Justia Public Benefits Opinion Summaries

After a bench trial, Xun Wang was convicted of two counts of Medicaid fraud, and one count of unauthorized practice of a health profession. Defendant earned a medical degree in her native China, and earned a Ph.D. in basic medical science in the United States. Notwithstanding her education in the United States and abroad, defendant was never licensed to practice in a health profession in the United States. The Michigan Department of the Attorney General’s Health Care Fraud Division discovered that a high volume of narcotics prescriptions were being written at the clinic for which she worked part time. In 2014, the department conducted an investigation, during which Drew Macon and Lorrie Bates, special agents with the department, separately went to the clinic while posing as patients with Medicaid benefits. Defendant saw both agents when they posed as patients, identified herself as clinic-owner Dr. Murtaza Hussain’s assistant, and took written notes of their medical histories. Defendant also performed physical examinations, answered their questions, and wrote prescriptions for both agents on a prescription pad that Hussain had previously signed, including a prescription for Ambien, a Schedule 4 controlled substance. The patients’ notes were entered into the clinic’s computer system and were electronically signed by Hussain; the notes indicated that both defendant and Hussain had seen the agents. The Medicaid processing system reflected that claims were submitted for both agents’ treatment and were paid to Hussain for a total of $260. The trial court sentenced her to concurrent terms of 365 days in jail for each conviction, which was suspended upon the successful completion of five years’ probation and the payment of $106,454 in fines and costs. The Michigan Supreme Court found after review that while the lower courts did nor err in determining there was sufficient evidence to convict defendant on unauthorized practice of a health profession, the evidence did not establish she was aware or should have been aware that the patients at issue were Medicaid beneficiaries and their treatment was substantially certain to cause the payment of a Medicaid benefit under the applicable statute. Therefore, defendant's convictions of Medicaid fraud were reversed. The matter was remanded back to the trial court for reconsideration of the fines assessed. View "Michigan v. Wang" on Justia Law

A jury convicted Dr. Chalhoub of defrauding health care benefit programs under 18 U.S.C. 1347. A Kentucky cardiologist, Chalhoub implanted permanent pacemakers in patients who did not need the devices or the tests that he ordered before and after surgery. On appeal, Chalhoub claimed that the district court repeatedly admitted evidence unduly prejudicial to him—and to which he could not effectively respond. The Sixth Circuit affirmed, acknowledging that “some of the government’s tactics here leave something to be desired.” Noting Chaloub’s failure to cross-examine, the court rejected a due process challenge to the admission of testimony by a doctor who claimed to have examined 20 of former Chaloub’s patients but could not name those patients. Chalhoub was not denied a right to be heard and the government did not base its case solely on allegations about those 20 victims. Chalhoub argued that he was severely prejudiced by testimony that he misbilled insurers for other unspecified procedures, but he did not seek clarification or additional information at trial. The court upheld the admission of testimony about Chaloub’s income and expenditures and testimony about his installation of a pacemaker in a former patient. View "United States v. Chalhoub" on Justia Law

Brooke Rojas received food stamp benefits to which she was not legally entitled. Colorado charged her with two counts of theft under the general theft statute, section 18-4-401(1)(a), C.R.S. (2019). Rojas moved to dismiss these charges, arguing that she could only be prosecuted under section 26-2-305(1)(a), C.R.S. (2019), because it created the specific crime of theft of food stamps. The trial court denied the motion, and a jury convicted Rojas of the two general theft counts. Rojas contended on appeal to the Colorado Supreme Court that the trial court erred by denying the motion to dismiss because section 26-2-305(1)(a) abrogated the general theft statute in food stamp benefit cases. A split division of the court of appeals agreed with her. The Supreme Court, however, disagreed with Rojas and the division majority. Based on the statute’s plain language, the Court held that the legislature didn’t create a crime separate from general theft by enacting section 26-2-305(1)(a). View "Colorado v. Rojas" on Justia Law

