Opinion ID: 2644638
Heading Depth: 3
Heading Rank: 2

Heading: Terrie Porter

Text: Porter, who was one of the alleged recruiters for Family Healthcare, argues the evidence was insufficient to prove she knew about an unlawful objective or joined the agreement with the intent to further that objective. Porter contends she referred patients to Family Healthcare because she believed they needed and would receive home health care. Porter states she had no agreement to recruit only Medicare beneficiaries. Between 2006 and 2009, Porter worked at the University of Texas Health Science Center in the Department of Physical Medicine and Rehabilitation. She 10 Case: 12-20095 Document: 00512456949 Page: 11 Date Filed: 12/02/2013 No. 12-20095 assisted physicians in administrative responsibilities. Her resume revealed that she worked with confidential patient information. Porter testified, though, that the only patient billing she handled was for compensation claims for workrelated injuries and not claims involving Medicare. She explicitly denied having access to patients’ Medicare information. Porter testified that her friend believed a nearby agency (Family Healthcare) was looking for community liaisons. She was put in touch with Clifford Ubani and eventually interviewed with him and Princewill Njoku in a vehicle outside of her place of employment. She wondered whether the two men were involved in a fraud. Porter later admitted at trial that Family Healthcare began paying her for referring patients. Agents eventually discovered a log of Porter’s referrals on the computer hard drives at Family Healthcare. Although Porter argues she was not listed as the referral source for corresponding patients on other documents, the jury heard testimony from Agent Harshaw that it was permissible to have more than one referral source per patient. Porter’s main defense was that she did not know about the Family Healthcare’s schemes or the illegality of the referral payments. She denied having an agreement with Clifford Ubani to receive payments only for Medicarebeneficiary referrals. Porter alleged he paid her for anyone she referred. There was testimony that Memorial Hermann Hospital was a teaching institution for the University of Texas in Houston. Hermann Hospital provided patient information to the University for billing purposes. Dr. Stephen Yang testified about Porter’s access to patients’ confidential information due to her employment at the University. Dr. Yang worked at the University between 2006 and 2010 as an assistant professor in the same department as Porter. He also 11 Case: 12-20095 Document: 00512456949 Page: 12 Date Filed: 12/02/2013 No. 12-20095 treated patients at the Hospital. Dr. Yang explained that he handled patients’ medical charts during his day-to-day practice. Those charts included what the Hospital called “face sheets.” The sheets contained information about patients’ insurance providers such as Medicare. Dr. Yang stated that he was required to report charges that he billed and would attach that billing data to the face sheet. He then placed the documents in a basket for processing. Dr. Yang knew Porter from their working at the University. Her desk as an administrative assistant was down the hall from where he placed documents in the basket. He also knew that Porter processed patients’ billing information because he had witnessed her speaking with a billing company. A legal privacy officer who worked for the University testified regarding Porter’s employment records. The officer reviewed documents in Porter’s employment file, which revealed one of Porter’s responsibilities was to maintain all medical billing and routine office duties. Porter had received advanced training on patients’ rights regarding the confidentiality of their health care information. We disagree with Porter that the evidence was insufficient to support a finding of guilt. Porter initially suspected Clifford Ubani and Princewill Njoku of fraudulent activity. She still agreed to work for them and admitted to referring patients to Family Healthcare and receiving payments in exchange. Porter defended her actions based on her belief that they were legitimate referrals, but the jury also heard her testify that she received payments for patients’ recertifications despite having provided no additional work in exchange. Agent Harshaw testified that the patients on a referral list associated with Porter were Medicare beneficiaries. According to his testimony, more than 12 Case: 12-20095 Document: 00512456949 Page: 13 Date Filed: 12/02/2013 No. 12-20095 three-quarters of those beneficiaries were also patients at the Memorial Hermann Hospital. This circumstantial evidence, along with the testimony that she had direct access to patients’ Medicare information and advanced training in confidentiality regulations, was sufficient to prove that Porter knew of the unlawful objective of recruiting Medicare beneficiaries and willfully joined the agreement with the intent to further that objective. 3. Counts 20 and 21 (False Statements for Use in Determining Rights) It is unlawful to “knowingly and willfully make[] . . . any false statement or representation of a material fact for use in determining rights to [any benefit or payment under a Federal health care program].” 42 U.S.C. § 1320a-7b(a)(2). The jury charge instructed that a false statement is material if it has a natural tendency to influence or is capable of influencing the recipient. The indictment alleged that Ellis described non-existent symptoms and services that were not performed for two patients. On appeal, Ellis concedes the evidence showed her nursing notes contained false statements. She argues that they were not material because they could not be used to determine either patient’s right to home health care. Ellis relies on a claims analyst’s testimony that an RN completes the OASIS questionnaire, and the RN and physician approve the resulting plans of care. Further, Medicare would not authorize payment if these forms merely were signed by an LVN such as Ellis. Ellis also acknowledges the testimony that an LVN was legally required to keep nursing notes that documented patient care. We conclude these notes were material in support of her conviction. The claims analyst explained at trial that Medicare required the preservation of nursing notes in the event of an audit. Ellis herself testified that Family Healthcare encountered two audits 13 Case: 12-20095 Document: 00512456949 Page: 14 Date Filed: 12/02/2013 No. 12-20095 while she worked with the company. In addition, Agent Harshaw testified that an RN partly relies on an LVN’s nursing notes when completing the recertification OASIS. The claims analyst testified that an RN partly would rely on nursing notes to determine future treatment. Regarding the two patients listed in the indictment for Counts 20 and 21, Ellis allegedly provided services for them as their LVN. Both patients were recertified for a second period of home health care. An RN was associated with each recertification. Family Healthcare billed Medicare for both patients. Under either circumstance, Ellis’s false statements on her nursing notes were material and capable of influence for purposes of determining rights to payment by Medicare. The evidence was sufficient to sustain Ellis’s conviction.