Massachusetts Appellate Court Rejects Defendant’s Appeal in Medicare False Claims and Larceny Case

In a recent Supreme Judicial Court of Massachusetts written opinion regarding a Massachusetts Medicare false claim and larceny case, the court upheld the trial court conviction of the defendant for four counts of violating the Medicaid false claims statute, and one count of larceny over $250 by false pretenses, holding that the trial court was correct in its decisions. The Supreme Judicial Court concluded that due to a variety of reasons, the five claims made by the defendant are not compelling, and subsequently, affirmed the trial court decision.

Facts of the Case

According to the court’s opinion, on April 8, 2014, the defendant signed a provider contract agreeing to “comply with all federal and state laws, regulations, and rules.” In 2015, the defendant overruled the assessment of a registered nurse regarding the care of two patients, directing that the two patients receive more hours than the registered nurse had determined was necessary for their care. These directions would become the basis for the larceny and Medicare false claim charges registered against the defendant.

Additionally, the defendant falsely instructed one of her employees to cover up illegal practices regarding overcharging, telling her to label them “clerical errors” and “inadvertent” even though they were intentional. Another employee involved in the defendant’s billing process raised the alarm, pointing out that home health aides working for the defendant did not have the required training certifications. When she brought this to the attention of the defendant, she was told to continue billing for the services regardless of certification level. Finally, facing an external audit, the defendant engaged in fraudulent practices, attempting to fool auditors by having files faxed to the office to convince outside observers that the files were received from external doctors when they were in fact sent by the defendant back to herself.

The Decision

The defendant advanced five major claims, (1) that her right to avoid self-incrimination was violated, (2) that her motions to suppress were improperly denied, (3) that the trial court improperly admitted a letter, (4) the validity of the MassHealth regulation, and (5) disputing the sufficiency of the evidence.

On the first issue, the appellate court found that someone who has agreed to report overpayments as part of her voluntary participation in a regulatory scheme has no constitutional right to ignore that obligation in furtherance of her efforts to retain money to which she knows she is not entitled. Regarding the second issue, the appeals court found no grounds on which the documents in question should have been suppressed, stating that the trial court properly denied the motion. On the third issue, the court found that the letters were properly admitted as they were not offered for their truth, but to establish additional context regarding the circumstances surrounding the defendant. Regarding the fourth issue, the appellate court found that the jury found properly on the issue and that interpreting the regulation was not the duty of the jury. Finally, on the fifth issue, the appeals court found that the investigative methods of the Commonwealth were sound and that the defendant’s last claim was without merit. Ultimately, the court affirmed the judgments of the trial court, rejecting the defendant’s appeals.

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