James Agbeze v. State

CourtCourt of Appeals of Texas
DecidedJuly 25, 2014
Docket01-13-00140-CR
StatusPublished

This text of James Agbeze v. State (James Agbeze v. State) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
James Agbeze v. State, (Tex. Ct. App. 2014).

Opinion

Opinion issued July 25, 2014.

In The

Court of Appeals For The

First District of Texas ———————————— NO. 01-13-00140-CR ——————————— JAMES AGBEZE, Appellant V. THE STATE OF TEXAS, Appellee

On Appeal from the 180th District Court Harris County, Texas Trial Court Case No. 1288928

MEMORANDUM OPINION

James Agbeze, a licensed government contractor, was indicted for

submitting a series of fraudulent Medicaid reimbursement claims. The jury

convicted Agbeze of theft of property by a government contractor with an aggregated value of $1,500 or more, but less than $20,000,1 assessed punishment at

seven years’ community supervision, and imposed a $10,000 fine. The trial court

ordered Agbeze to spend 90 days in jail as a condition of community supervision

and to pay $18,169.45 in restitution. On appeal, Agbeze contends that (1) there was

insufficient evidence to prove that he intentionally or knowingly committed theft

or that individual over-charges were part of a larger criminal scheme to allow the

theft amounts to be aggregated and tried as one offense and that (2) the trial court

abused its discretion in ordering him to pay $18,169.45 in restitution. We affirm.

Background

In 2005, Agbeze began doing business as Browne Medical Supply and

became a licensed Medicaid contractor providing durable medical equipment to

Medicaid beneficiaries. Agbeze would purchase and deliver certain medical

supplies, including incontinence products, and then submit a reimbursement claim

to the Health and Human Services Commission. HHSC would then reimburse him

for the products that he had provided to his clients.

In 2007, a state Medicaid investigator conducting an oversight review of

Agbeze’s records discovered that Agbeze was routinely filing reimbursement

1 See TEX. PENAL CODE ANN. § 31.03(a), (e)(4)(A), (f)(4) (West 2012) (listing penalties for theft when actor is Medicare provider with contractual relationship with federal government); see id. § 31.09 (West 2012) (aggregating amounts involved in theft when amounts are obtained in one scheme or continuing course of conduct and using aggregate amount to determine grade of theft). 2 claims for the monthly maximum number of incontinence products allowed under

Medicaid restrictions. According to HHSC’s preliminary review of Agbeze’s

claims, Agbeze was “consistently billing” his clients for 300 extra-large adult

diapers and other supplies including hygienic wipes and underpads.

Based on these preliminary findings, Agbeze became subject to a formal

Medicaid investigation, which revealed that Agbeze had submitted multiple

reimbursement claims for incontinence supplies without actually delivering the

products to clients. Based on this information, Jesse Mack, a member of the state

Medicaid Fraud Control Unit, initiated a criminal investigation into Agbeze’s

claims-filing practices. Relying on evidence that included unsigned and forged

delivery slips, outdated client authorization forms, and incomplete files

documenting client orders and authorizations, the investigators concluded that

Agbeze had submitted multiple fraudulent reimbursement claims over the course

of five years. The Fraud Control Unit determined that Agbeze was reimbursed an

estimated $77,000 for fraudulent claims for incontinence supplies between 2005

and 2007 and an additional $55,000 between 2008 and 2010.

Agbeze was indicted for first-degree felony theft of property by a

government contractor. At trial, the jury heard testimony from several HHSC

investigators, including Consuelo Chavez, who testified that HHSC investigators

had discovered Agbeze’s fraudulent claims-filing patterns and that, despite

3 HHSC’s request, Agbeze failed to produce complete files related to the disputed

reimbursement claims.

HHSC Senior Policy Advisor, Sharon Thompson, also testified regarding

Agbeze’s claims records and discussed the application process and rules governing

Medicaid contractors. Thompson testified that Agbeze’s billing records were

unusual because the maximum product limits were established based on a “worst

case scenario” and only a small percentage of beneficiaries actually required the

maximum number. Thompson also explained that a provider “trying to maximize

their billing, whether they provided the service or not . . . [would] consistently

[bill] for extra large adult [products].”

In his original application for licensure as a Medicaid contractor, Agbeze

affirmed that he understood the Medicaid provider duties and responsibilities,

including the duty to refund any overpayments, duplicate payments, or erroneous

payments as soon as an error was discovered and to verify and track claims that he

submitted. The State Medicaid provider manual, which accompanied Agbeze’s

application, limited the number of certain products for which he could submit

reimbursement claims without prior Medicaid authorization. The manual also

directed Agbeze to retain all documentation of submitted claims and patient

information for five to ten years to facilitate investigation of potential fraud and

ensure accurate provider reimbursement. The jury heard testimony from Agbeze’s

4 clients who did not receive the total number of incontinence supplies for which

Agbeze had sought reimbursement. The State also offered evidence of incomplete,

unsigned and forged delivery receipts, deficient physician authorization forms, and

noncompliance with the state Medicaid contractor manual.

Based on this evidence, the jury convicted Agbeze of the third-degree felony

offense of aggregated theft and assessed punishment at seven years’ community

supervision and imposed a $10,000 fine. Additionally, the trial court ordered

Agbeze to pay restitution of $18,169.45 to reflect the amount of fraudulently

submitted claims.

Agbeze timely appealed.

Sufficiency of the Evidence

In his first issue, Agbeze contends that the evidence was insufficient to

prove that he had intentionally or knowingly committed aggregated theft.

Specifically, Agbeze contends that the State failed to prove that (1) he intentionally

appropriated property without the effective consent of the owner or that (2) his

actions were part of one scheme or a continuous course of conduct such that the

amounts of theft could be aggregated.

A. Standard of review

We review challenges to the sufficiency of the evidence under the standard

enunciated in Jackson v. Virginia, 443 U.S. 307, 318–20, 99 S. Ct. 2781, 2788–89

5 (1979). See Ervin v. State, 331 S.W.3d 49, 52–56 (Tex. App.—Houston [1st Dist.]

2010, pet. ref’d) (citing Brooks v. State, 323 S.W.3d 893, 894–913 (Tex. Crim.

App. 2010)). Under the Jackson standard, evidence is insufficient to support a

conviction if, considering all the record evidence in the light most favorable to the

verdict, no rational factfinder could have found that each essential element of the

charged offense was proven beyond a reasonable doubt. See Jackson, 443 U.S. at

317–19, 99 S. Ct. at 2788–89; Laster v. State, 275 S.W.3d 512, 517 (Tex. Crim.

App. 2009).

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