State v. Mann

• Decision Date: 20 June 2000
• Citation: 23 S.W.3d 824
• Parties: (Mo.App. W.D. 2000) State of Missouri, Respondent, v. Millard F. Mann, Appellant. WD55586 0
• Court: Missouri Court of Appeals

23 S.W.3d 824 (Mo.App. W.D. 2000)

State of Missouri, Respondent, v. Millard F. Mann, Appellant.

WD55586

Missouri Court of Appeals Western District

06/20/2000

Appeal From: Circuit Court of Cooper County, Hon. Carl D. Gum, Jr.

Counsel for Appellant: Irene C. Karns

Counsel for Respondent: Philip M. Koppe

Opinion Summary: A jury convicted Millard F. Mann of four counts of the class C felony of stealing by deceit, in violation of section 570.030, RSMo 1994, and one count of making a false statement to receive a health care payment, in violation of section 191.905.1, RSMo 1994. The trial court sentenced Mr. Mann to a total of eight years imprisonment. The trial court also ordered Mr. Mann to pay the State over $45,000.00 as restitution, reimbursement for costs attributable to the investigation and prosecution of the case against him, and court costs. On appeal, Mr. Mann claims that (1) the evidence was insufficient to support his convictions on all of the counts; (2) the trial court erred in limiting his cross-examination of the State's expert; and (3) the trial court erred in ordering that he pay costs and restitution in excess of $45,000 without first affording him a full and fair hearing.

AFFIRMED.

Division IV holds: (1) Sufficient evidence supports Mr. Mann's convictions on the four counts of stealing by deceit. The evidence established that Mr. Mann knowingly and falsely represented to the Division of Medical Services that he provided services to patients on certain dates, and the Division of Medical Services relied on the incorrect dates Mr. Mann entered on the claim forms in paying Mr. Mann through the Medicaid program.

(2) Sufficient evidence supports Mr. Mann's conviction for knowingly making a false statement to receive a health care payment. The evidence established that Mr. Mann knowingly made a false representation to the Division of Medical Services that he provided three hours' worth of services to a child on a particular date in order to receive payment from the Medicaid program.

(3) The trial court did not err in limiting Mr. Mann's cross-examination of the State's expert witness about a possible motive to testify favorably to the State. Mr. Mann failed to establish a connection between the expert and the Medicaid billings of the expert's employer; therefore, the employer's Medicaid billings and overbillings were not probative of any potential bias or interest on the part of the expert.

(4) The trial court's order granting the State's motion for restitution, reimbursement for the costs of the investigation and prosecution, and court costs did not violate Mr. Mann's right to procedural due process. The record establishes that Mr. Mann, although presented with the opportunity for a full hearing on the State's motion, waived it.

Patricia Breckenridge, Chief Judge

A jury convicted Millard F. Mann of four counts of the class C felony of stealing by deceit, in violation of section 570.030, RSMo 1994,² and one count of making a false statement to receive a health care payment, in violation of section 191.905.1. The trial court sentenced Mr. Mann to a total of eight years imprisonment. The trial court also ordered Mr. Mann to pay the State over $45,000.00 as restitution, reimbursement for costs attributable to the investigation and prosecution of the case against him, and court costs. On appeal, Mr. Mann claims that (1) the evidence was insufficient to support his convictions on all of the counts; (2) the trial court erred in limiting his cross-examination of the State's expert; and (3) the trial court erred in ordering that he pay costs and restitution in excess of $45,000 without first affording him a full and fair hearing.

The judgment of the trial court is affirmed.

Factual and Procedural History

On appeal from a criminal conviction, this court reviews the facts and any inferences therefrom in the light most favorable to the jury's verdict. State v. Storey, 901 S.W.2d 886, 891 (Mo. banc 1995). Mr. Mann was a psychologist practicing in Marshall, Missouri. His office was located in his residence. In 1993, Mr. Mann enrolled as a provider of mental health services in the Department of Social Services Division of Medical Services' psychology and counseling program. Enrollment in the program authorized Mr. Mann to receive payment for services he rendered to Medicaid-eligible persons under the age of twenty-one. All providers enrolled in the program receive a copy of the Medicaid program's Psychology / Counseling Manual (Manual), which contains instructions and guidelines for participation in the program, including proper billing practices. Additionally, the Medicaid program offers a telephone number providers can call to obtain answers to questions about the program, plus educational seminars. Mr. Mann and his former office manager attended one such educational seminar in Columbia, Missouri. The subject of the educational seminar was how to properly complete claim forms in order to receive reimbursement.

