Medicare & Medicaid Guide P 42,940 United States of America v. Wendy Miller Desalvo

41 F.3d 505, 94 Cal. Daily Op. Serv. 9061, 94 Daily Journal DAR 16839, 1994 U.S. App. LEXIS 33531, 1994 WL 666080
CourtCourt of Appeals for the Ninth Circuit
DecidedNovember 30, 1994
Docket93-10686
StatusPublished
Cited by57 cases

This text of 41 F.3d 505 (Medicare & Medicaid Guide P 42,940 United States of America v. Wendy Miller Desalvo) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Medicare & Medicaid Guide P 42,940 United States of America v. Wendy Miller Desalvo, 41 F.3d 505, 94 Cal. Daily Op. Serv. 9061, 94 Daily Journal DAR 16839, 1994 U.S. App. LEXIS 33531, 1994 WL 666080 (9th Cir. 1994).

Opinion

LEW, District Judge:

I. Overview

On June 7, 1993 a jury found Appellant, Wendy DeSalvo guilty on eleven counts of an indictment charging conspiracy to defraud the United States and mail fraud. Pursuant to this verdict, on October 27, 1993, District Court Judge D. Lowell Jensen sentenced DeSalvo to 60 months imprisonment and ordered her to pay restitution in the amount of $970,166.75.

DeSalvo’s conviction arose out of activities connected with her employment at H.W. Care, Inc. (“HWC”), a business founded by her sister and co-defendant in the case below, Kristina Rowland Brambila. DeSalvo was the Chief Financial Officer of HWC, a business that provided consulting services for medical care providers, essentially consisting of auditing work for hospitals and nursing homes.

As part of the services offered to providers, HWC would perform “lost charge audits,” which entailed reviewing provider accounting records to uncover any potential under-billings of the Medicare program. When HWC undertook this service, it would enter into a contingency agreement providing that a portion of any money recovered by the provider from Medicare would be paid to HWC as a fee for its service.

Although the lost charge audits were shown to have been performed for a number of different providers, the grand jury only indicted DeSalvo and Brambila on charges relating to an audit they performed for Regency Hills Convalescent Hospital (“Regency Hills”) in May and June of 1990. Pursuant to a plea agreement, Brambila pled guilty to the charges arising out of this audit and testified against DeSalvo at trial.

DeSalvo’s indictment included one count of conspiracy to defraud the United States and ten counts of mail fraud. All eleven counts of the indictment related to Medicare bills prepared and submitted by HWC on behalf of Regency Hills. The basis of the Government’s allegations was that HWC submitted bills to Medicare for surgical dressings and bandages when the related surgeries had never been performed. These improper Medicare charges allowed Regency Hills to recover payments from Medicare to which it was not entitled. Under their contingency billing arrangement with Regency Hills and other providers, DeSalvo and Brambila profited by taking a percentage as high as 50% of these improper Medicare payments.

DeSalvo and Brambila presented themselves to providers as experts in Medicare billing practices and thus able to identify reimbursable items that the providers’ own accounting personnel might have overlooked. Since the lost charge audits were performed on a contingency basis, the service was presented as a no lose proposition for the provider: If no money was recovered from Medicare, the providers would not be obligated to pay HWC.

By early 1991, DeSalvo was no longer working with HWC or her sister, Brambila, and had started her own Medicare billing service called Medical Reimbursement Consultants (“MRC”), which continued to perform lost charge Medicare audits. As part of an ongoing investigation of HWC’s prior lost charge audits, federal authorities arranged for a meeting between DeSalvo and purported hospital administrators. At this meeting DeSalvo made a promotional presentation for the lost charge audit services that could be performed by her new business. This presentation was recorded on videotape and used as evidence at DeSalvo’s trial.

In the videotaped presentation, DeSalvo claimed to have extensive experience in Medicare billing practices, and she substantially misrepresented the size, success rate *508 and capacity of her business. Moreover, in the presentation DeSalvo described the same contingency fee arrangement for lost charge audits as had been used in HWC’s audit of Regency Hills.

At DeSalvo’s trial, her videotaped presentation was used as circumstantial subsequent similar acts evidence to show that she knew the claims she submitted to Medicare on behalf of Regency Hills were false. The Government alleged, and the trial court found below, that the promotion given on the videotape was probative evidence of DeSal-vo’s knowledge that the Medicare claims she submitted for Regency Hills were false. That is, the fact that DeSalvo acknowledged her experience in Medicare billing practices and continued to promote lost charge audits in the course of her own business illustrated that when she previously submitted lost charge audit claims for Regency Hills, she knew they were false.

In addition to their auditing work for Regency Hills, Brambila and DeSalvo were alleged to have been involved in a number of other lost charge audits. In total, Medicare was shown to have paid out nearly $5,000,000 in false claims as a result of their scheme. The audits done for these other providers were shown by the Government to be largely false, and the various providers eventually repaid Medicare for the improper amounts HWC’s audits allowed them to recover. These repayments included money retained by the providers as well as the contingency fees paid to HWC. Thus, as a condition of Brambila’s plea agreement and as part of DeSalvo’s sentence, they were jointly and severally ordered to pay restitution to the providers for profits paid to them under the lost charge audit scheme. This restitution order applied to all improper lost charge audits performed by HWC, not just those performed for Regency Hills on which De-Salvo was convicted.

DeSalvo raises three issues on appeal: (1) whether the District Court abused its discretion in admitting the promotional videotape into evidence in that it was unfairly prejudicial under Rule 403 of the Federal Rules of Evidence, and was not similar subsequent acts evidence under Rule 404(b); (2) whether the District Court erred in ordering restitution in excess of that allowed under the Victim and Witness Protection Act (‘VWPA”), 18 U.S.C. § 3663, because it applied the amended version of the Act in effect at the time of sentencing rather than the pre-amendment version in effect at the time the crimes DeSalvo was convicted of occurred; (3) whether the' District Court erred in granting restitution by failing to properly consider DeSalvo’s ability to pay. In its brief, the Government responds to all three of Appellant’s contentions and raises a procedural argument that this Court lacks jurisdiction to review the District Court’s orders regarding restitution because DeSalvo’s objections to them are being raised for the first time on appeal.

II. Analysis

A. District Court’s Admission of Videotape

The first substantive issue presented for review is DeSalvo’s contention that the District Court erred in admitting as evidence the promotional videotape she made after leaving HWC, which described her new business and her knowledge and proficiency in performing lost charge audits. DeSalvo claims that this videotape was not similar conduct within the meaning of Rule 404(b) of the Federal Rules of Evidence.

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Bluebook (online)
41 F.3d 505, 94 Cal. Daily Op. Serv. 9061, 94 Daily Journal DAR 16839, 1994 U.S. App. LEXIS 33531, 1994 WL 666080, Counsel Stack Legal Research, https://law.counselstack.com/opinion/medicare-medicaid-guide-p-42940-united-states-of-america-v-wendy-miller-ca9-1994.