United States v. James M. Bartkus

816 F.2d 255
CourtCourt of Appeals for the Sixth Circuit
DecidedJune 2, 1987
Docket86-3200
StatusPublished
Cited by3 cases

This text of 816 F.2d 255 (United States v. James M. Bartkus) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth 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. James M. Bartkus, 816 F.2d 255 (6th Cir. 1987).

Opinion

*256 KRUPANSKY, Circuit Judge.

Defendant-appellant James M. Bartkus (Bartkus) appealed from his jury conviction pursuant to 18 U.S.C. § 1027.

At all times relevant to the present controversy, Bartkus was employed as the Office Manager of Excavating, Building Material, Construction Drivers, Race Track Employees, Manufacturing, Processing, Assembling and Installer’s Employee’s Local 436 of the International Brotherhood of Teamsters (the union). As an employee of the union, Bartkus was entitled to health insurance benefits for himself and his dependents payable by the Teamsters Local 436 Welfare Fund (the fund).

Bartkus was married to Mary Lou Bartkus (Mary Lou). The record disclosed that Mary Lou had been an employee of the fund prior to her marriage to Bartkus. At the time of Mary Lou’s employment with the fund, it was operated as a “reimbursement fund” which paid benefits to employees without regard to collateral source payments from other insurers. In May of 1979, Mary Lou was employed by the Diamond Shamrock Corporation (Diamond Shamrock). By virtue of her employment with Diamond Shamrock, she qualified for health insurance benefits payable through the Prudential Insurance Company (Prudential).

On June 1, 1980, the fund adopted a “coordination of benefits” policy as a cost saving measure. Pursuant to the “coordination of benefits” policy, Bartkus was required to initially seek payment for Mary Lou’s medical expenses from Prudential. After Prudential exhausted the limits of its coverage, the fund would provide supplemental payments to satisfy any outstanding unpaid balance. A general mailing to all employees covered by the fund notified them of the adoption of the “coordination of benefits” policy.

On July 30, 1980, Mary Lou gave birth to a baby at St. John’s Hospital in Cleveland, Ohio. When she was admitted to the hospital, Bartkus informed the hospital that she was employed by Diamond Shamrock and insured by Prudential. He also authorized assignment of insurance benefits directly from Prudential to St. John’s Hospital. On August 3, 1980, Mary Lou executed a St. John’s Hospital form which confirmed that she had health insurance coverage through Prudential. Accordingly, on August 29, and September 23,1980, Prudential paid St. John’s Hospital for the totality of medical services rendered to Mary Lou and the baby.

In early September, 1980, Bartkus submitted a copy of the St. John’s statement for medical expenses to the fund and requested reimbursement. The copy of the hospital statement had been altered to delete all references to Mary Lou’s employment with Diamond Shamrock and her insurance coverage with Prudential resulting therefrom.

Upon receipt of the hospital’s statement, Debbie Hanson (Hanson), who processed the claim informed David Kerr (Kerr), the director of the fund, that she had been advised that Mary Lou was employed at Diamond Shamrock which would require the Bartkus claim to be coordinated with the Diamond Shamrock health insurance coverage. Kerr instructed Hanson to telephone the hospital to determine if Mary Lou’s Diamond Shamrock health insurance policy had provided coverage for the medical costs incurred. After Hanson informed him that Prudential had satisfied the entire amount of Mary Lou’s hospitalization, Kerr instructed Hanson to deny the Bartkus claim.

On September 10, 1980, Bartkus confronted Kerr about the denial of his claim. Although Kerr informed Bartkus that he had been notified by the hospital that it had received full payment from Prudential, Bartkus insisted that he also be paid from the fund. Shortly thereafter, Bartkus returned to Kerr’s office with Sam Busacca (Busaeca), the president of the Union and the Chairman of the Board of the fund. Kerr objected to Busacca’s direction that he pay the Bartkus claim, stating that it had already been satisfied by Prudential and that the entire office knew that Bartkus had received the benefits of the Prudential insurance payments. Busacca nevertheless instructed Kerr to supply *257 Bartkus with a “coordination of benefits” form.

Bartkus executed the form which falsely attested that Mary Lou was not employed and denied insurance coverage through any other employer. The “coordination of benefits” form incorporated the following acknowledgement:

I understand that according to regulations of Local 436 Welfare Fund, I am not entitled to any benefits payable through my spouse’s insurance and if payment is made by Local 436 Welfare Fund due to my withholding information I am liable for any such overpayment and will be made to repay the Fund in full.

After Bartkus completed the form, Busaeca ordered Kerr to pay the claim. Bartkus thereafter received payment from the fund in direct contravention of its “coordination of benefits” policy.

On August 1, 1985, a federal grand jury returned a three count indictment charging both Bartkus and Mary Lou with (1) conspiracy to embezzle moneys from the fund in violation of 18 U.S.C. § 371; (2) theft or embezzlement from an employee benefit plan in violation of 18 U.S.C. §§ 644; and (3) making false statements and concealing facts in documents required to be kept under ERISA in violation of 18 U.S.C. §§ 1027. The jury acquitted Mary Lou on all counts. Bartkus was convicted on the third court of the indictment for falisfying and concealing facts on ERISA mandated forms in violation of 18 U.S.C. §§ 1027. He was acquitted on all other charges. The district court placed Bartkus on probation for a three year period, conditioned upon his payment of restitution in the amount of $3,463.00. This appeal followed.

On appeal, Bartkus charged that the district court erred in submitting his case to the jury because, as a matter of law, he could not be convicted under 18 U.S.C. § 1027 which provides:

Whoever, in any document required by title I of the Employee Retirement Income Security Act of 1974 (as amended from time to time) to be published, or kept as part of the records of any employee welfare benefit plan or employee pension benefit plan, or certified to the administrator of any such plan, makes any false statement or representation of fact, knowing it to be false, or knowingly conceals, covers up, or fails to disclose any fact the disclosure of which is required by such title or is necessary to verify, explain, clarify or check for accuracy and completeness any report required by such title to be published or any information required by such title to be certified, shall be fined no more than $10,000, or imprisoned not more than five years, or both.

Bartkus contended that 18 U.S.C. § 1027 could not be utilized to prosecute fund participants. However, as this court noted in

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Bluebook (online)
816 F.2d 255, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-james-m-bartkus-ca6-1987.