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United States v. Adkins

United States District Court, E.D. Kentucky, Central Division, Lexington

May 30, 2017



          Danny C. Reeves United States District Judge.

         This matter is pending for consideration of Defendant Alfred Bradley Adkins's in limine motion to exclude from trial any evidence pertaining to the redetermination of claimant benefits that resulted in termination. [Record No. 140] The parties presented arguments on the motion during the pre-trial conference held on May 22, 2017.[1] [See Record No. 216] For the reasons that follow, the defendant's motion will be denied.

         I. Defendant's Motion

         The defendant's first motion in limine[2] seeks to prevent the government from using, at any stage of trial, “any results, findings or conclusions and any evidence relating to the re-determination hearings involving former clients of the Conn Law Firm, where Claimants have had their eligibility benefits revoked or terminated.” [Record No. 140 at 1] The motion speaks only of benefits terminations. It does not address the admissibility of evidence pertaining to the redetermination process for claimants who retained their previously-awarded benefits.

         a. The Redetermination Process

         Under the Social Security Act, the Commissioner is required to redetermine an individual's entitlement to benefits any time if there is “reason to believe that fraud or similar fault was involved in the application of the individual for such benefits.” 42 U.S.C. §§ 405(u)(1)(A) and 1383(e)(7)(A)(i). The Commissioner is required as part of this redetermination process to “disregard any evidence if there is reason to believe that fraud or similar fault was involved in the providing of such evidence.” 42 U.S.C. §§ 405(u)(1)(B) and 1383(e)(7)(A)(ii). The Social Security Administration reconsidered approximately 1, 765 claimant files related to this criminal action. [Record No. 156 at 3] The United States contends that it is has produced to defendant approximately 547 redetermination decisions that resulted in benefit terminations, and the process is ongoing. [Record No. 156 at 5]

         More specifically relevant here, the United States identified 216 claimant files that included purported pre-completed RFC forms signed by Defendant Adkins. [Record No. 156 at 7-8] Of those 216 files, 88 claimants had their benefits terminated during the redetermination process and 128 maintained their previously-awarded benefits. [Record No. 156 at 7-8, 10]

         b. Adkins's Position

         Defendant Adkins provides three separate grounds for the in limine ruling sought. First, he argues that, under Federal Rule of Evidence 401, [3] evidence of benefits termination “has no value” and “is irrelevant.” [Record No. 140 at 1] Second, he contends that, under Rule 403, such evidence would be “unfair” and “substantially prejudicial.” [Id.] Third, Adkins suggests that, because he was not a party to the redetermination proceedings, introduction of this evidence will violate his confrontation clause and due process rights. [Record No. 140-1 at 2]

         Adkins does not extrapolate on his relevance argument. Instead, he focuses his discussion on Rule 403's factors. He states that, even if the redetermination decisions do not specifically discuss or address a fraud allegation, “the nexus of the issues are so closely related [that] the jury will be confused, and will presume [that] the Claimants were not initially entitled to those benefits except that a fraud must have occurred.” [Record No. 140-1 at 2 (emphasis added)] Adkins suggests that the jury is likely to confuse the denial of benefits following a redetermination hearing with a judicial finding of fraud. He argues this confusion will “creat[e] a presumption and switch[] the burden of proof.” [Record No. 140 at 1] Adkins also claims that it will “add confusion and delay” if he “must tackle each one of those re-determinations to ascertain what part or effect on causation his evaluations had, or the absence thereof, played in those Claimants losing their eligibility.” [Record No. 140-1 at 2] “In essence, the trial of this action would be inundated with other mini trials, so the negative re-determinations must be excluded.” [Id. (emphasis added)]

