Opinion
NUMBER 2012 KA 1788
08-06-2013
STATE OF LOUISIANA v. DAVID REED
James "Buddy" Caldwell Louisiana Attorney General And Nicole Burke Tasha K. West Assistant Attorneys General Baton Rouge, LA Attorneys for Appellee State of Louisiana Alex J. Washington Shreveport, LA Attorney for Appellant Defendant - David Reed
NOT DESIGNATED FOR PUBLICATION
Appealed from the
19th Judicial District Court
In and for the Parish of East Baton Rouge, Louisiana
Trial Court Number 04-10-0669
Honorable Louis R. Daniel, Judge
James "Buddy" Caldwell
Louisiana Attorney General
And
Nicole Burke
Tasha K. West
Assistant Attorneys General
Baton Rouge, LA
Attorneys for Appellee
State of Louisiana
Alex J. Washington
Shreveport, LA
Attorney for Appellant
Defendant - David Reed
BEFORE: PARRO, WELCH, AND DRAKE, JJ.
WELCH , J.
The defendant, David Reed, was charged by grand jury indictment (as amended) with two counts of Medicaid fraud, violations of La. R.S. 14:70.1. The defendant pled not guilty. The defendant waived his right to a trial by jury, and was found guilty as charged after a bench trial. The trial court denied the defendant's motion for new trial. The trial court imposed five years imprisonment at hard labor on each count, but suspended execution of the sentences and ordered five years supervised probation and two years home incarceration with other general and specific conditions. The defendant now appeals, challenging the sufficiency of the evidence, the admission of other crimes evidence, the admission of medical records, and the trial court's ruling on the motion for new trial. For the following reasons, we affirm the convictions and sentences.
STATEMENT OF FACTS
From the latter half of 2005 through 2007, Dr. David Reed (the defendant) and Dr. Louis Pendleton provided services together at a dental office in Shreveport, Louisiana. Prior to this arrangement, the defendant was excluded from participating in the Medicaid program. In 1992, following a fraud investigation and after initially pleading guilty to Medicaid fraud, the defendant withdrew his guilty plea and pled no contest to two counts of Medicaid fraud. As a result, he was excluded from participation in the Medicaid program indefinitely by the State of Louisiana. Specifically, he was prohibited from billing Medicaid for services rendered to Medicaid patients and was not allowed to have others do so on his behalf. Evidence was presented during the trial demonstrating that in 2006, services were provided by the defendant's dental office on July 3, July 10-14, and December 27, dates on which Dr. Pendleton was hospitalized. The charges for those services were submitted under Dr. Pendleton's Medicaid provider number and paid to the dentists' office by Medicaid. The State further introduced bank records to show that funds paid by the Medicaid program were being tunneled into the Pendleton/Reed Family Dental bank account from which the defendant wrote checks to himself and withdrew funds.
ASSIGNMENTS OF ERROR NUMBERS ONE AND FOUR
In the first assignment of error, the defendant contends that the State failed to prove the element of specific intent in the instant offenses. The defendant notes that Jessie Smith testified that she did all the billing to Medicaid and that after Dr. Pendleton's death, she did not submit any additional claims to Medicaid. The defendant further notes that Smith also testified that she never discussed Medicaid claims with the defendant prior to Dr. Pendleton's death. The defendant contends that he did not submit Medicaid claims and alleges that he saw Medicaid patients at no charge. The defendant argues that he did not actively desire the prescribed criminal consequences to follow his act. Thus, the defendant concludes that the State did not prove beyond a reasonable doubt that he committed the offenses. On this basis, the defendant also argues in the fourth assignment of error that the trial court erred in denying his motion for new trial. The defendant reiterates that he did not submit any bills to Medicaid or make any request of the State's witness to submit a claim on his behalf.
