United States v. Rodriguez-Rivera
Opinion
*33
A United States grand jury indicted three doctors and three employees of a durable medical equipment ("DME") supplier in Puerto Rico on counts of health care fraud and conspiracy to commit health care fraud, under
I.
The relevant portion of the indictment at issue identifies the events and conduct alleged to give rise to a crime as follows.
Medicare covers a beneficiary's access to reusable DME that is medically necessary and that is ordered by a licensed medical doctor or other qualified health care provider. Examples of DME are motorized wheelchairs, hospital beds, oxygen concentrators, nebulizers, and surgical dressings. Medicare also covers certain DME accessories, such as adjustable wheelchair arm rests, safety belts, pelvic straps, reclining backs, seat cushions, and tire pressure tubes.
A DME supplier can submit a claim to Medicare in order to seek direct reimbursement for DME supplied to a beneficiary, but only if that beneficiary has assigned his or her right of payment to the DME supplier. When submitting a claim, the DME supplier must provide, among other things: (1) the beneficiary's name and Health Insurance Claim Number; (2) the name and identification of the physician or provider who ordered the DME; and (3) a description of the DME provided to the beneficiary.
The defendants are either physicians in Puerto Rico or employees of Equipomed, a Puerto Rican DME supplier. According to the indictment, from 2007 to 2013, the defendants engaged in a scheme to defraud Medicare. The alleged scheme was straightforward: (1) the defendant doctors wrote fraudulent prescriptions or medical orders for DME without beneficiaries' assent or knowledge and without even having examined the beneficiaries; (2) the Equipomed defendants then submitted fraudulent DME claims to Medicare; (3) Medicare paid the fraudulent claims; and (4) the defendants split the proceeds.
*34
The indictment also identified the specific crimes alleged to have been committed by each defendant as a result of that conduct. In particular, it pointed to aggravated identity theft under 18 U.S.C. § 1028A(a)(1), which criminalizes the knowing "transfer[ ], possess[ion], or use[ ], without lawful authority, [of] a means of identification of another person" during and in relation to an enumerated list of felony violations. 18 U.S.C. § 1028A. Tracking the statute, the indictment explicitly charged the defendants with "knowingly transfer[ing], possess[ing] and us[ing], without lawful authority, a means of identification of another person" during and in relation to violations of
The defendants moved, presumably under Federal Rule of Criminal Procedure 12(b)(3)(B), to dismiss the section 1028A counts. The government responded in opposition. The defendants argued that dismissal of the counts was warranted because the conduct alleged in the indictment did not sufficiently describe a "use" of a means of identification under section 1028A as defined by this court in
United States
v.
Berroa
,
The district court granted the defendants' motion and dismissed the section 1028A counts, holding that the defendants "submitted the reimbursement forms in their own names and for their own benefit" and did not submit the claim forms "as representatives of the beneficiaries nor for the benefit of the beneficiaries." This interlocutory appeal followed.
II.
Federal Rule of Criminal Procedure 12(b) provides that "[a] party may raise by pretrial motion any defense, objection, or request that the court can determine without a trial on the merits." The defense that the indictment "fail[s] to state an offense" must be raised by pretrial motion when "the basis for the motion is then reasonably available and the motion can be determined without a trial on the merits." Fed. R. Crim. P. 12(b)(3)(B)(v). For this reason, the district court was certainly correct to entertain such a pretrial motion claiming that the indictment failed to state a criminal offense.
The indictment, however, is on its face adequate to state an offense. Unlike a civil complaint that need allege facts that "plausibly narrate a claim for relief,"
Germanowski
v.
Harris
,
Such is just what the government's superseding indictment did in this case. It *35 fairly identified the defendants' conduct alleged to be a crime: the submission of specific, identified claim forms on specified dates falsely stating that a named beneficiary had received DME entitling that named beneficiary to reimbursement, and falsely indicating that the beneficiary had assigned his or her reimbursement right to a defendant. It also cited and tracked the statutory language said to make such conduct criminal. As a result, upon reading the indictment, each defendant knew both the specific offense with which he or she was charged and the specific conduct said to have constituted that offense. In this manner, the government sufficiently enabled the defendants to prepare defenses and protect themselves against being twice put in jeopardy for the same offense.
In nevertheless dismissing the indictment, the district court did not question that § 1028A is a criminal offense, that the indictment recited its elements properly, or that the indictment identified the defendants' conduct said to have constituted the offense. Instead, at the defendants' behest and over the government's objection, the district court undertook to determine whether the conduct identified in the indictment could, as a matter of law, support a conviction for the charged offense of aggravated identity theft. Among other things, the district court ruled that no facts were alleged showing that the defendants "submit[ted the] claim forms as representatives of the beneficiaries."
That ruling presumes that a Rule 12(b) motion provides an occasion to force the government to defend the sufficiency of its evidence to be marshalled in support of proving the charged offense. It does not. As we said in
Stepanets
(issued after the district court's decision in this case), "the government need not recite all of its evidence in the indictment."
As this court recently held, under Rule 12(b)(1), "a district court may consider a pretrial motion to dismiss an indictment where the government does not dispute the ability of the court to reach the motion and proffers, stipulates, or otherwise does not dispute the pertinent facts."
United States
v.
Musso
,
The district court in this case apparently regarded the factual record as complete and undisputed. The government has never so conceded. The claim forms said to constitute the use of other persons' names, dates of birth, and claim numbers are not in the record. Nor is there any evidence concerning how Medicare interprets such forms. The indictment alleges that the claim form must be read as a statement that the identified beneficiary has assigned his or her benefit claim to one of the defendants. Whether such a transfer of rights somehow also connotes permission to act on behalf of the assignor is unclear on the limited record as it now stands, as is whether the conduct alleged constitutes a requisite transfer or possession of the beneficiaries' personal identifying information. We tender no opinion as to whether the prosecution will turn out to have enough evidence to secure a conviction. We do hold that the proceedings as they now stand provide no occasion for determining *36 whether the government's proof is sufficient to sustain a conviction. And the record here lacks any agreed upon completeness.
III.
For the foregoing reasons, we reverse the district court's dismissal of the section 1028A aggravated identify theft counts, and remand for further proceedings in accordance with this opinion.
Reference
- Full Case Name
- UNITED STATES of America, Appellant, v. Dante RODRÍGUEZ-RIVERA; Javier Efraín Siverio-Echevarría; George D. Alcántara-Cardi; Martha Nieves; Javier Antonio Aguirre-Estrada; Carlos Maldonado-López, Defendants, Appellees.
- Cited By
- 3 cases
- Status
- Published