Hall v. State
| Decision Date | 19 November 1999 |
| Docket Number | No. A99A0883.,A99A0883. |
| Parties | HALL v. The STATE. |
| Court | Georgia Court of Appeals |
OPINION TEXT STARTS HERE
Chilivis, Cochran, Larkins & Bever, Anthony L. Cochran, James D. Durham, Atlanta, for appellant.
J. Tom Morgan, District Attorney, Thurbert E. Baker, Attorney General, Doris Williams-McNeely, Harrison W. Kohler, Assistant Attorneys General, for appellee.
Dr. Edwin Hall, Jr., a psychologist, appeals after denial of his motion for new trial following his conviction, along with his co-defendant Rickie Lewis, of conspiracy to defraud the State (OCGA § 16-10-21), Medicaid fraud (OCGA § 49-4-146.1), and theft by taking (OCGA § 16-8-2).1
Lewis alone was alleged to have committed the overt acts of incorporating We Care Family Services in February 1994; recruiting children who were Medicaid recipients for services represented to the parents and guardians as day care, after school programs, tutoring, and counseling services; "on multiple occasions, caus[ing] fraudulent billings to be submitted to [Electronic Data Systems]2 for psychological services to these children that were not medically necessary and in excess of the number of psychological services that were actually provided"; and causing "Medicaid recipient files to be fabricated to show that psychological services were rendered on certain dates, when in fact the services were not rendered on those dates."
Overt acts were alleged to have been committed jointly by Lewis and Hall in their entering an agreement that Hall would "provide psychological services at We Care Family Services," applying for a Medicaid provider number to provide these services, and in accepting medical assistance payments from Medicaid, in "an amount greater than that to which they were entitled, for services billed by We Care Family Services."
Hall alone was alleged to have committed the overt act of, from April 11, 1994 through April 3, 1995, "provid[ing] psychological services to Medicaid recipients that were not medically necessary."
Viewed with all inferences in favor of the verdict, the evidence was that Lewis, who was not a psychologist, set up We Care Family Services, a nonprofit corporation, and was provided space by the Atlanta Housing Authority at Bankhead Courts and Hollywood Courts, two Atlanta public housing projects. Lewis represented to the Authority that We Care was a living skills program which used only private funding. Lewis and Pelham, one of We Care's employees, went throughout the apartment complexes handing out flyers stating that We Care would provide computer training, a GED program, tutoring and counseling. Although none of these services were covered by Medicaid, Lewis and Tracey Pelham signed up numerous families and obtained the Medicaid numbers for all of the individuals in these families. The parents believed that the children were being signed up for after school and summer programs, which, they were told, would be paid for if they received public assistance. A few mothers also attended some of the computer training and GED sessions.
Jones, who was employed by a substance abuse program, was approached by Lewis and asked to do Medicaid billing for We Care. He gave her a legal pad with three or four pages of names, Medicaid numbers, and birthdays listed and asked her to bill for those names. At that point, he did not have a provider number, and no dates of service were listed. Jones advised Lewis that a provider number and dates of service were necessary for billing. Asked what codes of service she should bill under, Lewis told her to use the same ones she used for the substance abuse program, but she would not. Later, Lewis returned with the list and advised her that Hall was working with the program and gave her Hall's provider number. Dates of service had also been added to the list, and Jones prepared the billing.
Hall was contacted by Lewis and became the psychologist for We Care in mid-April 1994, obtaining a Medicaid provider number for We Care locations.3 He provided Lewis with his power of attorney to be used for We Care, and all Medicaid billing was done by Lewis or at Lewis' direction. We Care received its first Medicaid payment on May 2, 1994, and was deposited by Lewis in a bank account in his name, "d/b/a We Care Family Services, Inc." Lewis then wrote checks to Hall for half of the amount received. Hall's first payment was received on May 11, 1994.
Lewis back-billed Medicaid under Hall's provider number for $76,000 worth of services performed before Hall even began with We Care, and Hall received half of that amount.4
Jones only did the billing for Lewis for a short time, after which Lewis did the billing. After she quit in June 1994, she telephoned Hall and advised him of the back-billing and the codes Lewis had wanted her to use. Hall's only response was that he had his own format and codes. Although Jones did not tell Lewis she had called Hall, Lewis telephoned Jones several weeks after the call, called her an obscene name, and threatened to sue her for slander.
