Justia Public Benefits Opinion Summaries

Appellant was a personal care attendant for a Medicaid beneficiary. Appellant was later charged with Medicaid fraud for submitting a false claim for his services. After a bench trial Appellant was convicted under Kan. Stat. Ann. 21-3846(a)(1) for defrauding the Medicaid program. The court of appeals reversed Appellant's conviction, holding that the complaint charged that Appellant submitted statements for services he did not provide while the evidence at trial established that Appellant actually did provide the services for which he submitted statements. The Supreme Court reversed the court of appeals and affirmed the district court, holding that sufficient evidence supported Appellant's conviction for Medicaid fraud.View "State v. McWilliams" on Justia Law

Rebecca Kays was convicted of misdemeanor battery and sentenced to 180 days in jail, suspended to twelve months probation. The trial court ordered as a term of probation that Kays pay restitution in the amount of $1,496. Kays appealed, arguing that the trial court improperly ordered restitution as a term of probation because her only source of income was social security disability benefits. The court of appeals reversed, holding that restitution may not be based on social security income, and therefore, the trial court could not take into account Kays' social security income in determining her ability to pay. The Supreme Court granted transfer, thereby vacating the court of appeals, and reversed the trial court. The Court held that social security benefits may be considered by a trial court in determining a defendant's ability to pay restitution, but the trial court erred in failing to determine Kays' ability to pay restitution and to determine her manner of payment.View "Kays v. State" on Justia Law

Orillo, her husband (a doctor), and another owned Chalice, a home health care provider. Chalice was an enrolled provider with Medicare and could seek reimbursement of home health care through that program. Orillo falsified forms by altering the codes and information that had been completed by the Chalice nurses to make the patient’s condition appear worse and the health care needs greater than the actuality. Those alterations caused Medicare software to generate different reimbursement rates Orillo also aided her husband in paying kickbacks to a Chicago doctor in return for referrals of Medicare patients. Orillo pled guilty to healthcare fraud, 18 U.S.C. 1347 and paying kickbacks to physicians for patient referrals under a federal health care program, 42 U.S.C. 1320a-7b and 18 U.S.C. 2, and was sentenced to 20 months’ imprisonment. Orillo conceded that her scheme caused a loss, to Medicare, in excess of $400,000, and agreed to entry of a $500,000 forfeiture judgment.The district court determined that the loss amount for the healthcare fraud count was $744,481 and ordered her to pay that amount in restitution. The Seventh Circuit affirmed, rejecting Orillo’s argument that the loss and restitution amount should be limited to only those stemming from visible alterations. View "United States v. Orillo" on Justia Law

Defendants, brothers Mathew and Timothy, appealed their convictions related to their participation in Social Security fraud. The court concluded that the government presented sufficient evidence for a reasonable jury to find beyond a reasonable doubt that Mathew knowingly participated in a conspiracy to defraud the United States and that he intended to steal government property; the court rejected Mathew's challenges to his theft of government property conviction by arguing that the government failed to establish that the Social Security funds Timothy received were a "thing of value of the United States;" the government also presented sufficient evidence to support Timothy's convictions; and Timothy's sentence was not unreasonable where the district court considered 18 U.S.C. 3553(a) factors and did not clearly err in weighing them. Accordingly, the court affirmed the convictions and Timothy's sentence. View "United States v. Shirley" on Justia Law

Natale,a vascular surgeon, was compensated by Medicare for repairing a patient’s aortic aneurysm. Another doctor reviewed the post-surgical CT scan, which did not match the procedure Natale described in his operative reports. After an investigation, Natale was indicted for health care fraud related to his Medicare billing, mail fraud, and false statements related to health care. A jury acquitted Natale on the fraud counts but convicted him of making false statements, 18 U.S.C. 1035. The trial court used jury instructions that seemingly permitted conviction for false statements completely unrelated to Medicare reimbursement. The Seventh Circuit affirmed, finding the error harmless, but clarified that under the statute, even conviction for false statements made in connection with items or services still must relate to a “matter involving a health care benefit program.” View "United States v. Natale" on Justia Law

