Opinion ID: 29550
Heading Depth: 3
Heading Rank: 1

Heading: Lopez: Mail Fraud

Text: Both Lopez and Goldberg challenge the sufficiency of the 14 evidence to sustain their convictions. We address both Lopez’s and Goldberg’s arguments in turn. Lopez was convicted on two counts of mail fraud for submitting HCFA Forms that reflected the use of a physical-therapy device known as a Hubbard Tank.9 Although Lopez concedes that none of Dr. Bieganowski’s clinics ever contained a Hubbard Tank, he maintains that the evidence failed to show either that billing for a Hubbard Tank was a material misstatement or that he possessed the requisite intent to commit mail fraud. “The standard of review in assessing a challenge to the sufficiency of the evidence in a criminal case is whether a ‘reasonable trier of fact could have found that the evidence established guilt beyond a reasonable doubt.’” United States v. Smith, 296 F.3d 344, 346 (5th Cir. 2002). In evaluating the evidence, we view “all evidence and all reasonable inferences drawn from it in the light most favorable to the government.” Id. (quoting United States v. Mergerson, 4 F.3d 337, 341 (5th Cir. 1993)). “It is not necessary that the evidence exclude every reasonable hypothesis of innocence or be wholly inconsistent with every conclusion except that of guilt.” United States v. Henry, 849 F.2d 1534, 1536 (5th Cir. 1988); United States v. Lechuga, 888 9 Stedman’s Medical Dictionary defines a Hubbard Tank as a large tank, usually filled with warm water, used for therapeutic exercises in a program of physiotherapy. See STEDMAN’S MEDICAL DICTIONARY 1785 (27th ed. 2002). 15 F.2d 1472, 1476 (5th Cir. 1989). However, in a case depending on circumstantial evidence if the evidence viewed in the light most favorable to the prosecution gives equal or nearly equal circumstantial support to a theory of guilt and a theory of innocence, a defendant is entitled to a judgment of acquittal. United States v. Brown, 186 F.3d 661, 664 (5th Cir. 1999) (quoting United States v. Schuchmann, 84 F.3d 752, 754 (5th Cir. 1996)). Lopez was ultimately convicted on two counts of mail fraud in violation of 18 U.S.C. § 1341. To prove mail fraud under 18 U.S.C. § 1341, the government must show: (1) a scheme to defraud; (2) the use of the mails to execute the scheme; and (3) the specific intent to defraud. United States v. Peterson, 244 F.3d 385, 389 (5th Cir. 2001). In addition, the Supreme Court has interpreted section 1341 to require that the misstatement made in the course of the scheme to defraud be a material one. See Neder v. United States, 119 S.Ct. 1827, 1841 (1999). Lopez argues that billing for Hubbard Tank treatment could not have been a material misstatement since the billing rate for the use of a Hubbard Tank was lower than the rate at which Lopez could have billed for the treatment that he actually delivered. Specifically, Lopez maintains that although he submitted bills with CPT code 97220, the code for Hubbard Tank treatment, he could have billed under the more expensive CPT code 97420, the code used for 16 supervised pool therapy or Hubbard Tank therapy with exercises.10 On closer examination, however, Lopez’s argument fails. First, the evidence indicates that billing for Hubbard Tank therapy includes not only a representation that the clinic possessed a Hubbard Tank, but also the implicit representation that the Tank was used to deliver certain professional services. The evidence further indicated that a physical therapist may only bill for pool therapy under CPT code 97420 where the therapy is supervised. Ample evidence, however, was introduced to establish that such supervision was lacking in Lopez’s clinic, and that no professional services were being provided to Lopez’s patients while they were in the clinic’s pools.11 Lopez’s defense that he could have billed for the services he 10 In 1994, Lopez did cease billing for Hubbard Tank treatments and began billing instead, under CPT code 97420, for pool therapy at the same $35 per-half-hour rate that he had previously billed for Hubbard Tank therapy. Simply because Lopez could have billed for the services at the same rate, however, does not mean that the misstatement was immaterial or that the insurance companies reimbursed for the services at the same rate or at the same frequency. The record, for example, contains conflicting evidence regarding whether the insurance companies, at the time Lopez was billing for Hubbard Tank treatments, actually reimbursed at a higher rate for pool therapy than they did for Hubbard Tank therapy. In any event, it is unnecessary to reconcile this conflicting evidence as the evidence also showed that Lopez could not have billed for pool therapy without making a further misstatement, and that billing for Hubbard Tank therapy was itself a material misstatement. 11 Two former patients and a former assistant of Lopez’s testified that there were three to six people in the clinic whirlpools at a time and that they received no supervision or physical-therapy instruction while they were in the pool. 17 provided as pool therapy under CPT code 97420, therefore, is unsupported by the evidence. Lopez’s argument essentially amounts to the claim that his misrepresentation was not material since, by making an additional misrepresentation, he could have charged for a different service at an equal or higher rate. We find this reasoning unconvincing. Moreover, there was at least some evidence presented that insurance companies found the representation that the clinic possessed a Hubbard Tank to be material regardless of any actual charges billed. Lisa Hannusch, an expert witness from the Texas Workers Compensation Insurance Fund, testified that in order for the Fund to pay a bill for a Hubbard Tank, the clinic submitting the bill must actually have a Hubbard Tank. Hannusch also testified that had she known that there was no such tank at Lopez’s clinic, she would not have reimbursed his bills. Finally, Hannusch testified that a pool such as Lopez’s—a pool used to treat multiple individuals, with no window access, no aide present, and no physical therapist available to supervise the patients—would not be billable as a Hubbard Tank or as pool therapy. We also find that the evidence supported the jury’s finding that Lopez possessed the requisite intent to defraud. Lopez was active in selecting billing codes, he adjusted the billing codes submitted by other employees, and at least on one occasion, he received and annotated billing statements from insurance companies. When viewed in the light most favorable to the verdict, we find 18 this evidence sufficient to support the conclusion that Lopez intended to submit bills containing material misstatements to the insurance companies for reimbursement. After reviewing the record, therefore, we find that the evidence is sufficient to establish both that billing for a Hubbard Tank was a material misstatement and that Lopez possessed the requisite intent to support his conviction for mail fraud.