United States v. Robert D. Kaplan

832 F.2d 676, 1987 U.S. App. LEXIS 14453, 23 Fed. R. Serv. 1360
CourtCourt of Appeals for the First Circuit
DecidedNovember 2, 1987
Docket86-1557
StatusPublished
Cited by55 cases

This text of 832 F.2d 676 (United States v. Robert D. Kaplan) 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. Robert D. Kaplan, 832 F.2d 676, 1987 U.S. App. LEXIS 14453, 23 Fed. R. Serv. 1360 (1st Cir. 1987).

Opinion

TORRUELLA, Circuit Judge.

This case presents yet another example of an overly ambitious lawyer who finds himself convicted of knowingly and willfully participating with members of the medical profession in a scheme to defraud insurance companies in violation of 18 U.S.C. § 1341 (mail fraud) and § 2 (aiding and abetting in the commission of mail fraud). See, e.g., United States v. Krowen, 809 F.2d 144 (1st Cir.1987); United States v. Lebovitz, 669 F.2d 894 (3d Cir.), cert. denied, 456 U.S. 929, 102 S.Ct. 1979, 72 L.Ed.2d 446 (1982); United States v. Drury, 687 F.2d 63 (5th Cir.1982), cert. denied, 461 U.S. 943, 103 S.Ct. 2119, 77 L.Ed.2d 1300 (1983); United States v. Shavin, 287 F.2d 647 (7th Cir.1961).

On September 6, 1985, a grand jury returned a 15 count indictment against Robert D. Kaplan (Kaplan) for having mailed to insurance companies claims containing fraudulent medical bills and reports in motor vehicle accident cases. After a 24 day trial a jury found Kaplan guilty on 14 of the counts. On appeal the assignment of errors relates to the denial of motions for a new trial and judgment of acquittal, jury instructions, the limitation of an opportunity for cross-examination, and to the admissibility of evidence. We affirm.

Background

During the relevant period of the indictment (from about 1973 through at least February 12, 1981), Massachusetts operated under a “no fault” automobile insurance system. The plan required an owner of a vehicle registered in the state to purchase personal injury protection (“PIP”). Under PIP coverage, a party injured in an accident could claim (regardless of fault) from the owner’s insurer all reasonable and necessary expenses and a percentage of lost wages, up to a maximum of $2,000. See Mass.Gen.Laws Ann. ch. 90, § 34A (West Supp.1986). A negligence suit (referred to by Kaplan as a “third-party case”) could not be brought unless the medical expenses exceeded $500 or the accident resulted in death, disfigurement, fracture, or loss of a “body member,” sight, or hearing. Mass.Gen.Laws Ann. ch. 231, § 6D (1985).

Kaplan became acquainted with the “no fault” law from his high-volume personal injury practice. The typical motor vehicle accident case handled by Kaplan involved relatively minor “soft-tissue” injuries such as neck and back pain as opposed to “hard tissue” injuries (e.g., fractures). Briefly, the scheme operated as follows. If the client lacked his own physician, Kaplan would select for him a doctor from a “referral list” of forty to fifty medical providers. The list included doctors Hershenow, Rosenthal, Strauss, and Roodin who, it is uncontested, falsified bills by charging pa *679 tients for visits that never occurred. Acting under Kaplan’s directions, the doctor would send directly and only to Kaplan the patient’s medical bills and reports. It is undisputed that Kaplan then would forward these, with the claim, to the insurer. Kaplan would distribute the award to his client, and would recommend to him how much to pay the doctors (the client would note that figure in a “direction to pay” form). Normally, Kaplan paid the doctors two-thirds of their bills and almost always by money orders. This set up was an economic incentive for Kaplan. In the PIP cases, Kaplan retained an amount based on an hourly fee to process the claim, whereas in the third-party case — that is, when the bills exceeded the $500 threshold — Kaplan operated under a contingent fee agreement retaining one-third of the recovery obtained by the client.

Kaplan’s defense rests on the absence of specific intent, namely, that he never participated in the doctors’ scheme knowing it to be fraudulent. This claim of innocence was supported by the following: 1) in the third-party cases medical providers were required by law to sign affidavits attesting the accuracy of their bills (and that Kaplan relied on the presumptively correct reports); 2) Kaplan’s clients answered interrogatories propounded by insurance companies assuring that the amount charged by the doctor was accurate; 3) no medical provider ever told Kaplan about any false bills; 4) his employees did not know of or suspect the fraudulent scheme; and 5) because of the high workload at the law firm it was not unreasonable for Kaplan to lack knowledge of the scheme.

I. Sufficiency of the Evidence

Kaplan argues that the court erred in denying a motion for judgment of acquittal because the evidence was legally insufficient to sustain the verdict. There is no dispute here about the existence of a fraudulent scheme and the mailings as elements of mail fraud. The only issue is whether the jury had enough evidence to find beyond a reasonable doubt that Kaplan knowingly participated in the scheme.

For us to sustain the jury’s determinations we need not find a “smoking gun,” in the sense that Kaplan had been told “the bills are false, do not mail the claims.” It is sufficient if from the admissible circumstantial evidence a jury can infer and conclude beyond a reasonable doubt that indeed he knew the falsity of these claims. United States v. Tierney, 760 F.2d 382, 384 (1st Cir.), cert. denied, 474 U.S. 843, 106 S.Ct. 131, 88 L.Ed.2d 108 (1985); United States v. Cincotta, 689 F.2d 238, 241 (1st Cir.), cert. denied, 459 U.S. 991, 103 S.Ct. 347, 74 L.Ed.2d 387 (1982). In reviewing for sufficiency, we consider the evidence in toto — together with all legitimate inferences that can be drawn from the evidence — in the light most beneficial to the government. See, e.g., United States v. Rothrock, 806 F.2d 318, 320 (1st Cir.1986).

The scheme apparently grew out of a 1973 contact between Rosenthal, a chiropractor, and Kaplan. Rosenthal testified under immunity that Kaplan had agreed to refer clients to him, and in consideration Kaplan would pay him two-thirds of his billings. The other one-third, Kaplan had said, would go back to his clients or would be used to thank those who referred business to him. Payments were made by money orders, apparently to facilitate income tax evasion and to encourage the medical providers to accept less than payment in full. Rosenthal also testified that he recruited Dr. Hershenow, an internist, and told him about the financial arrangements with Kaplan. According to Rosenthal, Kaplan got “angry” upon learning about this and told Rosenthal never again to discuss this subject matter with anyone.

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Bluebook (online)
832 F.2d 676, 1987 U.S. App. LEXIS 14453, 23 Fed. R. Serv. 1360, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-robert-d-kaplan-ca1-1987.