United States v. Detra Wiley Pate

CourtCourt of Appeals for the Eleventh Circuit
DecidedApril 21, 2021
Docket19-13006
StatusUnpublished

This text of United States v. Detra Wiley Pate (United States v. Detra Wiley Pate) 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 v. Detra Wiley Pate, (11th Cir. 2021).

Opinion

USCA11 Case: 19-13006 Date Filed: 04/21/2021 Page: 1 of 22

[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT ________________________

No. 19-13006 ________________________

D.C. Docket No. 1:18-cr-00008-JRH-BKE-1

UNITED STATES OF AMERICA,

Plaintiff-Appellee,

versus

DETRA WILEY PATE,

Defendant-Appellant.

________________________

Appeal from the United States District Court for the Southern District of Georgia ________________________

(April 21, 2021)

Before WILLIAM PRYOR, Chief Judge, JILL PRYOR, and ED CARNES, Circuit Judges.

PER CURIAM: USCA11 Case: 19-13006 Date Filed: 04/21/2021 Page: 2 of 22

Detra Pate appeals her convictions and sentence for healthcare fraud

offenses. She contends the district court made three errors at trial and two at

sentencing. As to the trial errors, Pate argues the court abused its discretion by

admitting wealth evidence and by refusing to admit impeachment evidence, and

also that one slip up that the district court made in giving part of the jury

instructions violated her Fifth Amendment right to silence. As to the sentencing

errors, she argues the court incorrectly found that the fraud involved sophisticated

means and that she obstructed justice.

I. THE FACTS AND PROCEDURAL HISTORY

A. The Facts

Detra Pate was the owner and CEO of Southern Respiratory, a durable

medical equipment company. In that role, she was in charge of billing, ordering

equipment, and the day-to-day operations of the company, including managing and

training employees.

Southern rented out and sold durable medical equipment. The sales and

payment process went like this. First a physician prescribed to Southern’s patients

a piece of equipment, confirming the medical necessity by the written prescription

or a signed, written order. Then Southern completed a sales order for that

equipment. Sometimes the patient signed for and left with the equipment the same

day. Other times Southern had one of its employees deliver the equipment to the

2 USCA11 Case: 19-13006 Date Filed: 04/21/2021 Page: 3 of 22

patient. When a patient received the equipment, a Southern employee filled out a

delivery ticket specifying which equipment was going to which patient and the

date and time the patient received the equipment.

After all of that was done, Southern would bill the patient’s private

insurance or, beginning in 2011, would bill Medicare. The bills were submitted to

the insurer or Medicare through Southern’s billing program software, called

Brightree. The Brightree program created an “audit trail” by tracking which

employee used the system to add, remove, or alter information for a particular

claim and by logging the details of each claim — what equipment was delivered to

whom and when, and the name of the prescribing physician.

Medicare occasionally audits claims submitted to it by providers, sometimes

before it pays the claim and sometimes after. If Medicare audits a claim, it

requests from the provider a physician’s order, which is a prescription or other

written order showing the medical need for a particular piece of durable medical

equipment, and a delivery ticket, which is a written confirmation that the

prescribed equipment was delivered to, or taken by, the patient. The physician’s

order must be signed by the prescribing physician, and the delivery ticket must

include the patient’s name, address, and signature. If the provider cannot, or

otherwise fails to, provide a physical copy of the requested documents, Medicare

3 USCA11 Case: 19-13006 Date Filed: 04/21/2021 Page: 4 of 22

denies the claim and seeks a refund of any payment already made by it to the

provider.

Because of the possibility of audits, providers like Southern must keep

physical copies of physicians’ prescriptions or other orders and delivery tickets for

all Medicare claims. And for Southern to “pass” an audit, those copies must be

examined and found to match the bills submitted to Medicare. That is how the

system was supposed to work.

Between 2014 and 2017, however, Southern filed Medicare claims

requesting payment for wheelchairs that were different from, and more expensive

than, those that physicians had prescribed for Southern’s patients. And Southern

also filed Medicare claims that resulted in payments for wheelchair accessories and

other supplies that were never prescribed by a doctor and that were never obtained

by any of Southern’s patients.

Because Southern billed Medicare for medical equipment that wasn’t

prescribed, or that was different from what had been prescribed, the physicians’

orders and delivery tickets in its patient files often didn’t match the information

logged by the Brightree billing program’s audit trail. So whenever Medicare

audited a fraudulent claim, Southern had to get creative to prevent its fraud from

being detected. What Southern created were phony or altered documents to

4 USCA11 Case: 19-13006 Date Filed: 04/21/2021 Page: 5 of 22

“match” the claim. Several different Southern employees did the false matching,

and they did it in two different ways, both at Pate’s direction.

The first way involved altering the original documentation. The employees

would, for example, take the physician’s actual prescription or order, which bore

the physician’s signature, white out or physically cut out the portion of the

document that didn’t match Southern’s Brightree billing submission, and replace it

with the “correct” (i.e., matching) information. The second way for covering up

the fraud involved old-fashioned, garden-variety forgery. For example, an

employee would forge a physician’s signature onto a blank order form and then fill

in the equipment details on that form after receiving the Medicare audit request. If

necessary, the employees falsified the delivery tickets in the same two ways.

Where the falsification process yielded two physician’s orders or two delivery

tickets, Pate or one of her employees shredded the incriminating original

document. And then Pate mailed Medicare the falsified document.

B. The Investigation and Indictment

Eventually law enforcement, led by Agent David Graupner of the

Department of Health and Human Services, began investigating Southern’s billing

practices. During the investigation, Graupner collected Southern’s patient files and

compared them to its Brightree billing entries. The comparison showed Southern

5 USCA11 Case: 19-13006 Date Filed: 04/21/2021 Page: 6 of 22

was providing patients with the less expensive “K4 wheelchairs” but billing

Medicare for the more expensive “K7 wheelchairs.”

Using that evidence, federal agents got a warrant and searched Southern’s

offices. The search uncovered evidence of the matching process Southern used:

carbon paper, pieces of documents with a physician’s signature or a provider ID

number on them, patient forms with information whited or cut out, and blank

patient forms “pre-signed” by a physician. The altered documents bore the

proported signatures or provider ID numbers of 17 different physicians.

After the search, federal investigators and Pate’s lawyers began separately

interviewing Southern’s employees. One of those employees was Tina

Merkerison.

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United States v. Detra Wiley Pate, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-detra-wiley-pate-ca11-2021.