United States v. Anthony Roberts
778 F.3d 942
| 11th Cir. | 2015Background
- Biscayne Milieu Health Center (a PHP) billed Medicare ~$57.7M (2007–2011); Medicare paid ~$11.48M. Jury found pervasive fraud: ineligible admissions, falsified group notes, and kickback-driven recruitment.
- Eight appellants (seven individuals including owners/managers, a physician, clinical director, and two recruiters, plus the corporation) were tried; multiple co‑workers testified and some pled guilty. Trial lasted seven weeks.
- Convictions included: conspiracy to commit health care fraud (18 U.S.C. § 1349), substantive health‑care fraud (§ 1347), kickback conspiracy and substantive kickback counts (42 U.S.C. § 1320a‑7b), money‑laundering (§§ 1956/1957), and related counts. Significant restitution and long prison terms were imposed (up to 360 months for CEO Antonio Macli).
- District court found mass recruitment, falsified records, payment of recruiters via "money sheets," and laundering of proceeds; many patients were chronic substance abusers, elderly dementia patients, immigration‑seeking Haitian patients, or paid patients rather than true PHP beneficiaries.
- On appeal the panel considered sufficiency of evidence, multiplicity, juror removal/attorney misconduct, evidentiary rulings (lay opinion), prosecutorial remarks, jury instruction on "attempt," cumulative error, sentencing guideline calculations (loss, mass‑marketing, sophisticated means, vulnerable‑victim, role adjustments, obstruction), and restitution calculations.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of evidence for fraud/kickbacks/money‑laundering | Gov: abundant direct and circumstantial evidence tied defendants to recruiting, false notes, billing, kickbacks, and laundering | Defendants: challenged knowledge, participation, and sufficiency as to specific counts | Affirmed: evidence (including witness testimony, money sheets, signatory records) sufficient for convictions |
| Multiplicity (counts 1 and 15) | Gov: separate conspiracies with different objects (fraud vs kickbacks) | Huarte: count 15 is lesser‑included of count 1, double jeopardy violation (raised on appeal) | Rejected: counts have different elements and objectives; claim waived for failure to object below; concurrent sentences make any error harmless |
| Juror removal / attorney misconduct / ineffective assistance | Defendants: juror 13 biased after counsel's offensive remark; counsel should have withdrawn (prejudice) | Gov: remark isolated, court admonished, jurors (incl. juror 13) said they could be fair | No abuse: court questioned jurors; denial of mistrial and refusal to remove juror were within discretion; IAC not shown (no prejudice) |
| Admission of lay opinion on patient eligibility/diagnosis and signature authenticity | Defendants: testimony impermissibly opined on medical diagnoses and handwriting authenticity | Gov: witnesses gave perceptions from treatment experience; most testimony admitted without contemporaneous objection | No abuse: Rule 701 permits lay opinion based on personal perception; many objections waived by failure to renew at trial |
| Prosecutor comments in rebuttal / Fifth Amendment reference | Defendants: rebuttal and remarks (sympathy, death of patient) and elicited post‑arrest silence improperly prejudiced jury | Gov: remarks were brief, objection sustained, testimony struck, and court offered and gave curative instructions | No reversible error: single brief references were harmless given curative instruction and overwhelming evidence |
| Jury instruction omission (definition of "attempt") | Biscayne Milieu: failure to define "attempt" was erroneous | Gov: "attempt" is common word; no request was made | Plain‑error review: no plain error — jury charge as whole not misleading |
| Sentencing (loss, mass‑marketing, sophisticated means, vulnerable victims, role adjustments, obstruction) | Defendants: challenged specific guideline enhancements, loss amount attribution, role adjustments, and variances | Gov: enhancements supported by trial record, foreseeability of co‑conspirator acts, and individualized findings; loss measured as Medicare payments during relevant periods | Affirmed: district court's findings (intended loss ≈ Medicare payments, mass‑marketing, sophisticated means, vulnerable‑victim, role/organizer and obstruction findings) not clearly erroneous; variances within discretion |
| Restitution (offset for value of legitimate services) | Dr. Kushner: value of legitimate psychiatric services should offset restitution | Gov: district court found services were not proper PHP care; restitution limited to Medicare payments during his involvement | Affirmed: challenge inadequately preserved and district court did not err given finding that proper PHP treatment was not provided |
Key Cases Cited
- United States v. Vernon, 723 F.3d 1234 (11th Cir.) (conspiracy elements, proving knowledge by circumstantial evidence)
- United States v. Mateos, 623 F.3d 1350 (11th Cir.) (affirming Medicare fraud convictions on circumstantial proof)
- United States v. Bane, 720 F.3d 818 (11th Cir.) (restitution: offset value of medically necessary services in Medicare cases)
- United States v. Reeves, 742 F.3d 487 (11th Cir.) (single reference to post‑arrest silence is brief and often harmless)
- United States v. Medina, 485 F.3d 1291 (11th Cir.) (limitation: paying kickbacks alone does not establish § 1347 fraud; false claims required)
- United States v. Register, 182 F.3d 820 (11th Cir.) (standards for juror discharge review)
- United States v. Hill, 643 F.3d 807 (11th Cir.) (lay opinion testimony under Rule 701)
- Pinkerton v. United States, 328 U.S. 640 (U.S.) (co‑conspirator liability for reasonably foreseeable acts)