State v. Wiley
2017 Ohio 2744
Ohio Ct. App.2017Background
- Lenore Wiley pled guilty to one count of Medicaid fraud (value $1,000–$7,500) and the State sought restitution for $44,316.23 allegedly paid to agencies for her services.
- At plea and sentencing the State presented surveillance showing Wiley failed to provide services to one recipient, "Curry," producing $1,748.54 in wrongful payments.
- The State's investigator sought the full $44,316.23 as restitution, treating all Medicaid payments for Wiley's multi-year employment as losses because Wiley had used altered background checks and was disqualified from providing services.
- The investigator admitted there was no evidence Wiley failed to provide services to recipients other than Curry, nor that the services she provided were valueless; Wiley was paid by employers, not directly by Medicaid.
- The trial court ordered restitution of $44,316.23 and five years community control; Wiley appealed the restitution order.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether restitution may include all Medicaid payments to agencies for services Wiley performed despite her ineligibility | State: Wiley's deception caused Medicaid to pay $44,316.23; restitution may recover those payments | Wiley: Restitution limited to actual economic loss — only payments for services not performed ($1,748.54) | Reversed: restitution limited to $1,748.54 (only proved economic loss) |
| Whether restitution may exceed the statutory value range of the offense of conviction | State: full amount recoverable as victim loss | Wiley: restitution cannot exceed value range of guilty plea (fifth-degree felony range) | Moot (court limited restitution on evidentiary grounds) |
| Whether the trial court considered Wiley's present and future ability to pay | State: court considered restitution appropriate | Wiley: court failed to make any record consideration of ability to pay as required by R.C. 2929.19(B)(5) | Moot as to amount, but on remand court must consider ability to pay |
| Standard for restitution: require direct and proximate economic loss to victim | State: loss includes amounts Medicaid paid because of Wiley's ineligibility | Wiley: where services were actually provided and would have been provided by someone else, Medicaid suffered no loss | Held: restitution confined to direct, proximate economic loss; payments for services actually received are not a loss absent proof services were not provided or were valueless |
Key Cases Cited
- State v. Lalain, 136 Ohio St.3d 248 (Ohio 2013) (restitution amount cannot exceed the victim's economic loss as a direct and proximate result of the offense)