United States v. Maciejewski

70 F. Supp. 2d 129, 1999 U.S. Dist. LEXIS 15689, 1999 WL 809817
CourtDistrict Court, N.D. New York
DecidedSeptember 22, 1999
DocketNo. 97-CR-0428
StatusPublished
Cited by1 cases

This text of 70 F. Supp. 2d 129 (United States v. Maciejewski) is published on Counsel Stack Legal Research, covering District Court, N.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States v. Maciejewski, 70 F. Supp. 2d 129, 1999 U.S. Dist. LEXIS 15689, 1999 WL 809817 (N.D.N.Y. 1999).

Opinion

MEMORANDUM-DECISION & ORDER

McAVOY, Chief Judge.

Defendant James Best (“Best”) was convicted by a jury of aiding and abetting in the execution of a scheme to defraud the United States in violation of 18 U.S.C. § 2 (aiding and abetting) and the Major Fraud Act, 18 U.S.C. § 1031. Currently before the Court is Best’s motion pursuant to Fed. R. CRIM. P. 29 for a judgment of acquittal or, in the alternative, pursuant to Fed. R. Crim. P. 33 for a new trial.

[131]*131I, BACKGROUND

Because the Court is presented with Best’s motion pursuant to Fed. R. Crim. P. 29, the following evidence is presented in the light most favorable to the government. See Jackson v. Commonwealth of Virginia, 443 U.S. 307, 99 S.Ct. 2781, 2788, 61 L.Ed.2d 560 (1979); United States v. Stephenson, 183 F.3d 110, 113 (2d Cir.1999).

In 1992, Jerome Maciejewski (“Macie-jewski”) and Best were senior executives of WholeHealth Insurance Network, Inc. (“WIN”) 1, a non-profit health insurance company. WIN had divisions in Buffalo, Albany, and Binghamton. Maciejewski was the Chief Operating Officer (“COO”) of WIN’s Binghamton Division, known as the Upstate Medicare Division (“UMD”). Best was the COO of the Albany Division.

The Buffalo and Albany divisions were primarily involved in the sale of private health insurance policies. The UMD, however, had a contract with the Health Care Financing Administration to process claims for Part B of the Medicare Program. See 42 U.S.C. § 1395j, et seq.

The federal government contracts with ' “carriers” for the administration of Medicare benefits. See 42 U.S.C. § 1395u. The UMD was the Medicare Part B carrier responsible for processing Part B claims for health care providers in Central, Western, and Upstate New York.

Under the Medicare contract, the federal government paid WIN’s costs of administering the Medicare program. See 42 U.S.C. § 1395u(c). However, WIN’s costs pertaining to the administration of its private health insurance programs would not be paid for by the government. In order to ensure proper payments from the government, each carrier was required to report all Medicare-related costs to HCFA on a monthly and yearly basis.

In 1991 and 1992, WIN was experiencing financial difficulties. In an effort to cut costs, in 1991, WIN consolidated the mailroom operations of its three divisions into the UMD. In or about April 1992, Maciejewski was promoted to Executive Vice President and COO of WIN. Thus, he had responsibility for all three WIN divisions. Best continued to act as COO for the Albany division.

Shortly after his promotion, Maciejewski directed that fifty percent (50%) of the postage costs of WIN’s private insurance business be allocated to the Medicare program. This resulted in increased costs being charged to Medicare.

Each of the three WIN divisions had a professional relations department that educated health care providers about the billing practices necessary to submit claims for payment. The UMD was primarily responsible for providing professional relations with respect to the Medicare program and, accordingly, was reimbursed by Medicare for the costs of such professional relations. The Albany and Buffalo divisions were primarily responsible for providing professional relations with respect to their private health insurance business and, thus, their provider relations costs were not reimbursable by Medicare. While the Albany division did provide some Medicare-related professional relations services until 1990, such Medicare-related activity had ceased by 1992.

In May 1992, Maciejewski instructed an employee in the Buffalo accounting department, Robert Gastle, to allocate fifty percent (50%) of the costs of the Buffalo and Albany professional relations departments to Medicare. Maciejewski also instructed that the allocation be made retroactive to January 1,1992. Gastle relayed this information to WIN’s comptroller, David Voss. Voss, however, expressed a reluctance to allocate non-Medicare costs to the Medicare program without written instructions.

[132]*132After learning of Voss’s hesitancy, Ma-ciejewski told Gastle that he would generate a memorandum for Voss. Maciejewski also stated that he would “take care of it with Jim Best,” see Def. Mem. of Law at 2.

On or about May 6, 1992, Maciejewski had a memorandum prepared directing Voss to reallocate fifty percent (50%) of the Buffalo division’s professional relations costs to Medicare, and to make the allocation retroactive to January 1, 1992.2 The memorandum was back-dated to February 3, 1992. The trial evidence demonstrated, however, that the Buffalo division was not, in fact, performing any Medicare-related professional relations. As a result of the memorandum, private business costs were allocated to the Medicare program.

On or about May, 14, 1992, Best authored a memorandum similar to that of Maciejewski.3 The Best memorandum requested that Voss “make the necessary adjustment in the cost allocation system to properly credit this department for its Medicare involvement.” The memorandum further stated that “[s]ince the first of the year, Jerry Maciejewski has asked us to assist the Medicare B Operation by having our Professional Relations Representatives disseminate various [MJedicare information to our providers when they are making routine provider contacts and calls.” As did Maciejewski, Best requested that fifty percent (50%) of the Albany division’s provider relations costs be allocated to Medicare retroactive to January I, 1992. As noted, however, in 1992, the Albany division’s professional relations department had no involvement with the Medicare program. Similar to the Macie-jewski memorandum, Best’s memorandum was back-dated to February 18, 1992. As a result of Best’s memorandum, private business costs were allocated to the Medicare program.

Based on the foregoing, and other evidence adduced at trial, Best was convicted on one count of aiding and abetting the execution of a scheme to defraud the United States in violation of 18 U.S.C. §§ 2 and 1031.

Presently before the Court is Best’s motion for a judgment of acquittal pursuant to Fed. R. Crim. P. 29 or, in the alternative, a new trial pursuant to Fed. R. Crim. P.

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Bluebook (online)
70 F. Supp. 2d 129, 1999 U.S. Dist. LEXIS 15689, 1999 WL 809817, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-maciejewski-nynd-1999.