Opinion ID: 171708
Heading Depth: 2
Heading Rank: 1

Heading: sufficiency of the evidence

Text: Defendant first challenges the sufficiency of the evidence supporting his convictions for health care fraud and obstruction. [2]
As with Ms. Franklin-El, Defendant's convictions for health care fraud were based on the Medicaid claims The Great Meeting submitted. Defendant generally claims the government presented insufficient evidence of his intent to defraud, without addressing any of his seventeen convictions individually. We review this challenge de novo, determining whether, viewing the evidence in the light most favorable to the prosecution, any rational trier of fact could have found the essential elements of the crime[s] beyond a reasonable doubt. United States v. McPhilomy, 270 F.3d 1302, 1307 (10th Cir.2001) (internal quotation marks omitted). By viewing the evidence in the light most favorable to the government, we necessarily resolve any conflicts in the evidence in favor of the government and we assume the trier of fact found that evidence credible. United States v. Williamson, 53 F.3d 1500, 1516 (10th Cir.1995). Accordingly, we do not reweigh conflicting evidence or consider the credibility of witnesses. Id. In this respect, we must defer to the jury's resolution. United States v. Brooks, 438 F.3d 1231, 1236 (10th Cir.2006). The government charged Defendant with health care fraud and with aiding and abetting health care fraud. To prove Defendant violated 18 U.S.C. § 1347, the government had to show he knowingly and willfully executed or attempted to execute a scheme to defraud a health care benefit program or a scheme to obtain a health care benefit program's money or property through false pretenses, representations, or promises. 18 U.S.C. § 1347. To establish knowledge and willfulness, `the Government must prove that the defendant acted with knowledge that his conduct was unlawful.' Bryan v. United States, 524 U.S. 184, 191-92, 118 S.Ct. 1939, 141 L.Ed.2d 197 (1998) (quoting Ratzlaf v. United States, 510 U.S. 135, 137, 114 S.Ct. 655, 126 L.Ed.2d 615 (1994)). We conclude the government presented sufficient evidence of Defendant's individual intent to defraud. Significantly, the government presented evidence that The Great Meeting's records contained misrepresentations of the status of some of Defendant's clients. For instance, documents allegedly signed by Defendant characterized Gary H. as non-addicted, yet in need of drug and alcohol treatment. And the Great Meeting billed for another child client's addiction treatment, even though Defendant admitted that, based on the initial assessment, the child would have no reason to receive such treatment. Also notable is the evidence of Defendant's involvement in the Medikan hearing and in The Great Meeting's appeal of the recoupment. At the Medikan hearing, Defendant tacitly agreed that The Great Meeting had provided addiction treatment to two clients whose Medikan coverage was at issue. Yet the government's experts testified there was no evidence the Medikan clients received any such treatment. Moreover, Ms. Wagner, a government expert, testified that Defendant revealed his understanding of The Great Meeting's Medicaid billing during the company's appeal of the recoupment. In her opinion, Defendant knew the Medicaid claims were for drug and alcohol treatment and knew which claims had been submitted for which services. In conjunction with Defendant's trial admissions that the children and other clients were not addicts and that the support services offered by The Great Meeting did not constitute addiction treatment, this evidence supports a reasonable inference that Defendant was aiding and abetting the scheme to submit fraudulent Medicaid claims. But there is more. The government also established Defendant's active role in obtaining Medicaid cards for billing purposes. One witness testified that Defendant and Ms. Franklin-El both encouraged a relative to provide her Medicaid card to them in exchange for a rent-free place to live. Defendant later changed the locks of the home numerous times when she challenged The Great Meeting's use of the card. Further, the government presented evidence that Defendant attended Medicaid billing training. Although Defendant denied attending all of the training, it was reasonable for the jury to reject this testimony in light of the trainer's testimony and Defendant's continuing education records. Finally, like Ms. Franklin-El, Defendant significantly profited from the scheme. Defendant next argues that United States v. Rahseparian, 231 F.3d 1257 (10th Cir.2000), mandates reversal of his health care fraud convictions. In Rahseparian, we found no evidence establishing that the defendant knew a fraudulent business was not legitimate. Four out of the five pieces of evidence the government relied upon were consistent with a lawful business. The final piecethe defendant's false exculpatory statementswas not enough, alone, to prove the defendant's knowledge and intent. Defendant claims evidence of his knowledge and intent is similarly lacking in this case, but we find the evidence of intent to be greater than in Rahseparian. Defendant's knowledge of Medicaid billing and The Great Meeting's billing practices, his misrepresentation