United States v. Lia St. Junius
2013 U.S. App. LEXIS 25155
| 5th Cir. | 2013Background
- James Reese ran a durable medical equipment (DME) business (Arbor Oaks) that was suspended from Medicare; he created The Mobility Store (TMS) but listed his stepdaughter Lia St. Junius as the owner/operator to obtain Medicare enrollment.
- TMS and a marketing arm (TRG) billed Medicare/Medicaid for DME items often without valid prescriptions, for items not delivered or not matching purchases; between 2005–2008 TMS billed ~$19.5M and received millions in payments.
- Ramos and Spicer worked as marketers/recruiters: Ramos obtained patient data from Four Group (where she worked) and received commissions; Spicer obtained patient data from Elite Care and received commissions; both were paid by TRG/TMS.
- A grand jury indicted the defendants on a 47-count superseding indictment: St. Junius convicted of health-care fraud conspiracy, several substantive fraud counts, and money-laundering conspiracy; Ramos and Spicer convicted under the Anti-Kickback Statute.
- On appeal the Fifth Circuit affirmed convictions for all three defendants; it affirmed St. Junius’s sentence but vacated and remanded supervised-release/restitution aspects for Ramos and Spicer due to sentencing/restitution errors.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of rebuttal witness (Kuykendall) and hearsay/impeachment | Gov: testimony impeached Reese and was admissible to contradict his trial testimony | St. Junius: Kuykendall’s statements were irrelevant/hearsay/impermissible character evidence under Rule 404(b) | Court: testimony admissible as impeachment; not hearsay when offered to show inconsistency; any 404(b) concern was non-prejudicial or properly characterized as showing knowledge |
| Deliberate-ignorance jury instruction | Gov: instruction proper because defendant claimed lack of knowledge and evidence supported willful blindness | St. Junius: instruction lowered mens rea and singled her out unfairly | Court: instruction proper under the facts (subjective awareness + purposeful avoidance); singling out not plain error given trial dynamics |
| Sentencing enhancements (manager role and abuse of trust) for St. Junius | Gov: enhancements appropriate because St. Junius exercised managerial responsibilities and held a licensed position of trust as listed owner | St. Junius: lacked managerial control and fiduciary trust to justify enhancements | Court: affirmed both enhancements as plausible and supported by record (signed applications, issued checks, supervised operations) |
| Sufficiency and willfulness under Anti-Kickback Statute for Ramos | Gov: willfulness under §1320a-7b(h) requires willful act, not proof of knowledge of statute; Ramos knowingly received commissions | Ramos: conviction required proof she knew receiving commissions was illegal | Court: affirmed conviction; statutory willfulness requires willful conduct, not proof of knowledge of statute; personnel file evidence further supported knowledge |
| Discovery/exhibit timing (Ramos’s Four Group file) | Ramos: admission violated court’s exhibit-exchange order and prejudiced defense | Gov: file admissible and defendant had access to personnel file | Court: no abuse of discretion; even if error, no prejudice to substantial rights |
| Loss and restitution calculations (Spicer & Ramos) | Defendants: loss/restitution overstated; restitution exceeded conduct for which convicted | Gov conceded error on restitution amounts | Court: loss calculation based on amounts billed to Medicare was proper; but restitution orders exceeded losses tied to convictions — restitution vacated and remanded for recalculation |
Key Cases Cited
- United States v. Jackson, 636 F.3d 687 (5th Cir.) (standard for abuse of discretion review of trial rulings)
- United States v. Beechum, 582 F.2d 898 (5th Cir. en banc) (two-prong test for Rule 404(b) evidence)
- United States v. Jones, 664 F.3d 966 (5th Cir.) (standard for deliberate-ignorance instruction: subjective awareness + purposeful avoidance)
- United States v. Bieganowski, 313 F.3d 264 (5th Cir.) (addressing singling out a defendant with a deliberate-ignorance instruction)
- United States v. Ollison, 555 F.3d 152 (5th Cir.) (abuse-of-trust enhancement analysis and limits where duties are clerical)
- United States v. Isiwele, 635 F.3d 196 (5th Cir.) (intended loss in health-care fraud: billed amount as prima facie evidence)
- United States v. Maturin, 488 F.3d 657 (5th Cir.) (restitution limited to losses resulting directly from the offense of conviction)
- Stinson v. United States, 508 U.S. 36 (1993) (Guidelines Commentary is authoritative absent conflict with law)
- Alleyne v. United States, 133 S. Ct. 2151 (2013) (mandatory-minimum facts must be found by jury; court declined to extend Alleyne to Sentencing-Guidelines-only enhancements)