         Finally, Adkins points out that the standard of proof during a redetermination hearing is not the same as during a criminal trial. He suggests that the jury hearing evidence of claimant denials during redetermination will be “pre-dispose [] to believe a fraud has occurred.” [Record No. 140 at 1] Moreover, because the defendant was not a party to the redetermination, and did not have the right to contest or otherwise challenge the evidence used or the exclusion of evidence at the redetermination proceedings, he argues that his “right of cross-examination of the witnesses, and due process would be violated.” [Record No. 140-1 at 2] To preserve his right to a fair trial, Adkins wishes to exclude all evidence of redetermination hearings that resulted in revocation or termination of benefits.[4]

         c. Government's Response

         The government intends to use the conclusions and findings of the redetermination hearings “to evidence the materiality of the Pre-completed Residual Functional Capacity forms [prepared by Conn, signed by Adkins, and submitted to the SSA] in the disability determination process.” [Record No. 156 at 1-2] It contends that the results of the redetermination process are “highly probative to the offenses charged [because] materiality is an element of those offenses.” [Id. at 2] The government argues that the probative value of this evidence is not substantially outweighed by any of the Rule 403 factors. [Id.]

         The government identifies 216 of the redetermination hearings completed thus far as involving pre-completed RFCs signed by Adkins. [Record No. 156 at 4] To date, [5]approximately eighty-eight of those 216 claimants received unfavorable decisions. [Id.] With Adkins's pre-completed RFCs excluded, these claimants failed to re-establish (through other evidence in their original file and any new evidence they chose to submit) that they were disabled at the time of their initial award. [Id.] Taken together, these eighty-eight claimants received notices of overpayment totaling approximately $6.1 million. [Id.]

         Put succinctly, the government argues that, “when the Pre-completed RFCs, together with evaluation reports were excluded, in eighty-eight out of 216 instances so far, the SSA reached a different outcome than previously rendered by Daugherty.” [Record No. 156 at 8] “This fact, that different outcomes were reached between the initial decisions and the redeterminations when the Pre-completed RFCs were excluded, evidence the materiality of the Pre-completed RFCs in the decision making process.” [Id.]

         The government points to the Sixth Circuit pattern jury instructions for mail fraud and wire fraud, which have as an element that a scheme must include “a material representation or concealment of a material fact.” [Record No. 156 at 9 (citing pattern instructions 10.01(1)(B), 10.02(1)(B))] The false statement charge also requires materiality. [Id. (quoting 42 U.S.C. § 408(a)(3) (“Whoever at any time makes or causes to be made any false statement or representation of a material fact for use in determining rights to payment under this subchapter . . . shall be guilty of a felony. . .”) (emphasis added))] To be “material, ” a misrepresentation or concealment must have “a natural tendency to influence or [be] capable of influencing the decision of a person of ordinary prudence and comprehension.” [Id. (citing pattern instructions 10.01(2)(D), 10.02(2)(D))]

         According to the government, the fact of 88 claimants receiving different results when the Pre-completed RFCs were excluded is clear evidence of the RFCs' materiality. [Record No. 156 at 10] It argues that, although 128 claimants kept their benefits, this fact makes little difference because the claimants were able to submit new evidence to support their disability claims. [Id.] The 88 changed results establishes the relevancy and admissibility of this evidence under Rules 401 and 402. [Id.]

         The government offers little argument in responding the defendant's motion regarding the potential prejudice to the jury, or the potential for confusion of the issues or unwarranted delay. It that “[t]he prejudice Defendant argues he will suffer is substantially overstated.” [Record No. 156 at 10] And because of the highly probative value of this evidence, the government submits that the potential prejudice does not outweigh it under Rule 403. [Id.] Regarding potential due process or confrontation clause issues, the government contends “as the Pre-completed RFCs and evaluation reports signed by Defendant did not play a role in the redeterminations, Defendant's appearance at those hearings would have been wholly inappropriate.” [Id. at 8]

         According to the government, the bottom line is that whether the claimants are or were actually entitled to benefits is beside the point. [Record No. 156 at 11] What matters is that the defendant signed forms attesting to claimants' debilitating conditions regardless of whether they actually had those conditions. [Id.] Because the forms were severe enough to necessarily entitle an individual to disability, they were effective. And without the forms, at least 88 claimants had their benefits terminated. Accordingly, the government wishes to use the results of the redetermination process to establish materiality, and nothing more. [Id. at 12]

         d. Arguments During the Pre-Trial Conference

         The defendant restated his position during the May 22, 2017 pre-trial conference, with his “biggest” concern being that the jury will draw an improper inference from the termination of benefits being tied to the ...

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