United States v. Franklin-El

555 F.3d 1115, 78 Fed. R. Serv. 766, 2009 U.S. App. LEXIS 2011, 2009 WL 242911
Court of Appeals for the Tenth Circuit·Decided February 3, 2009·No. 07-3259·Published·Cited by 36 cases

Opinion

McKAY, Circuit Judge.

Defendant Johnnie Franklin-El appeals his seventeen convictions of health care fraud and one conviction of obstruction of justice. The principal issue on appeal is whether sufficient evidence supports these convictions. Defendant also claims entitlement to a new trial on the grounds of: (A) prosecutorial misconduct in closing argument, (B) erroneous admission of 404(b) evidence, and (C) cumulative error. 1 We *1119 find Defendant’s obstruction of justice conviction to be unsupported by sufficient evidence, but affirm the district court on the remaining claims of error.

Background

As discussed more thoroughly in the companion case of United States v. Peggy Franklin-El, No. 07-3257, 554 F.3d 903, 2009 WL 237780 (10th Cir.2009) the evidence at trial established that Defendant and his spouse, Peggy Franklin-El, incorporated, owned, and operated The Great Meeting Is On For Your Success, a nonprofit business that provided services to the community. Both Defendant and Ms. Franklin-El were highly involved in the business and worked as client counselors, and both were active in the drug and alcohol treatment community for numerous years.

The record shows that from 1993 to 2003, the business survived mostly on income from fundraising. Then, in 2003, The Great Meeting became eligible to bill Medicaid for drug and alcohol treatment and case management services for addicted clients. Defendant and Ms. Franklin-El attended a multi-day Medicaid billing class as a prerequisite to this eligibility. Defendant’s continuing education record, which was introduced as evidence, indicates he attended each session, and the trainer testified Defendant attended. The record shows that at the training, Defendant and Ms. Franklin-El were taught the assessment and authorization requirements as well as the processes for Medicaid billing. At trial, Defendant testified on his own behalf. He disputed that he attended all of the training but admitted he attended some.

Over the course of seventeen months, The Great Meeting submitted 1331 claims to Medicaid — counts two through fifty-three are representative of these. Both a billing expert and a medical expert testified that all fifty-two claims were false in numerous respects and none should have been paid. In fact, the billing expert reviewed all 1331 claims and found them all to be false and fraudulent. Specifically, the falsities consisted of: (1) indicating clients (including children) were addicted to drugs and alcohol when they were not, (2) claiming Defendants had provided drug and alcohol treatment when they had not, (3) indicating Defendants performed two assessments, when they really performed only one, (4) claiming services had been provided where no documentation supported these claims, and (5) implicitly representing that services were authorized by the regional assessment center when they were not.

The government presented evidence showing Defendant actively participated in a number of these schemes. For instance, documents allegedly signed by Defendant indicated a child, Gary H., was not using alcohol or drugs while also indicating that he needed drug and alcohol services and that such services were being provided. Another document showed Austen W., a nine-year-old client, was receiving individual and group therapy. At trial, Defendant admitted he was listed as Austen’s counselor, but denied memory of Austen. Defendant testified that, according to an initial assessment form, Austen had no addiction and would have no reason to receive addiction treatment, that is, individual or group therapy. Yet, The Great Meeting billed for individual and group therapy for Austen.

Further, Defendant admitted at trial that at least some of his clients — the children in particular — were not addicted to drugs or alcohol. This admission fits with evidence introduced by the government that it is not considered clinically possible *1120 to diagnose or treat anyone under age twelve as an addict.. Nonetheless, The Great Meeting submitted claims for two children who were only weeks old and several children who were Defendant and Ms. Franklin-El’s relatives. Defendant also admitted The Great Meeting provided transportation, after-school care, meals, and similar services, and that these services did not constitute addiction treatment. Defendant himself even provided some of these services. All in all, The Great Meeting received more than $420,000 from Medicaid for drug and alcohol claims for children alone.

Fact witnesses testified to Defendant’s role in specifically recruiting people with Medicaid cards. For instance, Defendant, along with Ms. Franklin-El, suggested a relative obtain a Medicaid card and turn it over to The Great Meeting in exchange for a rent-free place to live. The relative did so. Later, after she had problems obtaining grief counseling due to The Great Meeting’s use of her card, the relative confronted Ms. Franklin-El. Ms. Franklin-El threatened to throw her out of the house, and Defendant changed the locks on the house several times. Through all this, the relative received no counseling from The Great Meeting.

Defendant also participated in the administrative aspects of The Great Meeting’s Medicaid billing. Tracy Wagner, the government’s billing expert, testified to her firsthand knowledge of this. Ms. Wagner worked for Electronic Data Systems, a company that contracted with Kansas Medicaid. After investigating and determining none of The Great Meeting’s Medicaid claims should have been paid, Ms. Wagner sought to recoup the funds The Great Meeting had received. According to Ms Wagner, Defendant actively pursued The Great Meeting’s appeal of the recoupment. He spoke with Ms. Wagner numerous times, arguing the claims should have been paid. In Ms. Wagner’s opinion, during these conversations, Defendant showed an understanding of which claims had been submitted for which services and knowledge that the claims were for drug and alcohol treatment. Ms. Wagner attested that Defendant also voiced his understanding of the claims at numerous in-person meetings at the Office of Fair' Hearings in Topeka, Kansas.

■ Additionally, Defendant participated with Ms. Franklin-El in an administrative review hearing on November 12, 2003. A verbatim transcript of this hearing was admitted into evidence at trial. The hearing was an appeal of two of The Great Meeting’s claims for alcohol and drug treatment which had been denied by the Kansas Medikan program. Medikan is a state program similar in some ways to Medicaid, but with different enrollment criteria and stricter limitations on services. Because Ms. Franklin-El testified that she believed the Medikan clients to be covered by Medicaid at the time they received services, the defendants discussed Medicaid at the hearing. Defendant tacitly supported Ms. Franklin-El’s claim that the clients were addicts who had received drug and alcohol treatment. However, the government’s experts testified at trial that there is no indication any such treatment was provided.

The government presented evidence that Defendant personally benefitted from The Great Meeting’s Medicaid funds, receiving more than $186,000 of the more than $1.24 million in Medicaid money The Great Meeting obtained.

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United States v. Franklin-El, 555 F.3d 1115, 78 Fed. R. Serv. 766, 2009 U.S. App. LEXIS 2011, 2009 WL 242911 (10th Cir. 2009).

555 F.3d 1115 (United States v. Franklin-El) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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