Opinion ID: 2353541
Heading Depth: 1
Heading Rank: 7

Heading: Spilton's Summary Judgment Argument

Text: It is settled Missouri law that the state can rely on circumstantial evidence to demonstrate the knowing element of fraud. Farr v. Hoesch, 745 S.W.2d 830, 832 (Mo.App.1988). This is because fraud, by its nature, is very difficult to prove by direct evidence. Allison v. Mildred, 307 S.W.2d 447, 453 (Mo.1957) (stating that fraud claims are seldom capable of direct proof). Here, the state set out, in numbered paragraphs, every material fact as to which it claimed there was no genuine issue. And, pursuant to Rule 74.04(c)(1), it made specific references to the record to demonstrate the lack of a genuine issue suitable for trial. The state included in its motion for summary judgment both circumstantial evidence and direct evidence that Spilton violated sec. 191.905.1(1) 325 separate times. The state produced more than 300 copies of claims submitted by Spilton that stated, among other things, that she provided individual therapy she did not provide, that she spent longer periods of time with patients than she actually spent, that she followed Medicaid procedures when in fact she did not, and that she treated children she did not even see. Additionally, the state produced affidavits from Medicaid Fraud Control Unit investigators in which they detailed Spilton's ;confession to them that the claims she submitted for reimbursement contained false information. Spilton admitted to investigators Robert Hyder II and Melinda Ochoa that she never provided any individual therapy to numerous recipients, and that when she did provide therapy, she did not provide it for the full time required by Medicaid rules and regulations. She admitted to investigators Hyder and Ochoa that she submitted, or caused to be submitted, claims to Medicaid for non-qualifying, individual therapy for numerous recipients, and that she conducted therapy sessions ... but the children were not present ... [so they] could not be billed to Medicaid. And, she admitted to investigators Hyder and Ochoa that she created patient records which allegedly corroborated the claims submitted. Further, the state produced a voluntary statement, which Spilton wrote and signed after her interview with investigators, that said: I am responsible for illegal activities of at times not billing accurately. Specifically, I have billed for seeing a client individually, when in fact, I did not see (i.e., provide treatment to) the client. There were instances when I worked individually with the parent(s) and the client/child was not in the session ... in some cases the client/child was present but there were many times when the child was not present ... I am aware I did not follow required procedure for such treatment ... I cannot explain in any way why I displayed the illegal behavior I exhibited nor can I justify this behavior. It was 100% wrong for many reasons ... I accept full responsibility. [7] Pursuant to Rule 74.04(c)(2), a response to a motion for summary judgment must admit or deny each of the movant's factual statements and support each denial with specific references to the discovery, exhibits, or affidavits that demonstrate specific facts showing that there is a genuine issue for trial. Spilton did not deny a single one of the state's allegations in her response. Instead, she asserted the Fifth Amendment privilege against self-incrimination. [8] While a failure to deny does not automatically entitle summary judgment to the moving party, it does cause all factual assertions properly alleged and supported by the moving party to be considered as true. Johnson v. Missouri Bd. Of Nursing Adm'rs, 130 S.W.3d 619, 626 (Mo.App.2004). Civil defendants who choose to assert their Fifth Amendment privilege take the risk that there will be nothing to support [their] view of the case and a ... grant of summary judgment will be proper. 8 Charles Alan Wright, Arthur R. Miller & Richard L. Marcus, Federal Practice and Procedure, sec. 2018, at 288 (1994). Here, Spilton has simply not demonstrated that there is a genuine issue of material fact that would preclude summary judgment for the state. A factual dispute that is merely argumentative, imaginary, or frivolous is not enough to defeat summary judgment. ITT, 854 S.W.2d at 382. Spilton argues in the alternative that if summary judgment was proper, she is not subject to the penalties proscribed in subsection 191.905.12 because it is applicable only to criminal prosecutions, not civil actions brought by the state of Missouri. Instead, she claims that she is subject only to the penalties set out in subsection 191.905.14. However, Spilton draws the wrong distinction between subsections 12 and 14. The plain reading of the statute is that subsection 12 provides civil penalties for knowing violations of the statute, and subsection 14 provides civil penalties for unintentional violations of the statute. Because violations of subsections 191.905.1(1-3)the violations referenced in subsection 12require a knowing act, the civil penalties for those violations are steeper. There is no civil/criminal distinction. Therefore, because there is no genuine issue of material fact as to whether Spilton knowingly violated 191.905.1(1), she is liable for the penalties set out in subsection 12. There is nothing left for a jury to resolve.