United States v. Bek

United States Court of Appeals for the Seventh Circuit · Evidence

EvidencePhysician-patient privilegeHIPAASufficiency of the evidenceControlled substancesHealth care fraudFed. R. Evid. 501physician-patient privilege

Facts

Law enforcement investigated Dr. Bek after unusually long lines formed outside his pain-management clinic, and undercover officers recorded visits in which Bek performed brief, uniform examinations and then prescribed requested Schedule III and IV drugs for cash. Former patients, Bek's assistant Faloona, pharmacists, and government experts described a practice in which Bek used the same menu of drugs, failed to obtain records or diagnostic tests, ignored signs of abuse, and prescribed without legitimate medical purpose. The government also introduced patient medical records obtained through a judicial warrant and disclosed under a protective order. Bek argued those records were privileged and protected by HIPAA, and also claimed the evidence was insufficient on multiple counts.

Issue

Whether the evidence was sufficient to support Bek's convictions for unlawful distribution, conspiracy, and health care fraud, and whether the district court erred in admitting patient medical records on the theory that they were protected by a physician-patient privilege or HIPAA. The court also considered whether Bek could obtain relief based on his claim that the government vindictively prosecuted his former counsel.

Rule

On a sufficiency challenge after a jury trial, the court views the evidence in the light most favorable to the government and reverses only when no rational jury could find guilt beyond a reasonable doubt. A registered practitioner violates 21 U.S.C. § 841(a)(1) when he prescribes controlled substances outside the course of professional practice or without a legitimate medical purpose. Federal common law does not recognize a physician-patient privilege, and HIPAA does not create such a privilege; instead, HIPAA permits disclosure of protected medical information without patient authorization when records are seized pursuant to a judicial warrant and later used in litigation under a qualifying protective order.

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

Federal agents in Milwaukee investigate Dr. Lena Moritz for unlawful prescribing. They obtain a magistrate-issued search warrant for her clinic files, and before trial the district court enters an order barring disclosure of the records outside the case and requiring their return or destruction when the case ends.

At trial, Dr. Moritz moves to exclude the patient files because none of the patients signed HIPAA authorizations and she claims a federal physician-patient privilege. How should the court rule?

Explanation. The majority held that federal common law does not recognize a physician-patient privilege, and HIPAA does not create one. Instead, HIPAA supplies procedures for disclosure. Where agents obtain records through a warrant issued by a judicial officer and the court enters a protective order limiting use and requiring return or destruction, admission is proper without patient waivers. (Derived from United States v. Bek (n.d.).)