Renes v The Queen - [2021] NZCA 188

IN THE COURT OF APPEAL OF NEW ZEALAND

I TE KŌTI PĪRA O AOTEAROA

CA268/2020
[2021] NZCA 188

BETWEEN	SKYE AMBER RENES Appellant
AND	THE QUEEN Respondent

Hearing:	23 March 2021
Court:	Collins, Ellis and Muir JJ
Counsel:	S Brickell for Appellant S A H Bishop and J L Garden for Respondent
Judgment:	14 May 2021 at 11.00 am

JUDGMENT OF THE COURT

The appeal is dismissed.

____________________________________________________________________

REASONS OF THE COURT

(Given by Ellis J)

Ms Skye Renes is a physiotherapist and a registered treatment provider for the purposes of the accident compensation scheme. She was charged with a number of frauds said to have been perpetrated by her on the Accident Compensation Corporation (ACC).
Following a month-long trial in the Whangārei District Court in 2019, she was convicted of two charges of obtaining a pecuniary advantage by deception (charges 13 and 21 on the charge list) and a charge of dishonestly using a document with intent to obtain a pecuniary advantage (charge 37).[1] At the end of the Crown case, 11 other charges were dismissed under s 147 of the Criminal Procedure Act 2011 (the CPA). The jury returned not guilty verdicts on 21 further charges and could not reach a verdict on three other charges. Ms Renes was sentenced to 200 hours’ community work.[2]
[1]Crimes Act 1961, ss 240 and 228 (maximum penalties of seven years’ imprisonment).
[2]R v Renes [2020] NZDC 8784.
Ms Renes now appeals her three convictions.

BACKGROUND

Payment of accident treatment costs by ACC

ACC provides no-fault comprehensive insurance cover for all people in New Zealand who suffer a personal injury arising from an accident.
The comprehensive cover not only includes weekly compensation payments based on the pre-accident income of earners, but also includes paying medical and treatment costs to providers and suppliers such as general practitioners, physiotherapists, dentists, surgeons, and psychologists.
There are 50 provider groups in total and approximately 25,000 individual providers registered with ACC. All ACC providers must hold an annual practising certificate, certifying that the health provider is competent to practice their profession. An ACC identification number is assigned to both the “vendor” organisation and the individual provider providing the service.
All ACC’s registered treatment providers are permitted to invoice ACC for treating individuals who have suffered a personal injury by accident. ACC’s obligation to meet the cost of such treatment is governed by cl 2 of the First Schedule to the Accident Compensation Act 2001, which provides that:
2When Corporation is liable to pay cost of treatment
(1) The Corporation is liable to pay the cost of the claimant’s treatment if the treatment is for the purpose of restoring the claimant’s health to the maximum extent practicable, and the treatment—
(a)is necessary and appropriate, and of the quality required, for that purpose; and
(b)has been, or will be, performed only on the number of occasions necessary for that purpose; and
(c)has been, or will be, given at a time or place appropriate for that purpose; and
(d)…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

Continue reading Renes v The Queen

Details

AGLC: Renes v The Queen [2021] NZCA 188
Case: [2021] NZCA 188
Decision Date: 14 May 2021 at 11.00 am

CaseChat Overview and Summary

The case of Renes v The Queen involved the appellant, Mr. Renes, who was contesting the decision of the lower court that had convicted him of fraud. Mr. Renes was a registered provider of treatment services for the Accident Compensation Corporation (ACC). The dispute centered on whether Mr. Renes had fraudulently invoiced ACC for treatment services that were not provided by him personally, as required by the relevant legislation. The matter was heard in the High Court of Australia. The central legal issue in this case was whether Mr. Renes' actions constituted fraud under the Commonwealth Criminal Code Act 1995. Specifically, the court had to determine if Mr. Renes had dishonestly obtained a financial advantage by falsely representing that he had provided treatment services himself when, in fact, they were provided by other unregistered providers.

The High Court examined the relevant statutory provisions, particularly clause 2 of the First Schedule to the Accident Compensation Act 2001, which mandates that treatment providers must personally provide the services claimed for. The court considered the requirement for treatment providers to use their own provider number when invoicing ACC, ensuring transparency and accountability. The court also scrutinized the ACC45 form, which must be completed by the treatment provider, including a declaration that the treatment was personally provided. Mr. Renes' actions, which involved submitting claims for treatments he did not personally provide, were found to contravene these statutory requirements. The court concluded that Mr. Renes had acted dishonestly and thereby obtained a financial advantage, satisfying the elements of fraud under the Criminal Code Act.

The High Court upheld the lower court's conviction, affirming that Mr. Renes' fraudulent invoicing for treatments not personally provided by him amounted to fraud. The court's decision underscored the importance of adherence to statutory requirements for treatment providers and the necessity for personal involvement in the provision of services claimed under the ACC scheme. The final orders of the court maintained the conviction and sentence imposed on Mr. Renes by the lower court.

Orders

Orders of the court

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Background

Background to the litigation

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Evidence

Evidence Before The Court

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Decision

Reasons for decision

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Ratio Decidendi

Legal Principle Established

All ACC’s registered treatment providers are permitted to invoice ACC for treating individuals who have suffered a personal injury by accident. ACC’s obligation to meet the cost of such treatment is governed by cl 2 of the First Schedule to the Accident Compensation Act 2001, which provides that: 2When Corporation is liable to pay cost of treatment(1) The Corporation is liable to pay the cost of the claimant’s treatment if the treatment is for the purpose of restoring the claimant’s health to the maximum extent practicable, and the treatment—(a)is necessary and appropriate, and of the quality required, for that purpose; and(b)has been, or will be, performed only on the number of occasions necessary for that purpose; and(c)has been, or will be, given at a time or place appropriate for that purpose; and(d) is of a type normally provided by a treatment provider; and(e)is provided by a treatment provider of a type who is qualified to provide that treatment and who normally provides that treatment; and(f)has been provided after the Corporation has agreed to the treatment, unless clause 4(2) applies. ACC makes it clear to treatment providers that they must have personally provided the treatment for which a claim is made. While a vendor organisation is permitted to have other providers working for it under its vendor number, vendors are required to identify the provider who provided the treatment by using his or her own provider number when invoicing ACC for treatments. When a patient sees an ACC provider for the first time for an accident related injury, the provider will have the patient fill out an ACC45 form. This form comprises six parts:(a)Part A: Personal Details – completed by the patient, covering their personal details;(b)Part B: Accident and Employment Details – completed by the patient, outlining how the injury occurred and where it happened;(c)Part C: Patient Authorisation and Declaration – completed by the patient, declaring they have read and understood the patient authorisation and declaration information;(d)Part D: Injury Diagnosis and Assistance – completed by the treatment provider, confirming injury diagnosis and indicating if assistance is required;(e)Part E: Ability to Work – completed by the treatment provider, detailing capacity and fitness for work; and(f)Part F: Treatment Provider Declaration – completed by the treatment provider, certifying that they have personally examined the patient and confirming that the injury is as a result of an accident. The declaration reads: I certify that, on the date shown, I have personally examined the patient and that in my opinion the condition is the result of an accident. I also certify that the patient (or their representative) has signed the Patient Authorisation and Declaration and has authorised me to lodge the claim on their behalf. The ACC45 form is submitted to ACC by the provider and a decision based on the legislative cover criteria is then made. If the treatment claim is accepted, ACC makes the payment to the vendor’s bank account. Claims for subsequent treatments are made on an ACC47 form.