United States v. Crabtree, 11th Circuit, filed 1/3/18: Fraud and Double Jeopardy Clause, Dismissed Juror, Jury Charges

Defendants’ conviction of Medicare fraud was upheld, after finding that an acquittal of one crime did not necessarily elicit a finding of acquittal for other charges, nor was this a violation of the Double Jeopardy Clause. The court also upheld the adequacy and appropriateness of evidence and failed to find any procedural impropriety in dismissing a juror or issuing jury charges.

Health Care Solutions Network, Inc (HCSN) was set up as a partial hospitalization program (PHP), a bridge between more restrictive inpatient care and outpatient care. PHP’s reimbursed by Medicare are required to follow specific standards and comply with strict documentation requirements. The defendants, workers at HCSN, were part of an elaborate defrauding scheme, which started with patient recruitment. Patients were referred to them by various other medical practitioners in exchange for cash kickbacks. HCSN altered patient records and profiles which would have otherwise revealed disqualifying criteria, among other violations. The scheme happened for 7 years, resulting in $63 million in fraudulent Medicare claims.

The procedure of this case is a bit confusing. Two trials occurred. At the end of the first trial, the defendants were acquitted of making false statements, but the jury was hung on the counts of conspiracy to commit health care fraud. The defendants moved for acquittal, arguing that if the jury acquitted them of false statements, then that would entail a finding they were not part of the conspiracy. The district court disagreed, and a second trial was held. The defendants were found guilty of conspiracy to commit health care fraud. The defendants appealed.

Double Jeopardy

First, the defendants argued that because they were acquitted on the false statement counts, their conspiracy charges should be acquitted under the double jeopardy clause. The Double Jeopardy Clause of the 5^th amendment does not prevent the government from retrying defendants on mistrials unless an issue of ultimate fact has been determined by a valid and final judgment, and that issue contains an essential element of the mis-tried charge. Here, the defendants’ acquittal did not determine any factual issue that was an essential element of the health care fraud conspiracy charge, and therefore, the double jeopardy clause was not violated. Just because the defendants were found to have not made false statements on the specific patient notes in question does not mean that there were any other factual determinations that were determined from the acquittal of this charge. Not making false statements was not a fact essential to the health care fraud conspiracy count.

Insufficient Evidence

The defendants argued that the evidence was circumstantial and demonstrated mere negligence, rather than an intent to defraud. In a conspiracy to defraud, the prosecution has to prove that the defendant knew of the ‘essential nature’ of the conspiracy, and convictions can be upheld when the evidence shows that the conspiratorial activity is so obvious that the defendant must have known- even with just circumstantial evidence. Witnesses testified that defendants asked them to doctor-patient notes and files and that kickbacks were often discussed in the office. Testimony showed it was obvious that patients were unqualified for PHP treatment. Evidence showed Rousseau was aware of the nature of the fraud occurring in the office, too: he was paid money to sign whatever documents were put in front of him without meeting patients or reviewing their medical needs. He allowed his signature stamp to be used without permission so that documents could get signed more quickly. Witnesses also testified he instructed the alteration of patient files to make them Medicare compliant. The evidence provided was sufficient to support a conviction.

Wrongful admission of Evidence and Dismissal of Juror

The defendants also claimed that the trial court inappropriately admitted evidence and testimony which confused the jury, or was irrelevant and overly prejudicial. The appellate court found that testimony was relevant concerning motive, and to the knowledge of the defendants concerning the conspiracy. Any error was harmless in light of the other overwhelming evidence presented.  The defendants argued that the district court erred when dismissing a juror for showing up late during closing arguments. The decision to remove a juror is at the sound discretion of the judge, and will not be disturbed unless there is evidence of prejudice to the defendant as a result. The court was entitled to dismiss a juror who had been late on several other occasions throughout the trial and delayed closing arguments by 15 minutes. The trial court did not err in dismissing this juror.

Finally, the defendants argue that the jurors were improperly charged when the court delivered a “deliberate ignorance” instruction. These instructions are appropriate when there is evidence a defendant purposely avoided finding out the truth to also avoid prosecution. There was no evidence of this.  The instruction came with a confusing analogy as well. Instructing the jury on deliberate ignorance is harmless if the jury could also have convicted on an alternative and supported theory – and they were in this case. The analogy was not an error – it was an accurate analogy, and no defendant objected to its inclusion at trial.

None of the arguments warranted any reversal of the trial court’s convictions in this matter.

The court also reviewed the sentence enhancements added on for Dr. Rousseau’s conviction. Essentially, because he was in such a position of authority and power, the court held that the trial court did not err in implementing enhancements to his sentences.