Justia Public Benefits Opinion Summaries

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

Gumila, the head of clinical operations for a company that provided home medical care to the elderly, was convicted of 21 counts of health-care fraud, 18 U.S.C. 1347 and three counts of making a false statement in a health-care matter, 18 U.S.C. 1035. There was testimony from more than 20 witnesses and documentary evidence establishing that Gumila regularly overruled physicians who wanted to discharge patients and instructed employees to bill services at unjustifiably high rates, to claim that patients were homebound even when they weren’t, and to order skilled-nursing services even if no doctor had ever examined the patient. The government estimated Medicare’s financial loss: approximately $2.375 million for unnecessary and upcoded home visits; $9.45 million for unnecessary skilled-nursing services that did not meet Medicare’s requirements; and $3.779 million for oversight services that did not qualify for payment or were never performed. The guidelines range was 151-188 months in prison. Gumila argued that the loss should be limited to payments for the eight patients specifically mentioned in the indictment ($14,449). The judge concluded that the government was not required to present specific evidence to prove the fraudulent nature of each individual transaction contributing to the total loss, determined that the loss estimate was reasonable, imposed a sentence of 72 months, and ordered Gumila to pay $15.6 million in restitution. The Seventh Circuit affirmed, upholding the loss calculation and the prison term as substantively unreasonable. View "United States v. Gumila" on Justia Law

Social security survivors' benefits are a thing of value of the United States that can support a conviction under 18 U.S.C. 641. Viewed in the light most favorable to the government, the Fourth Circuit concluded that substantial evidence supported defendant's conviction for theft of government property beyond a reasonable doubt. In this case, the jury could reasonably infer from two denied benefits applications that defendant had a motive to file under a different benefits program to again attempt to obtain benefits to which he was not entitled. Finally, the district court's trial management was reasonable and far from an abuse of discretion. Accordingly, the court affirmed the judgment. View "United States v. Kiza" on Justia Law

Plaintiff was a registered sex offender when he was admitted to the state rental assistance program. Thereafter, the legislature promulgated section 17b-812-13(9) of the Regulations of Connecticut States Agencies, which makes sex offender registration a ground for termination or denial of rental program assistance. The Commissioner of Housing (Commissioner) subsequently terminated Plaintiff’s rental program benefits. Plaintiff took an administrative appeal of the Commissioner’s decision to the trial court, which concluded that the Commissioner’s application of section 17b-812-13(9) was not retroactive and therefore did not exceed the authority granted to the Commissioner by the legislature. The Supreme Court reversed, holding (1) the Commissioner applied section 17b-812-13(9) of the regulations retroactively in this case by imposing a new obligation on Plaintiff’s sex offender status that terminated his rental program assistance; and (2) such retroactive application of the regulation was not statutorily authorized, and therefore, the trial court erred in dismissing Plaintiff’s administrative appeal. View "Shannon v. Comm’r of Housing" on Justia Law

In 2009 Crespo applied for Supplemental Security Income benefits for his mother, representing that she lived with him in Illinois and that he took care of her. He served as her representative payee. By signing the form, Crespo acknowledged that he could be held liable for any improper overpayments he caused. Crespo’s mother was not entitled to those benefits because she lived in Puerto Rico (20 C.F.R. 416.215), which Crespo hid from the Social Security Administration by falsely representing, in three subsequent reports as representative payee, that she lived with him. Airline records established that she resided in Puerto Rico; his mother was serving as representative payee for her own mother’s retirement benefits, declaring herself a resident of Puerto Rico. An ALJ imposed a $114,956 civil penalty on Crespo for misrepresentation. The Departmental Appeals Board of the Department of Health and Human Services dismissed his appeal as untimely. The Seventh Circuit affirmed. The Board did not abuse its discretion in rejecting Crespo’s untimely appeal and finding good cause lacking. Appeals are due 30 days after the ALJ’s initial decision is deemed served. A copy of the regulation is included when the decision is delivered. Crespo offered no reason why he did not request an extension. View "Crespo v. Colvin" on Justia Law