United States v. Dennis Barson, Jr., 2016 U.S. App. LEXIS 23355

Background

Defendants Dennis Barson Jr. and Dario Juarez were convicted by a jury of one count of conspiracy to commit health care fraud (18 U.S.C. § 1349) and 19 substantive counts of health care fraud (18 U.S.C. § 1347); sentences of 120 and 130 months were imposed.
Barson signed blank forms to obtain and authorize use of a Medicare number, opened a bank account in his name to receive Medicare payments, signed blank checks for clinic manager Edgar Shakbazyan, and reviewed patient charts for $7,000/month. He testified he never reviewed bank or Medicare remittance statements and later closed the clinic after suspecting wrongdoing.
Juarez, an unlicensed worker, posed as a physician’s assistant, saw most patients (many delivered by a van and paid to attend), had access to mail and remittances, and was paid large sums; he denied medical training and minimized billing involvement.
The clinic billed Medicare for 9,339 procedures for 429 beneficiaries, including many services the clinic could not and did not perform; some patients testified they were paid to attend and received no care.
Government relied on circumstantial evidence (blank forms, account control, payments, large-volume suspicious patient flow, false statements) and Pinkerton liability to prove both conspiracy and substantive health-care-fraud counts.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Sufficiency of evidence for conspiracy and substantive fraud	Govt: circumstantial evidence (blank forms, account, payments, clinic operations, patient testimony) proves agreement, knowledge, and foreseeability; Pinkerton supports substantive convictions	Barson/Juarez: lacked knowledge; limited roles (Barson only chart review; Juarez no billing access/medical training); no agreement to defraud	Affirmed. Any rational trier could find elements beyond reasonable doubt; Pinkerton made substantive convictions supportable by conspiracy verdict
Deliberate-ignorance jury instruction	Govt: evidence permitted inference defendants deliberately avoided knowing fraud	Defs: claimed innocent lack of knowledge	Affirmed. Court properly gave deliberate-ignorance instruction where record supported inference of deliberate blindness
Instruction on object of conspiracy (jury charge language)	Govt: pattern instruction on health-care fraud sufficed	Defs: jury should be instructed to prove object in the exact indictment language	Affirmed. District court’s instruction tracked Fifth Circuit pattern and adequately described conspiracy object
Admission/exclusion of various evidentiary items & prosecutor remarks	Govt: rulings within discretion	Defs: various evidentiary errors and prosecutorial misconduct claimed	Affirmed. No abuse of discretion found in the challenged evidentiary rulings or prosecutor statements
Sentencing: “victim” enhancement & obstruction enhancement	Govt: beneficiaries whose IDs were used qualify as "victims" under U.S.S.G. §2B1.1 note 4(E); court found Barson testified untruthfully so obstruction enhancement applied	Defs: beneficiaries were not victims (many were paid participants or uninjured); Barson’s testimony did not warrant obstruction enhancement	Majority: affirmed both enhancements; concurrence disagreed on "victim" definition and would remand for resentencing

Key Cases Cited

Jackson v. Virginia, 443 U.S. 307 (establishes standard for reviewing sufficiency of the evidence)
Pinkerton v. United States, 328 U.S. 640 (co-conspirator liability for foreseeable acts)
Stinson v. United States, 508 U.S. 36 (authority of Sentencing Guidelines commentary)
United States v. Whitfield, 590 F.3d 325 (approving pattern jury instruction reliance)
United States v. Umawa Oke Imo, 739 F.3d 226 (Fifth Circuit precedent on sufficiency/review standards)
United States v. Delgado, 668 F.3d 219 (conspiracy knowledge and inference principles)
United States v. Grant, 683 F.3d 639 (agreement and conspiracy issues)
United States v. Vasquez, 677 F.3d 685 (deliberate ignorance instruction standard)