Because the existence of a provider agreement is not an element of the crime of health care fraud, the district court properly denied a motion to dismiss the indictment on that ground. However, there was no evidence to support the conviction of the manager of a home health agency of making false statements to the government when she signed a document stating justification for a waiver of the training requirement with respect to a particular employee. Although the manager was involved with supervision and billing, there was no evidence that she knew that the particular document was false. The district court should have acquitted her of that specific count. The trial court's enhancement of the sentence based on the abuse of a relationship of trust and confidence was improper. A provider may hold a position of trust with respect to the Medicare or Medicaid programs. However, the submission of bills is not sufficient to establish the trust relationship. There was no evidence that the Medicaid agency placed greater trust and confidence in the manager than trusting that her bills were accurate.
U.S. v. Hayes, 8th Cir., Aug. 3, 2009, ¶302,941
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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