On the claim forms, providers are to list, among other things, the patient's name and Medicaid number, the date the service was rendered or provided, the place of service, the type and code number of the service provided, the amount of time spent providing that service, and the provider's name and program number. Medicaid reimburses providers based upon the time spent providing the particular type of service.

The program requires that all services provided "must be adequately documented in the medical record." The Manual defines "adequate documentation" and "adequate medical records" as follows:

Adequate documentation means documentation from which services rendered and the amount of reimbursement received by a provider can be readily discerned and verified with reasonable certainty.

Adequate medical records are records which are of the type and in a form from which symptoms, conditions, diagnoses, treatments, prognosis and the identity of the patient to which these things relate can be readily discerned and verified with reasonable certainty. All documentation must be made available at the same site at which the service was rendered.

There are six types of services reimbursable under the Medicaid program. These services are (1) individual psychological counseling; (2) family psychological counseling with the child present; (3) family counseling without the child present; (4) diagnostic evaluation and assessment; (5) group therapy; and (6) crisis intervention. The Manual contains definitions and limitations of each type of service, and the maximum amount which is reimbursable for each service. In the Manual, the service of diagnostic evaluation and assessment is defined as the following:

An assessment service is for the purpose of identifying the treatment needs of the individual or family and . . . must include direct patient contact and could include any or all of the following types of activities:

-- Interview with child (includes topics of family, peers, school relationships, behavior, emotions, observation of social skills, developmental level of planning skills and informal assessment of overall development.)

-- Parent report:

a. Complete child behavior checklist

b. Interview to complete Vineland Adaptive Behavior Scale or similar rating tool.-- Teacher report:

a. Complete form regarding child's development, academic progress, and social adaptive behavior

b. Complete Conner's Teacher Rating Form.

c. Child Behavior checklist --Teacher's report form

Psychiatrist A.E. Daniel, M.D., the State's expert and a consultant to the Medicaid program since 1984, testified at trial that adequate documentation for an assessment service must consist of identifying the date of the service, the patient's symptoms and history, the provider's diagnosis, a treatment plan, and any follow-up procedures.

The service of crisis intervention is defined in the Manual as:

A face-to-face contact to diffuse a situation of immediate crisis. The situation must be of significant severity to pose a threat to the patient's well being or is a danger to him/her self or others. Crisis intervention can not be scheduled.

Dr. Daniel testified that examples of crisis situations prompting this type of service are suicide attempts, violence to others, incessant crying, uncontrollable behavior, and the death of a family member or pet. Dr. Daniel emphasized that the service of crisis intervention by definition cannot be scheduled, as a crisis is not planned.

In late 1994, the Surveillance and Utilization Review Unit of Missouri Medicaid (SURS unit) decided to audit Mr. Mann by reviewing the documentation of several of the claims he had submitted. The decision to audit Mr. Mann was based upon the high number of claims he submitted. At that time, Mr. Mann ranked seventh highest in terms of dollars the program paid to all providers in the state who were enrolled in the program. In January of 1995, Sandra Call of the SURS unit conducted an on-site review of Mr. Mann's patient records. After she was unable to reconcile Mr. Mann's documentation with the claims he submitted, she made copies of all of the files she was reviewing, and referred the case to the Medicaid Fraud Control Unit of the Attorney General's Office.

James Garrison from the Medicaid Fraud Control Unit investigated Mr. Mann. Mr. Garrison subpoenaed Mr. Mann's appointment books and twenty-four of Mr. Mann's patient files. Of the twenty-four files, Mr. Mann gave Mr. Garrison twenty-two complete files and two partial files. Mr. Mann told Mr. Garrison he could not provide a record of any of his appointments because he kept his appointment records on his computer and his computer "crashed," destroying all record of his appointments.

In investigating Mr. Mann's Medicaid practice, the auditors noted that between December 12, 1993, and March 1, 1995, there were fifty-one instances in which Mr. Mann billed Medicaid for more than nine hours in a day. In...