Judge’s Use of Red Pen to Note Humorous Points During Health Care Fraud Trial Not Plain Error; Restitution Orders Vacated for Erroneous Calculation
Three defendants were convicted by a jury of various crimes
related to their involvement in a health care fraud conspiracy. The panel affirms their convictions. At one point during trial, the district judge
commented to the jury that he will make notes about things he finds humorous
with a red pen so that he can visit with the jury after the case in the jury
room about those things; all other notes he will take in black ink. None of the defendants objected
contemporaneously to these remarks. The
panel rejects the argument that the jury could look to see what color of pen
the judge was using to help them determine how to interpret the evidence. No plain error.
Ramos objected to the introduction of her personnel file on
the first day of trial on the grounds that her counsel had not seen the records
before and did not have sufficient time to review them. She challenges the admission of the documents
as a violation of the court’s order requiring parties to exchange exhibits
seven days prior to the start of trial.
Ramos did not request discovery pursuant to Rule 16, and could not
therefore challenge the admission under Rule 16. The panel finds that the admission of the
personnel file did not prejudice Ramos’s substantial rights because the
Government would have sustained its burden of proof without it, noting that
Ramos had equal access to it prior to trial.
The panel finds that the district court properly allowed
rebuttal testimony that was relevant, was not hearsay (because not offered for
the truth of the matter but rather to impeach the defendant’s credibility), and
was not offered as character evidence. The
panel also defers to the district court’s decision to limit the deliberate
ignorance instruction to one of the defendants whose defense at trial focused
on her alleged lack of guilty knowledge.
The panel rejects Ramos’s argument that she could not have willfully violated the Anti-Kickback
Statute because she did not know that engaging in a commission-based pay
arrangement with a Medicare provider violated the law. The panel finds that the Government need only
“prove that the defendant willfully committed an act that violated the
Anti-Kickback Statute,” not that the defendant knew of the statute or acted
with a specific intent to violate it.
The panel affirms St. Junius’s sentence, finding that it is
plausible that she held a managerial role in the offense since she led others
to believe she owned the business and “signed Medicare documents, signed and
issued paychecks, and sent correspondence as the owner” of the business. St. Junius also held a position of trust
since she had a license to provide medical equipment for Medicare, and she
abused that trust by signing documents and engaging in other activities that
helped facilitate the health care fraud conspiracy. The panel finds that Ramos and Spicer also
abused positions of trust even though they did not have a fiduciary
relationship with Medicare; they both transferred patients’ “means of
identification” to facilitate the crime.
The panel vacates Spicer’s and Ramos’s restitution orders,
however, because they were improperly based on conduct outside of the offense
for which they were convicted. The
restitution amount was based on the total amount Medicare/Medicaid paid the
business based on Spicer’s and Ramos’s referrals ($794,434.08); “a figure that grossly
exceeded the amount Medicare/Medicaid paid with respect to the crimes for which”
they were convicted.
Labels: Abuse of Trust, Fraud, Restitution
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