Opinion ID: 2387754
Heading Depth: 1
Heading Rank: 22

Heading: The Letter of Transmittal

Text: Two days after the order authorizing disclosure to the federal government, the State filed a Motion for Appropriate Relief (Motion to Supplement Record). The State sought permission to forward the documents with an explanatory letter. The request had been anticipated by counsel for the pharmacy and the employee and was questioned at the conclusion of the hearing on the motion to disclose. Counsel asked the judge whether he was going to permit the State as a part of its disclosure to the federal government to provide the summaries of the documents, its analysis of the documents which is prepared in the grand jury sessions and during the grand jury process, and to comment on the nature of a report or cover letter explaining what we have here, other than just dropping the documents into an envelope and sending them.... At the judge's request the State responded. It explained that the only summary or analysis prepared by Medicaid Fraud Unit investigators during the course of the investigation is contained as Exhibit A to the disclosure motion. It is a summary of the name of the prescription, the date of the original prescription was submitted and paid, and the date that the unauthorized refill was submitted and paid. With reference to statements made by the pharmacy's counsel and the head of the pharmacy unit, the State's position was that the statements were outside the grand jury and that they could be put in letter form and submitted to the federal government. The judge pointed out that the other items you talk about [apparently the statements] have already been agreed by the respondents not to be subject to this court's jurisdiction.... The judge declared that he was not going to comment on those. Counsel for the employee made it clear for the record that [he] had not conceded... that the interviews with [the pharmacy officials] were not testimonial or not protected by the grand jury. Counsel for the pharmacy made clear that he was concerned with the contents of any cover letter  [t]hey're going to write a narrative. He told the judge: I am very concerned about the cover letter. I'm very concerned about the narrative and I'm concerned about the grand jury secrecy in relation thereto. He took the judge's comments as an indication that the judge was going to order that the State may construct a narrative report relating to the interpretation of [the] documents [permitted to be disclosed] made by [the State's] agents during the course of their investigation of the grand jury subpoenas and on the basis of documents which were produced in response to those subpoenas. [The State] can transmit that narrative and transmit and make that disclosure. Asked by the court to comment, counsel for the State gave assurance that beyond what is appended to the disclosure motion, there are no reports, interpretations, summaries or anything else of the fact of the grand jury investigation, what took place before the grand jury, the analysis and the documents received from the grand jury. But, counsel for the State conceded, there was additional information that she planned to disclose. She said: I contemplate sending to the [federal government] or otherwise making available to anyone else ... the statements of [the pharmacy's] counsel as to why the documents were destroyed.... These are statements of counsel made voluntarily without the service of a grand jury subpoena, without there even being a suggestion that anyone should come in and testify before the grand jury. They were made to me. They were not made to an investigator as an interview in order to find out what went on in the [pharmacy's] stores in furtherance of grand jury investigation. The order of 20 July 1988, permitting disclosure, did not embrace a letter of transmittal. Appended as Exhibit B to the State's Motion to Supplement the Record was a proposed letter of transmittal. The motion called attention to the suggestion at the hearing on the Motion for Disclosure by counsel for the pharmacy and the employee that any transmittal letter explaining documents which the court ordered disclosed might bear on the issues before [the trial] court and the appeals courts. The Motion to Supplement the Record stated that, therefore, counsel for the pharmacy and the employee consent to the supplementation of the record [by inclusion of the letter of transmittal], but do not thereby consent to any disclosure or transmittal of the contents of Exhibit B. Without further comment on the record, the judge granted the Motion to Supplement the Record the same day it was proffered by endorsing thereon SO ORDERED, and thereby approved the proposed letter of transmittal. The transmittal letter was addressed to the Regional Inspector General for Investigations, Dept. of Health and Human Services, under date of 18 July 1988. It enclosed a copy of the order for disclosure issued by the Circuit Court for Baltimore City, and the documents to be disclosed, so that the Department of Health