State v. McWilliams

283 P.3d 187, 295 Kan. 92, 2012 WL 3537849, 2012 Kan. LEXIS 446
CourtSupreme Court of Kansas
DecidedAugust 17, 2012
DocketNo. 102,688
StatusPublished
Cited by2 cases

This text of 283 P.3d 187 (State v. McWilliams) is published on Counsel Stack Legal Research, covering Supreme Court of Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State v. McWilliams, 283 P.3d 187, 295 Kan. 92, 2012 WL 3537849, 2012 Kan. LEXIS 446 (kan 2012).

Opinions

The opinion of the court was delivered by

Nuss, C.J.:

This case requires us to determine whether sufficient evidence exists to support the bench trial conviction of Oliver McWilliams (McWilliams) under K.S.A. 21-3846(a)(l) for defrauding the Medicaid program. Because we conclude that it does, we affirm the district court and reverse the Court of Appeals.

[93]*93Facts

Mary McWilliams is a Medicaid beneficiary who received Medicaid’s “Home and Community Based Services.” Under the program she received help with her day-to-day life activities, including assistance from “personal care attendants” (PCAs). Mary had two PCAs—her husband, Oliver McWilliams, and her daughter, Shar-nette McWilliams. While a beneficiary’s spouse generally may not provide services per K.A.R. 30-5-307, McWilliams apparently received a spousal exemption under the regulation.

McWilliams submitted his work timesheets to SKIL, a payroll agency, which then submitted the paperwork to Medicaid. After deductions by SKIL, he received $7.75 net per hour for his daytime services and a $20 payment for overnight “sleep cycle support.”

As stated in a form McWilliams signed as part of his enrollment with SKIL, Medicaid prohibits PCAs from providing services to the Medicaid beneficiary while the beneficiary is in a hospital. The form also advises of the prohibition against PCAs submitting a claim to be paid for that time. Yet McWilliams claimed payment for 182.98 service hours and 76 sleep cycles while Mary was hospitalized. And Medicaid paid for these hospital hours.

After an investigation into McWilliams’ timesheets, the State charged both Shamette and McWilliams with Medicaid fraud and tried them separately. Count I of the first amended complaint/ information charged McWilliams with engaging in a conspiracy with Sharnette to defraud Medicaid. Count II essentially charged him with defrauding Medicaid in the amount of $3,704.78 by submitting a false claim for the hospital hours:

“Oliver McWilliams, for himself, did then and there, unlawfully, feloniously, knowingly, and with the intent to defraud, engaged in a pattern of... submitting . . . false or fraudulent statements ... for services for which payment may be made, in whole or in part, under the Kansas Medicaid program, whether or not the claims for payment for services is allowed or allowable ... to wit; In violation of K.S.A. 21-3846(a)(l), Oliver McWilliams did knowingly and intentionally and with foe intent to defraud, . . . submit[ ] ... to foe Kansas Medicaid program, false and fraudulent statements, representations, books, records, documents and claims for personal care services which were not provided by Oliver McWilliams, and were therefore not allowable under the Kansas Medicaid program. As a result [94]*94of said conduct the Kansas Medicaid program paid $3,704.78, which should not have been paid.”

At the bench trial, McWilliams did not dispute that he had claimed payment for hospital hours. But he argued that Mary needed PCA support to receive adequate care while hospitalized because she was “about dead.” He further testified that her case manager, Lawrence Reece-—-who did not testify and was described by McWilliams as “the boss”—permitted him to claim payment for hospital hours. McWilliams also testified that he was not aware of Medicaid’s ban on PCA hospital hours until the State began the fraud investigation. SKIL employee Rebecca Lemon testified for the State that Medicaid makes “no allowance for someone who is hospitalized” to receive personal care services.

The district court acquitted McWilliams of the conspiracy charge. But it found him guilty of fraudulently billing Medicaid for the hospital time. The court primarily based its ruling on the “Personal Care Attendant Acknowledgement” form which it found that McWilliams had signed. It quoted the form’s language: “Under no circumstances will Personal Care Attendants be authorized to provide services nor submit hours for the time that an employer is hospitalized or receiving any other institutional care.” The court found this language “to be pretty compelling in support of a conviction for Count II” because the form “clearly, unequivocally, veiy specifically says that under no circumstances may a personal care attendant provide services to the employer/patient while the employer/patient is hospitalized.”

In addition to this language, the court also emphasized that this form signed by McWilliam states:

“I have read and understand the information provided in the Personal Care Attendant Acknowledgement and I agree to perform my duties as a Personal Care Attendant accordingly. I further understand my responsibility to record accurate and timely information in correlation to the information provided.”

The court then sentenced McWilliams to 12 months’ probation with an underlying sentence of 6 months in jail and ordered restitution of $3,704.78 and court costs.

[95]*95The Court of Appeals reversed McWilliams’ conviction, holding that the evidence at trial did “not support a guilty finding for the specific act charged in the complaint.” State v. McWilliams, No. 102, 688, 2010 WL 3564738, at *2 (Kan. App. 2010) (unpublished opinion) rev. granted November 5, 2010. More particularly, it adopted McWilliams’ contention: he “specifically argues the complaint charges that he submitted statements for services he did not provide, while the evidence establishes that he actually did provide the services for which he. submitted statements.” (Emphasis added.) 2010 WL 3564738, at *2.

We granted the State’s petition for review. Our jurisdiction is under K.S.A. 20-3018(b).

Analysis

Issue: Sufficient evidence supports McWilliams’ conviction for Medicaid fraud.

Standard of Review

In analyzing this issue we consider “whether, after review of all the evidence, viewed in the light most favorable to the prosecution, [we are] convinced that a rational factfinder could have found the defendant guilty beyond a reasonable doubt.” State v. Gutierrez, 285 Kan. 332, 336, 172 P.3d 18 (2007).

Discussion

The State’s complaint/information charged McWilliams with making a false or fraudulent Medicaid claim in violation of K.S.A. 21-3846(a)(l), which states:

“(a) Malang a false claim, statement, or representation to the medicaid program is, knowingly and with intent to defraud, engaging in a pattern of making, presenting, submitting, offering or causing to be made, presented, submitted or offered:
(1) Any false or fraudulent claim for payment for any goods, service, item, facility, accommodation for which payment may be made, in whole or in part, under the medicaid program, whether or not the claim is allowed or allowable.”

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Related

Village Villa v. Kansas Health Policy Authority
291 P.3d 1056 (Supreme Court of Kansas, 2013)
State v. LeClair
287 P.3d 875 (Supreme Court of Kansas, 2012)

Cite This Page — Counsel Stack

Bluebook (online)
283 P.3d 187, 295 Kan. 92, 2012 WL 3537849, 2012 Kan. LEXIS 446, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-v-mcwilliams-kan-2012.