The Colorado Supreme Court upheld the Medicaid fraud conviction of a Garfield County woman on Monday.
In a 4-3 decision, the high court said the Colorado Court of Appeals shouldn’t have reduced a lower court’s felony conviction of Garfield County resident Alma Vidauri for defrauding the state in Medicaid and Child Health Plan Plus benefits.
Vidauri had been convicted in a Garfield County district court for under-reporting her income in order to receive more benefits. The appeals court, which said the prosecution failed to show that she had been ineligible for the additional benefits, reduced her 2016 felony conviction to petty theft.
But four of the state’s justices wrote in their majority opinion that the state’s theft statutes places no such burden on prosecutors.
“Eligibility is not entitlement,” Justice Williams W. Hood III wrote in the majority ruling. “Because an applicant is not entitled to, and so has no legally cognizable interest in, any benefits until she has submitted accurate information demonstrating as much, we conclude that all the benefits Vidauri received by submitting false information were obtained by deception.”
In a precedent-setting case, a three-judge panel of the appeals court unanimously ruled in 2019 that reducing the sentence was the only remedy in dealing with what it saw as a hole in Colorado’s Medicaid fraud statues because prosecutors failed to provide evidence of overpayments made to recipients because of deceit, money beyond what they were actually entitled to receive.
“Because the prosecution presented only evidence showing the total amount of benefits paid, it failed to prove the value of the benefits which Vidauri obtained by deceit,” Judge John Webb wrote in that 2019 ruling. “The theft statute nor any Colorado case explains how the prosecution proves the value of public assistance benefits obtained as a result of a defendant’s deceit. Perhaps the prosecutor did not do so because Colorado law is silent on whether the prosecution must prove the value of public assistance benefits obtained by deceit.”
Vidauri and her three children received a total of $31,417 in Medicaid and CHP+ benefits over an eight-year period. Both public-assistance programs are income based, but Vidauri understated her annual earnings, getting more than she should have, the rulings said.
But while the prosecution proved that she intended to defraud the state, it did not provide evidence of the difference between what she and her children were entitled to receive and the defrauded overpayments, Webb wrote.
The high court, however, said that places an unfair burden on prosecutors.
“Vidauri asserts that any benefits for which she would have been eligible were not property ‘of another’ because she alone had a possessory or proprietary interest in those benefits,” Hood wrote. “But both the (appeals court) and Vidauri seem to conflate eligibility with entitlement in assessing when one may be said to have acquired a possessory or proprietary interest in public benefits.”
In a dissenting opinion that was joined by Justices Monica Marquez and Melissa Hart, Justice Maria E. Berkenkotter argued the majority opinion unfairly took a “total amount approach” in determining whether Vidauri’s felony conviction should stand.
Berkenkotter wrote that Vidauri was entitled to certain benefits, and it is incumbent on the prosecution to show how much more in benefits she shouldn’t have received.
“This approach is unprecedented in that it can penalize defendants by requiring them to pay more than they stole,” Berkenkotter wrote.