Opinion ID: 2652557
Heading Depth: 3
Heading Rank: 2

Heading: Martin’s conviction

Text: Martin argues that the evidence was insufficient to support the jury’s verdict as to Counts 3 and 4 of the indictment, which charged her with committing health care fraud upon Blue Cross. The crux of her argument is that the trial evidence showed that she in good faith believed she could bill Blue Cross under her individual provider number for the services of her employees. In support, she states that she never attempted to hide the fact that other LPNs were providing nursing services to E.D. and C.S., and that she engaged in extensive research, including conversations with Blue Cross, before obtaining an individual provider number with Blue Cross. Martin also argues that her understanding that services provided by other LPNs could be charged to Blue Cross is supported by Blue Cross’s billing structure, which paid a fixed fee for specific CPT-coded procedures. She explains her escalating billing rate as a billing error by Blue Cross. The government responds that, viewing the evidence in the light most favorable to the verdict, a rational jury could have convicted Martin of health care fraud beyond a reasonable doubt based on her failure to provide the care described in the nurse notes. It states that “[c]ontrary to Martin’s argument, the government did not assert that it was fraud if Martin billed for services 9 Case: 12-31275 Document: 00512524708 Page: 10 Date Filed: 02/06/2014 No. 12-31275 rendered by another,” but rather “[t]he government proved that Martin billed Blue Cross for services that were not rendered.” The government counters Martin’s explanation for her escalating charges by observing that the wide variations occurred over a relatively short period of time (between February 2007 and September 2008), and without any accompanying change in services. 18 U.S.C. § 1347, the statute under which Martin was convicted, provides that (a) Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice--
(2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both. . . . (b) With respect to violations of this section, a person need not have actual knowledge of this section or specific intent to commit a violation of this section. 18 U.S.C. § 1347. After considering Martin’s sufficiency-of-the-evidence argument, we find the following evidence sufficient to affirm Martin’s conviction. Martin applied for an individual provider number from Blue Cross. Although she could have created a business entity and applied for a provider number that would allow her to bill Blue Cross for services rendered by her employees, she instead elected to obtain a provider number as an individual. In that capacity, she billed Blue Cross over the course of several months vastly different amounts for the same services. As to one of her two patients, Martin submitted claims that fluctuated between $450 per day of care in July 2007 and $800 per day of care in December 2007. As to her other patient, Martin submitted claims for 10 Case: 12-31275 Document: 00512524708 Page: 11 Date Filed: 02/06/2014 No. 12-31275 $500 per day of care from February 2007 to May 2007, before eventually filing daily claims for as much as $1,600 in March 2008. When Blue Cross requested supporting billing documentation, Martin was “not very cooperative.” After Blue Cross persisted in its demand for the records it was contacted by Susan Turner, Martin’s new point-of-contact, who proved “very aggressive” and challenged Blue Cross’s authority to access the records. The nurse notes that eventually were sent to Blue Cross contain Martin’s signature at the bottom of each note in the section reading “Nurse’s Signature.” Trial testimony by Blue Cross investigator Kandyce Cowart stated that such a signature represented that the signing nurse provided the care detailed in the note. Martin does not dispute that on at least some of the days when she was working at Morehouse General (or when one of her patients was hospitalized), she did not personally provide all the care listed in the nurse notes. This evidence was sufficient for the jury to find Martin guilty of committing health care fraud, in violation of 18 U.S.C. § 1347. Martin’s arguments to the contrary are unpersuasive. She relies on Cotton’s testimony that she carefully researched Blue Cross’s billing practices, and on E.D.’s testimony that the billed-for services were provided, but the jury was entitled to find those witnesses not credible. Martin also attacks her conviction by relying on Blue Cross’s billing structure. She describes Blue Cross’s purported reason for not allowing an individual to bill for employees’ services—double-billing—as nonsensical because if two providers billed Blue Cross for the same care to the same client, then Blue Cross would surely investigate. Martin appears to suggest that the mere fact that a scheme to defraud an insurance company would likely fail due to that company’s safeguards bolsters her good-faith-belief defense. To the 11 Case: 12-31275 Document: 00512524708 Page: 12 Date Filed: 02/06/2014 No. 12-31275 extent this argument is in any way persuasive, the jury was able to consider it, and evidently rejected it in rendering a guilty verdict. Paradoxically, while Martin argues that Blue Cross’s ability to catch mistakes like double-billing supports her understanding of Blue Cross’s billing structure, she also argues that Blue Cross’s propensity for making mistakes explains her escalating billing rates. Martin quotes Cowart’s trial testimony that Blue Cross would mistakenly pay claims without cross-checking whether the amount matched what Blue Cross had agreed to pay under a particular plan. Martin’s argument appears to be that there must have been nothing wrong with her billing if Blue Cross paid it. As the government rightly observes, “the evidence that [Martin] cites explains only why Blue Cross paid the ridiculously high bills she was submitting. It does not address why she submitted them.” Turning to the nurse notes, Martin contends that Blue Cross did not pay claims according to the amount of time it took to complete a procedure, but only based on whether the service was provided. From this premise, Martin leaps to the conclusion that the jury should not have interpreted the nurse notes to mean that the signing nurse was required to provide the care detailed therein. We understand Martin to mean that because Blue Cross allegedly was concerned only with whether the procedure was performed, not how long it took, Blue Cross also must not have been concerned with who provided the care, so long as it was provided by an LPN like Martin. Whatever persuasive value Martin’s argument might have in isolation from the other trial evidence is undone by considering that evidence in its entirety. As we have observed, Cowart’s trial testimony was that by signing the nurse notes, Martin represented that she herself provided the care in question. Martin also charged an ever-changing amount for the same services. Additionally, she charged Blue Cross for care that neither she, nor any other LPN in her employ, 12 Case: 12-31275 Document: 00512524708 Page: 13 Date Filed: 02/06/2014 No. 12-31275 could have provided because the patient who purportedly received it was, at that, hospitalized. In addressing sufficiency-of-the-evidence arguments, we ask only “whether a rational trier of fact could have found the essential elements of the crime beyond a reasonable doubt.” United States v. Grant, 683 F.3d 639, 642 (5th Cir. 2012) (internal quotation marks and citation omitted). Here, the jury heard evidence of Blue Cross’s billing structure and was unpersuaded by Martin’s novel interpretation of it. The jury acted as a rational trier of fact in finding Martin guilty in light of the trial evidence. Accordingly, we affirm Martin’s conviction for health care fraud.