Opinion ID: 3012591
Heading Depth: 2
Heading Rank: 1

Heading: Did the District Court Err by Constructively

Text: Amending the Indictment? A constructive amendment occurs where a defendant is deprived of his substantial right to be tried only on charges presented in an indictment returned by a grand jury. United States v. Miller, 471 U.S. 130, 140 (1985) (quoting Stirone v. United States, 361 U.S. 212, 217 (1960)) (internal quotation marks omitted). A constructive amendment to the indictment constitutes a per se violation of the fifth amendment's grand jury clause. United States v. Castro, 776 F.2d 1118, 1121-22 (3d Cir. 1985). In their text, counts 18-29 of the superseding indictment charge Syme under three alternative theories of fraud: (1) that he submitted Medicare forms indicating that ambulance trips were medically necessary when they were not (medical necessity); (2) that he falsified the description of the treatment, service, or destination of the ambulance trip (treatment, service, or destination); and (3) that he submitted duplicate bills for single ambulance trips, one using a Delaware ambulance provider number, and one using a Pennsylvania ambulance provider number (duplicate billing). The text of the indictment for counts 18-29 does not specifically charge Syme under the Pennsylvania rate theory of fraud. However, a chart accompanying these counts, which lists the various theories supporting each charge, does list the Pennsylvania rate theory in the sections for counts 19, 21, 23, 24, 27, and 29. The chart appeared in the superseding indictment as follows: 24 ID: Graphic of Counts XVIII through XXIX 25 Although the Pennsylvania rate theory was neither mentioned in the text of the indictment, nor listed in the accompanying chart for several of the counts in the 18-29 group, the District Court instructed the jury that it could convict on all of the counts in this group based on the Pennsylvania rate theory. In its jury instructions, the Court stated: The next criminal act that has been charged is false claims. Counts 10 through 29 of the indictment charge that the defendants did make and present and caused to be made and presented to the Health Care Financing Administration, . . . claims for services provided to Medicare and/or Medicaid patients, the defendants knowing the claims to be false and fraudulent, which is prohibited by federal law. The indictment charges that defendants falsely submitted bills that were not medically necessary and were not for covered services, and that bills were improperly submitted at the higher Pennsylvania rate . (emphasis added). The District Court repeated its erroneous instruction on the Pennsylvania rate theory in its response to the following question from the deliberating jury (which references the abbreviations for the government's different theories of fraud in the case, explained in the margin)6: First let me read the question. The question says: Must we find all elements of the false statement proven? Then, there is parentheses, (i.e., PA, MN, _________________________________________________________________ 6. The superseding indictment defines the abbreviations that the prosecution and the jury used to refer to the different theories of fraud presented. PA refers to the scheme whereby Syme would submit bills . . . for transportation services billed at the Pennsylvania rate instead of the Delaware or Maryland rate. MN means a scheme in which the defendants intentionally falsely represent[ed] that the [ambulance] transportation was medically necessary. Dest. refers to the practice of intentionally . . . send[ing] false and misleading information concerning the destination of the ambulance trip. And finally, Treat. means intentionally transmit[ting] false and misleading information concerning the . . . reason for the transportation, i.e., the medical treatment sought. 26 treat., dest.), close parens, to render a verdict on each count, or would only one element suffice? The first part of my answer is this: In your deliberations, to render a verdict on the false statement counts, you must find that the government has proven beyond a reasonable doubt each element of the crime of making a false statement. And in the instructions I provided you, I gave you the law of what the elements are for the crime of false statement. . . . . Now, in the question, the second part of my answer is, when you refer to items such as PA, MN, Treat. and Dest. as elements, I interpret your question to mean entries on the statements. In order to find on an entry, you would only have to find one of the entries was proven to be false beyond a reasonable doubt, as long as all the other elements were proven to your satisfaction beyond a reasonable doubt. So I answer you in two parts. Using the word element, all elements of the crime have to be proven beyond a reasonable doubt. One of the elements is there has to be a false entry. It only has to be proven beyond a reasonable doubt that one of the entries entered meets all of the elements. The government concedes that the District Court committed error in its instructions to the jury on Counts 18, 20, 22, 25, 26 and 28 because the sections of the indictment corresponding to these counts do not reference the Pennsylvania rate theory. As to the remaining counts in the 18-29 group, the government argues that the District Court did not constructively amend the indictment because the Pennsylvania rate theory was alleged in the indictment for these counts. The government relies on the chart that was included in the indictment. See supra at 25. The chart lists the various charges, and the theories on which each is based. Each horizontal row of the chart represents a different count of the indictment. Each vertical column in the chart has a heading telling which information corresponds to which count (e.g., Billing Date or Money Billed). One heading labeled False State. refers to the 27 category of statement or statements that the count alleges Syme to have falsely made on his reimbursement forms. This box contains abbreviations that correspond with the different categories of information that the government charged Syme with falsifying. The abbreviation PA appears in the False State. column for the rows corresponding to counts 19, 21, 23, 24, 27, and 29. As we explained above, see supra note 6, PA is defined earlier in the indictment to mean submit[ting] bills . . . for transportation services billed at the Pennsylvania rate instead of the Delaware or Maryland rate. Therefore, argues the government, Syme was effectively indicted in these counts on the Pennsylvania rate theory and the District Court therefore did not amend these counts in its jury instructions or its answer to the jury's question. Syme responds that including the termPA in the chart corresponding to the counts in question was alone insufficient when the theory was not also described in the text of the indictment that corresponded to these counts. It is particularly confusing, argues Syme, because when the same `PA' abbreviation was used in a chart pertaining to the other fraud and false claims counts, it was used together with charging language. Although the indictment is below the level of clarity to which prosecutors should aspire, we agree with the government that the chart sufficiently alleges the Pennsylvania rate theory for counts 19, 21, 23, 24, 27, and 29 for the purpose of determining whether there has been a constructive amendment to the indictment. There is nothing impermissible about setting out allegations in an indictment by a chart as long as the terms used in the chart are clearly defined, as they were here. Cf. United States v. Heath, 122 F.3d 682, 684 (8th Cir. 1997) (holding that it was not error for a sentencing court toconsider all of the acts charged in the indictment including a chart that was incorporated by reference in one of the counts). Indeed, Federal Rule of Evidence 1006 recommends the value of presenting evidence to a jury in the form of a chart when doing so would increase the clarity of presentation. In sum, while the use of charts in this indictment is somewhat inconsistent internally, we find that the chart 28 accompanying counts 19, 21, 23, 24, 27, and 29 makes it sufficiently clear that those counts alleged the Pennsylvania rate theory. Therefore, we find that the District Court erred by constructively amending the indictment only as to counts 18, 20, 22, 25, 26 and 28.