of Gary H.'s addiction status in client care documents, his $5,000 a week profit from Medicaid proceeds, and his active steps to obtain others' Medicaid cards is enough to establish Defendant's intent to defraud. Finally, Defendant complains about the prosecutor's conduct at trial. Although Defendant characterizes this final claim as a sufficiency challenge, it is more a claim of trial error. Specifically, Defendant contends the prosecutor's use of the pronoun they to refer to the defendants at trial led the jury to confuse and conflate the evidence against Ms. Franklin-El with the evidence against Defendant. We disagree. Although the government's pigeonholing of the defendants is concerning, defense counsels' regular objections prevented jury confusion. The record reflects that the court largely sustained defense counsels' objections, requiring the prosecutor to refer to the defendants individually. [3] Although there were instances where the prosecutor's grouping of the defendants went unaddressed because defense counsel did not object, the court's overall pattern of sustaining the objections and correcting the prosecutor adequately signaled to the jury the need to individually view the evidence. Taken in the light most favorable to the government, we conclude the evidence supports a finding beyond a reasonable doubt that Defendant knowingly and willfully executed, attempted to execute, or aided and abetted the execution of a scheme to defraud a health care benefits plan. Accordingly, we sustain his convictions of health care fraud.
Defendant next argues the evidence was insufficient to support his conviction for obstructing justice. Defendant concedes our review is for plain error, as he did not move for judgment of acquittal on the obstruction conviction at trial. Therefore, to secure relief, Defendant must show: (1) an error, (2) that is plain (clear or obvious under current law), and (3) that affects substantial rights. United States v. Goode, 483 F.3d 676, 681 (10th Cir.2007). If Defendant satisfies these criteria, we may exercise discretion to correct the error if it seriously affects the fairness, integrity, or public reputation of judicial proceedings. Id. (internal quotations marks omitted). We find this to be one of the unusual cases where Defendant has met this standard. To establish Defendant obstructed or attempted to obstruct justice, the government had to show he willfully prevented, obstructed, misled, or delayed the communication of information or records relating to a violation of a Federal health care offense to a criminal investigator or attempted to do so. 18 U.S.C. § 1518. Defendant contends the government failed to establish willfulness or intent. We agree. The government largely relies upon evidence that only after Defendant was served with a federal subpoena seeking specific client records (including records of preauthorizations for the Medicaid claims), did The Great Meeting submit requests for preauthorization to the regional center. Defendant contends this evidence is meaningless because the government presented no evidence tying him to any attempts to submit preauthorization forms. In its responsive brief, the government does nothing to address this concern. The government does not establish Defendant's individual participation in these submissions, nor does it appear from the record that it could do so. The evidence shows Ms. Franklin-El, not Defendant, spoke with a Kansas Medicaid consultant while she filled out several of these client preauthorizations forms. Therefore, evidence relating to the belated preauthorizations is inapposite to Defendant's willfulness or intent. The government also presented evidence that Ms. Franklin-El transferred more than $162,000 in Medicaid proceeds from her personal account to a newly-created Success, Inc., savings at a commercial bank. Thisagainrelates only to Ms. Franklin. It does not link Defendant to any effort to hide wrongdoing. The government's strongest evidence is that, near the time he received the federal subpoena, Defendant went to the home of the company's accountant and asked him to recreate the transactions of The Great Meeting. Defendant explained to the accountant that he and Ms. Franklin-El might be under investigation. He asked the accountant to go over all their transactions and determine whether they were business-related or personal. The accountant characterized this as a request to help them look over their receipts and help them get everything in order. (R. Vol. 16 at 1429.) Nothing in the accountant's testimony would support an inference that Defendant exhibited any intent to prevent, obstruct, mislead, or delay. Accordingly, the evidence is insufficient for a jury to reasonably conclude beyond a reasonable doubt that Defendant was trying to obstruct justice. In light of this lack of evidence, we find the court plainly erred by allowing this conviction to stand. This error certainly affected Defendant's substantial rights. Moreover, our failure to mandate reversal of a conviction resting on insufficient evidence in this case would seriously affect[] the fairness, integrity or public reputation of judicial proceedings. Goode, 483 F.3d at 681. Therefore, we must reverse Defendant's conviction for obstruction of justice.