Background
A jury convicted chiropractor Benjamin Tekippe of six counts of health care fraud and one count of wire fraud arising from fraudulent reimbursement claims submitted to Blue Cross and Blue Shield of Louisiana. Evidence showed that approximately 93% of the claims billed during the relevant period used the same six service codes, that Tekippe billed more massage therapy than any other Louisiana chiropractor, and that patient records showed little differentiation. Employees also testified about fabricated or backdated treatment notes, unsupervised services, and billing for services that were not performed.
The presentence report initially used more than $2.3 million in billed claims as intended loss, but the district court ultimately found a total loss of $753,794.36, including $740,842.36 paid by BCBSLA and $12,952 from separate unemployment-insurance fraud. The court found the health care fraud pervasive and declined to subtract payments tied to 25 patient declarations that Tekippe offered as evidence of legitimate treatment. It calculated a Guidelines range of 121 to 151 months but varied downward and imposed an 84-month prison sentence followed by three years of supervised release.
The Court’s Holding
The Fifth Circuit affirmed. Reviewing for clear error, the court held that the district court’s finding of pervasive fraud was plausible in light of the record as a whole. The evidence included Tekippe’s repeated billing of nearly identical service bundles, unusually high massage-therapy billing, testimony that billed services were not performed, medically necessary, properly supervised, or adequately documented, and evidence of widespread record fabrication.
Because the government showed that the fraud was sufficiently extensive and pervasive to make separating legitimate claims from fraudulent ones impracticable, the burden shifted to Tekippe to identify particular legitimate amounts. His patient declarations did not satisfy that burden: they showed at most that some services were provided, not that the associated claims complied with BCBSLA’s reimbursement requirements. Moreover, even accepting Tekippe’s proposed reduction to $582,515.12 would not have changed the applicable loss enhancement or Guidelines calculation.
Key Takeaways
- A sentencing court’s finding that fraud was pervasive is factual and receives clear-error review.
- Once pervasive fraud makes legitimate and fraudulent benefits impracticable to separate, the defendant must show which particular amounts were legitimate.
- Evidence that patients received some treatment does not establish that reimbursement claims were legitimate under the insurer’s medical-necessity, supervision, and documentation rules.
Why It Matters
The decision reinforces the significant sentencing consequences of pervasive billing fraud. In health care fraud cases involving systemic documentation and billing irregularities, the government need not isolate every fraudulent claim before the court may treat the broader payment stream as loss.
Defendants seeking credits against loss must connect specific payments to claims that actually satisfied the payer’s reimbursement requirements. General evidence that some patients received some legitimate care may not be enough.