United States v. Kelechi Ajoku, 718 F.3d 882

Ajoku, a licensed vocational nurse, served as an exemptee for Santos Medical Supply; backdated employment documents and affidavits were used to obtain his exemptee license in California.
Santos billed Medicare for prescription devices without a genuine exemptee overseeing distribution; the scheme totaled about $2.9 million with roughly $1.8 million paid by Medicare.
Ajoku never performed exemptee duties but signed forms certifying delivery/training for Medicare, and renewed the exemptee license annually from 2006–2008.
California inspector visit in 2008 triggered federal investigation after Santos payroll records and Ajoku’s statements raised concerns about compliance.
Ajoku was charged in a multi-count indictment with health care fraud and false statements; the government proceeded to trial on §1035 false statement counts, ultimately convicting Ajoku on all counts.
The panel affirmed the convictions, rejecting sufficiency challenges and upholding jury instructions and admission of evidence.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Jurisdictional element of §1035	Ajoku communicated with state investigators; matter affected federal Medicare.	Statements must involve a health benefit program.	Sufficient evidence that matter involved Medicare; statements to state authorities can violate §1035.
Materiality to Medicare	Statements had tendency to influence Medicare decisions.	Statements may be immaterial to Medicare.	Evidence showed statements could influence Medicare payments; materiality supported.
Knowing falsehood (mens rea)	Ajoku knowingly made false statements and concealed facts.	Ajoku believed some statements were true or contextually true.	Evidence supported knowingly false statements; rational juror could reject defendant’s interpretation.
Willfulness instruction	Willful means knowingly and deliberately.	Willfulness may require knowledge of unlawfulness.	Court correctly used willful = deliberately and with knowledge; no error in instruction.
Admission of evidence on scope of fraud	Details of fraud were probative to materiality to Medicare.	Potential prejudice from scope of fraud evidence.	No abuse of discretion; probative value outweighed potential prejudice.

United States v. King, 660 F.3d 1071 (9th Cir. 2011) (false statements to state inspectors tied to federal interests under §1001)
United States v. Balk, 706 F.2d 1056 (9th Cir. 1983) (falsified documents intended for use in a matter of federal concern)
Gaudin v. United States, 515 U.S. 506 (1995) (materiality defined as a tendency to influence the decisionmaker)
Bryan v. United States, 524 U.S. 184 (1998) (willfulness context in false-statement prosecutions)
Tatoyan v. United States, 474 F.3d 1174 (9th Cir. 2007) (definition of willfulness for § 1035/1001)
Heuer v. United States, 4 F.3d 723 (9th Cir. 1993) (willful conduct standard in false statements)
Carrier v. United States, 654 F.2d 559 (9th Cir. 1981) (definition of willful for § 1001)
Old Chief v. United States, 519 U.S. 172 (1997) (evidentiary/prejudice considerations in character evidence)
Frega v. United States, 179 F.3d 793 (9th Cir. 1999) (materiality instruction alignment with § 1035/1001)
Nevils v. United States, 598 F.3d 1158 (9th Cir. 2010) (standard for evaluating sufficiency of evidence on appeal)