After Hall began work with We Care in April 1994 and until January 1995, Pelham, employed by We Care, assisted him. While Pelham had an undergraduate degree in psychology and had some teaching experience, she was not a psychologist or specifically trained in psychological testing. Medicaid policies and procedures allowed for "auxiliary personnel" employed by a clinic or doctor's office to conduct psychological evaluation and testing, but only under the direct supervision of a licensed psychologist. Psychotherapy, either group or individual, was to be conducted only by a licensed psychologist enrolled in the Medicaid program.
Pelham, however, prepared the paperwork for the files maintained for the children involved with We Care. She prepared an intake sheet and filled out the mental status examination and checklist forms. She was provided with a copy of the Diagnostic & Statistical Manual of Mental Disorders by Hall, and, in the fall of 1994, Hall gave Pelham and other lay workers with We Care a list of the most commonly diagnosed disorders with the appropriate codes for billing. All children involved were given a diagnostic code, although the parents were unaware of this. Also, the only psychological testing done was performed by Pelham without oversight by Hall. The majority of the tests were not scored and, therefore, were unusable for therapeutic purposes.
Groups of children were periodically gathered together by Pelham, Terika Ford, and Gwendolyn Marshall, also lay employees of We Care, for group therapy sessions. Hall attended these sessions only sporadically initially and did not enter any notes in the files. All note taking was done by Pelham, Ford, and Marshall. None of these women were trained or had any experience in this area. As Hall acknowledged, he instructed Pelham, Ford, and Marshall regarding note taking. He testified that it was not complex to be "able to follow these kind of cookbook directions in order to generate ongoing session notes." Hall further acknowledged that, because Lewis maintained custody of these files, he never consulted or reviewed them. During these group sessions, described by various participants as "rap sessions," the children had snacks, received minimal computer instruction, played, watched videos or just talked.
After another We Care employee was arrested by Georgia Bureau of Investigation agents in connection with a separate investigation, Hall and Lewis told We Care employees that it was very important that the files be up-to-date because the GBI was going to come for them. Hall told Pelham and others that the files had to be Lewis told the women they would have to work all weekend on the files, and they did. Hall told them he had to go out of town and was not present when the files were supplemented. Lewis produced the billing sheets, and the women wrote out "session notes" for the files that matched what was billed. Pelham and Ford both testified they made up the notes.
After working all weekend on the files, Pelham told Hall that she was concerned about the situation. He told her he would try to regulate it and not to worry.
From May 1994 until April 1995, We Care was paid, under Hall's provider number, $538,920.41 by 42 separate checks which combined numerous billings. This was only a portion of the total of $1,103,449.53 which was billed by We Care. The primary code given as a reason for nonpayment was that the number of contacts billed for a patient exceeded those allowed by Medicaid for one year.
The session supplementing the case files for the children occurred after Hall had been...
To continue reading
Request your trial
-
Robinson v. State
...challenges, as it had instead proffered evidence in support of the other overt acts set forth in Count 2. See Hall v. State, 241 Ga.App. 454, 460(1), 525 S.E.2d 759 (1999) ( “[Defendant] could be convicted of conspiracy even if ... the jury did not believe that [defendant] had committed the......
-
Mellott v. State
...to be charged as separate offenses. See Commonwealth v. Goodman , 9 Mass. L. Rptr. 318 (Mass. Super. Ct. 1998) ; Hall v. State , 241 Ga.App. 454, 525 S.E.2d 759 (1999).8 This ineffective assistance of counsel claim is one of first impression. As discussed infra at ¶ 28, we previously have c......
-
Smith v. State
...kind of conduct generally and the other to prohibit a specific instance of such conduct.We note that in Hall v. State , 241 Ga. App. 454, 459 (1), 525 S.E.2d 759 (1999), the Court of Appeals stated without analysis of the statutory language that "OCGA § 16-1-7 (a) (2) prohibits multiple pro......
-
Lockett v. State, A02A1255.
...or accusation for charging more than one offense in a single count is properly styled a special demurrer. Hall v. State, 241 Ga.App. 454, 459(1), 525 S.E.2d 759 (1999); Morgan v. State, 212 Ga.App. 394(1), 442 S.E.2d 257 5. State v. Williams, 247 Ga. 200, 202-203(2), 275 S.E.2d 62 (1981). 6......