U.S. Fifth Circuit - The FindLaw 5th Circuit Court of Appeals Opinion Summaries Blog

Court Reverses Medicare Fraud Convictions for New Orleans Doctor

Sixty-eight-year-old Dr. Pramela Ganji is serving her last days in federal prison, but she will soon be free again.

The U.S. Fifth Circuit Court of Appeals court threw out the case against her in United States of America v. Ganji. The appeals court said prosecutors did not prove she was guilty beyond a reasonable doubt.

The government's case was "rather peculiar," the judges said. It was also a lesson in how not to try a case.

Circumstantial Evidence

Ganji was convicted of fraud by making bogus referrals to a home health care business that she owned. According to the government, Ganji and a co-conspirator defrauded Medicare of $29.6 million.

Prosecutors produced cooperating witnesses, including doctors and nurses, who admitted the Medicare fraud. However, the appeals court said, none of the witnesses directly implicated Ganji or co-defendant Elaine Davis.

"Although these witnesses admitted to their own fraud, they did not implicate Dr. Ganji," the appeals panel said. "Although the government presented a plausible scheme of fraudulence, it did not implicate Davis in the scheme with proof beyond a reasonable doubt." 

The prosecutors put on circumstantial evidence that Ganji "should have known" her business was involved in fraud. But they needed to show that she actually knew it, the judges said.

"Almost as Peculiar"

The government's dependence on its witnesses was "almost as peculiar," the Fifth Circuit panel said, as the investigation into the alleged scheme. The witnesses worked sixty miles away from the defendants' workplace.

"Unlike other salient cases involving conspiracy to commit health care fraud, here the Government presented eighteen witnesses, none of whom could provide direct evidence of their alleged co-conspirator's actions because the witnesses never acted with the defendants to commit the specific charged conduct," the judges said.

The appeals court reversed and vacated the convictions, including the trial court's restitution orders. Ganji had been ordered to pay Medicare more than $5 million; Davis, $9.3 million.

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