U.S. v. Lucien, Docket No. 02-1228.
| Decision Date | 14 October 2003 |
| Docket Number | Docket No. 02-1228.,Docket No. 02-1266.,Docket No. 02-1395. |
| Parties | UNITED STATES of America, Appellee, v. Jean Maxon LUCIEN, Frantz Mevs, Waldon Desir, Joseph Agnant, Marie Agnant, Sherly Bouche, Max Deralus, Harry Desir, Rhode Dorlus, Gino Faurelus, Pierre Francois, Soline Germain, Jean Germain, Oddy Jean-Marie, Claudia Paul, Joseph Noncent, Daniel Richard, Edouarcin Romeo, Guerline Dormetis, Jean Sereme, Marie Berger, Claudette Augustin, also known as Claudette Franck, Vincent Virgil, Ketty Israel, Lahens Castile, Defendants, Yves Baptiste, Policia Baptiste, Guerline Dormetis, Defendants-Appellants. |
| Court | U.S. Court of Appeals — Second Circuit |
Jonathan C. Scott, Smithtown, New York (Scott & Scott, LLP, Smithtown, New York, of counsel), for Defendant-Appellant Policia Baptiste.
Jason L. Solotaroff, New York, New York (Giskan & Solotaroff, New York, New York; Robert A. Culp, Law Office of Robert A. Culp, New York, New York, of counsel), for Defendant-Appellant Guerline Dormetis.
Martin G. Goldberg, Franklin Square, New York, submitted a brief for Defendant-Appellant Yves Baptiste.
Andrew J. Frisch, Assistant United States Attorney, Brooklyn, New York (Roslynn R. Mauskopf, United States Attorney, Peter A. Norling, Scott B. Klugman, Assistant United States Attorneys, Eastern District of New York, Brooklyn, New York, of counsel), for Appellee United States of America.
Before: MESKILL, CARDAMONE, and CABRANES, Circuit Judges.
Because health care fraud drains billions of dollars from public and private payers annually, Congress has since 1992 sought a tool to combat this problem. See Comm. on Gov't Reform and Oversight, Health Care Fraud: All Public and Private Payers Need Federal Criminal Anti-Fraud Protections, H.R.Rep. No. 104-747 (1996). In 1996 Congress enacted the latest in a series of health care fraud statutes making any fraud perpetrated against a public or private payer a federal criminal offense. See Health Insurance Portability and Accountability Act of 1996, Pub.L. No. 104-191, § 242(a)(1), 110 Stat. 1936, 2016 (1996). Defendants' convictions before us on this appeal were for violations of that statute. Their challenge to the statute's application to frauds they committed against private payers arises from staged automobile accidents and feigned injuries for which medical providers reimbursed them, and raises issues of first impression. Case law interpreting the 1996 federal health care fraud statute is, so far as we can discover, virtually non-existent.
Yves Baptiste and Policia Baptiste (unrelated) and Guerline Dormetis (defendants or appellants) appeal from judgments of the United States District Court for the Eastern District of New York (Gleeson, J.), entered on April 10, April 17, and July 26, 2002, respectively, convicting them — after a jury trial — of health care fraud in violation of 18 U.S.C. § 1347. Defendants were sentenced as follows: Yves Baptiste, to 30 days incarceration, which he has served, three years of supervised release, restitution in the amount of $46,701 and a special assessment of $100; Policia Baptiste, to five months incarceration, which she has served, three years of supervised release, restitution in the amount of $41,065 and a special assessment of $100; and Guerline Dormetis, to 21 months incarceration, which she is presently serving, three years of supervised release, restitution in the amount of $56,172 and a special assessment of $100.
Defendants challenge their convictions and sentences on a variety of grounds. This opinion considers: (1) whether the federal health care fraud statute applies to the conduct of defendants, who participated as passengers in staged automobile accidents designed to exploit New York's no-fault automobile insurance regime; (2) whether the district court fulfilled its statutory duty to inquire into defendant Yves Baptiste's economic circumstances when imposing restitution; and (3) whether in Dormetis' case the district court improperly (a) calculated the amount of loss attributable to her in determining her base offense level, and (b) enhanced her base offense level for risk of serious bodily injury. Defendants' remaining claims are considered and rejected in a summary order filed concurrently with this opinion.
