United States v. Doris Crabtree
878 F.3d 1274
| 11th Cir. | 2018Background
- HCSN operated PHPs in Miami and North Carolina and billed Medicare over $63M for fraudulent services (2004–2011).
- Rousseau was HCSN-East’s medical director; Crabtree, Marks, and Salafia managed day-to-day therapy there.
- Scheme included recruiting patients via cash kickbacks, falsifying intake information, fabricating and copying therapy notes, and recycling patients to maximize billing.
- Defendants were charged with conspiracy to commit healthcare fraud; Rousseau faced two substantive healthcare-fraud counts; Crabtree, Marks, and Salafia faced two counts of making false statements.
- At trial, Crabtree, Marks, and Salafia were acquitted on the false-statements counts in the first trial, prompting retrial on the conspiracy count; Pinkerton liability instruction was used; collateral estoppel arguments were raised but rejected on retrial.
- Court affirmed on all issues, including sufficiency of evidence and sentencing enhancements for Rousseau (organizer/leader and vulnerable victims).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| collateral estoppel in double jeopardy | Crabtree, Marks, Salafia argue acquittal on false statements foreclosed conspiracy | Defendants contend acquittal on related counts bars retrial | No collateral estoppel; retrial for conspiracy permissible |
| sufficiency of evidence for conspiracy and fraud | Evidence showed knowledge and participation in the conspiracy | Evidence mainly circumstantial and negligible mens rea | Sufficient evidence for conspiracy and fraud convictions |
| trial evidentiary decisions and kickback testimony | Evidentiary rulings supported showing knowledge and motive | Testimony on Medicare rules and kickbacks prejudicial | No reversible error; any error harmless |
| juror dismissal during closing | Dismissal was to preserve trial integrity | Dismissal prejudiced defendants | No abuse of discretion; replacement with an alternate was reasonable |
| jury instructions on deliberate ignorance and aiding/abetting | Instructions correctly guided knowledge and liability | Deliberate ignorance and aiding/abetting were improper or confusing | Harmless error; correct theory of actual knowledge supported conviction; no reversal |
Key Cases Cited
- Ashe v. Swenson, 397 U.S. 436 (U.S. 1970) ( collateral estoppel requires essential issue determined by final judgment)
- Yeager v. United States, 557 U.S. 110 (S. Ct. 2009) (hangings verdicts cannot be used for collateral estoppel (Yaeger))
- Ohayon, 483 F.3d 1281 (11th Cir. 2007) (two-step collateral estoppel analysis; essential element required)
- Larkin, 605 F.2d 1360 (5th Cir. 1979) (pre-Yeager context on collateral estoppel (overruled in part))
- Moran, 778 F.3d 942 (11th Cir. 2015) (standard for reviewing sufficiency; favorable-inference rule)