Monday, April 29, 2013

Unnecessary Cardiac Stents Can Support Health Care Fraud Conviction

US v. McLean: McLean was a heart doctor who performed (among other things) procedures that inserted stents into the arteries of those with blockages.  Following an internal investigation at the hospital where he worked, which led his resignation, McLean was charged with health care fraud and several counts of filing false paperwork as a part of the fraudulent scheme.  The basis for the fraudulent scheme was that McLean would bill insurance companies for medically unnecessary stent procedures (i.e., a procedure where the arteries weren't blocked enough to warrant it).  After trial, McLean was convicted and sentenced to 97 months in prison.

On appeal, McLean challenged both his convictions and his sentence.  The Fourth Circuit affirmed.  As to his convictions, McLean raised three arguments.  First, he argued that the health care fraud statute as applied to him was unconstitutionally vague because it contained no clear standard of "medical necessity."  The court disagreed, concluding that the requirement that the Government prove the fraud was done "knowingly and willfully" covered any fair notice argument McLean might have.  Second, McLean argued that there was insufficient evidence to support his convictions.  The court disagreed, concluding that there was sufficient evidence from which a jury could conclude he was guilty (see the opinion for a lengthy discussion of those facts).  Third, McLean argued that several evidentiary issues deprived him of a fair trial.  The court disagreed, finding no Brady error with regard to one piece of evidence and no abuse of discretion on the district court's part on the others.  As to his sentence, McLean argued that the district court erred when calculating the amount of loss attributable to him.  The court disagreed, finding no clear error in the district court's acceptance of the hospital's calculation of loss that included additional expenses incurred beyond the actual payments fraudulently obtained.

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