United States v. Guillermo A. Alemany Rivera, United States of America v. Edgar M. Stella Perez

781 F.2d 229, 1985 U.S. App. LEXIS 25059
CourtCourt of Appeals for the First Circuit
DecidedDecember 26, 1985
Docket83-1713, 83-1733
StatusPublished
Cited by29 cases

This text of 781 F.2d 229 (United States v. Guillermo A. Alemany Rivera, United States of America v. Edgar M. Stella Perez) is published on Counsel Stack Legal Research, covering Court of Appeals for the First 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. Guillermo A. Alemany Rivera, United States of America v. Edgar M. Stella Perez, 781 F.2d 229, 1985 U.S. App. LEXIS 25059 (1st Cir. 1985).

Opinion

LEVIN H. CAMPBELL, Chief Judge.

Defendants-appellants Dr. Edgar M. Stella-Perez and Guillermo A. Alemany-Rivera appeal from their convictions in the United States District Court for the District of Puerto Rico. We affirm.

I.

On July 7, 1982, defendants-appellants Stella and Alemany were jointly charged in a nine-count indictment. Count one charged Stella, the President, Chairman of the Board of Directors, and former Medical Director of the Hospital Nuestra Señora de la Guadalupe in Hato Rey, Puerto Rico (the “Hospital”), and Alemany, the former controller of the Hospital, with conspiracy to defraud the Departments of Housing and Urban Development (“HUD”) and Health and Human Services (“HHS”) in connection with a federally insured $12.46 million mortgage loan obtained by the Hospital for remodeling and expansion. Count one alleged that Stella and an unindicted co-conspirator named Jose A. Cardona-Alvarez, the Hospital’s former assistant administrator, controlled a furniture company known as Casa Cardona, Inc., and its subsidiary, an equipment company by the name of AAA Hospital Supply, Inc. Stella and Car-dona allegedly used these two corporations, with Alemany’s assistance, to siphon off the Hospital’s mortgage funds by selling equipment and furnishings to the Hospital at inflated prices, and by charging the Hospital for equipment that the corporations never furnished.

Counts two through four of the indictment charged Stella and Alemany with submitting and causing to be submitted false documents to HUD to procure mortgage funds. Counts five through seven charged the defendants with submitting and causing to be submitted false Medicare cost reports for the years 1977, 1978, and 1979. Counts eight and nine charged Stella and Alemany with making, aiding, and abetting false oaths in bankruptcy in connection with personal bankruptcy petitions filed by Stella and his wife in 1979.

After a 30-day jury trial, Stella was found guilty on all counts, sentenced to a 20-year term of imprisonment, and placed on probation for another five years on condition that he make restitution of $686,349. Alemany was found guilty on counts one, five, and six of the indictment, sentenced to ten years in prison, and fined $10,000. This appeal followed.

II.

Stella and Alemany 1 were charged under counts five, six, and seven with submitting and causing to be submitted false Medicare cost reports on the Hospital’s behalf for the years 1977, 1978, and 1979, in violation of 18 U.S.C. §§ 1001 & 2 (1982). 2 It was alleged in these counts, inter alia, that the cost reports falsely represented to HHS’s fiscal intermediaries, Blue Cross of Florida and Cooperativa de Seguros de Vida de Puerto Rico, that none of the costs for *232 which the Hospital sought reimbursement “resulted from transactions with related organizations as defined in the Provider Reimbursement Manual, Part I, Chapter 10,” when in fact a number of expenses included in the cost reports arose out of transactions with AAA Hospital Supply.

The significance of whether the Hospital had transacted business with a related organization was that equipment acquired from such a source could only be reimbursed “at the cost to the related organization.” 1 Medicare & Medicaid Guide (CCH) ¶ 5,679, at 1181 (1983). The Provider Reimbursement Manual contained the following definitions pertaining to related organizations:

Definitions. — The term “related to the provider” means that the provider to a significant extent is associated or affiliated with, or has control of, or is controlled by, the organization furnishing the services, facilities, or supplies to the provider.... Common ownership arises when an individual, or individuals, holds significant ownership or equity in both the provider and the organization serving the provider.... The term “control” means that an individual or an organization has the power to influence or direct the actions or policies of both a provider and a related organization to a significant extent....

Id., II 5,677, at 1879-3. These definitions substantially track the definitions of “related to the provider,” “common ownership,” and “control” contained in 42 C.F.R. § 405.-427(b) (1984). At trial, the government introduced testimony explaining what related organizations were within the meaning of the Medicare Regulations. 3

Stella and Alemany argue that counts five, six, and seven of the indictment should have been dismissed, because there was never any finding by HHS or its intermediaries, Blue Cross of Florida and Cooperativa de Seguros de Vida de Puerto Rico, that AAA Hospital Supply was “related to” the Hospital as that term is defined in the Medicare Regulations and the Provider Reimbursement Manual. 4 Both defendants contend that, because the Medicare Regulations provide that, in the event of question, a determination of whether a provider has acquired supplies or services from a related organization is to be made in the first instance by an intermediary, and the provider then has a right of appeal to a Provider Reimbursement Review Board, see 42 C.F.R. §§ 405.1801-07, 405.-1835 (1984), the district court was without jurisdiction to decide whether, contrary to the representations in the cost reports, the Hospital was “related to” AAA Hospital Supply.

We disagree. The district court’s jurisdiction over counts five, six, and seven was predicated on allegations that the defendants had violated a criminal statute, 18 U.S.C. § 1001. See 18 U.S.C. § 3231 (1982). Patently, the district court’s as *233 sumption of criminal jurisdiction over these counts did not usurp HHS’s primary, civil jurisdiction over any claims made by the Hospital for reimbursement. Compare, e.g., Kechijian v. Califano, 621 F.2d 1 (1st Cir.1980) (sustaining district court’s refusal to exercise jurisdiction over physician’s claims for reimbursement under the Medicare Act where physician had failed to first avail himself of administrative remedies).

Whether or not it was clear that AAA Hospital Supply was related to the Hospital would, of course, bear on whether or not the defendants had the requisite criminal intent. If the relationship was sufficiently questionable, the defendants could not be held criminally accountable for denying its existence. But there was overwhelming evidence in this case that the Hospital was “related to” AAA Hospital Supply within the meaning of the Medicare Regulations and the Provider Reimbursement Manual.

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Bluebook (online)
781 F.2d 229, 1985 U.S. App. LEXIS 25059, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-guillermo-a-alemany-rivera-united-states-of-america-v-ca1-1985.