In reviewing the sufficiency of the evidence to support a conviction, a Louisiana appellate court is controlled by the standard enunciated by the United States Supreme Court in Jackson v. Virginia, 443 U.S. 307, 319, 99 S.Ct. 2781, 2789, 61 L.Ed.2d 560 (1979). That standard of appellate review, adopted by the Legislature in enacting La. C.Cr.P. art. 821, is whether the evidence, when viewed in the light most favorable to the prosecution, was sufficient to convince any rational trier of fact that all of the elements of the crime had been proved beyond a reasonable doubt. State v. Brown, 2003-0897 (La. 4/12/05), 907 So.2d 1, 22, cert. denied, 547 U.S. 1022, 126 S.Ct. 1569, 164 L.Ed.2d 305 (2006). The Jackson standard of review is an objective standard for testing the overall evidence, both direct and circumstantial, for reasonable doubt. When analyzing circumstantial evidence, La. R.S. 15:438 provides that, in order to convict, the trier of fact must be satisfied that the overall evidence excludes every reasonable hypothesis of innocence. State v. Graham, 2002-1492 (La. App. 1st Cir. 2/14/03), 845 So.2d 416, 420. When a case involves circumstantial evidence and the trier of fact reasonably rejects the hypothesis of innocence presented by the defendant's own testimony, that hypothesis falls, and the defendant is guilty unless there is another hypothesis that raises a reasonable doubt. State v. Captville, 448 So.2d 676, 680 (La. 1984).
All persons concerned in the commission of a crime, whether present or absent, and whether they directly commit the act constituting the offense, aid and abet in its commission, or directly or indirectly counsel or procure another to commit the crime, are principals. La. R.S. 14:24. However, a defendant's mere presence at the scene is not enough to "concern" him in the crime. Only those persons who knowingly participate in the planning or execution of a crime may be said to be "concerned" in its commission, thus making them liable as principals. A principal may be connected only to those crimes for which he has the requisite mental state. State v. Neal, 2000-0674 (La. 6/29/01), 796 So.2d 649, 659, cert. denied, 535 U.S. 940, 122 S.Ct. 1323, 152 L.Ed.2d 231 (2002).
Medicaid fraud is the act of any person, who, with intent to defraud the State through any medical assistance program created under the federal Social Security Act and administered by the Department of Health and Hospitals (DHH), presents for payment any false or fraudulent claim for furnishing services or merchandise or knowingly submits false information for the purpose of obtaining greater compensation than that to which he is legally entitled for furnishing services or merchandise. La. R.S. 14:70.1(A)(1) and (2). Medicaid fraud is a specific intent crime. State v. Romero, 574 So.2d 330, 337 (La. 1990); State v. Dudley, 2006-1087 (La. App. 1st Cir. 9/19/07), 984 So.2d 11, 23-24.
Specific criminal intent is "that state of mind which exists when the circumstances indicate that the offender actively desired the prescribed criminal consequences to follow his act or failure to act." La. R.S. 14:10(1). Though intent is a question of fact, it need not be proven as a fact. It may be inferred from the circumstances of the transaction. Specific intent may be proven by direct evidence, such as statements by a defendant, or by inference from circumstantial evidence, such as a defendant's actions or facts depicting the circumstances. Specific intent is an ultimate legal conclusion to be resolved by the fact finder. State v. Henderson, 99-1945 (La. App. 1st Cir. 6/23/00), 762 So.2d 747, 751, writ denied, 2000-2223 (La. 6/15/01), 793 So.2d 1235.
State witness Ronnie Beaver, a Medicaid fraud investigator with the Louisiana Department of Justice, testified that his involvement in the instant case began when investigator Veronica Brantley of the Office of Inspector General issued a complaint that an excluded dentist was billing under a deceased dentist's provider number. Beaver's supervisor assigned him to investigate the complaint. Beaver noted that an excluded dentist is prohibited from working in a facility where Medicaid is provided. As a part of his investigation, Beaver verified Dr. Pendleton's death, executed a search warrant, checked to make sure that the exclusion of the defendant was still in effect, determined that the defendant was the only other dentist in the office with Dr. Pendleton, and subpoenaed medical records including Dr. Pendleton's admit and discharge records from Schumpert Hospital. According to the hospital records, Dr. Pendleton was hospitalized from July 1, 2006 to July 18, 2006, and again from December 27, 2006 to January 9, 2007, the date Dr. Pendleton passed away. Beaver ordered a provider history for the Pendleton/Reed Dental Clinic and determined that the clinic billed Medicaid while Dr. Pendleton was hospitalized. The documents show that in 2006, services were provided on July 3, July 10-14, and December 27, dates on which Dr. Pendleton was hospitalized, for which the charges were submitted under Dr. Pendleton's Medicaid provider number and paid to the dentists' office by Medicaid.
We note that the records show that Dr. Pendleton was discharged on July 5 but was admitted again that same date. (R. 70, 98).
