State v. Martinez

920 A.2d 715, 392 N.J. Super. 307
CourtNew Jersey Superior Court Appellate Division
DecidedApril 19, 2007
StatusPublished
Cited by16 cases

This text of 920 A.2d 715 (State v. Martinez) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State v. Martinez, 920 A.2d 715, 392 N.J. Super. 307 (N.J. Ct. App. 2007).

Opinion

920 A.2d 715 (2007)
392 N.J. Super. 307

STATE of New Jersey, Plaintiff-Respondent,
v.
Eliezer MARTINEZ, Defendant-Appellant.

Superior Court of New Jersey, Appellate Division.

Argued December 19, 2006.
Decided April 19, 2007.

*716 Justin T. Loughry, Moorestown, argued the cause for appellant (Loughry and Lindsay, attorneys; Mr. Loughry, on the brief).

Sherry L. Wilson, Deputy Attorney General, argued the cause for respondent (Stuart Rabner, Attorney General, attorney; Ms. Wilson, of counsel and on the brief).

Before Judges WEISSBARD, PAYNE and LIHOTZ.

The opinion of the court was delivered by

*717 PAYNE, J.A.D.

Defendant, Eliezer Martinez, the former chief executive officer and president of Hispanic Counseling & Family Services (HCFS), a Camden mental health counseling center founded by defendant, appeals from his convictions for second-degree health care claims fraud in violation of N.J.S.A. 2C:21-4.2 and -4.3, and third-degree Medicaid fraud in violation of N.J.S.A. 30:4D-17(a), arising from knowing over-billing of mental health counseling services performed by HCFS's counselors. After reducing the second-degree crime to one of the third degree for purposes of sentencing, the trial judge imposed a custodial sentence of five years for health care fraud and a concurrent three-year custodial sentence for Medicaid fraud. Additionally, the judge imposed a restitution obligation of $137,958 and a fine of $275,916. The judgment of conviction stated with respect to restitution:

The restitution of $137,958.00 imposed by the Court represents approximately 20% of the total claims submitted by Hispanic Counseling and Family Services from May 1, 1998 through December 31, 1998, said restitution is imposed pursuant to N.J.S.A. 2C:43-3h.[1]

With respect to the fine, the judgment of conviction stated:

The fine of $275,916.00 represents twice the pecuniary benefit realized by the defendant, said fine is authorized pursuant to N.J.S.A. 2C:21-4.3(a).[2] Additionally, the fine imposed is necessary to deter this defendant and others from engaging in similar fraudulent enterprises.

This portion of the judgment of conviction concluded with the following statement:

It is the Court's opinion that the fines and restitution imposed against this defendant are necessary and appropriate and are imposed in accordance with the criteria set forth in N.J.S.A. 2C:44-2.

On appeal, defendant initially asserted the following arguments:

I. THE PROSECUTION'S SUMMATION URGED A THEORY THAT THE STATE NEVER PRESENTED TO THE GRAND JURY AND THUS SOUGHT CONVICTION FOR A CRIME FOR WHICH ELIEZER MARTINEZ NEVER HAD BEEN INDICTED, IN VIOLATION OF HIS RIGHT NOT TO BE CONVICTED OR PROSECUTED WITHOUT A GRAND JURY HAVING INDICTED, AND IN VIOLATION OF PRINCIPLES OF DUE PROCESS AND FUNDAMENTAL FAIRNESS.
A. The State's Change Of Theory Upon Summation, And Injection Of A Theory Of Liability That Contradicted The Grand Jury Presentation, Violated The Grand Jury Clause Of The State Constitution, Art. I Sec. 8.
B. The Prosecution's Summation Involved Impermissible "Sandbagging."
C. The Holding in State v. Talley Does Not Save This Case From The Constitutional Infirmity of Transgressing From The Indictment Clause Of The Federal And State Constitutions, Nor Does It Cure The Violation Of Fundamental Fairness From An Eleventh-Hour Change Of Theory.
*718 D. Independent Of Concerns For "Notice" And "Due Process," The Doctrine Of Judicial Estoppel Renders The Prosecution's Summation Improper.
II. THE STATE IMPERMISSIBLY INVOKED THE JURY'S SUPPOSED DUTY TO VINDICATE OR AVENGE THE INTERESTS OF THE POOR AND THE DISABLED.
III. THE COURT ERRED IN DECLINING TO CHARGE THE JURY ON THE DIFFERENCE BETWEEN NEGLIGENCE AND RECKLESSNESS, AND IN DECLINING TO CHARGE ON THE DEFINITION OF NEGLIGENCE.
IV. THE COURT'S IMPOSITION OF RESTITUTION IN THE PROSECUTION'S SUGGESTED AMOUNT WAS CONTRARY TO LAW.
V. EVEN IF THE COURT MAKES THE DETERMINATION AS TO AMOUNT OF RESTITUTION, THE COURT'S ANALYSIS, IN ACCEPTING THE PROSECUTION'S PROFFERED SUGGESTION, LACKED ANY BASIS IN THE RECORD, AND MUST BE REVERSED.

At oral argument, defense counsel withdrew arguments expressed pursuant to Points I through III, and limited the appeal to the restitution and fine arguments set forth in Points IV and V. We affirm in part and reverse in part.

I.

At trial, the State established that defendant had created HCFS in July 1995 to provide mental health counseling services primarily to members of the Latino community. The organization's application for status as a Medicaid provider was approved, effective July 1996, and pursuant to that approval, it submitted claims to the State as administrator of the Medicaid program. The Medicaid Provider Manual that HCFS received set forth billing codes for half-hour and one-hour counseling sessions that required, in accordance with state Medicaid regulations, twenty-five minutes of counseling as a condition for billing a half-hour session and fifty minutes of counseling as a condition for billing a one-hour session. Additionally, it provided a code for one-hour family counseling sessions, requiring fifty minutes of counseling. See N.J.A.C. 10:66-6.4(f)(2)-(4).

After Medicaid program employees noticed that "the number of counselors that they had approved for the clinic did not account for the number of hours that they could possibly have billed the Medicaid Program," in February 1999, an investigation of HCFS's billing practices was commenced. An inspection of the facility by Medicaid investigators, occurring on February 19, 1999, disclosed evidence of substantial over-billing. The facility closed within a short time thereafter. On May 31, 2002, defendant, along with office manager Olga Marquez and counselors Sandy Silva, Olga Bonett, Juanita Melendez, Jose Jimenez, Bartolo Moreno, and Luz Senquiz, were indicted for health care claims and Medicaid fraud.

Trial of defendant was held over a period of fourteen days in September and October 2004. Prior to trial, defendants Marques and Silva had been admitted into Camden County's pretrial intervention program, and at the time of trial, defendant Moreno's application for admission to that program was pending. Defendants Melendez, Bonett and Jimenez had pled *719 guilty to unspecified charges.[3] Each of these defendants testified at the trial, as did other part-time employees of the facility and a number of its clients.

Testimony disclosed that, although the number of hours worked by the witnesses varied, each testified to billing and being paid for counseling hours that were substantially in excess of the time during which counseling actually had been performed. Melendez testified to working from 9:00 a.m. to 5:00 p.m. and some Saturdays, but to billing twelve to fifteen hours per day, a fact confirmed by a summary chart prepared by the State and introduced into evidence. Documents relating to Bonnet disclosed, among other things, that when she worked 136 hours, she billed and was paid by HCFS for 180.[4] Silva, who worked from 8:30 a.m. to 4:30 p.m., billed twelve, thirteen or fifteen hours per day.[5]

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Cite This Page — Counsel Stack

Bluebook (online)
920 A.2d 715, 392 N.J. Super. 307, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-v-martinez-njsuperctappdiv-2007.