794 F.3d 106
1st Cir.2015Background
- Brothers José (physician) and Carlos (dentist) operated related mobile-clinic practices in Puerto Rico; José submitted 10,231 Medicare claims (≈ $3.5M) though he never treated the patients.
- José obtained patient identifying and coverage information from Carlos’s dental patient files; Williams and Rodríguez (assistants) helped prepare CMS-1500 forms for José outside Carlos’s presence.
- Carlos ran a mobile dental clinic that used a protocol where dental assistants recorded vital signs for physician review; José reviewed/initialed those records and sometimes paid assistants to take vitals when he was unavailable.
- Indictment charged conspiracy to commit health-care fraud, substantive health-care fraud counts, and aggravated identity theft as to both brothers (most charges later narrowed); jury convicted José on all counts and convicted Carlos on conspiracy and aggravated identity theft but acquitted Carlos on substantive fraud counts.
- First Circuit: affirmed José’s convictions but vacated Carlos’s convictions for insufficient evidence that Carlos knew (or was willfully blind to) José’s fraudulent billing or that Carlos knew José had no basis to bill Medicare for the services at issue.
Issues
| Issue | Plaintiff's Argument (Government) | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of evidence to convict Carlos of conspiracy and aggravated identity theft (knowledge/willful blindness) | Carlos gave José access to patient files and paid staff; jury could infer Carlos knew José was billing fraudulently | Carlos argued no evidence he knew José billed for non-reviewable services or received proceeds; protocol plausibly authorized physician review and payment | Reversed Carlos’s convictions — record lacked evidence that Carlos knew José had no lawful basis to bill or was willfully blind; inferences against Carlos were speculative |
| Validity of aggravated-identity-theft counts without separate predicate fraud charges (José) | Indictment need not separately charge predicate felony; §1028A requires proof of predicate only as element | José argued indictment defective because it listed predicate fraud as "not charged herein" | Affirmed — statute requires proof at trial, not separate indictment charge; indictment adequately apprised defendant |
| Brady request / in camera review of MCS search materials (José) | Defense sought documents from government search of insurer (MCS) as potentially exculpatory | Government declined to produce; court reviewed in camera and found materials irrelevant | No abuse of discretion — defendant’s relevance theory was speculative; court properly denied broader disclosure |
| Jury instructions: prior knowledge for aiding and abetting aggravated identity theft and other instruction errors (José) | Rosemond requires advance knowledge of each element for aiding/abetting — jury should have been instructed José had prior knowledge that IDs were obtained without lawful authority | District court’s instructions were adequate; the objection was not preserved; the omitted element is not required for §1028A | No reversible error — instructional claim waived or fails plain-error review; omitted prior-knowledge element not required for §1028A; typographical and other minor slip-ups not prejudicial |
Key Cases Cited
- United States v. Flores-Rivera, 787 F.3d 1 (1st Cir. 2015) (standard for reviewing sufficiency of evidence and inferences from circumstantial evidence)
- Rosemond v. United States, 134 S. Ct. 1240 (2014) (aider/abettor must have advance knowledge of each element in §924(c) context)
- United States v. Appolon, 695 F.3d 44 (1st Cir. 2012) (willful blindness requires awareness of high probability of wrongdoing and deliberate avoidance)
- United States v. Spinney, 65 F.3d 231 (1st Cir. 1995) (appellate review of jury inferences from circumstantial evidence)
- United States v. Stepanian, 570 F.3d 51 (1st Cir. 2009) (§1028A does not require separate charging of predicate offense in the indictment)