Beaver noted that while the provider history documents show that Dr. Pendleton performed the services rendered, Dr. Pendleton could not have done so since he was hospitalized. The funds for the services in question were electronically transferred into Dr. Pendleton's business account. Beaver further testified that during the course of his investigation, he subpoenaed mid-to- late 2006 and early 2007 bank records for Dr. Pendleton's business and personal accounts, the Pendleton/Reed business account, and Dr. Reed's personal account, and determined that the defendant was receiving Medicaid money for services provided while Dr. Pendleton was hospitalized. Specifically, the records reveal that Medicaid was the sole source of deposits into Dr. Pendleton's business account, Medicaid funds were being electronically transferred to Dr. Pendleton's personal checking account, deposits and checks were written to the Pendleton/Reed Family Dental Clinic from Dr. Pendleton's personal account, and payroll checks were signed and endorsed by Dr. Reed to himself out of the Pendleton/Reed Family Dental Clinic account. Beaver devised a flowchart to show the manner in which funds were transferred. Beaver acknowledged that in the bank records that he reviewed, he did not see any paychecks for Dr. Pendleton, and that Dr. Reed was the only person who wrote checks out of the Pendleton/Reed Family Dentistry Account.
On cross-examination, Beaver agreed that no claims were submitted on Dr. Pendleton's Medicaid account after his death. Beaver further confirmed that the provider history does not indicate who personally submitted the bills for Medicaid payment or that the defendant knew they were being submitted. Beaver also agreed that in executing the search warrant for the defendant's office, he photographed a box that, according to its label, contained patient bills that were being delayed awaiting the defendant's Medicaid reinstatement. Beaver conceded that he had no personal knowledge of the nature of any business arrangement between the defendant and Dr. Pendleton and he did not know whether the defendant was Dr. Pendleton's employee. Beaver confirmed that records of the Secretary of State indicated that the defendant formed his own corporation. Secretary of State records show that on May 10, 2006, the defendant registered a professional dental corporation in his name only. On redirect examination, Beaver clarified that the box of pending patient bills consisted of two hundred fifty to three hundred Medicaid patients who were seen after Dr. Pendleton passed away, noting that at that point the clinic was no longer able to use Dr. Pendleton's Medicaid provider number.
State witness George Campagna, the Attorney General's Medicaid Fraud Control Unit chief investigator, assisted in the 1990 investigation of the defendant prior to his Medicaid exclusion. In conjunction with that investigation, on February 28, 1991, the defendant gave a written statement admitting that he was aware that false claims for x-rays were submitted to the Medicaid program. As a result of the investigation, the defendant was charged with Medicaid fraud. He originally pled guilty but later withdrew his plea of not guilty and pled no contest to two counts of Medicaid fraud. Thereafter, the defendant was excluded from the Medicaid program in 1993 for five years and then indefinitely in 1999 by both the State and Federal government.
State witness Joseph Kopsa, former DHH section chief of program integrity, testified that exclusion from the Louisiana Medicaid Program prohibits participation in any way, shape, or form with the Medicaid program. Excluded persons would no longer be allowed to bill any services rendered to Medicaid recipients, no one could bill on their behalf, and they would not be allowed to collect money from the program. Further, they would not be allowed to work in a facility where Medicaid services were rendered, unless they could show that they were not directly or indirectly accepting Medicaid money. Notification letters of exclusion are sent by certified mail. Kopsa confirmed that the defendant's notification letter was delivered August 13, 1999, and bears the defendant's signature. In a letter dated February 3, 2009, DHH rejected the defendant's formal request to be reinstated, continued his exclusion from further participation in the Medicaid program for a period of at least five years, and informed him of his right to request a hearing on the matter.
