United States v. Blanca Ruiz
698 F. App'x 978
| 11th Cir. | 2017Background
- Defendants Blanca Ruiz and Alina Fonts were employees at Health Care Solutions Network (HCSN) and convicted of Medicare-related fraud: Ruiz (conspiracy under 18 U.S.C. § 1349); Fonts (conspiracy under § 1349 and two substantive counts under 18 U.S.C. § 1347). Both sentenced to 72 months and ordered to pay >$10 million restitution.
- HCSN operated partial hospitalization programs (PHPs) and billed Medicare for long or non-existent treatments, paid referral kickbacks, fabricated intake and therapy records, and maintained "ghost" patients (the so-called "white group").
- Evidence included testimony that employees routinely fabricated or altered records, falsified documentation for Medicare reviews, and that Ruiz and Fonts participated in or supervised such falsification; both received checks annotated "notes."
- Fonts supervised group therapy documentation at HCSN-West, arranged false admissions (including of her parents), and enlisted her son to draft fabricated notes for another facility. Ruiz worked in intake and was linked to creation/maintenance of the ghost "white group."
- The government presented exhibits of Medicare billings during each defendant’s employment; district court attributed multi-million dollar loss amounts to each for Guidelines purposes (triggering a 22-level enhancement).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of evidence for conspiracy (Ruiz) | Govt: circumstantial proof (fabricated records, role in "white group", payments) shows knowledge and voluntary joining. | Ruiz: lacked knowledge of Medicare rules; insufficient proof she knowingly joined conspiracy. | Affirmed — sufficient circumstantial evidence to convict Ruiz of conspiracy. |
| Sufficiency of evidence for conspiracy and substantive fraud (Fonts) | Govt: supervisory role, fabrication, receipt of kickbacks, Pinkerton liability for submissions of false claims. | Fonts: signatures may be forged; challenges specific-substantive proof. | Affirmed — conspiracy supported; substantive counts sustained under Pinkerton theory. |
| Trial rulings and alleged cumulative error (both) | Defendants: errors in admitting LCDs, witness handling, limiting closing, Allen charge, prosecutorial vouching/coercion. | Govt: evidentiary rulings proper; limiting instructions and Allen charge not coercive; witness testified despite any government contact. | Affirmed — no reversible error; instructions and rulings within discretion; no substantial interference with witnesses. |
| Sentencing: loss attribution and leadership enhancement (both; leadership for Fonts) | Defendants: loss over-attributed (affecting Guidelines); Fonts: denial of challenge to leadership enhancement. | Govt: loss attributed via billing exhibits during employment; Fonts supervised staff and son — justifies leadership enhancement. | Affirmed — district court’s loss findings not clearly erroneous; leadership enhancement properly applied to Fonts. |
Key Cases Cited
- United States v. Moran, 778 F.3d 942 (11th Cir.) (conspiracy proof and Pinkerton liability in Medicare-fraud context)
- United States v. Willner, 795 F.3d 1297 (11th Cir.) (reversing where no evidence defendant knew of kickbacks)
- United States v. Olano, 507 U.S. 725 (1993) (plain-error standard for unpreserved claims)
- United States v. Dabbs, 134 F.3d 1071 (11th Cir.) (government must prove loss amount by preponderance for Guidelines)
- United States v. Miller, 188 F.3d 1312 (11th Cir.) (district court need only make reasonable — not precise — loss determination)
- United States v. Perry, 340 F.3d 1216 (11th Cir.) (standard for leadership-role enhancement)