Defendant appealed a district court order adding to her previously imposed sentence a new requirement that she apply all tax refunds and other money she received from any "anticipated or unexpected financial gains" toward an outstanding restitution obligation imposed on her as a part of her sentence. Defendant was convicted of theft of government property because she received Supplementary Security Income (SSI) from the Social Security Administration after her eligibility for such payments had ended. Defendant had been receiving the money on behalf of her special-needs daughter but failed to notify the government when she subsequently married and her husband's income made her ineligible for SSI. The court concluded that the district court abused its discretion by later amending the original sentence in the absence of evidence of the impact the amendment would have on defendant's ability to support herself and her family and, therefore, the court vacated the order. View "United States v. Grant" on Justia Law

Taylor owned a convenience store. In 2008, the store received authorization to redeem benefits through the Supplemental Nutrition Assistance Program, a federally funded program providing nutritional assistance to needy individuals. In 2010-2011, the USDA conducted an undercover operation. Taylor allowed undercover police officers and confidential informants working under USDA special agents to redeem SNAP benefits for cash that Taylor knew would be used to purchase illegal drugs. Taylor once exchanged a firearm for SNAP benefits. Taylor pled guilty to conspiracy to defraud the U.S., SNAP fraud, drug distribution, and being a felon in possession of a firearm. Based on the firearm conviction and Taylor’s criminal history, the probation officer recommended an enhanced sentence under the Armed Career Criminal Act, 18 U.S.C. 924(e), resulting in a Guidelines range of 188 to 235 months. The district court sentenced Taylor to 188 months. Graves, a friend of Taylor’s, worked in the store and would stand outside the store and either sell drugs to people who redeemed benefits for cash or tell them where to find drugs. Graves also sold an informant a firearm and split the proceeds with Taylor’s wife. The district court sentenced Graves to 200 months. The Sixth Circuit affirmed. View "United States v. Taylor" on Justia Law

Venti’s father received federal Civil Service Retirement System benefits. Venti’s father died in 1990, which should have terminated his benefits. The Office of Personnel Management continued to deposit the CSRS funds into a checking account that Venti had shared with his father. In 2003, Venti opened a new joint checking account at RFCU in the names of himself and his father and arranged for the CSRS benefits, as well as his own Social Security benefits, to be deposited in the new account. In 2005, OPM learned of the death of Venti's father and stopped depositing the CSRS benefits. In 2009, Venti was convicted of theft of government property (18 U.S.C. 641), one count for each of nine checks written in his father’s name during 2005, and was sentenced to 15 months. The First Circuit affirmed, rejecting an argument that one count was time-barred. If the count had been time-barred, the sentence would have been limited to one year because Venti would be treated as a misdemeanant rather than as a felon. View "United States v. Venti" on Justia Law

Defendant Barbara Norris, an organizational payee with the Social Security Administration, pled guilty to social security representative payee fraud. The district court sentenced Defendant to eighteen months in prison, the top of her guideline range. Defendant appealed, arguing that her sentence was substantively unreasonable. The Eighth Circuit Court of Appeals affirmed, holding that the district court did not abuse its discretion in sentencing Defendant to eighteen months in prison, as the court properly applied its wide latitude to weigh the factors in the federal sentencing statute and assigned some factors greater weight than others in determining an appropriate sentence. View "United States v. Norri" on Justia Law

Defendant appealed his conviction for social security fraud pursuant to 42 U.S.C. 408(a)(5). The court held that the district court committed no reversible error in the formulation of jury instructions; the district court acted within its discretion when it admitted computer-generated records into evidence; the prosecutor's comments did not warrant reversal of defendant's conviction; the district court committed no error when it denied defendant's motion for judgment of acquittal; and 42 U.S.C. 408(a)(5) was not unconstitutionally vague. Accordingly, the court affirmed the judgment. View "United States v. Berry" on Justia Law