People v. Doshi, 17 N.Y.3d 155 (2011)
A physician can be found guilty of falsifying business records in the first degree for submitting fraudulent medical documentation to a no-fault insurance carrier to receive payments for unnecessary or unperformed treatments; these documents qualify as “business records” under the statute, even when submitted by a third party.
Summary
Defendant Doshi, a physician, was convicted of falsifying business records and insurance fraud for submitting false consultation reports to State Farm, an insurance carrier, seeking payment for procedures purportedly performed on accident victims. The New York Court of Appeals affirmed the conviction, holding that these submissions constituted falsifying business records, even though the defendant was an outside party providing the false information. The Court reasoned that the submitted documents directly affected State Farm’s financial condition and legal obligations, thus qualifying as business records under Penal Law § 175.00.
Facts
Doshi worked at IK Medical P.C., a clinic investigated for insurance fraud. She submitted false “Verification of Treatment Forms” and accompanying medical reports to State Farm for nerve testing purportedly performed on two accident victims. These forms were intended to evidence State Farm’s obligation to pay for medical services and became part of State Farm’s permanent business records. The patients testified that Doshi did not perform all the tests she billed for. IK Medical was found to be fraudulently billing no-fault insurance companies irrespective of the patients’ actual needs.
Procedural History
The Supreme Court denied Doshi’s motion to dismiss the falsifying business records counts. At trial, Doshi was convicted of insurance fraud and falsifying business records, but acquitted of scheme to defraud. The Appellate Division affirmed the conviction. The New York Court of Appeals granted leave to appeal and affirmed the Appellate Division’s decision.
Issue(s)
- Whether Penal Law § 175.10 is violated when a third party submits false information to a company to induce action based on that information.
- Whether medical reports submitted to an insurance carrier constitute “business records” under Penal Law § 175.00 when they falsely evidence the submitter’s activities and the condition of their patients, rather than the recipient’s condition or activity.
Holding
- Yes, because the Penal Law does not limit the types of persons who may be liable; outsiders or third parties are not immune from prosecution under this statute.
- Yes, because State Farm “kept or maintained” the consultation reports and claim forms, which evidenced or reflected its legal obligation to reimburse medical providers for services rendered, thus affecting its financial condition.
Court’s Reasoning
The Court focused on the plain language of Penal Law §§ 175.00 and 175.10. It stated, “Where the language of a statute is clear and unambiguous, courts must give effect to its plain meaning.” The Court rejected the argument that only insiders could be liable for falsifying business records, citing People v. Bloomfield, 6 N.Y.3d 165 (2006), which eliminated the “insider/outsider distinction.” Several other courts have held third parties accountable for submitting fraudulent records. The Court also distinguished People v. Papatonis, 243 A.D.2d 898 (1997), noting that in that case, the falsifications on a job application did not relate to any rights or obligations of the recipient agency, whereas Doshi’s submissions created financial liabilities for State Farm. The court emphasized that State Farm’s financial condition was directly affected by the false submissions, giving rise to liabilities under its policies and classifying the documents as business records. The court held that the excluded evidence regarding the Attorney General’s investigator would not have changed the outcome, since Doshi was acquitted of the scheme to defraud charge, and the evidence was not relevant to the fraudulent submission of claims for unperformed treatments.