Jessie Lee Smith, also a State witness, was the office manager at Dr. Pendleton and the defendant's dental clinic and was in charge of Medicaid billing. She worked at the clinic from 2002 to 2007. She noted that at some point, the name of the clinic was changed to include both dentists' names. Smith testified that the patient charts and files used by the dentists identified patients as Medicaid or private insurer users. Smith confirmed that the defendant did have some patients who were Medicaid recipients. She further verified that Dr. Reed was the only dentist who saw patients during Dr. Pendleton's hospitalization. She explained that the same billing procedure was used by both dentists and that Dr. Pendleton's Medicaid provider number was used to submit claims for Medicaid recipient/patients for both doctors until Dr. Pendleton's death. Smith testified that shortly before Dr. Pendleton's death, she asked the defendant about the need to get the defendant's Medicaid provider number because Dr. Pendleton was contemplating retirement. She stated that when Dr. Reed never gave her one, she obtained an application for a provider number and gave it to the defendant to fill out. Smith stated that she did not ask the defendant why he did not have a provider number, she did not have any knowledge as to why he did not have a number, and she did not know of the defendant's felony conviction. She also denied having ever been instructed that it was not proper to bill for one dentist under another's number. Smith testified that the defendant was aware of the fact that the services for the Medicaid patients he saw were being billed to the Medicaid program. Smith further testified that the office was able to track the amount of money received from Medicaid payments and that Dr. Pendleton's wife would routinely write a check to the defendant for the amount of Medicaid payments for the defendant's patients that had been deposited into Dr. Pendleton's account.
After Dr. Pendleton passed away, Smith told the defendant that she would discontinue billing Medicaid patients until the defendant obtained his own Medicaid provider number. She placed the outstanding Medicaid claim files in a box. Smith testified that the defendant terminated her from her position in October 2007, but did not give her a reason for the termination. During cross-examination, Smith confirmed that she never had any conversations with the defendant regarding Medicaid recipients or billing procedures. During questioning by the trial court, Smith confirmed that file labels indicating that patients were Medicaid recipients were apparent as the pink labels with 'Medicaid' written in black were placed at the top of the file. She further indicated that the defendant never instructed her not to bill Medicaid patients.
The defendant's chair-side assistant, Geraldine Fuller, also testified as a State witness. She stated that she would give the patients' charts to the dentist to review before care was given. Fuller testified that they saw Medicaid patients when Dr. Pendleton was present, but further stated that they "didn't really see any Medicaid patients after [the defendant] got in, because he didn't have a license to do Medicaid." After being shown a file for a patient who was a Medicaid recipient, Fuller verified that the file included notes by the defendant describing the care that the patient received. Fuller also identified the defendant's signature on a page in the patient file containing a blank for "approximate cost." A handwritten notation "Medicaid" appears in the blank. Fuller denied writing anything on this page and indicated that the defendant's writing appeared on this page of the file. Fuller further indicated that additional files introduced by the State had handwritten notes written by the defendant for patients identified as Medicaid recipients with services rendered in July, August, and December of 2006, and January of 2008.
After the State rested, the defendant recalled Ronald Beaver as a defense witness. Regarding the bank records subpoenaed and introduced by the State for the accounts in Dr. Pendleton's and his wife's names, Beaver noted that he also obtained signature cards for the bank accounts, but could not recall whether the defendant's name was on the signature cards for those accounts. Beaver also confirmed that the dental office address was not listed on those accounts and that he had no reason to believe that the bank statements were mailed out to the Pendletons at an address other than the address on those accounts.
The defendant testified that he owned a dental office in 1988 and that he became Medicaid eligible some time around 1989. The defendant further testified that at some point, he was charged and pled no contest to Medicaid fraud because he billed Medicaid for exams and x-rays, although the x-rays were not actually taken. The defendant also noted that he was stripped of his license for six years by the dental board as a result.
At some point after his license was reinstated, the defendant began working with Dr. Pendleton. The defendant noted that Dr. Pendleton liked to delegate authority and allowed the defendant to pay the bills and the employees from the office account. The defendant further testified that the office belonged to Dr. Pendleton and that he was an employee. The defendant testified that he was aware that Dr. Pendleton's office took Medicaid patients, but stated that he never billed any services using Dr. Pendleton's Medicaid provider number.
When shown the patient files introduced by the State, the defendant indicated that a portion of the file would remain with Smith and that he had not seen the full patient files, specifically not the parts that included copies of the patients' Medicaid cards. He denied writing handwritten notes regarding Medicaid coverage. The defendant denied involvement in the billing of patients. The defendant confirmed, however, that he did make the bank deposits at the end of the day with deposit slips prepared by Smith. The defendant denied having any discussions about Dr. Pendleton billing his Medicaid number for services the defendant performed and acknowledged that he told Dr. Pendleton he was an excluded person.