All three defendants participated in staged automobile accidents and fabricated personal injury claims to take advantage of the operation of the New York Comprehensive Motor Vehicle Insurance Reparations Act, see N.Y. Ins. Law § 5101 et seq. (McKinney 2000) (formerly N.Y. Ins. Law § 670 et seq.), more commonly known as the New York No-Fault Act. See generally Montgomery v. Daniels, 38 N.Y.2d 41, 45-49, 378 N.Y.S.2d 1, 340 N.E.2d 444 (1975) ().
The New York No-Fault Act provides compensation for victims of automobile accidents without regard to fault. Central to the law is the requirement that every owner of a motor vehicle maintain a liability insurance policy that provides the owner, members of the owner's household, operators and occupants of the vehicle and pedestrians with compensation for "basic economic loss" resulting from injuries occasioned by the use or operation of that vehicle in New York State, regardless of fault. N.Y. Ins. Law §§ 5102(6), 5103. "Basic economic loss" is defined under the statute to include costs for medical treatment, lost earnings, and other reasonable expenses not to exceed $25 per day. Each person involved in an automobile accident is entitled to reimbursement of up to $50,000 for basic economic loss. Id. § 5102(a)(1)-(3). Under the no-fault law an injured person may assign his or her right to payment for medical expenses to a medical care provider. If an injured person sustains a serious bodily injury, as defined by the statute, that person may also initiate a civil suit for non-economic loss, that is, pain and suffering, against the owner of either car involved in the accident. Id. § 5104.
The government proved at trial that defendants were recruited to participate in the charged health care fraud by Binsonn Guillaume, Jackson Clerveaux and Frantz Mevs. The trial in this case was one of six trials arising from related indictments charging numerous individuals with participating in an overarching scheme of health care fraud based on a series of deliberately staged automobile accidents in several boroughs of New York City. This is the first appeal from these trials to reach this Court. Guillaume and Clerveaux — who both testified for the government in the instant case — and Mevs recruited and paid individuals to drive or ride as passengers in vehicles that were deliberately crashed into other vehicles. Following the accidents, the recruited passengers were referred, in exchange for a fee, to various medical clinics in New York City. The recruited passengers assigned their no-fault insurance benefits to the health care clinics (medical providers), which billed the insurance companies directly. The recruited passengers subsequently advanced their own civil causes of action for their feigned injuries. To receive no-fault reimbursements, the health care clinics generated fictitious treatment records for the passengers in the accidents. The accident participants used these fictitious medical records to support their claims of personal injury and to obtain settlements from insurance companies.
Each of the present defendants participated in this health care fraud by riding as a passenger in a vehicle that was intentionally crashed into another vehicle. They were involved in separate accidents on different dates. No one was hurt in any of these collisions, but each defendant sought medical benefits for non-existent injuries. The medical providers received payment from insurance companies for imaginary medical expenses allegedly incurred on defendants' behalf, under the no-fault law, as follows: for Yves Baptiste $10,876.91, for Policia Baptiste $9,213.45, and for Guerline Dormetis $6,022.14. In addition to these payments to medical providers, each defendant retained a lawyer and sought damages in a civil suit for feigned personal injuries. Each defendant obtained a settlement from an insurance company, as follows: Yves Baptiste $6,500, Policia Baptiste $1,500, and Guerline Dormetis $7,000. All three defendants were thereafter charged with and convicted of a separate count of health care fraud arising from his or her participation in an arranged accident. They appeal their convictions and sentences. We affirm.
On appeal the defendants contest the application of the health care fraud statute, 18 U.S.C. § 1347, to their conduct. They challenge the scope and applicability of the statute on somewhat different bases, although their arguments are simply variations on the same theme. Yves Baptiste, whose arguments we now consider, contends the statute applies only to health care professionals, and that the New York State no-fault automobile insurance program is not a "health care benefit program" within the meaning of the statute. Policia Baptiste's and Dormetis' challenges to the statute on related grounds are addressed in our accompanying summary order.
Analysis begins with a review of the two relevant statutory provisions in question, 18 U.S.C. § 1347 and 24(b). Section 1347, that defines the offense of which defendants were convicted, states
Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice — (1) to defraud any health care benefit program; or (2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care...
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