaid because it was necessary to get money into the facility, and Emerald Health could, in any event, send in a recoupment if [it] billed something in error. Even if Ms. Bolden had contemplated correcting these Medicaid Bills, such an effort would not have been a valid defense to the charges. Under § 287, the Government was obliged to establish only her knowing submission of the false claims. The jury was entitled to conclude, on the evidence of Ms. Cox and the related circumstances, that Ms. Bolden knowingly submitted false claims to Medicaid. See United States v. Adamson, 700 F.2d 953, 962 (5th Cir. 1983) (Where sufficiency is at issue, a finding that an accused acted recklessly may be enough to sustain a jury verdict, because a jury may properly infer the requisite intent. (emphasis in original)); United States v. Cincotta, 689 F.2d 238, 242 (1st Cir. 1982) (concluding that evidence of defendant’s pervasive involvement in operations of corporation involved in transactions in question was sufficient for a reasonable juror to infer that [defendant] knew of . . . the conspiracy). Ms. Bolden also contends that her submission of false claims to Medicaid were simply mistakes, due to poor bookkeeping and accounting practices. She presented this explanation to the jury as a defense, however, and it was rejected. Viewed in the proper light, there was sufficient evidence for the jury to convict Ms. Bolden on each of the false claim charges.