Culver v. State

562 S.E.2d 201, 254 Ga. App. 297
Court of Appeals of Georgia·Decided June 21, 2002·No. A01A2319, A01A2339·Published·Cited by 6 cases

Opinion

Ruffin, Judge.

A Fulton County grand jury indicted Michael J. Kell and Michael D. Culver for conspiracy to defraud the State, Medicaid fraud, false writings, and, as to Kell, three counts of tax evasion. Following a bench trial, the trial court found Kell and Culver guilty of the charged offenses. They appeal, primarily challenging the sufficiency of the evidence and venue. For reasons that follow, we affirm in part and reverse in part the convictions of both defendants. 1

Viewed favorably to support the verdict, 2 the evidence shows that Kell, a medical doctor, founded Private Clinic and Private Clinic Laboratories (“PCL”), which were located in the same building in Fulton County. Culver worked for Kell, helping with Kell’s daily business activities and acting as his “right hand man.”

Both Kell and PCL were enrolled as Medicaid providers with the Georgia Department of Medical Assistance (“DMA”), the state agency that administered the Medicaid program. In the early 1990s, Kell individually billed Medicaid millions of dollars annually as a physician provider in Georgia’s methadone drug treatment program. During this time, PCL submitted only a small volume of Medicaid billings. Around 1996, however, the DMA discontinued the methadone program, ending Kell’s significant reimbursements for methadone treatments.

Also in 1996, Kell became concerned about the legality of referring his Medicaid patients to a laboratory that he owned. Accordingly, he agreed to sell PCL’s assets to Servicios Medicos Panamerica-nos Sociedad (“Servicios”), a Costa Rican corporation, for $300,000, payable over five years. Ecomed Labs, LLC, a corporation organized *298 by Kell’s attorney and in which Servicios held 98 percent of the ownership, took over PCL’s laboratory operations. Kell employees Mark Bailey and Patsy Lewis were told that each owned one percent of Ecomed’s stock, although they never paid for the stock, received a stock certificate, or earned any stock dividends.

Following the sale, various Kell employees began working for Ecomed, and Kell served as Ecomed’s laboratory director, as well as an Ecomed corporate officer. Bailey was also appointed trustee of a trust Servicios created to operate Ecomed. Bailey acted in that capacity until 1997, when Kell became trustee.

After taking over PCL’s operations, Ecomed became a Medicaid provider and granted to Michael Jon Kell, M.D., Ph.D. & Associates, PC. (“Kell P.C.”), one of Kell’s corporations, a power of attorney to submit electronic claims to DMA for Medicaid reimbursement. In 1996, after the State discontinued the methadone program, Ecomed began submitting Medicaid billings to DMA in excess of $1 million, which caught the attention of DMA investigators. As described by one DMA employee, the billings from Kell and the laboratory “almost swapped.” When the methadone program ended, billings “in excess of a million dollars . . . started coming out of the laboratory.”

DMA investigators reviewed Ecomed’s Medicaid records and determined that the laboratory was submitting a high volume of billings for urine drug testing on a small patient base, charging Medicaid $25,000 to $30,000 annually per patient for these tests. Investigators further discovered that “testing was occurring with such a frequency that the results would not be back from the first test before [the patients] were given their second or sometimes third test in a week.” The billings also revealed that Kell referred these patients to Ecomed through Private Clinic.

For urine drug tests conducted between September 1996 and November 1997, Medicaid paid Ecomed between $180 and $204 per test. These tests, often run on a patient twice a week, screened for multiple drugs, such as amphetamines, barbiturates, alcohol, and methadone. The individual cost to screen for each drug factored into the overall price.

In contrast, Michael Kulas, a Kell employee who worked with the billing system, testified that Ecomed charged self-pay patients referred by the Grady Hospital Drug Dependence Unit just $19.20 for a urine drug test. Invoices generated throughout the summer of 1996 also confirmed that Ecomed charged Grady Hospital $19.20 to test a patient’s urine, and the evidence showed that Ecomed conducted urine drug tests on Grady patients during the September 1996 through November 1997 time period. The documentary evidence does not reveal which individual drug screens were included in those tests. But Kulas testified that the tests conducted on Grady self-pay *299 patients were the same as those run on Medicaid patients. Ecomed’s lab manager similarly testified that she knew of no difference between the urine tests performed on patients referred by Grady and patients referred by Private Clinic, such as the Medicaid patients.

Investigators also discovered that, in 1994, PCL, through Kell, bid for a contract with Grady Health System to perform drug testing on Grady patients. The proposal recommended that patients be tested at least weekly for methadone and opiates to detect abuse. According to the proposal, however, drugs such as amphetamines, barbiturates, propoxyphene, and alcohol “[could] be adequately monitored through once a month testing in persons without recent histories of abuse.” Thus, PCL advocated that Grady “test for all drugs [listed in the proposal] at least once a month on a random schedule, except for opiates and methadone (and prescribed/a&used drugs in any particular patient) [which should] be tested at least once a week on a random schedule.” 3 Despite this recommendation, between August 1996 and November 1997, Ecomed screened certain Medicaid patients well over once per month for amphetamines, barbiturates, propoxyphene, and alcohol, even when those patients showed no recent history of abuse.

In addition to this Medicaid-related evidence, the State introduced testimony and documents involving taxation. In 1995, the employee leasing company that processed the payroll for various Kell-related companies (“employee leasing”) issued Kell a W-2 form reporting that he earned $342,457.81 in wages. The following year, Kell received $23,000 in miscellaneous income from Ecomed, wages totaling $25,798.56 from employee leasing, and $34,496 in compensation as an officer of Kell PC. As an officer in PCL, Kell also earned $204,022 in compensation for the October 1,1995 through September 30, 1996 fiscal year, and $121,539 from October 1, 1996, through September 30, 1997. In 1997, employee leasing reported $165,340.75 in wages for Kell, and he also earned $27,600 as a Kell P.C. corporate officer. The evidence further showed that, in 1998, Kell received $67,456 from employee leasing and $194,325 from UD Testing, a company that employed Kell as its research director.

Free access — add to your briefcase to read the full text and ask questions with AI

Culver v. State, 562 S.E.2d 201, 254 Ga. App. 297 (Ga. Ct. App. 2002).

562 S.E.2d 201 (Culver v. State) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Malloy v. State
744 S.E.2d 778 (Supreme Court of Georgia, 2013)
New York v. Amgen Inc.
652 F.3d 103 (First Circuit, 2011)
Kell v. State
585 S.E.2d 915 (Court of Appeals of Georgia, 2003)
Cash v. State
581 S.E.2d 726 (Court of Appeals of Georgia, 2003)
State v. Kell
577 S.E.2d 551 (Supreme Court of Georgia, 2003)