Ala. Pattern Jury Instr. (Criminal) 13A-9-150(B) (INDIVIDUAL OR BUSINESS)

Public Assistance Fraud

(Individual or Business Entity)

The defendant is charged with public assistance fraud.

A person commits the crime of public assistance fraud if he/she is an individual or

business entity and knowingly does any of the following: [Read all appropriate]

(1) Fails, by false statement, misrepresentation, impersonation, or other

fraudulent means to disclose a material fact used in making a determination

as to the qualification of the person to receive public assistance;

(2) Fails to disclose a change in circumstances in order to obtain or continue to

receive any public assistance to which he/she is not entitled or in an amount

larger than that to which he/she is entitled;

(3) Aids and abets another person to fail, by false statement,

misrepresentation, impersonation, or other fraudulent means to disclose a

material fact used in making a determina tion as to the qualification of the

person to receive public assistance;

(4) Aids and abets another person to fail to disclose a change in circumstances

in order to obtain or continue to receive any public assistance to which

he/she is not entitled or in an amount larger than that to which he/she is

entitled;

(5) Uses, transfers, acquires, traffics, alters, forges, possesses, attempts to

use, attempts to transfer, attempts to acquire, attempts to traffic, attempts

to alter, attempts to forge, attempts to possess, or aid and abet another

person in the use, transfer, acquisition, traffic, alteration, forgery, or

possession of a food assistance identification card, an authorization,

including but not limited to, an electronic authorization, for the expenditur e

of food assistance benefits, a certificate of eligibility for medical services, or

a Medicaid identification card in any manner not authorized by law, or to re-encode a magnetic strip on any card with information issued by any state or

federal agency that grants monetary benefits that were not issued by that

agency or that does not match the information on the front of the card;

(6) Files, attempts to file, or aids and abets in the filing of a claim for services

to, or on behalf of, a recipient of public assistance for services that were not

rendered;

(7) Files a false claim or a claim for nonauthorized items or services under any

state or federally funded public assistance program;

(8) Bills the recipient of public assistance, or his/her family, for an amount in

excess of that provided for by law or regulation;

(9) Fails to credit, return, or pay back to the state or its agents any payments

received from Social Security, insurance, or other sources of funds paid or

administered by any state agency that are in excess of the approved or

listed amount or were received or approved based on fraud or fraudulent

conduct;

(10) In any way, receives, attempts to receive, or aids and abets in the receipt

of unauthorized payments or other unauthorized public assis tance or

authorization or identification to obtain public assistance;

(11) Converts, charges, accepts, or in any way takes any funds administered by

a public assistance program in excess of the listed price plus any applicable

taxes; (OR)

(12) Receives payment that includes public assistance funds, in any form, for

the purchase of items that are not authorized or are prohibited by state or

federal law.

To convict, the State must prove beyond a reasonable doubt each of the following

elements:

(1) The defendant was an individual or business entity;

(2) The Defendant did the following: [Read all appropriate]

(a) Failed, by false statement, misrepresentation, impersonation, or

other fraudulent means to disclose a material fact used in making a

determination as to the qualification of the person to receive public

assistance;

(b) Failed to disclose a change in circumstances in order to obtain or

continue to receive any public assistance to which he/she was not

entitled or in an amount larger than that to which he/she was entitled;

(c) Aided and abetted another person to fail, by false statement,

misrepresentation, impersonation, or other fraudulent means to

disclose a material fact used in making a determination as to the

qualification of the person to receive public assistance;

(d) Aided and abetted another person to fail to disclose a change in

circumstances in order to obtain or continue to receive any public

assistance to which he/she was not entitled or in an amount larger

than that to which he/she was entitled;

(e) Used, transferred, acquired, trafficked, altered, forged, possessed,

attempted to use, attempted to transfer, attempted to acquire,

attempted to traffic, attempted to alter, attempted to forge, attempted

to possess, or aided and abetted another person in the use, transfer,

acquisition, traffic, alteration, forgery, or possession of a food

assistance identification card, an authorization, including but not

limited to, an electronic authorization, for the expenditure of food

assistance benefits, a certificate of eligibility for medical services, or

a Medicaid identification card in any manner not authorized by law,

or to re-encode a magnetic strip on any card with information issued

by any state or federal agency that granted monetary benefi ts that

were not issued by that agency or that did not match the information

on the front of the card;

(f) Filed, attempted to file, or aided and abetted in the filing of a claim

for services to, or on behalf of, a recipient of public assistance for

services that were not rendered;

(g) Filed a false claim or a claim for nonauthorized items or services

under any state or federally funded public assistance program;

(h) Billed the recipient of public assistance, or his/her family, for an

amount in excess of that provided for by law or regulation;

(i) Failed to credit, return, or pay back to the state or its agents any

payments received from Social Security, insurance, or other sources

of funds paid or administered by any state agency that were in

excess of the approved or listed amount or were received or

approved based on fraud or fraudulent conduct;

(j) In any way, received, attempted to receive, or aided and abetted in

the receipt of unauthorized payments or other unauthorized public

assistance or author ization or identification to obtain public

assistance;

(k) Converted, charged, accepted, or in any way took any funds

administered by a public assistance program in excess of the listed

price plus any applicable taxes; (OR)

(l) Received payment that incl uded public assistance funds, in any

form, for the purchase of items that were not authorized or were

prohibited by state or federal law; (AND)

(3) The Defendant did so knowingly.

