United States v. Matilda Prince

CourtCourt of Appeals for the Eleventh Circuit
DecidedAugust 12, 2019
Docket18-13656
StatusUnpublished

This text of United States v. Matilda Prince (United States v. Matilda Prince) 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. Matilda Prince, (11th Cir. 2019).

Opinion

Case: 18-13656 Date Filed: 08/12/2019 Page: 1 of 20

[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT ________________________

No. 18-13656 Non-Argument Calendar ________________________

D.C. Docket No. 2:15-cr-00037-RWS-JCF-1

UNITED STATES OF AMERICA,

Plaintiff-Appellee,

versus

MATILDA PRINCE,

Defendant-Appellant.

________________________

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

(August 12, 2019)

Before ROSENBAUM, JILL PRYOR and FAY, Circuit Judges.

PER CURIAM: Case: 18-13656 Date Filed: 08/12/2019 Page: 2 of 20

Matilda Prince appeals her convictions for 29 counts of health care fraud, in

violation of 18 U.S.C. § 1347. We affirm.

I. BACKGROUND

Prince was charged in a superseding indictment by a grand jury with 29

counts of health care fraud by filing 29 false claims for payment with Medicare

and Medicaid, in violation of 18 U.S.C. § 1347. The superseding indictment

alleged the following. Prince was the owner and operator of Pickens Eye Clinic, a

company located in Jasper, Georgia, which purported to provide a variety of

optometry and ophthalmology services to a primarily senior citizen population.

Her brother, Martin Prince, owned an eye care company called The Eye Gallery,

which provided the same services and for which Prince worked, advertised, and

provided eye care services. Prince was never licensed in Georgia as a physician,

optometrist, ophthalmologist, or dispensing optician.

In order to obtain reimbursement for the eye care services allegedly

performed by Pickens Eye Clinic and The Eye Gallery, Prince entered “Current

Procedural Terminology Manual” (“CPT”) codes identifying medical services and

procedures on claims she electronically submitted to Medicare and Medicaid,

which, through fiscal intermediaries, relied on the codes in paying the claims. The

claims were submitted to Medicare and Medicaid using the names, identities, and

uniquely assigned provider numbers of two medical providers who were licensed

2 Case: 18-13656 Date Filed: 08/12/2019 Page: 3 of 20

optometrists that Prince had hired through a third-party physician contracting

agency. Prince made claims to Medicare and Medicaid for optometry services that

had not been provided.

In November 2010, Prince was ordered in a proceeding in the Superior Court

of DeKalb County, Georgia, not to receive any benefits, or be employed or

involved with, any entity that received Medicaid or Medicare funding for a period

of five years and to pay restitution in the amount of $109,712.26 to Georgia

Medicaid. She and Pickens Eye Clinic were also excluded by the U.S. Department

of Health and Human Services from participating in Medicare, Medicaid, and all

federal health care programs, making them ineligible to submit claims for any

services provided after September 20, 2011.

The superseding indictment also alleged that Prince generated business by

offering on-site eye exams and prescription glasses at no charge to Medicare and

Medicaid recipients at public housing complexes with large senior citizen

populations. After receiving Medicare and Medicaid numbers from recipients, she

used their identities and the identities of the licensed optometrists to submit claims

for optometry services, such as “closure of the lacrimal punctum by plug,” and

backdated claims for optometry services that were not rendered. The indictment

included a table of the Medicare and Medicaid claims by date of service, date the

claim was submitted, CPT code, and patient, separated into 29 counts. Counts 2

3 Case: 18-13656 Date Filed: 08/12/2019 Page: 4 of 20

through 4 alleged that Prince had made fraudulent claims with respect to a patient

named “W.M.” for services dated June 27, July 18, and August 8, 2011.

Prince entered a not-guilty plea. The government filed a notice of intent to

introduce evidence under Federal Rule of Evidence 404(b). It then filed a motion

in limine to admit at trial intrinsic evidence or, in the alternative, to admit similar

acts evidence under Rule 404. The exhibits included a single-count indictment

from DeKalb County Superior Court on December 10, 2009, charging Prince with

Medicaid fraud, in violation of § 49-4-146 of the Georgia Code. The exhibits also

included Prince’s state court criminal judgment and a later consent order to modify

her sentence, which showed that Prince pled guilty to the count and was sentenced

as a “first offender” to a ten-year term of probation, required to pay restitution of

$109,172.26, and barred from owning, deriving income from, or being employed

by any business that received Medicare or Medicaid funds for five years.

The district court granted the motion with respect to Prince’s 2010

conviction for Medicaid fraud and sentencing under the Georgia First Offender Act

and evidence of her exclusion from federal health care programs in 2011. It

reasoned that the evidence was intrinsic because it was inextricably intertwined

with the charged offenses and was therefore not prohibited by Rule 404(b). It also

concluded that, even if it was not intrinsic, the evidence was still admissible under

Rule 404(b).

4 Case: 18-13656 Date Filed: 08/12/2019 Page: 5 of 20

Walter Morton and Debbie Sanders, residents of the Summerville Housing

Authority apartment building, testified about their experiences with The Eye

Gallery and Prince. They both testified that they received eye exams and ordered

glasses when Prince visited their apartment building in May 2012. They each saw

Prince a few more times when she came to their apartment building to deliver

glasses, fit some residents for sunglasses, and deliver sunglasses. Prince billed

Medicare and Medicaid for providing Morton and Sanders with the service of

closing the lacrimal punctum by plugs multiple times and listed Dr. Carl Llabres as

the treating optometrist. While Morton could not recall whether he had very small

plugs placed in his tear ducts, Sanders confirmed that she did not receive that

procedure, nor had she seen any residents getting plugs in their eyes during

Prince’s visits. Sanders identified three forms she had signed but not read, which

she was required to bring to Prince on May 23, 2012, for the free eye exam and

eyeglasses. The documents were claim forms, which showed she had plug

procedures to close her tear duct openings on June 27, July 18, and August 8, 2011,

billed through Pickens Eye Clinic. On cross-examination, she confirmed that she

did sign the documents.

Dorothy Swift, an investigative analyst with the Department of Health and

Human Services, Office of the Inspector General, testified regarding Prince and

Pickens Eye Clinic’s exclusion from Medicare in September 2011 based on her

5 Case: 18-13656 Date Filed: 08/12/2019 Page: 6 of 20

state conviction. The government asked the district court to give a limiting

instruction regarding her testimony about Prince’s state court conviction and

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United States v. Matilda Prince, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-matilda-prince-ca11-2019.