and Human Services could pursue any action it deems appropriate under the Civil Monetary Penalties Law. It warned: The Order ... strictly limits the use of the documents transmitted herewith to Civil Monetary Penalties Law proceedings against the [pharmacy] and/or [its named pharmacists employee]. Any other use constitutes a violation of the Grand Jury secrecy laws and rules of the State of Maryland, and of the orders of ... the Circuit Court for Baltimore City. The letter explained that three sets of documents were transmitted and described each set. The first set of documents consisted of [o]ne hundred twelve (112) original prescription forms. These are Maryland Medical Assistance prescriptions filled by [two of the pharmacy's stores].... Exhibit A (to the Disclosure Motion) identifies these 112 prescriptions by: a. Prescription number; b. Medical Assistance recipient; c. Type of medication and dosage; d. Date the prescription was filled; e. Date the prescription was allegedly refilled; f. The amount which Medical Assistance paid on the refill claim; and g. The store, identified by number, which refilled the prescription. These prescriptions were received from [the pharmacy]. The prescriptions are being forwarded for Civil Monetary Penalties Unit consideration as evidence of false claims because, as is facially evident, these prescriptions do not contain any authorized refills. The second set of documents consisted of [the pharmacy's] daily prescription audit reports for [a designated store] for the dates October 1, 1985 through March 31, 1986. Separate reports are prepared for each day's prescriptions. Each daily report lists the prescriptions by prescription number. Other information included in the report is: a. The method of payment (this information included under the column headed Plan); b. The [employee] pharmacist who filled or refilled the prescription (RPH); c. The number of pills or milliliters remaining on the prescription (Remain. Qty); d. Whether the entry denotes an original prescription, a refilling, or a deletion. This information is contained under the heading Typ. No entry indicates an original prescription, R indicates a refilling, and D indicates a deletion. The data base for these reports is also used for the computerized billings submitted to the Maryland Medical Assistance Program (Medicaid). The letter gave the name of the employee pharmacist shown as submitting the refill claims for the 112 prescriptions forwarded herewith and identified on the daily prescription reports [by initials]. The third set of documents consisted of [d]aily prescription audit report for [a designated store] for the period October 1, 1985 through March 31, 1985. This is a single report listing all prescriptions filled during that six month period by prescription number. The letter explained: This report was prepared by [the pharmacy] after the daily reports similar to those presented for [the other designated store] were destroyed. Although the daily reports were subject to a grand jury subpoena, [the pharmacy] retained possession of the original document pursuant to an agreement between the Medicaid Fraud Control Unit of the Attorney General's Office and [the] Executive Vice-President and Counsel for [the pharmacy]. The Attorney General's Office was assured by [the Executive Vice-President and the pharmacy's] District Manager ... that the documents would be properly preserved while retained by [the store]. The Attorney General was further assured that all computer information contained on these documents was protected against loss or tampering because the pharmacy computers were programmed to retain all information which a pharmacist attempted to delete, including making a record of the attempted deletion. Nevertheless, when possession of the daily audit reports for [one designated store] was sought by the Attorney General's Office, the office was advised that: a. The daily prescription audit reports had been recently destroyed; b. The pharmacists destroying the documents were not aware of the agreement between [the pharmacy's] counsel and the Attorney General's Office; c. All cash sales had since been deleted from the computers; and d. There was no fail safe mechanism for recovering this deleted information as had been originally communicated to the Attorney General's Office. The document which is transmitted herewith for [the store whose documents were destroyed] was prepared by [the pharmacy] from the information remaining on the computer and, with the exception of all cash sales, contains the same information as that described above for the daily prescription audit reports for [the other designated store]. The transmittal letter concluded by informing the federal government that Maryland Medical Assistance Program payment histories proving paid claims for both original prescriptions and refills and summarized on Exhibit A are available for your inspection at the Office of the Attorney General, Medicaid Fraud Control Unit, .. . or may be obtained from the Department of Health and Mental Hygiene.