Public Assistance means money or property provided directly or indirectly to

eligible persons through programs of the federal government, the state, or any political

subdivision thereof, including any program administered by a public housing authority.

[13A-9-150(a)]

[Read as appropriate]:

1. Public assistance fraud includes the introduction of fraudulent records into a

computer system, the unauthorized use of computer facilities, the intentional or deliberate

alteration or destruction of computerized information or files, fraudulent billing or charging,

and the stealing of financial instruments, data, and other assets. [13A-9-150(g)]

2. A person acts intentionally with respect to a result or to conduct described by a

statute defining an offense, when his/her purpose is t o cause that result or to engage in

that conduct. [13A-2-2(1)]

[Read as appropriate]: The introduction into evidence of a paid state warrant to

the order of the defendant is prima facie evidence that the defendant did receive public

assistance from the state. [13A-9-150(i)]

[Read as appropriate] : The introduction into evidence of a transaction history

generated by a personal identification number (PIN) establishing a purchase or

withdrawal by electronic benefit transfer is prima facie evidence that the id entified

recipient received public assistance from the state. [13A-9-150(j)]

[Read as appropriate]: The value of a food assistance authorization benefit shall

be equal to the cash or exchange value unlawfully obtained by the fraudulent act

committed. [13A-9-150(f)]

A person acts knowingly with respect to conduct or to a circumstance when he/she

is aware that his/her conduct is of that nature or that the circumstance exists. [13A-2-2(2)]

[Read as appropriate] : Three or more violations of this section establish a

rebuttable presumption that the defendant knowingly violated this section. [13A -9-

150(e)(3)]

[Read as appropriate]:

1. A hospital, or an employee, agent, contractor, subcontractor, or independent

contractor of a hospital, or a physician or a physician’s employee, agent, contractor,

subcontractor, or independent contractor must have specific intent to make a claim or

obtain a payment for a health care item or service for which he/she has actual knowledge,

as opposed to constructive knowledge, that he/she is not entitled to the claim or payment

or that he/she has actual knowledge that his/her patient is not otherwise entitled to

coverage under a public assistance program. [13A-9-150(c)]

2. A hospital includes general and specialized hospitals, including ancillary

services; independent clinical laboratories; rehabilitation centers; ambulatory surgical

treatment facilities for patients not requiring hospitalization; end stage renal disease

treatment and transplant centers, including free-standing hemodialysis units; abortion or

reproductive health centers; hospices; health maintenance organizations; and other

related health care institutions when such institution is primarily engaged in offering to the

public generally, facilities and se rvices for the diagnosis and/or treatment of injury,

deformity, disease, surgical or obstetrical care. Also included within the term are long term

care facilities such as, but not limited to, skilled nursing facilities, intermediate care

facilities, assisted living facilities, and specialty care assisted living facilities rising to the

level of intermediate care. The term "hospitals" relates to health care institutions and shall

not include the private offices of physicians or dentists, whether in individua l, group,

professional corporation or professional association practice. This section shall not apply

to county or district health departments. [22-21-20(1)]

3. A person acts intentionally with respect to a result or to conduct described by a

statute defining an offense, when his/her purpose is to cause that result or to engage in

that conduct. [13A-2-2(1)]

[Read as appropriate]:

1. Repayment of public assistance benefits or services or return of authorization

or identification wrongfully obtained is not a defense to, or ground for dismissal of, criminal

charges brought under this section. However, in situations in which a hospital, or an

employee, agent, contractor, subcontractor, or independent contractor of a hospital, or a

physician or his/her emplo yee, agent, contractor, subcontractor, or independent

contractor has overbilled or received an overpayment for a medical or health care service

or improperly charted, coded, or billed for any medical or health care service, common

practices, including, but not limited to, repayment, even years later, may use as a defense

to, or ground for dismissal of, a prosecution under this section. [13A-9-150(h)]

2. A hospital includes general and specialized hospitals, including ancillary

services; independent clinica l laboratories; rehabilitation centers; ambulatory surgical

treatment facilities for patients not requiring hospitalization; end stage renal disease

treatment and transplant centers, including free-standing hemodialysis units; abortion or

reproductive heal th centers; hospices; health maintenance organizations; and other

related health care institutions when such institution is primarily engaged in offering to the

public generally, facilities and services for the diagnosis and/or treatment of injury,

deformity, disease, surgical or obstetrical care. Also included within the term are long term

care facilities such as, but not limited to, skilled nursing facilities, intermediate care

facilities, assisted living facilities, and specialty care assisted living fac ilities rising to the

level of intermediate care. The term "hospitals" relates to health care institutions and shall

not include the private offices of physicians or dentists, whether in individual, group,

professional corporation or professional association practice. This section shall not apply

to county or district health departments. [22-21-20(1)]

If you find from the evidence that the State has proved beyond a reasonable doubt

each of the above elements of public assistance fraud, then you shall find the defendant

guilty of public assistance fraud.

If you find that the State has failed to prove any one or more of the elements of the

offense of public assistance fraud, then you cannot find the defendant guilty of public

assistance fraud.