United States v. Akhigbe

642 F.3d 1078, 395 U.S. App. D.C. 257, 2011 U.S. App. LEXIS 12028, 2011 WL 2314993
CourtCourt of Appeals for the D.C. Circuit
DecidedJune 14, 2011
Docket10-3019
StatusPublished
Cited by24 cases

This text of 642 F.3d 1078 (United States v. Akhigbe) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States v. Akhigbe, 642 F.3d 1078, 395 U.S. App. D.C. 257, 2011 U.S. App. LEXIS 12028, 2011 WL 2314993 (D.C. Cir. 2011).

Opinion

Opinion for the Court filed by Circuit Judge TATEL.

TATEL, Circuit Judge:

Appellant, a primary care physician who served Medicaid patients in the District of Columbia, appeals his convictions for health care fraud and for making false statements relating to health care matters, as well as his 53-month sentence. Finding no merit in appellant’s assertions of trial errors, we affirm the judgment of conviction. But because the district court gave an inadequate explanation for its above-Guidelines sentence and because this procedural defect amounted to plain error, we vacate the sentence and remand.

I.

During the time period relevant to this case, the Amerigroup Corporation, a private insurance company, served as the *1080 Medicaid administrator for the District of Columbia. Appellant Ehigiator Akhigbe entered an agreement to join Amerigroup’s network of Medicaid providers as a primary care physician in December 2001.

To receive payments from Amerigroup for services provided to Medicaid patients, doctors submit claim forms — which at the time relevant to this case were called “HCFA 1500” forms or “HCFA” forms— on which they record their patients’ identifying information, the dates of services, diagnosis information, and procedure codes specifying the type and level of service the physician provided (which in turn dictate the final charges). Although doctors have no obligation to personally fill out the forms, they must sign them and certify that the services not only were provided, but also were medically appropriate and necessary. Once Amerigroup receives and processes the forms, it sends providers an explanation of payment and, if appropriate, a check.

During Akhigbe’s participation in Amerigroup’s network, the company began noticing unusual trends in his claims, including billings for an abnormally large number of high-level visits, numerous claims for certain procedures that primary care physicians rarely perform, and repeated instances where visits following such procedures were billed as new diagnoses rather than as uncompensated follow-up visits. Prompted by these observations, Amerigroup launched an investigation of Akhigbe’s practice and conducted an onsite audit in May 2004. Based on the sample of patient files audited, Amerigroup discovered that Akhigbe had documentation for only six percent of the services billed. Several weeks later, the company terminated its provider agreement with Akhigbe.

The matter was then referred to the FBI. At the conclusion of the FBI investigation — which involved surveillance, interviews with several of Akhigbe’s patients and employees, and the seizure of records from Akhigbe’s office — the government indicted Akhigbe on one count of health care fraud in violation of 18 U.S.C. § 1347 and 18 counts of knowingly and willfully making false statements in connection with the delivery of or payment for health care services in violation of 18 U.S.C. § 1035. In the health care fraud charge, the government alleged that over a period of several years, Akhigbe intentionally defrauded Amerigroup by submitting claims for visits and surgical procedures that never took place. The false statement charges related to 18 specific false HCFA claims, all submitted in June 2004. After dismissing one of the false statement counts, the government proceeded to trial on the other claims.

At trial, the government supported its allegations with testimony from patients and employees that numerous visits and procedures for which Akhigbe had billed Amerigroup either never occurred or were misrepresented, as well as with evidence that he had created false progress report notes for patient files to cover up discrepancies. Over Akhigbe’s objection, the government also introduced documentation of HCFA claims dating back to December 2002 that Akhigbe had submitted to Amerigroup. It used this evidence to demonstrate that Akhigbe had billed for so-called impossible days — i.e., days where the sum of the claim forms indicated Akhigbe had worked more than 24 hours. To link Akhigbe to false HCFA forms, the government relied on testimony by two former employees who claimed they could identify Akhigbe’s handwriting on such forms. One of the former employees also testified that Akhigbe had told him that he did his own billing, although that employee never *1081 actually saw the doctor complete HCFA forms.

For its part, the defense denied that Akhigbe intentionally committed fraud or knowingly made false statements, arguing instead that any billing discrepancies were the result of negligent oversight. Defense counsel claimed that because Akhigbe had a busy medical practice, he delegated billing responsibilities to others who may have recorded false information. Although Akhigbe never testified, the defense did call two individuals who said they worked for the doctor. Both witnesses claimed they never saw Akhigbe fill out HCFA forms or otherwise involve himself with billing. They testified that Akhigbe relied on an employee named Ibrahim Mohammad to carry out such administrative tasks. According to those witnesses, Mohammad died of cancer in 2007.

Based on its mismanagement defense, Akhigbe’s counsel asked the district court to provide a “good faith” instruction to the jury, which would have explained that good faith by Akhigbe constituted a complete defense to the charged offenses and that evidence proving only that he made “a mistake in judgment or an error in management” could not establish fraudulent intent. Although declining to give that instruction, the district court did instruct the jury that the government had to prove beyond a reasonable doubt that Akhigbe defrauded a health care benefit program knowingly and willfully and that he knowingly made false statements in connection with such a program.

The jury convicted Akhigbe of the healthcare fraud charge and all but one of the false statement charges. At the sentencing hearing, Akhigbe and the government agreed that the applicable advisory Guidelines range was 83 to 41 months’ imprisonment, and each argued for a within-Guidelines sentence — albeit at opposite ends of the range. The district court, however, sentenced Akhigbe to 53 months’ imprisonment — an upward variance of 12 months.

On appeal, Akhigbe urges us to vacate his conviction, arguing that the district court committed evidentiary errors and improperly refused to give the good faith instruction he requested. Akhigbe also contends that we should vacate his sentence as procedurally unreasonable.

II.

Akhigbe first argues that the district court erred by admitting evidence of false HCFA claim submissions that predated the 17 remaining specific false statements from June 2004 charged in the indictment. According to Akhigbe, the district court should have excluded this evidence under Federal Rule of Evidence 403 because, although the past claims were relevant to proving health care fraud, such evidence was cumulative given the government’s ability to rely exclusively on evidence regarding the specific false statements.

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Bluebook (online)
642 F.3d 1078, 395 U.S. App. D.C. 257, 2011 U.S. App. LEXIS 12028, 2011 WL 2314993, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-akhigbe-cadc-2011.