BHM443 - Legal Aspects of Health Care

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Name
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Institution
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Dr. Robert stokes practiced medicine in Grand Rapids, Michigan as a licensed board-certified dermatologist. He was investigated by federal agents in 2001 for billing medical insurers for more expensive procedures than those he had actually performed. Incriminating malpractices were revealed by these investigations. Stoke billed simple and light surgery procedures as if they were full and complicated surgeries which were more costly. Stokes also often billed patients for office visits and surgical procedures on the same day. This is a practice that is normally prohibited by insurers. The investigations` results guided the jury to indict stokes with multiple counts of defrauding the government of more than two million dollars. (As cited in Green, 2010, p. 1).
Dr. Stokes also re-used medical equipment including scalpels, sutures, syringes and many others with no or insufficient sanitization. An investigation by Kent County Health Department of Stoke`s medical practices found that he had re-used many medical equipment when handling patients for many years. The sanitization procedures stokes performed on the medical equipment were not enough. They did not eliminate the chances of disease transmission via these equipment. (Shellenbarger, 2008)
At the trial, stokes claimed that all improper billing was a result of honest mistakes and not an intent to defraud as claimed. The government countered with audit evidence that showed that Stoke was warned and well aware that his billing was being questioned by insurance firms. After analyzing the evidence in detail, the district court found Mr. Stokes guilty and having committed a total of 32 offenses. With this amount of offences, if found guilty, yields a range of between 121 and 151 months in prison. All sentencing factors taken into account, Mr. Stokes was sentenced to 126 months in prison by the district court. He lodged an appeal to this sentence soon. (Green, 2010)
Before the initial trial began, the government had notified Stokes that correspondence and audit notifications would be used as evidence in the case. However, they would only be used to prove that he was aware of the billing rules and therefore had intended to commit fraud. Warning and inquiry letters from insurers on billing matters were used. Testimonies concerning the audit notifications were also used. Stokes asked the court to exclude this evidence. The court however rejected his plea but limited the use of the evidence to only as ‘evidence of prior warnings and proof of knowledge and intent to defraud`. During the appeal, after the trial at the district court, Stokes challenged his conviction stating that audit evidence had been erroneously admitted against him at the district court. He claimed that it was inadmissible hearsay. The appellant judges disagreed with this since the district court properly admitted the audit evidence to show that Stokes had prior knowledge of auditors` guidance and warnings. Stoke disregarded the warnings and persisted in his practices. Therefore, the erroneous billings were not a product of an honest mistake but an intended practice. The court of appeal therefore found that the district court did not abuse its discretion by admitting the audit evidence and there was no basis upon which ...