United States v. Enyibuaku Uzoaga
680 F. App'x 343
| 5th Cir. | 2017Background
- Dr. Enyibuaku Rita Uzoaga was convicted of conspiracy to commit health care fraud, health care fraud, and aiding and abetting in violation of 18 U.S.C. §§ 1347, 1349, and § 2.
- At trial the district court gave a deliberate-ignorance jury instruction; Dr. Uzoaga challenges that instruction on appeal as plain, harmful error.
- The Government presented evidence that Dr. Uzoaga’s patient files named specific vestibular tests, showed excessive testing billed to Medicare, and that she agreed some testing was “absolutely unnecessary.”
- Evidence showed Dr. Uzoaga reviewed Medicare remittance notices, submitted audit-response documents, received post-audit denials, and nonetheless did not investigate the provider’s billing or attend treatments, continuing to use a third party for testing.
- The panel reviewed whether the instruction was warranted under the legal standard and whether the record supported an inference that Dr. Uzoaga knew of a high probability of unlawful billing and deliberately avoided confirming it.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the deliberate-ignorance instruction was improper and prejudicial | Instruction was erroneous and harmful | Instruction was proper because evidence supported deliberate ignorance; any error invited by defense | Affirmed: instruction proper; no reversible error |
| Whether deliberate-ignorance can support a conspiracy to commit health-care fraud conviction | Instruction incompatible with conspiracy conviction | Binding precedent allows such an instruction for conspiracy convictions when supported by evidence | Rejected plaintiff: precedent allows deliberate-ignorance instruction for conspiracy convictions |
| Whether evidence supported inference that defendant knew of a high probability of unlawful billing | Argued she lacked actual knowledge and defense insisted on lack of knowledge | Government showed records, audit denials, lack of inquiry, and defendant’s agreement tests were unnecessary — supporting deliberate ignorance | Held: evidence supports that she knew of high probability and purposefully avoided learning more |
| Standard of review — plain error or invited-error/manifest injustice | Urged plain error review and reversal | Government argued invited error/manifest injustice; in any event record sufficed under plain-error standard | Court applied plain-error standard and found no reversible error |
Key Cases Cited
- United States v. Nguyen, 493 F.3d 613 (5th Cir.) (deliberate-ignorance instruction standard and when it may be given)
- United States v. Lara-Velasquez, 919 F.2d 946 (5th Cir.) (consider totality of evidence for instruction review)
- United States v. McElwee, 646 F.3d 328 (5th Cir.) (deliberate-ignorance instruction should be rare)
- United States v. St. Junius, 739 F.3d 193 (5th Cir.) (deliberate-ignorance instruction consistent with conspiracy convictions)
- United States v. Harris, 740 F.3d 956 (5th Cir.) (plain-error review discussion)
- United States v. Salazar, 751 F.3d 326 (5th Cir.) (plain-error standard application)