Medicare&medicaid Guide P 41,995 United States of America v. Tom Henry, David Jones and James Henry

12 F.3d 215
CourtCourt of Appeals for the Sixth Circuit
DecidedNovember 29, 1993
Docket92-6649
StatusUnpublished

This text of 12 F.3d 215 (Medicare&medicaid Guide P 41,995 United States of America v. Tom Henry, David Jones and James Henry) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth 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 41,995 United States of America v. Tom Henry, David Jones and James Henry, 12 F.3d 215 (6th Cir. 1993).

Opinion

12 F.3d 215

Medicare&Medicaid Guide P 41,995
NOTICE: Sixth Circuit Rule 24(c) states that citation of unpublished dispositions is disfavored except for establishing res judicata, estoppel, or the law of the case and requires service of copies of cited unpublished dispositions of the Sixth Circuit.
UNITED STATES of America, Plaintiff-Appellee,
v.
Tom HENRY, David Jones and James Henry Defendants-Appellants.

Nos. 92-6649, 92-6650 and 92-6653.

United States Court of Appeals, Sixth Circuit.

Nov. 29, 1993.

Before: KEITH and KENNEDY, Circuit Judges; and JORDAN, District Judge.*

PER CURIAM:

Defendants-Appellants, Tom Henry, David Jones and James Henry, appeal their convictions in connection with the theft of Medicare funds. James Henry was convicted of Making False Statements, in violation of 18 U.S.C. Sec. 1001. Tom Henry and David Jones were convicted of Conspiring to Defraud the United States, in violation of 18 U.S.C. Sec. 371, Obstructing a Federal Audit, in violation of 18 U.S.C. Secs. 1516 and 2, and Making False Statements, in violation of 18 U.S.C. Secs. 1001 and 2. In addition, Tom Henry was convicted of Theft Concerning Programs Receiving Federal Funds in violation of 18 U.S.C. Sec. 666(a)(1)(A), Paying Kickbacks for Referral of Patients in violation of 42 U.S.C. Sec. 1320(a)-7b(b)(2)(a), and Money Laundering in violation of 18 U.S.C. Secs. 1957 and 2. For the reasons stated below, we AFFIRM the convictions and sentences imposed by the district court.

I.

Tom Henry owned and operated Tennessee Health Services, Inc., (THS), which was the home office for numerous Home Health Care Agencies (HHCA) which he also owned, including First Tennessee In-Home Care (FTHHA); Mid-Cumberland Home Health (MCHHA); Doctors Home Health, Inc., (DHHA); South Central Home Health (SCHHA); and South West Home Health, Inc. (SWHHA). Tom's brother, James Henry, was the administrator of SCHHA. Unlike the other HHCAs owned by Tom Henry, SCHHA maintained its own checking accounts, accounts receivable and payroll. Tom Henry controlled the accounts of the other HHCAs from THS.

The HHCAs were licensed by Medicare. Medicare is administered by the U.S. Department of Health and Human Services (HHS). HHS contracts with insurance companies (intermediaries) to distribute Medicare funds. The intermediary pays the Medicare funding to providers of medical care, such as HHCAs. Medicare covers the reasonable cost of direct patient care and overhead expenses incurred.

The HHCAs receive Medicare funds through the intermediary at interim periods during the year based on claims for the preceding year. At the end of the fiscal year, the HHCA submits a cost report to the intermediary summarizing expenses incurred that year for its Medicare patients. The intermediary reviews the cost report and if the actual costs on the report are more than the HHCA received during the year, Medicare pays the difference. If, however, the actual costs incurred by the HHCA for the year are less than the amount advanced by the intermediary, the HHCA must repay Medicare the difference.

The appellants in this case were involved in a number of transactions which enabled them to pilfer Medicare funds. One method of unlawfully receiving Medicare funds was to direct the HHCAs to conduct business transactions with companies which the appellants secretly owned, and seek reimbursement for the profits made. An HHCA may do business with a related party, such as a company that is owned by or controlled by the owner of the HHCA. However, the HHCA may not receive Medicare money for profits made on the goods or services provided by that related party.

The appellants perpetrated this scam a number of times. For example, In 1989, David Jones and Tom Henry formed a management company called Datom International to manage the HHCAs. In addition, they formed Datom Business Service to perform accounting services for the HHCAs. In order to receive Medicare money for profits made from the management and accounting businesses, Tom Henry purported to sell THS and the HHCAs for $25,000 to John Greer, Jr. In fact, the transaction was a sham; no money changed hands. Tom Henry and David Jones continued to control the agencies.

Also, in 1988, Tom Henry and David Jones "bought" Argus Medical Supply (Argus) from Sidney Ford, again for no money. Argus sold medical supplies to the HHCAs owned and operated by Tom Henry, with a markup of at least 65 percent. In addition, Tom Henry was one of the owners of First Tennessee Medical Supplies, Inc. Tom Henry directed employees of his HHCAs to purchase medical equipment from First Tennessee Medical Supplies, Inc. Tom Henry also formed KM & M Leasing Company (KM & M) with John Greer, Sr. KM & M leased vehicles and office furniture to the HHCAs owned by Tom Henry. Tom Henry split KM & M's profits with John Greer, Sr.

For each of the cost reports filed for the HHCAs, the appellants indicated that business was conducted with Argus, First Tennessee Medical Supplies, KM & M and profit was charged to Medicare as a cost. Nevertheless, the cost reports falsely stated that there had been no transactions conducted with related parties for the years in question.

In another scheme to illegally receive Medicare funds, Tom Henry paid a number of physicians a monthly fee to refer patients to his HHCAs. In 1988, Henry paid approximately $50,000 to these physicians under the guise of "medical advisors." Henry claimed that amount on the Medicare cost report for that year.

In an additional effort to defraud Medicare funding, in 1989, David Jones and Tom Henry hired Dan Miller, an accountant, to prepare a draft of the 1988 cost reports for the HHCAs. The agencies received money from Medicare during 1988 through interim payments. Miller found that in 1988, Medicare paid the HHCAs approximately $300,000 over the actual reimbursable costs incurred. In order to avoid reimbursing Medicare, David Jones told Miller to falsify the records so that it would appear nothing was owed to Medicare. Accordingly, Miller increased the salary amounts listed in the cost reports of some of the HHCAs for 1988, to make it appear that bonuses were paid to employees.

In 1989, the 1987 costs reports for a number of HHCAs were audited. To hide the fact that these bonuses were never paid, Tom Henry ordered Miller to give the auditors bogus checks and bank statements, including checks that had not cleared the bank and checks that were altered.

After learning that the 1988 cost reports would be audited, Tom Henry told Miller to prepare a list of employees and the amount supposedly paid to them in bonuses to match the amounts stated on the 1988 cost report. Tom Henry also told Miller to prepare notes of financial obligation purporting to reflect bonuses due to the employees, containing the employees' initials or signature. Many employees testified that the initials or signatures on the notes were not their own. In addition, David Jones told Miller to prepare Merit Pay Schedules purporting to show liquidation of the bonus amounts. The schedules were actually a listing of the employees' regular pay checks.

Miller also gave auditors documentation to support mileage expenses for Tom Henry for the THS cost report.

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Bluebook (online)
12 F.3d 215, Counsel Stack Legal Research, https://law.counselstack.com/opinion/medicaremedicaid-guide-p-41995-united-states-of-america-v-tom-henry-ca6-1993.