Reported / Citable
Background
A jury convicted chiropractor Benjamin Tekippe of six counts of health care fraud and one count of wire fraud arising from his operation of Metairie Chiropractic & Rehab. Over roughly three and a half years, Tekippe submitted more than $2.3 million in claims to Blue Cross and Blue Shield of Louisiana, which paid $740,842.36. Evidence showed that approximately 93% of his claims used the same six service codes, that employees provided services without required supervision, and that some billed services were not performed.
Witnesses also described widespread deficiencies and fabrication in patient records. Massage therapists testified that they provided massages without chiropractic-massage training or individualized direction, and employees said Tekippe pressured staff to create backdated treatment notes. At sentencing, the district court found the health care fraud pervasive and combined BCBSLA’s payments with $12,952 in fraudulently obtained unemployment benefits, producing a total loss of $753,794.36. The court calculated a Guidelines range of 121 to 151 months but imposed a downward variance to 84 months, followed by three years of supervised release.
The Court’s Holding
The Fifth Circuit affirmed, holding that the district court did not clearly err in finding Tekippe’s fraud pervasive. The evidence made that finding at least plausible: Tekippe routinely billed the same bundle of services, billed unusually high volumes of massage therapy, sought payment for services that witnesses said were not provided, and operated amid widespread record fabrication and unsupervised treatment.
Because the government showed that the fraud was so extensive that separating legitimate claims from fraudulent ones was not reasonably practicable, the burden shifted to Tekippe to identify particular legitimate amounts. His declarations from 25 patients did not satisfy that burden. Even if those patients received some legitimate care, Tekippe did not establish that the associated claims complied with BCBSLA’s reimbursement requirements, and subtracting his proposed amount would not have changed the applicable loss enhancement.
Key Takeaways
- A sentencing court may treat an entire group of claims as loss when pervasive fraud makes it impracticable to separate legitimate claims from fraudulent ones.
- Once the government establishes pervasive fraud, the defendant must show that particular claimed amounts were legitimate.
- Evidence that patients received some services does not establish that the corresponding insurance claims were reimbursable or properly documented.
Why It Matters
The decision reinforces the Fifth Circuit’s deferential clear-error review of sentencing findings concerning pervasive fraud. In health care fraud cases, patterns of uniform billing, unsupported services, fabricated records, and lack of required supervision can permit courts to use aggregate payments as the loss amount rather than requiring claim-by-claim proof.
Defendants seeking credits against loss must connect specific amounts to claims that complied with the insurer’s reimbursement rules. General declarations that patients received treatment may be insufficient.