State v. Venman

564 A.2d 574, 151 Vt. 561, 1989 Vt. LEXIS 109
CourtSupreme Court of Vermont
DecidedApril 14, 1989
Docket88-054
StatusPublished
Cited by23 cases

This text of 564 A.2d 574 (State v. Venman) is published on Counsel Stack Legal Research, covering Supreme Court of Vermont primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State v. Venman, 564 A.2d 574, 151 Vt. 561, 1989 Vt. LEXIS 109 (Vt. 1989).

Opinion

Dooley, J.

Defendant appeals his conviction under 33 V.S.A. § 2581(d) of two counts of knowingly filing false claims with the State of Vermont Medicaid Program. Defendant makes numerous claims on appeal: (1) that the trial court’s denial of defendant’s motion to sever the multiple counts brought by the State constitutes reversible error; (2) that the State failed to prove “deliberate overcharging,” which defendant contends is an element of the offense; (3) that the trial court failed to instruct the jury on the element of “deliberate overcharging”; (4) that certain evidence which went to defendant’s intent was erroneously excluded; (5) that the State did not prove beyond a reasonable doubt a knowing submission of a false claim and therefore defendant’s motion for acquittal should have been granted; (6) that defendant’s cross-examination and impeachment of adverse witnesses was unconsti *563 tutionally restricted; (7) that the Medicaid Fraud Act is unconstitutional due to its penalty provisions; and (8) that defendant was denied a speedy trial, We reject each of these claims and affirm.

Viewing the evidence in the light most favorable to the State and excluding any modifying evidence, State v. Norton, 147 Vt. 223, 225, 514 A.2d 1053, 1055 (1986), the facts are as follows. Defendant is a practicing surgeon in Middlebury, Vermont. On April 6,1987, he was charged with and arraigned on twenty-nine counts of filing false claims with the Medicaid Program. The information alleged that defendant “knowingly filed and caused to be filed under [the] Vermont Medicaid Program” false claims “in violation of 33 V.S.A. § 2581(d) as punishable by 33 V.S.A. § 2583.” On October 23, 1987, defendant filed a motion to sever the charges, which the trial court denied. On its own motion, however, the court chose to divide the case due to the complexity of the counts and allowed the State to proceed on only twelve counts. One of these counts was dismissed by the State, and trial was commenced on the remaining eleven. The jury returned a verdict of guilty on two of the eleven counts.

To understand the charges against defendant, it is helpful to examine certain features of the Medicaid Program. Vermont’s Medicaid Program pays for free medical care for eligible needy Vermonters. Eligible recipients are issued a card which they take to a provider when they receive care. Using the card number provided by the recipient, the provider then bills the State of Vermont for the services provided. The claims for services are actually submitted to the Medicaid Program’s fiscal intermediary, EDS Federal Corporation (EDS). EDS then reimburses the provider based on the itemized claim submitted. Each claim must be submitted on forms which require the provider to state certain information such as the name of the Medicaid recipient, the date services were provided, the kinds of services provided, the number of services provided, and the identifying provider number. Most importantly for the case at bar, the provider must describe the type of service rendered through use of a procedure code. The procedure code determines how much the provider will be paid for the services rendered to the recipient.

Defendant was originally investigated by the Medicaid Fraud Control Unit of the Attorney General’s Office because of what appeared to be excessive use of a particular procedure code. The allegation against defendant was that he repeatedly filed claim *564 forms stating that a consultation with a referring physician had occurred when, in fact, he had conducted no more than an office visit with no involvement of another physician.

The procedure code for an office visit entitles the provider to a payment of $8.00. The procedure code for a complex consultation, on the other hand, entitles the provider to a payment of $45.00. A consultation is defined in the American Medical Association, Physician’s Current Procedural Terminology Manual (4th ed.) as:

services rendered by a physician whose opinion or advice is requested by a physician or other appropriate source for the further evaluation and/or management of the patient. When the consulting physician assumes responsibility for the continuing care of the patient, any subsequent service rendered by him will cease to be a consultation. Five levels of consultation are recognized: limited, intermediate, extensive, comprehensive and complex consultation.

Defendant was accused of filing Medicaid claim forms which billed for consultations when, in fact, the services in question involved only an office visit.

Defendant was convicted on counts one and four of the information brought against him. Count one involved an undercover visit to defendant by a Medicaid fraud investigator. Using an alias, the investigator posed as a Medicaid recipient. Defendant examined the investigator for four minutes. No other physician’s name was mentioned during the visit, nor did the investigator provide defendant or his staff with information about another physician. The claim form filed by defendant indicated that defendant rendered a consultation on the investigator’s behalf with a Dr. William Barrett. Defendant wrote Dr. Barrett’s name as the referring physician in his personal daily log. Defendant’s secretary then filled out a claim form stating the same, which defendant signed. Subsequent investigation showed that Dr. Barrett knew of no patient by the name used by the investigator. The investigator denies having ever mentioned Dr. Barrett’s name as a referring physician or having met with Dr. Barrett prior to the investigator’s visit to defendant.

Count four charged that defendant rendered services to a certain patient and then billed Medicaid for a consultation with a Dr. Henderson. As with count one, the evidence was that no consultation occurred.

*565 I.

First, defendant argues that the denial of his motion to sever constitutes reversible error. Defendant moved prior to trial for severance of the counts against him, alleging that V.R.Cr.P. 14(b)(1)(A) gave him an absolute right to severance because the offenses were joined solely because they were “of the same or similar character.” The motion was denied. V.R.Cr.P. 14(b)(4)(B) provides:

If a defendant’s pretrial motion for severance was overruled, he may renew the motion on the same grounds before or at the close of all the evidence. Severance is waived by failure to renew the motion.

At the close of all the evidence, and after arguments on various motions by defendant, defendant’s counsel stated:

I want to place two things on the record, your Honor. One is in connection with our previous motion for sequestration. At this time I would ordinarily call my client on some of the counts and not on other counts, but because of the joinder I do not feel I can put him on the stand ....

We will treat this statement as a reference to defendant’s former motion for severance. 1 The defendant made no further motions at that time. Instead, defendant’s counsel went on to discuss certain evidentiary rulings made by the court.

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Cite This Page — Counsel Stack

Bluebook (online)
564 A.2d 574, 151 Vt. 561, 1989 Vt. LEXIS 109, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-v-venman-vt-1989.