When asked about Medicaid recipients who were seen while Dr. Pendleton was hospitalized, the defendant stated, "I treated patients, but I never ... did any of the billing. I was just an employee and that's all I did. I did the work. If they came in, they had a need, I serviced the need." He admitted that he would discuss the cost of services with the patients, but added that Smith always did the billing and that he was computer illiterate. The defendant testified that he and Dr. Pendleton opened up the Pendleton Reed Family Dentistry account so that Dr. Pendleton could delegate to him the duties of paying employees and writing other checks for him. The defendant testified that he became aware of the existence of another account when he could not make payroll from the office account. He testified that he was aware that all of the Medicaid money went into this account. He also admitted that he was aware that Dr. Pendleton's Medicaid provider number was being used for services that the defendant performed; however, he denied having voiced any complaints in that regard.
The defendant testified that sometime after Dr. Pendleton died, he received approval from the federal government for Medicaid reinstatement, although he had been told that he still needed approval from Louisiana before he "could practice Medicaid." The defendant reiterated that he never personally presented or knowingly submitted any false or fraudulent claims for furnishing services or merchandise to Medicaid. He also denied having ever asked anyone else to present fraudulent or false claims on his behalf. When asked who determined how much he was paid, the defendant stated, "I just took whatever there was left after all the bills were paid." He testified that Dr. Pendleton had other successful financial dealings and did not need any money from the dentistry, which Dr. Pendleton practiced as a hobby.
On cross-examination, the defendant testified that he could not recall when he first learned that he was receiving Medicaid money, indicating that it was sometime around July 2006 or in 2007. Regarding a 2005 check that he endorsed with a memo indicating it was a Medicaid payment, the defendant admitted that he would have known at that time that he was receiving Medicaid funds. The defendant noted that he informed Dr. Pendleton, another dentist working in the office at the time, and an office manager that he was not allowed to see Medicaid patients, and they told him that there was no problem, as they would use Dr. Pendleton's number. The defendant insisted that he did not read the Medicaid provider rules and regulations and was led to believe that this procedure would be acceptable since Dr. Pendleton owned the office and it was common practice to use the owner's number for the billing. The defendant admitted that he was aware that after he treated a patient, Smith did all of the billing procedures for that patient. He further admitted to paying and ultimately firing Smith, although he claimed that it was not his place to tell her what to do since he was only an employee and it was Dr. Pendleton's office. The defendant indicated that his incorporation papers were executed by his accountant.
The trier of fact may accept or reject, in whole or in part, the testimony of any witness. State v. Lofton, 96-1429 (La. App. 1st Cir. 3/27/97), 691 So.2d 1365, 1368, writ denied, 97-1124 (La. 10/17/97), 701 So.2d 1331. Moreover, where there is conflicting testimony about factual matters, the resolution of which depends upon a determination of the credibility of the witnesses, the matter is one of the weight of the evidence, not its sufficiency. State v. Richardson, 459 So.2d 31, 38 (La. App. 1st Cir. 1984). A reviewing court is not called upon to decide whether it believes the witnesses or whether the conviction is contrary to the weight of the evidence. State v. Smith, 600 So.2d 1319, 1324 (La. 1992). In the absence of internal contradiction or irreconcilable conflict with physical evidence, one witness's testimony, if believed by the trier of fact, is sufficient support for a requisite factual conclusion. State v. Thomas, 2005-2210 (La. App. 1st Cir. 6/9/06), 938 So.2d 168, 174-75, writ denied, 2006-2403 (La. 4/27/07), 955 So.2d 683. In this case, in accordance with the defendant's own testimony, he knew that Dr. Pendleton's Medicaid provider number was being used to collect payments for patients who were being treated by the defendant, not Dr. Pendleton. The defendant was also aware of the fact that he was receiving money from the Medicaid payments, despite the fact that he was not an authorized Medicaid provider and had been specifically excluded from participating in the program.