Defendant Leola Allen plead guilty to committing felony welfare fraud in 1993, 1997, and 2000 (and to committing felony perjury in 2000). At sentencing in each case, the trial court ordered Allen to pay direct victim restitution and various fines and fees. In 2018, Allen petitioned pursuant to Penal Code sections 1203.4 and 1203.42 seeking discretionary "expungement" of her convictions on the basis she had been rehabilitated. She also sought to stay, dismiss, or delete her court-ordered fines and fees because she asserted she was unable to pay them. The prosecution opposed the expungement requests because Allen still owed about $9,000 in direct victim restitution; the prosecution did not oppose the request for relief from the fines and fees. The trial court denied Allen's petitions based on her outstanding victim restitution obligations, but did not directly address her request for relief from the fines and fees. On appeal, Allen argued that under the recent decision in California v. Duenas, 30 Cal.App.5th 1157 (2019), the trial court's denial of her expungement petitions violated her due process or equal protection rights because she was financially unable to pay the victim restitution. Alternatively, Allen contended the trial court erred in its conclusion her outstanding restitution obligations deprived the court of the authority to grant discretionary expungement. The Court of Appeal found Duenas was materially distinguishable: it involved revenue-generating assessments and a punitive restitution fine, whereas this case involves voter-mandated direct victim restitution intended to make the victim whole. Furthermore, the Court agreed with the analysis of numerous courts that rejected Duenas's due process framework. On remand, however, the Court directed the trial court to conduct further proceedings: (1) because the trial court did not directly address Allen's request for relief from the court-ordered fines and fees (other than victim restitution); and (2) because the record was unclear regarding whether Allen paid all the victim restitution owed in connection with her convictions in 2000. In all other respects, judgment was affirmed. View "California v. Allen" on Justia Law

Brooke Rojas received food stamp benefits to which she was not legally entitled. The prosecution charged her with two counts of theft under the general theft statute, section 18-4-401(1)(a), C.R.S. (2019). Rojas moved to dismiss these charges, arguing that she could only be prosecuted under section 26-2-305(1)(a), C.R.S. (2019), because it created the specific crime of theft of food stamps. The trial court denied the motion, and a jury convicted Rojas of the two general theft counts. Rojas contended on appeal that the trial court erred by denying the motion to dismiss because section 26-2-305(1)(a) abrogated the general theft statute in food stamp benefit cases. A split division of the court of appeals agreed with her. The Colorado Supreme Court, however, disagreed with Rojas and the division majority. Based on the statute’s plain language, the Supreme Court held the legislature didn’t create a crime separate from general theft by enacting section 26-2-305(1)(a). View "Colorado v. Rojas" on Justia Law

Medicare pays for doctors’ home visits if a patient is homebound. Mobile Doctors offered physician services to homebound Medicare beneficiaries, hiring doctors who assigned their Medicare billing rights to the company. Upon receipt of payment, Mobile would pay the physician-employee a percentage of what Mobile received from billing Medicare. Many of Mobile’s patients did not actually qualify as homebound. Some doctors signed certifications for additional unneeded treatment from companies that provided at-home nursing or physical therapy services—companies that had referred the patients to Mobile. Mobile submitted Medicare codes for more serious and more expensive diagnoses or procedures than the provider actually diagnosed or performed. Mobile instructed physicians to list at least three diagnoses in the patient file; if the doctors did not list enough, a staff member added more. Mobile only paid the physicians if they checked at least one of the top two billing codes. Doctors who billed for the higher of the top two codes were paid more. Mobile also paid for “standing orders” for testing, although Medicare prohibits testing done under standing orders. Daneshvar joined Mobile as a physician in 2012. After following Mobile’s policies Daneshvar was convicted of conspiracy to commit healthcare fraud but found not guilty of healthcare fraud; he was sentenced to 24 months' imprisonment. The Sixth Circuit affirmed. Daneshvar’s trial was fair; none of the district court’s rulings during that proceeding should be reversed. There was no reversible error with his sentencing. View "United States v. Daneshvar" on Justia Law

Plaintiff, a civilly committed sexually violent predator, had to pay for GPS monitoring or be prosecuted under a now-repealed Texas law. Plaintiff filed suit alleging that the pay-or-be-prosecuted penalty violated the Social Security Act's anti-attachment provision, 42 U.S.C. 407(a), which protects benefits from execution, levy, attachment, garnishment, or other legal process.The Fifth Circuit affirmed the district court's grant of summary judgment to officials based on qualified immunity, holding that plaintiff's Social Security benefits were not executed on, levied, attached, or garnished. Furthermore, criminalizing a sexually violent predator's failure to pay for GPS monitoring is not "other legal process" under section 407(a). Therefore, the district court correctly interpreted the anti-attachment provision and the officials were entitled to qualified immunity. View "Reed v. Taylor" on Justia Law

