UNITED STATES of America, Plaintiff-Appellee, v. Della WHITE, Roy S. White, Defendants-Appellants

27 F.3d 1531, 1994 U.S. App. LEXIS 20173, 1994 WL 377196
CourtCourt of Appeals for the Eleventh Circuit
DecidedAugust 4, 1994
Docket91-3407
StatusPublished
Cited by17 cases

This text of 27 F.3d 1531 (UNITED STATES of America, Plaintiff-Appellee, v. Della WHITE, Roy S. White, Defendants-Appellants) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
UNITED STATES of America, Plaintiff-Appellee, v. Della WHITE, Roy S. White, Defendants-Appellants, 27 F.3d 1531, 1994 U.S. App. LEXIS 20173, 1994 WL 377196 (11th Cir. 1994).

Opinion

CARNES, Circuit Judge:

On November 21, 1990, a jury convicted Roy White, a chiropractor, and his wife Della of one count of conspiring to defraud the United States, in violation of 18 U.S.C. § 371, and five counts of submitting false or fraudulent Medicare claims between January and August 1986, in violation of 18 U.S.C. §§ 2 & 287. The jury also convicted Roy White of four additional counts of filing false Medicare claims in 1988 and 1989, and four counts of mail fraud for using the U.S. Mail to submit false claims to Blue Cross/Blue Shield (“Blue Cross”) and private insurers, in violation of 18 U.S.C. §§ 2 & 1341. We affirm.

I. BACKGROUND

The Whites created a series of corporate entities to operate three vascular testing facilities in South Florida. 1 Della White served as president of at least two of these entities and obtained Medicare provider numbers for them. The Whites offered free or inexpensive cholesterol testing and blood screenings at shopping malls and senior citizens’ centers. The “patients” were strongly encouraged to visit one of the Whites’ three clinics to receive their test results and a free *1533 “consultation.” When they arrived at the clinic, patients were told that the results of their initial tests were inconclusive or indicated a potential problem and that extensive follow-up testing was recommended. Because the screenings were not performed under proper conditions, false positives frequently resulted, leading to unnecessary follow-up testing. In certain cases, patients were told that the testing revealed serious vascular problems requiring immediate treatment. The Whites then billed Blue Cross, Medicare’s agent in Florida, for tests averaging $1,000 per patient. Patients were frequently told to return for periodic retesting, even though such retesting was not medically necessary.

In order to secure Medicare provider numbers, the Whites hired a series of medical doctors to serve as “supervising physicians” at their facilities. In theory, these doctors were to perform physical examinations on patients and to recommend appropriate testing. Although Medicare Part B covers medically necessary diagnostic tests, see 42 U.S.C.A. §§ 1395k(a)(l), 1395x(s)(3), & 1395y(a)(l)(A) (1992 & Supp.1994), the program does not authorize payment for diagnostic tests performed or ordered by a chiropractor, 42 C.F.R. § 410.22(b) (1993). However, the testimony at trial established that Roy White would frequently examine the patients himself, determine which tests he considered necessary, and then instruct one of the doctors to prescribe those tests. In other instances, Roy White would order additional tests on his own authority. Roy White’s sense of medical necessity was significantly broader than that of his supervising physicians and of the government’s expert witness, Dr. Blackshear. Each time suspicion focused on the Whites’ activities, the Whites would simply create a new corporate entity — with a new name — to conduct the tests.

Block 19 of Medicare Claim Form 1500 requests the name of the physician who referred the Medicare beneficiary provider for testing. On at least five occasions (counts 2 through 6), both of the Whites submitted Medicare claim forms that named one of the supervising physicians as the referring doctor, when, in fact, Roy White had ordered the tests in question. Block 25 of the claim form is a certification that the tests performed were: “medically indicated and necessary for the health of the patient and were personally rendered by me or were rendered incident to my professional service by my employee under my immediate supervision.” On at least four occasions (counts 7 through 10), Roy White submitted claims to Medicare bearing a forged doctor’s signature in block 25.

At trial, the Whites argued that Medicare, at least until December 1986, did not prohibit the payment of claims for diagnostic tests ordered by chiropractors. The Whites concede that, under the Medicare statute, chiropractors are only “physicians” for purposes of the act with respect to a manual manipulation of the spine, 42 U.S.C.A. § 1395x(r)(5) (1992 & Supp.1994). However, the Whites argued that the provisions which authorize payment for diagnostic tests, 42 U.S.C.A. §§ 1395k(a)(l) & 1395x(s)(3) (1992 & Supp. 1994), do not require such services to be rendered by a physician or incident to a physician’s services. The Whites further maintained that, even if the law did prohibit such payments, “during 1985 and 1986 (the first two years of the period of the indictment), [Roy White], in good faith, believed that as a chiropractor, he could properly bill Medicare for vascular tests that he had ordered.” Therefore, the Whites claimed, they lacked the specific intent necessary to violate the false claims statute. See United States v. Slocum, 708 F.2d 587, 596 (11th Cir.1983) (stating that one element of a violation of 18 U.S.C. § 287 is the submission of a known false or fraudulent claim to the United States “with the specific intent to violate the law or with a consciousness that what he was doing was wrong”).

II. DISCUSSION

The Whites raise three issues that merit discussion. First, the Whites claim that the district court’s instructions on materiality and the court’s response to a jury question were “internally inconsistent and confusing,” and require reversal. Second, the Whites argue that the Medicare program authorized payment for diagnostic tests ordered by chi *1534 ropractors prior to December 15, 1986. Third, the Whites contend that the district court violated Fed.R.Crim.P. 30 by modifying its jury charge after closing arguments. We address the first two contentions in subpart A, below, and then turn to the third contention in subpart B. 2

A. THE MATERIALITY ISSUE

Counts 2 through 6 alleged that on specified dates between January and August 1986, the Whites submitted Medicare claims that falsely indicated that the billed diagnostic tests were ordered by a medical doctor, who was shown in block 19 to be the referring physician. These claims were false because the tests had actually been ordered by Roy White. With respect to counts 2 through 6, the court instructed the jury that it need not consider whether the false claim was material. However, immediately thereafter, the court instructed the jury that:

[Y]ou must determine as a factual matter whether at the time alleged in the count line 19 of the [claim form] was required to be filled out. If you find that it was not required to be filled out, I instruct you that it was not material.

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Bluebook (online)
27 F.3d 1531, 1994 U.S. App. LEXIS 20173, 1994 WL 377196, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-of-america-plaintiff-appellee-v-della-white-roy-s-white-ca11-1994.