The trial court heard the defense hypothesis of innocence that he was not responsible for the billing and that he believed his actions were not prohibited. The guilty verdicts rendered against the defendant demonstrate that the trial court reasonably rejected his hypothesis of innocence and concluded that he was at least a principal to Medicaid fraud in that he had the specific intent to receive payment for services that were falsely presented as having been rendered by Dr. Pendleton. In reviewing the evidence, we cannot say that this determination was irrational under the facts and circumstances presented to the trier of fact. See State v. Ordodi, 2006-0207 (La. 11/29/06), 946 So.2d 654, 662. Based on a thorough review of the evidence, in the light most favorable to the prosecution, we are convinced that any rational trier of fact could have concluded that the State presented sufficient evidence to prove each element of Medicaid fraud, including the requisite intent to defraud Medicaid, beyond a reasonable doubt and to the exclusion of every reasonable hypothesis of innocence. Accordingly, we find no merit to the first and fourth assignments of error,
ASSIGNMENT OF ERROR NUMBER TWO
In assignment of error number two the defendant argues that the trial court erred in allowing the introduction of other crimes evidence and acts by the defendant. The defendant notes that prior to his 1992 conviction, he admitted in writing to billing Medicaid for x-rays that he did not complete and subsequently pled no contest to Medicaid fraud in 1992. The defendant notes that the events on which the 1992 conviction was based took place approximately twenty years ago. Additionally, the defendant argues that the prior offenses were not similar to the instant case. The defendant notes that in this case, he was not responsible for the billing, he was not the owner/operator of the clinic, he saw patients for Dr. Pendleton, and he was not responsible for any financial contact with Medicaid. He further notes that the prior offenses involved billing that he personally handled, submissions for work that was not done, and a facility that he owned and operated. The defendant argues that the probative value of the prior offenses and the 1999 exclusion letter was outweighed by the prejudicial impact of this evidence.
Relevant evidence is any evidence tending to make the existence of any fact that is of consequence to the determination of the action more or less probable than it would be without the evidence. La. Code Evid. art. 401. Generally, all relevant evidence is admissible. La. Code Evid. art. 402. It may be excluded, however, if its probative value is substantially outweighed by the danger of unfair prejudice. La. Code Evid. art. 403. A trial judge has broad discretion in determining the relevancy of evidence, and his ruling will not be overturned on appeal absent a clear showing of an abuse of that discretion. State v. Miles, 402 So.2d 644, 647 (La. 1981). Generally, evidence of other crimes, wrongs, or acts committed by the defendant is inadmissible due to the substantial risk of grave prejudice to the defendant. Under Louisiana Code of Evidence article 404(B)(1), however, such evidence may be admitted for the purpose of showing motive, opportunity, intent, preparation, plan, knowledge, identity, or absence of mistake or accident. Evidence of other bad acts is not admissible simply to prove the bad character of the accused. La. Code Evid. art. 404(B)(1). Furthermore, the other crimes evidence must tend to prove a material fact genuinely at issue, and the probative value of the extraneous crimes evidence must outweigh its prejudicial effect. State v. Williams, 96-1023 (La. 1/21/98), 708 So.2d 703, 725, cert. denied, 525 U.S. 838, 119 S.Ct. 99, 142 L.Ed.2d 79 (1998). The underlying policy is not to prevent prejudice (since evidence of other crimes is always prejudicial), but to protect against unfair prejudice when the evidence is only marginally relevant to the determination of guilt of the charged crime. State v. Humphrey, 412 So.2d 507, 520 (La. 1981) (on rehearing).
The Louisiana Supreme Court has yet to address the issue of the burden of proof required for the admission of other crimes evidence in light of the repeal of La. Code Evid. art. 1103 and the addition of La. Code Evid. art. 1104. However, numerous Louisiana appellate courts, including this Court, have held that burden of proof to now be less than "clear and convincing." State v. Millien, 2002-1006 (La. App. 1st Cir. 2/14/03), 845 So.2d 506, 514; see also State v. Williams, 99-2576 (La. App. 1st Cir. 9/22/00), 769 So.2d 730, 734 n.4. We note that the initial requirement of establishing that the defendant committed the other crimes was clearly met in this case, as the defendant admitted to commission of the acts in a written statement and later pled no contest to the offenses.
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Under Louisiana Code of Evidence article 404(B), other crimes evidence is also admissible "when it relates to conduct that constitutes an integral part of the act or transaction that is the subject of the present proceeding." For other crimes to be admissible under the integral act exception (formerly known as res gestae), they must bear such a close relationship with the charged crime that the indictment or information as to the charged crime can fairly be said to have given notice of the other crime as well. State v. Schwartz, 354 So.2d 1332, 1334 (La. 1978). Thus, evidence of other crimes forms part of the res gestae when said crimes are related and intertwined with the charged offense to such an extent that the State could not have accurately presented its case without reference to it. In such cases, the purpose served by admission of other crimes evidence is not to depict the defendant as a bad man, but rather to complete the story of the crime on trial by proving its immediate context of happenings near in time and place. Evidence of crimes committed in connection with the crime charged does not affect the accused's character because the offenses are committed as parts of a whole. State v. Brewington, 601 So.2d 656, 657 (La. 1992) (per curiam).Integral act evidence in Louisiana incorporates a rule of narrative completeness, without which the State's case would lose its "narrative momentum and cohesiveness, 'with power not only to support conclusions but to sustain the willingness of jurors to draw the inferences, whatever they may be, necessary to reach an honest verdict.'" State v. Colomb, 98-2813 (La. 10/1/99), 747 So.2d 1074, 1076 (per curiam)(quoting Old Chief v. United States, 519 U.S. 172, 187, 117 S.Ct. 644, 653, 136 L.Ed.2d 574 (1997)).
