People v. Berke

603 N.E.2d 737, 236 Ill. App. 3d 322, 177 Ill. Dec. 667, 1992 Ill. App. LEXIS 1598
CourtAppellate Court of Illinois
DecidedSeptember 30, 1992
Docket1-90-1849
StatusPublished
Cited by1 cases

This text of 603 N.E.2d 737 (People v. Berke) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
People v. Berke, 603 N.E.2d 737, 236 Ill. App. 3d 322, 177 Ill. Dec. 667, 1992 Ill. App. LEXIS 1598 (Ill. Ct. App. 1992).

Opinion

JUSTICE CERDA

delivered the opinion of the court:

Defendant, Richard Berke, was indicted on 184 counts of felony theft from the City of Chicago (City) from 1980 to 1985, totalling approximately $100,000, under two criminal statutes: theft by deception (Ill. Rev. Stat. 1979, ch. 38, par. 16 — 1(a)(2)) and theft by unauthorized control (Ill. Rev. Stat. 1979, ch. 38, par. 16 — 1(a)(1)). Following a bench trial, defendant was acquitted of all the counts of theft by deception, but was convicted of 76 counts of theft by unauthorized control. He was sentenced to 30 months’ probation with the condition that he perform eight hours of community service per week. We affirm.

The indictments resulted from defendant’s dentistry practice, which was mostly City employees, and his payment claims for future dental work to be performed, but never completed. On appeal, defendant asserts that this is a civil matter and no crime is involved. The State maintains that this is a criminal matter.

The issue in this case is whether a dentist, who fails to complete dental work for which he submits specific claims and receives payment, is liable for theft and is not merely a contractual dispute.

Dr. Berke, a licensed dentist, performed dental work under the City employee dental plan. When the City instituted its employee dental plan in 1980, Blue Cross/Blue Shield administered the self-insured plan. Two years later, Bankers’ Life and Casualty Company began administering the plan with Blue Cross/Blue Shield. Under the terms of the plan, either the dentist or the patient could submit a dental claim on insurance claim forms. The insurance company would review the claim, pay out the appropriate amount of money, and be reimbursed by the City. The employee had the option of paying his dentist and seeking reimbursement or having his dentist seek payment directly from the plan. As a result of his dental claims, defendant received $208,000 in 1982, $891,000 in 1983, and $309,000 in 1984 from the City.

In 1984, defendant testified before the city council concerning Bankers’ failure to pay him. On January 14, 1985, the City’s corporation counsel’s office asked the Chicago police department financial crimes unit to investigate defendant for suspected fraud. As part of that investigation, police officers spoke with City employees who were defendant’s patients to determine if the work defendant claimed to have provided had actually been done. Then, in November 1985, defendant filed a lawsuit against Bankers’, the City, and Dr. Randall.

Several patients testified, either through direct testimony or by stipulation, about the treatment that defendant provided for themselves and their families. They explained work not completed by defendant and how other dentists finished some of that work. The patients’ charts, claim forms, and payments to defendant were entered into evidence by stipulation.

The State presented several expert witnesses. Dr. Steven Randall, a dental expert, reviewed several of defendant’s claims that were part of the indictment. It was stipulated that Dr. Randall began his review after defendant sued him and the City for nonpayment of 1984 and subsequent claims. It was also stipulated that the review began after other dentists filed claims for purported work done and paid to defendant. Dr. Randall testified that defendant submitted several claim forms for which the dental work claimed on specific dates had not been done.

Dr. Randall also explained that it was reasonably common for dentists to bill for treatment in progress when it reaches an irreversible state of completion. Most insurance companies would not accept a claim before that point, he stated, and anticipated treatment would generally not be billable.

Dr. Robert Sommerfeld, a dentistry expert, examined several of defendant’s patients to determine if the work for which defendant claimed payment had actually been provided. Dr. Sommerfeld compared defendant’s payment claim forms with the work done on those patients. Wherever gold onlays were not installed, Dr. Sommerfeld concluded that the work had not been completed or was finished by other dentists.

Edward Radwinski, a Bankers’ group claims supervisor, testified that Bankers’ made payments when all services had been completed. Under no circumstances, he stated, would Bankers’ authorize payment before completion.

The claim forms for dental reimbursement from Bankers’ contained the certification:

“I hereby certify that the procedures as indicated by date have been completed.”

Defendant testified that 90% of his practice from 1980 through 1984 was City employees. Defendant and his staff saw 65 to 75 patients a day and treated thousands of patients between 1980 and 1984. The office was open six days a week from 6:30 a.m. to 7:30 p.m. and on Saturdays from 6:30 a.m. to 4 or 5 p.m.

In his reconstructive dentistry practice, defendant explained, patients were examined, X-rayed, and a long-term treatment plan was established. The treatment plan would be charted and recorded on the insurance form. All patients were X-rayed and the X rays accompanied the claim form so that the insurance company could evaluate the work. Defendant testified that he listed on the claim form all the work that he intended to do. Often, the work was not complete at the time the form was submitted. Defendant maintained that he intended to finish all the work for which he submitted claim forms.

Defendant stated that his laboratory fees were between $250,000 and $600,000 a year, which he was required to pay. The majority of defendant’s products installed in patients’ mouths were made in the laboratory. Instead of using silver to fill patients’ teeth, defendant always used gold onlays.

Defendant testified that he received payments within three to four weeks when Bankers’ initially became involved in the dental plan. In 1983, however, the turnaround time slowed to two to three months and then, six to seven months. Defendant continually complained, advising Bankers’ that the work claimed had not been finished and that he must be funded to be able to complete the work. At first, Bankers’ explained that their late payments were a result of computer problems. Later, they said payments were not made because not all the work claimed on the forms was completed. Defendant contends that he never concealed the fact that the work was not completed.

Defendant then contacted the city department of insurance, informing them that payments from Bankers’ were very slow, that his work on patients was not completed, and that it could not be completed if he did not get payments within a reasonable amount of time. Kay Berman of the City’s health insurance benefit office acknowledged receiving defendant’s complaints concerning Bankers’ failure to pay him. When defendant came to her office with a suitcase full of unpaid bills, he readily acknowledged that the work on the patients was not finished. Berman presented a letter from defendant that explained the discrepancies in the payment practices of Bankers’ and Blue Cross/Blue Shield and his need to have payment to complete his work.

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Related

People v. Moran
632 N.E.2d 1115 (Appellate Court of Illinois, 1994)

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Bluebook (online)
603 N.E.2d 737, 236 Ill. App. 3d 322, 177 Ill. Dec. 667, 1992 Ill. App. LEXIS 1598, Counsel Stack Legal Research, https://law.counselstack.com/opinion/people-v-berke-illappct-1992.