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Bejerano v. State5/12/2000
Appeal from the Circuit Court for Orange County, Robert W. Rawlins, Jr., Senior Judge.
Bejerano appeals from a final judgment finding him guilty of racketeering, organized fraud (less than $20,000), and two counts of insurance fraud. His primary points on appeal are that the trial court erred in failing to grant a motion for judgment of acquittal in his favor on the RICO charge, because the state failed to prove sufficient evidence of an "enterprise," and because the trial court erred in refusing to modify the standard jury instruction to encompass the necessity for the jury to find, in order to determine an "enterprise," that the group must have an identifiable decision making structure and a mechanism for controlling and directing the group on an ongoing, rather than an ad hoc basis. We affirm.
In this case, the indictment set forth that Bejerano and other named persons, while employed by or associated with an enterprise consisting of the group of persons named in footnote four, associated in fact with named corporations to conduct and participate in the enterprise through a continuous pattern of racketeering activity by engaging in at least two incidents of racketeering conduct. The predicate acts set forth were to cause false claims for payments or benefits to be presented to the Walt Disney Corporation's self-insured group insurance fund, as well as Prudential Insurance which covered Walt Disney employees, Albertson's self-insurance group policy, and Cigna Insurance Company , which covered United Airlines employees.
Looked at in the light most favorable to the state, the evidence at trial showed that Valdes and his partners, Erick Bernal and Louis and Miriam Portas, opened medical clinics in the Orlando area. They had previously met in connection with clinics owned by Jaramillo in Miami, which also was engaged in making false billings for insurance claims. The purpose was to fraudulently bill insurance companies. Louis Portas set up the procedure of recruiting patients by going to Walt Disney World or Albertsons and offering $150.00 or $200.00, primarily to Hispanic employees, to come to the clinics to see a doctor. Portas also enlisted the aid of recruiters to bring in patients, who also were paid for their efforts. Portas coached the patients to make false claims of pain and symptoms to justify unneeded and excessive tests. Rosa recruited medical doctors to order the tests, but the doctors were not involved in the fraud.
Valdes recruited Bejerano to do testing and lab work for the clinics. He was paid for his testing and reading the results of the tests. Bejerano understood patients were to be given a complete battery of tests. He and other associates were also to perform additional tests not indicated by the doctors. Bejerano was aware of how the clinics were getting patients and the general scam. He also fabricated tests and falsified reports for tests not actually done, which he submitted to the clinics, knowing they would be used for false billing and claims. He had technicians working for him to perform the tests. At one point, Bejerano said he wanted the runners to bring in patients for his own clinics. Valdes refused. Not all of the billings and tests done by Bejerano were fraudulent, nor were all of the billings submitted to the insurers. However, a substantial percentage were either fraudulent or bogus.
At the trial, Valdes and Bernal testified as to how the medical claims scam actually operated. They had pled guilty to the charges against them. On cross-examination, they admitted they were hoping for a reduced sentence in exchange for their testimony. Evidence concerning how the various clinics operated and the roles played by the
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