State v. McWilliams
| Decision Date | 17 August 2012 |
| Docket Number | No. 102,688.,102,688. |
| Citation | 283 P.3d 187 |
| Parties | STATE of Kansas, Appellee, v. Oliver McWILLIAMS, Appellant. |
| Court | Kansas Supreme Court |
OPINION TEXT STARTS HERE
Syllabus by the Court
1. When the sufficiency of evidence is challenged in a criminal case, the standard of review is whether, after review of all the evidence, viewed in the light most favorable to the prosecution, the appellate court is convinced that a rational factfinder could have found the defendant guilty beyond a reasonable doubt.
2. Intent may be inferred from acts, circumstances, and the inferences reasonably deducible from them.
3. The facts alleged in an indictment or an information must constitute an offense within the terms and meaning of the statute upon which the offense is based.
4. On the record of this Medicaid fraud prosecution under K.S.A. 21–3846(a)(1), the State's evidence that defendant made an untrue statement he knew to be untrue was sufficient to support the conviction.
Reid T. Nelson, of Capital and Conflicts Appeal Office, argued the cause and was on the brief for appellant.
Kristafer R. Ailslieger, deputy solicitor general, argued the cause, and Jabari B. Wamble, assistant attorney general, and Steve Six, attorney general, were on the brief for appellee.
This case requires us to determine whether sufficient evidence exists to support the bench trial conviction of Oliver McWilliams (McWilliams) under K.S.A. 21–3846(a)(1) for defrauding the Medicaid program. Because we conclude that it does, we affirm the district court and reverse the Court of Appeals.
Mary McWilliams is a Medicaid beneficiary who received Medicaid's “Home and Community Based Services.” Under the program she received help with her day-to-day life activities, including assistance from “personal care attendants” (PCAs). Mary had two PCAs—her husband, Oliver McWilliams, and her daughter, Sharnette McWilliams. While a beneficiary's spouse generally may not provide services per K.A.R. 30–5–307, McWilliams apparently received a spousal exemption under the regulation.
McWilliams submitted his work timesheets to SKIL, a payroll agency, which then submitted the paperwork to Medicaid. After deductions by SKIL, he received $7.75 net per hour for his daytime services and a $20 payment for overnight “sleep cycle support.”
As stated in a form McWilliams signed as part of his enrollment with SKIL, Medicaid prohibits PCAs from providing services to the Medicaid beneficiary while the beneficiary is in a hospital. The form also advises of the prohibition against PCAs submitting a claim to be paid for that time. Yet McWilliams claimed payment for 182.98 service hours and 76 sleep cycles while Mary was hospitalized. And Medicaid paid for these hospital hours.
After an investigation into McWilliams' timesheets, the State charged both Sharnette and McWilliams with Medicaid fraud and tried them separately. Count I of the first amended complaint/information charged McWilliams with engaging in a conspiracy with Sharnette to defraud Medicaid. Count II essentially charged him with defrauding Medicaid in the amount of $3,704.78 by submitting a false claim for the hospital hours:
At the bench trial, McWilliams did not dispute that he had claimed payment for hospital hours. But he argued that Mary needed PCA support to receive adequate care while hospitalized because she was “about dead.” He further testified that her case manager, Lawrence Reece—who did not testify and was described by McWilliams as “the boss”—permitted him to claim payment for hospital hours. McWilliams also testified that he was not aware of Medicaid's ban on PCA hospital hours until the State began the fraud investigation. SKIL employee Rebecca Lemon testified for the State that Medicaid makes “no allowance for someone who is hospitalized” to receive personal care services.
The district court acquitted McWilliams of the conspiracy charge. But it found him guilty of fraudulently billing Medicaid for the hospital time. The court primarily based its ruling on the “Personal Care Attendant Acknowledgement” form which it found that McWilliams had signed. It quoted the form's language: “Under no circumstances will Personal Care Attendants be authorized to provide services nor submit hours for the time that an employer is hospitalized or receiving any other institutional care.” The court found this language “to be pretty compelling in support of a conviction for Count II” because the form “clearly, unequivocally, very specifically says that under no circumstances may a personal care attendant provide services to the employer/patient while the employer/patient is hospitalized.”
In addition to this language, the court also emphasized that this form signed by McWilliam states:
The court then sentenced McWilliams to 12 months' probation with an underlying sentence of 6 months in jail and ordered restitution of $3,704.78 and court costs.
The Court of Appeals reversed McWilliams' conviction, holding that the evidence at trial did “not support a guilty finding for the specific act charged in the complaint.” State v. McWilliams, No. 102,688, 2010 WL 3564738, at *2 (Kan.App.2010) (unpublished opinion) rev. granted November 5, 2010. More particularly, it adopted McWilliams' contention: he “specifically argues the complaint charges that he submitted statements for services he did not provide, while the evidence establishes that he actually did provide the services for which he submitted statements.” (Emphasis added.) 2010 WL 3564738, at *2.
We granted the State's petition for review. Our jurisdiction is under K.S.A. 20–3018(b).
Issue: Sufficient evidence supports McWilliams' conviction for Medicaid fraud.
In analyzing this issue we consider “whether, after review of all the evidence, viewed in the light most favorable to the prosecution, [we are] convinced that a rational factfinder could have found the defendant guilty beyond a reasonable doubt.” State v. Gutierrez, 285 Kan. 332, 336, 172 P.3d 18 (2007).
The State's complaint/information charged McWilliams with making a false or fraudulent Medicaid claim in violation of K.S.A. 21–3846(a)(1), which states:
“(a) Making a false claim, statement, or representation to the medicaid program is, knowingly and with intent to defraud, engaging in a pattern of making, presenting, submitting, offering or causing to be made, presented, submitted or offered:
(1) Any false or fraudulent claim for payment for any goods, service, item, facility, accommodation for which payment may be made, in whole or in part, under the medicaid program, whether or not the claim is allowed or allowable.”
The State asserts that it proved beyond a reasonable doubt that McWilliams (1) knowingly and with intent to defraud, (2) submitted a false or fraudulent claim for payment of services under the Medicaid program, and (3) received between $1,000 and $25,000 in illegal payments. See PIK Crim.3d. 60.40.
McWilliams responds that the State has not established an intent to defraud because he received permission to provide the service in the hospital. He also asserts that he did not defraud Medicaid because he actually provided the services claimed on his timesheets for payment. Both of his points will be addressed in turn.
In 1965, Congress established Medicaid in Title XIX of the Social Security Act, now codified as amended at 42 U.S.C. § 1396 et seq. (2006). Medicaid is jointly funded by the federal government and participating States to provide medical assistance to certain categories of low income individuals.
The Code of Federal Regulations defines “personal care services” under Medicaid as
“ services furnished to an individual who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility for the mentally retarded, or institution for mental disease that are—
(1) Authorized for the individual by a physician in accordance with a plan of treatment or (at the option of the State) otherwise authorized for the individual in accordance with a service plan approved by the State;
(2) Provided by an individual who is qualified to provide such services and who is not a member of the individual's family; and
(3) Furnished in a home, and at the State's option, in another location.” (Emphasis added.) 42 C.F.R. § 440.167(a); accord 42 U.S.C. § 1396d(a)(xvii)(24) (2006).
Against this backdrop, McWilliams argues that he did not intend to violate Medicaid and accompanying Kansas law because he received permission from Lawrence Reece to provide the hospital services and to file those claims for payment. The State responds that intent may be inferred from “ ‘ “acts,...
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