David Austin Price v. State, 456 S.W.3d 342

Background

Appellant (Price) and Wesley Simmons, non-dentist owners, opened Lupe’s Wonderful Smiles and registered it as a Medicaid provider, agreeing to comply with Medicaid rules requiring claims be true and personally rendered by the billing provider or under that provider’s supervision.
Dr. Joon Kim was hired as the clinic dentist; after he left in June 2008, the clinic continued submitting claims under Dr. Kim’s Medicaid provider number until May 2010 while using temporary dentists.
Simmons handled most billing and admitted he submitted fraudulent claims and used clinic funds for lavish personal expenses; auditors later found at least $1.2 million in Medicaid payments were for services never rendered (over $1.6M billed under Kim’s number overall).
Price acknowledged knowledge that Kim’s provider number was being used after Kim left and told Simmons to keep the business “under the radar;” Price received large salary payments and had access to clinic accounts but testified he did not review claims or bank statements.
Dr. Jennifer Molandes discovered mismatched charts and billed services in 2011 and reported the fraud; Simmons pled guilty and testified against Price at trial.
Trial and appeal: Price was convicted of theft aggregating at least $200,000; on appeal the sole question was whether the evidence was legally sufficient to establish Price’s criminal responsibility as a party to Simmons’s theft.

Issues

Issue	Plaintiff's Argument (State)	Defendant's Argument (Price)	Held
Whether Price was a knowing party to theft for directing or encouraging use of Kim’s provider number	Price knew misuse of Kim’s number and told Simmons to keep billing “under the radar,” showing encouragement to deceive Medicaid	Price claimed an agreement with Kim authorized use and denied submitting fraudulent claims	Court held evidence supported a finding Price knowingly encouraged deceptive billing and was a party to theft
Whether Price is criminally responsible for theft of services never performed (>$1.2M) by failing to prevent it while owing a legal duty	As owner, Price had legal duty to verify claims; his deliberate failure to review claims or implement safeguards, combined with knowledge of abnormal billing and Simmons’s spending, shows intent to assist or share in theft	Price argued Simmons, not he, committed the overbilling; Price asserted limited involvement in clinic management and disputed salary amount and specific use of debit card	Court held a rational juror could infer Price intentionally failed to prevent the theft to promote/assist it and thus was criminally responsible
Whether appellate sufficiency review requires weighing contrary evidence	State: sufficiency is measured by viewing evidence in the light most favorable to the verdict; inconsistencies are for jury	Price argued inconsistencies and alternative explanations (salary, noninvolvement) undercut sufficiency	Court reiterated legal-sufficiency standard and declined to reweigh, affirming conviction
Whether aggregation of amounts was proper under single scheme/continuing course of conduct	State contended the fraudulent billings formed one scheme enabling aggregation to highest-grade theft	Price did not dispute aggregation here	Court applied aggregation under Penal Code §31.09 and treated the conduct as one continuing scheme for grading

Key Cases Cited

Odelugo v. State, 443 S.W.3d 131 (Tex. Crim. App. 2014) (Medicaid/Medicare fraud prosecuted under general theft principles)
Turner v. State, 636 S.W.2d 189 (Tex. Crim. App. 1980) (theft prosecutions involving insurer/benefit programs)
Wirth v. State, 361 S.W.3d 694 (Tex. Crim. App. 2012) (requirement that appropriation in contractual setting be by false pretext and intent to deprive)
Hooper v. State, 214 S.W.3d 9 (Tex. Crim. App. 2007) (circumstantial evidence can alone support conviction)
Smith v. State, 965 S.W.2d 509 (Tex. Crim. App. 1998) (intent may be inferred from surrounding circumstances)
Medrano v. State, 612 S.W.2d 576 (Tex. Crim. App.) (criminal responsibility where one neglects a duty with intent to assist another's offense)