Eleventh Circuit Court of Appeals - Published Opinions

Thursday, June 19, 2014

Houser: Affirming Health Care Fraud Conviction based on failure to provide nursing home services

In U.S. v. Houser, No. 12-14302 (June 19, 2014), the Court affirmed the conviction and sentence of a defendant charged with committing health care fraud by failing to provide required services at nursing homes. The Court found that it need not address whether the concept of “worthless services” is unconstitutionally vague when used to define health care fraud, because it was affirming the conviction based on “the nursing facilities’ complete failure to provide some necessary services.” The Court found that House “sought reimbursement from Medicare and Georgia Medicaid for required services – pharmaceutical, diagnostic, medical and dietary – that simply were not provided.” The Court rejected the argument that the government failed to show Houser’s “willfulness” in failing to pay payroll taxes. “Although Houser made frequent visits [to the IRS] the evidence reveals that those visits were an effort to stave off further investigation and prosecution, as opposed to an effort to correct an innocent mistake.” The Court similarly rejected Houser’s claim that his failure to file a federal tax return was not willful.