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

Heading: Turner’s conviction

Text: Like Martin, Turner challenges the sufficiency of the evidence in this case. Turner argues that there was insufficient evidence to convict him on Count 1 of the indictment, which charged him with conspiracy. According to Turner, the only evidence potentially linking him to the conspiracy relates to two distinct time periods: August 28 to August 31, 2005; and September 16 to September 26, 2005. Turner’s argument as to both of these periods is the same. He does not dispute that timesheets, nurse notes, and paychecks show that he purportedly provided homecare services to a Medicaid patient on those dates. He also does not dispute that the patient listed in those records could not have received the stated care because the patient was hospitalized. Turner instead argues that this overlap is insufficient to convict him of conspiracy because he worked more hours that were not billed to Medicaid caring for the patient while the patient was not in the hospital, than hours that were billed while the patient was hospitalized. In other words, he asserts that Medicaid made a net gain. The government in its response contends that the evidence at trial established a pattern of fraudulent billing by Bayou. It relies on nurse notes 13 Case: 12-31275 Document: 00512524708 Page: 14 Date Filed: 02/06/2014 No. 12-31275 that show that Turner provided care to a patient, J.M., while that patient was hospitalized. The government draws a parallel to other care purportedly provided by other Bayou caretakers, which it says was similarly fraudulent. Relying on United States v. Stephens, 571 F.3d 401, 404 (5th Cir. 2009), the government contends that “[t]his evidence of concerted action establishes the conspiracy and Turner’s knowing participation in it.” Under 18 U.S.C. § 371, the government was required to prove three elements beyond a reasonable doubt to convict Turner of conspiracy to commit health care fraud: “(1) [that] two or more persons made an agreement to commit health care fraud; (2) that [Turner] knew the unlawful purpose of the agreement; and (3) that [Turner] joined in the agreement willfully, that is, with the intent to further the unlawful purpose.” Grant, 683 F.3d at 643. “The [g]overnment is not required to provide direct evidence of the conspiracy.” Stephens, 571 F.3d at 404. “Circumstantial evidence can prove knowledge and participation.” United States v. Njoku, 737 F.3d 55, 63 (5th Cir. 2013). Turner’s arguments largely amount to asking us to vacate his conviction because there was no direct evidence of his participating in or knowing of the conspiracy. However, “voluntary participation may be inferred from a collection of circumstances, and knowledge may be inferred from surrounding circumstances.” Stephens, 571 F.3d at 404 (citation omitted). Here, the trial evidence showed that timesheets and nurse notes were submitted at Turner’s behest, which represented that he provided homecare to a patient who was, at the time, hospitalized. The jury was free to consider Turner’s untruthful timesheets and nurse notes in the context of other Bayou employees submitting similarly inaccurate reports, which also alleged care that was not actually provided. For example, one patient was admitted into a hospital on June 14, 2008, and discharged on July 16, 2008. Bayou nevertheless billed Medicaid for home services during this time, and nurse notes by one of Turner’s co14 Case: 12-31275 Document: 00512524708 Page: 15 Date Filed: 02/06/2014 No. 12-31275 defendants documented care from June 16 through June 22, 2008. Another patient was hospitalized from December 3 to December 19, 2005. Bayou billed for services rendered from December 5 to December 11, 2005, and nurse notes by another co-defendant stated that services were rendered on December 5 through December 9, and December 13 through December 15, 2005. From these examples and others, the jury had sufficient evidence of fraudulent activity to compare to Turner’s own dishonest acts, and infer Turner’s willing participation in Bayou’s scheme to defraud Medicaid. That Turner did not personally prepare the timesheets or nurse notes is irrelevant because other trial evidence showed that Turner paid another employee to prepare them for him. Specifically, Emery testified that Dewanda Turner prepared the forms for Turner. Moreover, trial testimony by Bryan Edwards, an investigator with the Louisiana Attorney General’s Office, showed that it was the caretaker’s responsibility to accurately fill out the timesheets. The jury thus could conclude that the information contained in the timesheets and nurse sheets was provided by Turner. It likewise is irrelevant that Medicaid may have been charged less than the number of hours Turner worked. The operative grounds for Turner’s conviction was his submission of timesheets and nurse notes seeking payment for care Turner did not, in fact, provide. It is that act which caused Medicaid’s injury, and permitted the jury to find him guilty of conspiracy. Because there was sufficient evidence from which the jury could infer Turner’s participation in the scheme to defraud Medicaid, his conspiracy conviction is affirmed.