In 2016, Washington charged Jason Catling with two counts of delivery of heroin. Pursuant to a plea deal, Catling pleaded guilty to one count in exchange for the State's agreement to dismiss the other, and to recommend a residential drug offender sentencing alternative (DOSA). During the sentencing hearing, Catling's attorney argued that because Catling's sole source of income was Social Security disability benefits, the trial court should not impose any legal financial obligations (LFOs), including mandatory obligations, based on the Washington Supreme Court's decision in City of Richland v. Wakefield, 380 P.3d 459 (2016), which had just issued the day before Catling's sentencing hearing. The trial court took the LFO matter under advisement, finding Catling's sole source of income were benefits totaling $753 per month. The trial court ultimately issued an order imposing LOFs totaling $800, finding LFOs could be ordered when a person was indigent and whose only source of income was social security disability. The Court of Appeals held that the particular obligations imposed here did not violate the federal antiattachment statute, but remanded for clarification of the payment order. The Supreme Court reversed the Court of Appeals in part, holding that the trial court erred in imposing a $200 filing fee on Catling. Further, the case was remanded to the sentencing court for a determination of whether Catling previously provided a DNA sample; if so, then the trial court's imposition of a $100 DNA collection fee was in error. The Supreme Court affirmed the imposition of the $500 crime victim fund assessment, but remanded for the trial court to revise the judgment and sentence and repayment order to comply with HB 1783, and to indicate the LFO could not be satisfied out of Catling's Social Security benefits. View "Washington v. Catling" on Justia Law

In this case, a Supplemental Nutrition Assistance Program (“SNAP”) recipient, Cindy Gonzalez, was found to have defrauded the federal government of $6,159 worth of SNAP benefits by representing that she lived alone and did not receive any income, when in fact she was not living alone and was receiving income. After discovering this wrongdoing, the Delaware Department of Health and Social Services (“DHSS”) brought an administrative proceeding against Gonzalez to disqualify her from continued participation in SNAP and claw back the benefits she received through her misrepresentations. The hearing officer found that DHSS had established intentional program violations and disqualified Gonzalez from continued participation in SNAP for one year, and DHSS’s audit and recovery arm assessed an overpayment of $6,159, which the federal government has started to collect by offsetting the other federal benefits she receives against her SNAP obligations. About five months after the DHSS final decision, the State of Delaware brought a civil action against Gonzalez under Delaware common law and the Delaware False Claims and Reporting Act based on the same circumstances underlying the DHSS administrative proceeding. This time, however, the State sought between approximately $200,000 and $375,000 in restitution, damages, and penalties; attorneys’ fees and costs; and an order enjoining Gonzalez from participating in SNAP until she pays the judgment. Gonzalez in turn filed an answer asserting an affirmative defense that federal law preempted the State’s Delaware law claims, and the State moved for judgment on the pleadings. The Superior Court granted the State’s motion, holding that federal law did not preempt the State’s claims. Gonzalez brought an interlocutory appeal of that determination. After review, the Delaware Supreme Court reversed, finding federal law prohibited the State from bringing consecutive administrative and civil actions against a SNAP recipient based on the same fraud. View "Gonzalez v. Delaware" on Justia Law

Brown, the manager of a company that provided home physician visits, and Talaga, who handled the company’s billing, were convicted of conspiracy to commit health-care fraud, 18 U.S.C. 1349; six counts of health-care fraud, 18 U.S.C. 1347; and three counts of falsifying a matter or providing false statements, 18 U.S.C. 1035(a). The district court sentenced Mr. Brown to 87 months’ imprisonment, 34 months below the Guidelines’ range, stating that a significant sentence was warranted because of the duration of the scheme, the amount of the fraud, the need for general deterrence, and Brown’s failure to accept responsibility. Ms. Talaga was sentenced to 45 months. The Seventh Circuit affirmed, rejecting Brown’s argument that the court’s assumptions about the need for general deterrence were unfounded and constituted procedural error and Talaga’s arguments that the court calculated the amount of loss for which she was responsible by impermissibly including losses that occurred before she joined the conspiracy. The district court was under no obligation to accept or to comment further on Brown’s deterrence argument. Talaga, as a trained Medicare biller, knew that that the high-volume billings were fraudulent. View "United States v. Talaga" on Justia Law