(HC) Pierce v. Holifield

CourtDistrict Court, E.D. California
DecidedJanuary 13, 2022
Docket1:20-cv-00459
StatusUnknown

This text of (HC) Pierce v. Holifield ((HC) Pierce v. Holifield) is published on Counsel Stack Legal Research, covering District Court, E.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
(HC) Pierce v. Holifield, (E.D. Cal. 2022).

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 FOR THE EASTERN DISTRICT OF CALIFORNIA 10 11 DOLPHUS DWAYNE PIERCE, Case No. 1:20-cv-00459-DAD-HBK 12 Petitioner, FINDINGS AND RECOMMENDATIONS TO DENY PETITION FOR WRIT OF HABEAS 13 v. CORPUS AND TO DECLINE TO ISSUE A CERTIFICATE OF APPEALABILITY1 14 ERICA HOLIFIELD, T.R. MERICKEL, FOURTEEN-DAY OBJECTION PERIOD 15 Respondents. (Doc. No. 1) 16 17 Petitioner Dolphus Dwayne Pierce, a state probationer represented by counsel, has 18 pending a petition for writ of habeas corpus under 28 U.S.C. § 2254. (Doc. No. 1). The Petition 19 raises two grounds for relief: (1) the trial court failed to require jury unanimity on the criminal 20 objects of his conspiracy charge and (2) the prosecutor’s office was biased against him. (See 21 generally id.). For the reasons set forth below, the undersigned recommends the Court deny 22 Petitioner any relief on his petition and decline to issue a certificate of appealability. 23 I. BACKGROUND 24 A. Procedural History 25 Pierce initiated this case on March 31, 2020 by filing the instant petition. (Doc. No. 1). 26 On April 15, 2020, the Court ordered Respondents to respond to the petition. (Doc. No. 6). On 27 1 This matter was referred to the undersigned pursuant to 28 U.S.C. § 636(b)(1)(B) and Local Rule 302 28 (E.D. Cal. 2019). 1 June 10, 2020, Respondents filed an answer to the petition and lodged the pertinent state court 2 record. (Doc. Nos. 13, 14, 15, 16). On July 6, 2020, Pierce filed a reply. (Doc. 17). On 3 November 17, 2020, the case was reassigned to the undersigned. (Doc. No. 18). 4 B. Facts Based Upon the Record 5 In 2016, a Kern County jury convicted Pierce of conspiracy to commit insurance fraud. 6 (Doc. No. 13 at 12). Pierce was sentenced to five years of probation on the condition that he 7 serve one year in jail and was ordered to pay restitution. (Id.) The Court sets forth below the 8 pertinent facts of the underlying offenses, as summarized by the California Court of Appeal. A 9 presumption of correctness applies to these facts. See 28 U.S.C. § 2254(e)(1); Crittenden v. 10 Chappell, 804 F.3d 998, 1010-11 (9th Cir. 2015). 11 Introduction 12 Operating under their company, P&R Med-Legal Medical Corporation (P&R), Dolphus Dwayne Pierce II, a chiropractor, and 13 Tomas Ballesteros Rios, a physician, conspired with others to defraud various workers’ compensation insurance carriers. P&R 14 contracted with physicians to perform cursory (if any) examinations of workers’ compensation patients at chiropractic clinics, and then 15 dispense prepackaged medications to these patients with little or no regard for medical need. Pierce and Rios contracted with a 16 company to prepare and submit canned medical reports and bills to workers’ compensation insurance carriers. These bills sought 17 payment for the medications dispensed, and for services relating to the dispensing of medications—some of which were not performed, 18 and some costlier than the services actually performed by the physician. Eventually, a search warrant was executed on businesses 19 and homes associated with P&R. After P&R shut down, Pierce and Rios contracted with another company to rebill the insurance 20 carriers for services initially billed by P&R, seeking to collect on existing unpaid bills for medications previously dispensed. 21 Prosecution’s Evidence 22 Witness Tomas Rios, M.D. 23 Rios pled guilty to conspiracy as charged in count 1 and testified 24 for the prosecution. 25 In the mid 1990’s, while still a medical resident, Rios began moonlighting at a physician’s group as a disability evaluator for 26 Social Security claimants, where he met Dr. Lonnie Powell, a chiropractor. The physicians’ group rented office space from 27 Powell in Visalia, and Rios saw Social Security disability patients there two weekends a month. 28 1 During this time, Rios familiarized himself with the operations of medical corporations having a chiropractic partner, and between 2 1999 and 2002, Rios and Powell formed Physicians Medical Management Group (PMMG), which managed independently 3 contracted physicians to provide medical services as secondary treating physicians for workers’ compensation patients at various 4 chiropractic locations throughout California. Most of the chiropractors whose workers’ compensation patients were seen by 5 these independent contractor physicians were friends and acquaintances of Rios or Powell. The chiropractors were seeking 6 physicians to provide medication and care for their workers’ compensation patients. 7 As explained by Rios, in the workers’ compensation system 8 generally, the chiropractor (as primary treating physician) can provide therapy, but many patients need some type of pain 9 medication, which a chiropractor cannot prescribe. The chiropractor would then refer the patient to a PMMG physician (as 10 a secondary treating physician), who would come to the chiropractic clinic, do their own evaluation and prescribe 11 medication if appropriate. The physician generated a report and signed it, a bill was then prepared, and the report and bill were sent 12 out by PMMG to the workers’ compensation insurance carriers. Payment was made by the carriers to PMMG. 13 Rios knew which various current procedural terminology (CPT) 14 codes were related to the medical services provided and determined which CPT codes would be billed by PMMG for a physician’s 15 services. According to Rios, because the cases referred by chiropractors to the physicians involved nonsurgical muscular- 16 skeletal injuries, the injuries were similar from patient to patient. As such, Rios “already” knew what treatment would be required for 17 the physician to manage the patient, allowing Rios to predetermine what code was necessary to bill. Unless the physician corrected the 18 report to indicate such services were not provided, it was billed as Rios predetermined. 19 Rios testified that there are five levels of examinations specified in 20 the CPT billing codes, ranging from the most basic to the most complex. The report given to the physician would have a specific, 21 predetermined statement on the level of care expected of him, such as a comprehensive medical examination or an intermediate 22 medical consultation. The initial consultation could take anywhere from 30 to 60 minutes and the CPT billing code for that 23 consultation was set at the highest level of service. Follow-up consults were scheduled for less time and billed for less. Rios 24 acknowledged that he might not have specifically articulated to the physicians hired by PMMG that the treatment level, depicted in the 25 reports he showed them as examples, were necessarily the CPT codes that would be billed. 26 PMMG also created a formulary of medicines purchased by PMMG 27 that could be dispensed by the consulting physician. The formulary was a collection of medications Rios predetermined would be used 28 in the practice, although the independent contractor physician could 1 also write a prescription for medication they deemed more appropriate. PMMG would purchase medications to be dispensed 2 with an expectation of later repayment by the workers’ compensation insurance carrier. Since 80 to 90 percent of the 3 workers’ compensation patients referred to the physicians suffered back pain, it was anticipated that the physicians would utilize the 4 formulary of medicines that were available for dispensing. Rios testified that he expected the physicians to dispense medication, 5 because “that’s the reason why [the physician is] in the clinic in the first place.” 6 In 2003, Rios began doing business with Pierce.

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(HC) Pierce v. Holifield, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hc-pierce-v-holifield-caed-2022.