10th Circuit Finds Gov't Argument Weak in Medicare Fraud Case

The Tenth Circuit has reversed a defendant's convictions on all counts in a recent health care fraud case.

In a joint trial, a jury initially convicted defendants Olalekan Rufai and Adedayo Adegboye, which the Tenth Circuit then ultimately reversed for Rufai, in a 38-page opinion, as reported by The Oklahoman.

The Original Convictions

Rufai and Adegboye initially had both incorporated and set up a durable medical equipment (power wheelchairs and power scooters, in particular) provider called First Century Medical Supply. Rufai and Adegboye were then both convicted under 18 U.S.C. § 1347 and 18 U.S.C. § 2 of aiding and abetting fraudulent claims that First Century had apparently billed to Medicare, on behalf of five beneficiaries.

The government and Rufai both conceded the fact that an un-indicted third party, Joshua Ohaka, had filed fraudulent claims on behalf of First Century. Rufai and Adegboye also allegedly obtained identification numbers of Medicare beneficiaries and then successfully billed the government for equipment that those beneficiaries did not actually need, nor receive, on top of that.

Weak Government Case, Says Tenth

However, in 3-0 decision, the Tenth Circuit's found that the government's case was not strong enough and too insufficient to properly prove that Rufai knowingly aided in fraud committed by First Century.

The Tenth, from citing United States v. Self and United States v. Summers, stated that the government must prove the following:

• that someone committed the underlying substantive offense
• that the defendant willfully associated with the charged criminal venture; and
• that he aided that venture through affirmative action.

Under these requirements, the Tenth found that the government had no direct evidence of Rufai's actual awareness of the fraudulent scheme to defraud Medicare, and that if there was any proof of knowledge, it was too speculative to sustain the conviction.

In a separate but related case in United States v. Adegboye, however, the Tenth held that there was enough evidence, so Adegboye's conviction was affirmed, while Rufai's was reversed.

Related Resources:

• United States v. Rufai (Tenth Circuit Court of Appeals)
• Report fraud & abuse (Medicare.gov)
• Insurance Fraud (FindLaw)