4th Circuit upholds six-year sentence in NC healthcare fraud case

The 4th US Circuit of Appeals has upheld a conviction and six-year prison sentence for a man convicted of taking part in a multimillion-dollar Medicare fraud in North Carolina. A unanimous appellate panel rejected defendant Colby Joyner’s argument that he was denied a fair trial.

Joyner, who held a physician assistant license in North Carolina, took a remote, part-time job in 2018 with MedCare Staffing, “a telehealth company also known as Provider Partners or Telehealth Solutions,” according to Wednesday’s 4th Circuit opinion.

“His job was simple: review patient files that the company sent him and sign forms ordering genetic tests for Medicare beneficiaries,” Judge Julius Richardson wrote. “Over ten months, Joyner signed orders for some 607 beneficiaries — people he certified were his ‘patients,’ despite having spoken with only about 20 of them. For each file he reviewed, he was paid $12 to $15, whether or not he approved the testing. Based on his orders, laboratories billed Medicare for more than 14,600 tests — over $10 million in claims.”

A jury convicted Joyner of healthcare fraud and of making false statements related to healthcare matters. District Judge Robert Conrad sentenced Joyner to 72 months in prison.

“Joyner asks us to undo his conviction and sentence,” Richardson explained. “His main contention is that the district court deprived him of a fair trial by excluding documents relating to MedCare’s internal compliance efforts, by quashing trial subpoenas for four witnesses who invoked their Fifth Amendment privilege, and by overruling his objection to the prosecution’s rebuttal summation. He also says the jury was improperly instructed, the evidence was insufficient, and the Guidelines calculation was wrong.”

The “guidelines calculation” helped determine the sentence.

“We find no reversible error,” Richardson wrote. “The district court acted within its discretion in excluding the compliance documents under Federal Rule of Evidence 403, whatever their marginal relevance may have been. It permissibly excused the four witnesses after a proper and particularized inquiry. Assuming the prosecution’s rebuttal improperly invited an adverse inference from the absence of witnesses who had asserted the Fifth Amendment privilege, the isolated comment did not prejudice Joyner’s substantial rights. Joyner’s remaining challenges to his convictions and sentence fare no better.”

MCS employees used patient information from the company’s clients to get Medicare approvals for medical equipment and genetic testing, Richardson explained. The company’s medical director, Dr. Kevin Smith, and the owner of two MCS corporate clients, Christopher White, trained Joyner and others in October 2018 on “documenting medical necessity for two kinds of genetic tests and on completing laboratory requisition forms, letters of medical necessity, and cover letters transmitting results.”

The company first told Joyner to call patients to confirm they wanted testing, the 4th Circuit opinion explained. But in December 2018, a supervisor “advised him that he was responsible only for ‘chart review and signature’ and did not need to call patients unless there was a discrepancy, because MCS had ‘a team of in-house Medical Assistants and Registered Nurses to call patients.’”

The government’s case against Joyner had “two strands,” Richardson explained. “First, Joyner himself knowingly executed a scheme to defraud Medicare through the false forms he signed. Second, he aided and abetted an existing scheme — run through MCS’s clients and, above all, White — by supplying the one thing that scheme could not function without: a licensed provider’s signature.”

“The district court found that Joyner ‘clearly knew that this was fraudulent activity he jointly engaged in with others,’” Richardson wrote. “The trial evidence amply supports this finding. Joyner knew he was one of numerous providers feeding a single pipeline; he was trained alongside other providers by White and Dr. Smith; and he understood that the genetic tests he ordered through pre-populated forms would be processed by laboratories and billed to Medicare, the program every beneficiary file identified as the payer. The scheme’s entire object was to generate Medicare billings. So the fact that the laboratories did in fact bill Medicare for the tests that Joyner ordered was not some remote contingency.”

“Rather, it was the foreseeable — indeed, intended — consequence of the scheme,” Richardson added. “On these facts, the district court permissibly attributed the resulting $10 million in billings to Joyner as reasonably foreseeable conduct in furtherance of the jointly undertaken scheme.”

“Joyner’s defense was that he was a small player in someone else’s fraud — a guileless provider who trusted seasoned professionals and never saw the scheme for what it was,” Richardson concluded. “The jury was entitled to accept that defense. But it rejected it. Nothing Joyner raises on appeal disturbs that verdict or the sentence built on it.”

“The rulings he challenges were within the district court’s discretion, the errors we have assumed did him no harm, and the findings underlying his sentence were not clearly erroneous,” the opinion continued. “‘A defendant is entitled to a fair trial but not a perfect one.’ Joyner received just that.”

Judges Robert Bruce King and Stephanie Thacker joined Richardson’s opinion.

“4th Circuit upholds six-year sentence in NC healthcare fraud case” was originally published on www.carolinajournal.com.