Here, the fact that the defendant committed prior acts of Medicaid fraud that resulted in the revocation of his right to bill Medicaid for services and led to his fraudulent use of Dr. Pendleton's Medicaid provider number constitutes res gestae evidence in that it would be difficult for the State to present its case without mentioning it. Moreover, we note that the prior offenses were highly relevant to show intent, knowledge, and absence of mistake, which were real and genuine contested issues at trial. See La. Code Evid. arts. 403 & 404(B); State v. Romero, 574 So.2d at 336; State v. Kahey, 436 So.2d 475, 488 (La. 1983); State v. Cupit, 189 La. 509, 515, 179 So. 837, 839 (1938). The offenses were similar in that the defendant collected Medicaid money based on fraudulent claims in the present and prior offenses. Further, the fact that the other acts or crimes happened twenty years before the charged offenses is not sufficient, in and of itself, to require the exclusion of the evidence. Remoteness in time, in most cases, is only one factor to be considered when determining whether the probative value of the evidence outweighs its prejudicial effect. A lapse in time goes to the weight of the evidence, rather than to its admissibility. Cupit, 189 La. at 517, 179 So. at 839. We find that the probative value of the other crimes evidence in this case is not substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the trier of fact (in this case, the trial court). Thus, we find no error in the trial court's ruling on the admissibility of evidence of the defendant's prior offenses.
ASSIGNMENT OF ERROR NUMBER THREE
In the third assignment of error, the defendant argues that the trial court erred in allowing the introduction of his patients' medical charts. The defendant notes that he timely objected to this evidence, asserting his desire to invoke a health care provider-patient privilege on behalf of his patients. The defendant contends that he had the authority to claim the privilege on behalf of the patients and that the medical charts were inadmissible.
In a criminal proceeding, a patient has a privilege to refuse to disclose and to prevent another person from disclosing a confidential communication made for the purpose of advice, diagnosis, or treatment of his health condition between or among himself, his representative, and his physician or psychotherapist, and their representatives. La. Code Evid. art. 510(C)(1). The patient for whom protection was intended by this article is a person in need of medical care who might otherwise withhold relevant information for fear that it may later embarrass him or her or be used against the individual in legal proceedings. Moss v. State, 2005-1963 (La. 4/4/06), 925 So.2d 1185, 1191. Thus, the purpose of the health care provider-patient privilege is to protect confidential communications made by the patient to the physician. State v. Romero, 533 So.2d 1264, 1270 (La. App. 3rd Cir. 1988), reversed in part on other grounds, 574 So.2d 330 (La. 1990).
While paragraph D of Article 510 states in part that the physician or health care provider at the time of the communication is presumed to have authority to claim the privilege, it must be asserted on behalf of the patient. The privilege seeks to secure the patient from disclosure, in court, of potentially humiliating, embarrassing, or disgraceful information, or information that could be the basis for the patient's legal liability. Moss, 925 So.2d at 1191. Since the patients are not parties in this case, no prejudice to the patients can arise. Moreover, the records were not introduced in order to disclose confidences made by the patients to the defendant or Dr. Pendleton, but for the limited purpose of showing correlation between the actual dates of the visits and treatments and the dates Dr. Pendleton was unavailable to provide such treatment, which are non-privileged matters. See La. Code Evid. art. 510. Therefore, we agree with the trial court's finding that this case does not present a situation to which the health care provider-patient privilege applies; moreover, the defendant does not have standing to invoke the privilege for his personal protection.
CONCLUSION
For the foregoing reasons, the defendant's convictions and sentences are affirmed.
CONVICTIONS AND SENTENCES AFFIRMED.