United States v. Carmen Gonzalez
834 F.3d 1206
11th Cir.2016Background
- Carmen Gonzalez, who worked at St. Jude Rehabilitation Center (an HIV clinic), was indicted and convicted by a jury of: (1) conspiracy to defraud the United States (18 U.S.C. § 371) and (2) conspiracy to commit health care fraud (18 U.S.C. §§ 1347, 1349). She was sentenced to concurrent prison terms (84 months total for the counts at issue).
- St. Jude billed Medicare for extensive WinRho infusions while maintaining far fewer vials than billed; expert testimony established the treatments were largely medically unnecessary. The clinic paid patients cash kickbacks ($150–$250) to return for treatments.
- Gonzalez worked in the infusion room, filled out billing/treatment logs showing many lengthy infusions (though actual infusions were short), ordered supplies/medication, and distributed cash payments behind locked doors.
- She fled after a 2008 bond-reconsideration hearing and was a fugitive for roughly five years; she later pled guilty to failure-to-appear and admitted the prior flight in a factual proffer. The flight was introduced at trial.
- Post-trial, Gonzalez appealed contending (a) insufficient evidence for both conspiracy convictions, (b) double jeopardy/multiplicity because both conspiracies were the same offense, and (c) cumulative trial errors (erroneous jury instructions, hearsay admission, improper prosecutorial remarks). The Eleventh Circuit affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of the evidence to convict on conspiracy counts | Gonzalez argued government proved only her presence; she lacked knowledge and voluntary agreement to conspiracy | Govt. argued circumstantial evidence — kickback payments, billing logs, role in ordering meds, locked infusion room, inconsistent inventories, and flight — established knowledge and voluntary participation | Affirmed: Evidence was sufficient for both § 371 and § 1349 conspiracies (jury could infer knowledge and voluntary joining) |
| Double jeopardy / multiplicity (two conspiracies) | Gonzalez argued the two conspiracy convictions were effectively the same offense and multiplicious | Govt. (and Gonzalez at oral argument) noted the statutes have distinct elements (overt act/United States as victim for § 371; § 1349/§ 1347 targets healthcare benefit programs and lacks overt-act element) | Affirmed: No double jeopardy violation; Blockburger element test shows distinct elements, so parallel convictions permitted; reviewed for plain error and none found |
| Jury instructions (conflation of counts; failure to define “kickback”) | Gonzalez said instructions blurred differences between counts and failed to define “kickback,” misleading jury and implicating fairness/Double Jeopardy | Court: instructions, read as a whole, correctly stated elements and distinguished counts; “kickback” is not unduly technical and was understandable from evidence/indictment | No plain error: instructions adequate when read in context and jury had indictment during deliberations; omission of statutory definition not plain error |
| Evidence/admission and prosecutorial remarks (hearsay, proffer, vouching) | Gonzalez claimed admission of co-conspirator hearsay and rebuttal remark about her five-year flight were prejudicial | Court: analogous testimony was admitted without objection earlier; flight evidence was in the factual proffer introduced at trial, so prosecutorial inference was reasonable | No reversible error: any hearsay admission harmless; prosecutor did not impermissibly vouch; cumulative-error claim fails |
Key Cases Cited
- United States v. Mateos, 623 F.3d 1350 (11th Cir. 2010) (conspiracy proof by circumstantial evidence)
- United States v. Boffil-Rivera, 607 F.3d 736 (11th Cir. 2010) (standard for reviewing sufficiency of evidence)
- United States v. Moran, 778 F.3d 942 (11th Cir. 2015) (elements for conspiracy to commit health care fraud)
- United States v. Medina, 485 F.3d 1291 (11th Cir. 2007) (health-care fraud requires proof claims were false or services not delivered)
- Olano v. United States, 507 U.S. 725 (1993) (waiver vs. forfeiture; plain-error review)
- Blockburger v. United States, 284 U.S. 299 (1932) (double jeopardy/multiplicity element test)
- Albernaz v. United States, 450 U.S. 333 (1981) (inquiry into legislative intent for separate punishments)
- United States v. Cotton, 535 U.S. 625 (2002) (plain-error standard, effect on substantial rights)
- Jones v. United States, 527 U.S. 373 (1999) (evaluating jury instructions in context of entire charge)
- United States v. Hasson, 333 F.3d 1264 (11th Cir. 2003) (elements of § 371 conspiracy)