Opinion ID: 69278
Heading Depth: 4
Heading Rank: 1

Heading: Patel

Text: Patel asserts that the evidence is insufficient to support her convictions for health-care fraud because she did not knowingly or intentionally defraud Medicare. But the Government introduced evidence from which a reasonable juror could infer that, by signing the CMN form, Patel certified to Medicare that each patient was currently using a wheelchair, suffered from physical limitations that made a wheelchair necessary, and was incapable of using a manual wheelchair.5 The Government introduced evidence that Patel approved 4 Patel asserts that this court reviews the sufficiency of the evidence de novo. That is incorrect. This court does review a district court’s denial of a motion for judgment of acquittal de novo; however, even under that standard we ask whether a reasonable jury could find the evidence sufficient to support a finding of guilt beyond a reasonable doubt. United States v. Percel, 553 F.3d 903, 910 (5th Cir. 2008). Conversely, where “a motion for judgment of acquittal insufficiently preserves a claim, our review is only for a manifest miscarriage of justice.” United States v. McDowell, 498 F.3d 308, 312 (5th Cir. 2007). 5 Patel and Skripka argue that the requirements to receive a power wheelchair were ambiguous and inconsistent at the time the health-care fraud occurred. For the first time on appeal, they assert that this court should take judicial notice of congressional testimony regarding purported ambiguities in the Medicare coverage guidelines, which were disseminated through the DME suppliers’ manual. We need not reach this issue because the Government introduced evidence from which a reasonable jury could conclude that Patel and Skripka were guilty of health-care fraud. The Government introduced evidence that Patel and Skripka were aware of the standard contained on the CMN form, and nonetheless certified patients for power wheelchairs who did not meet that standard. Because this evidence is sufficient to sustain Patel and Skripka’s convictions for health-care fraud, we need not reach the issue of whether the requirements to receive a power wheelchair in the DME suppliers’ 4 No. 07-20471 patients for power wheelchairs who were able to walk into the clinic. Patel certified to Medicare that these patients required power wheelchairs without investigating whether they exhibited physical restrictions or were capable of operating a manual wheelchair, as required by the CMN. This is sufficient to support a finding that Patel committed health-care fraud. See United States v. Ogba, 526 F.3d 214, 232 (5th Cir. 2008) (“In signing these forms and certifying their truth, [the doctor] would have had to deliberately ignore the requirements for prescribing a wheelchair.”), cert. denied, 129 S. Ct. 220 (2009); Mauskar, 557 F.3d at 230 (rejecting sufficiency of the evidence challenge to health-care fraud conviction where doctor was aware that the patient was able to jog at the time he prescribed a motorized wheelchair). Patel claims—and the Government does not dispute—that she crossed out the words “and use” on the CMN form.6 She asserts that, in doing so, she refused to certify that the patients were using a wheelchair at the time of the evaluation; rather, she certified only that she believed they would benefit from one, regardless of the Medicare standard. We need not reach the effect of Patel’s crossing out this language because the Government introduced substantial circumstantial evidence that Patel had the requisite knowledge and intent to commit health-care fraud. The record is replete with circumstantial evidence that Patel had constructive knowledge of Gottlieb’s fraudulent scheme: the large number of patients in the clinic, Gottlieb’s failure to review test results or adhere to the proper standard on the CMN, and the presence of recruiters and DME suppliers manual were ambiguous. We note, however, that neither Patel nor Skripka presented any evidence that they relied on a reasonable interpretation of the Medicare regulations when prescribing power wheelchairs; rather, they disavowed any knowledge of the substance of the regulations and claimed that they never received the DME suppliers’ manual. 6 Before Patel’s crossing-out of “and use,” this portion of the form read as follows: “Does the patient require and use a wheelchair to move around in their residence?” 5 No. 07-20471 in the clinic. As we explain below, this evidence supported an instruction to the jury on deliberate ignorance, and the record contains sufficient evidence from which a reasonable jury could conclude that Patel was aware of the health-care fraud and acted to further Gottlieb’s scheme.7