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A scheme using medical clinics to defraud insurance companies under New York’s no-fault law is punishable under a federal anti-medical fraud statute, the 2nd U.S. Circuit Court of Appeals has ruled. Deciding an issue of first impression, the appeals court rejected the claim of a defendant who was prosecuted for staging automobile accidents under a federal anti-fraud statute passed in 1996. The defendant, in United States v. Yves Baptiste, 02-1228, had argued on appeal that Congress had intended the statute to apply only to health care professionals. Yves Baptiste and co-defendants Policia Baptiste and Guerline Dormetis were convicted in 2002 before Eastern District of New York Judge John Gleeson. Their trial was one of six held in the Eastern District following a broad investigation into car accidents staged by a number of individuals acting with the complicity of health care clinics. The clinics produced false treatment records to buttress personal injury claims. Baptiste challenged the application of the statute, 18 U.S.C. � 1347, to his criminal prosecution, contending that the state no-fault automobile insurance program is not a “health care benefit program” under the law. Judge Richard J. Cardamone, noting that the law was one of the latest in a series of attempts by Congress to address the draining of “billions of dollars from public and private payers annually,” said that case law interpreting the 1996 federal health care fraud statute “is, so far as we can discover, virtually non-existent.” The statute, he said, defines a “health care benefit program” as any “public or private plan or contract, affecting commerce, under which any medical benefit, item or service is provided to any individual, and includes any individual or entity who is providing a medical benefit, item or service for which payment may be made under the plan or contract.” The court was not persuaded by Baptiste’s argument that the language could not possibly include the no-fault insurance program. “Rather, we read the statute to mean that any person — whether that person is a medical professional, a patient, or otherwise — who purposefully endeavors to defraud a health care benefit program may be found guilty of health care fraud,” Cardamone said. “The broad language of Sec. 1347 shows that Congress intended for this statute to include within its scope a wide range of conduct so that all forms of health care fraud would be proscribed, regardless of the kind of specific schemes unscrupulous persons may concoct.” NO-FAULT BENEFITS Baptiste, the judge said, argued that the statute should not apply to him because the benefits under the no-fault insurance law were paid to the medical providers. Judge Cardamone disagreed. “This point ignores the fact that the submission of fraudulent no-fault claims by the medical providers and the subsequent settlements received by the defendants as passengers were independent parts of one integrated fraudulent plan,” he said. Cardamone added that it was an “intended and necessary consequence” of the defendants’ participation in the staged collisions that the clinics received no-fault payments and the defendants obtained civil cash settlements from insurers. The defendants had received medical benefits as a result of their no-fault insurance contracts, making their scheme fall clearly within the reach of the statute, Cardamone said. Judges Thomas J. Meskill and Jose A. Cabranes joined in the decision. Martin G. Goldberg represented Yves Baptiste. Jonathan C. Scott of Scott & Scott in Smithtown represented Policia Baptiste. Jason L. Solotaroff of Giskan & Solotaroff, along with Robert A. Culp, represented Guerline Dormetis. Assistant U.S. Attorneys Andrew J. Frisch, Peter A. Norling and Scott B. Klugman represented the government.

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