United States v. Mansour Sanjar
853 F.3d 190
| 5th Cir. | 2017Background
- Spectrum Psychiatric Services (owned by Drs. Mansour Sanjar and Cyrus Sajadi) billed Medicare over $90 million for partial hospitalization program (PHP) services from 2006–2012; Medicare paid just under $7 million.
- Government presented evidence that PHP admissions were driven by paid referrals and that Spectrum provided recreational rather than intensive PHP treatment; medical records were allegedly falsified and backdated by staff.
- Recruiter Charles Roberts (pleaded guilty) and group-home operators (notably Chandra Nunn and Shawn Manney) paid or received cash kickbacks for referrals; Office Administrator Shokoufeh Hakimi managed referrals and payment tracking.
- Physician Assistant Adam Main and other staff falsified charts and affixed retrospective evaluation dates; several employees cooperated and testified.
- Indictment charged health-care fraud and conspiracy under 18 U.S.C. §§ 1347, 1349; conspiracy to defraud/anti-kickback violations under 18 U.S.C. § 371 and 42 U.S.C. § 1320a–7b. Jury convicted most defendants; sentences ranged 24–148 months; forfeiture and restitution orders followed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Validity/scope of search warrant (seizure of all patient files) | Govt: affidavit showed pervasive fraud in Spectrum’s PHP program so magistrate properly authorized broad seizure | Sanjar: warrant lacked particularity/overbroad as it authorized seizure of all patient files without individualized probable cause | Warrant sufficiently particular; probable cause supported seizure of PHP patient files because scheme was pervasive |
| Multiplicity/duplicity of indictments | Govt: separate statutes and elements justify separate conspiracy and substantive counts | Sanjar/Nunn: counts charging both fraud conspiracy and conspiracy under §371 duplicate or combine multiple offenses into one count | No multiplicity problem; counts properly charged distinct crimes; duplicity not prejudicial given indictment/evidence delineated who paid vs received kickbacks |
| Evidentiary rulings (patient lay testimony; limits on agent cross; binder testimony) | Defendants: patient testimony on severity and medical condition required expert; cross-examination and records completeness rules compelled broader inquiry; binder identification was hearsay | Govt: patient testimony is factual/lay-opinion permissible; defendant’s out-of-court statements offered by defense are hearsay; supervising agent had personal knowledge of binder location | Admission of patient testimony and binder location testimony was not erroneous; court properly limited hearsay-based cross and did not abuse discretion |
| Jury instructions (safe-harbor, deliberate indifference, Pinkerton/Wharton) | Defendants: safe-harbor charge created an impermissible mandatory presumption; deliberate ignorance instruction improper; Pinkerton without foreseeability and Wharton’s Rule bar liability | Govt: instructions consistent with law and supported by evidence; foreseeability effectively established by nature of conspiracy; Wharton inapplicable to anti-kickback statute | Safe-harbor wording imperfect but not reversible in context of full charge; deliberate ignorance instruction appropriate; Pinkerton instruction omission of conjunctive foreseeability not reversible; Wharton’s Rule does not bar conspiracy + substantive anti-kickback convictions |
| Restitution and forfeiture offset | Govt (cross-appeal): district court erred by offsetting restitution with forfeited funds | Defendants: restitution should be offset by forfeiture (district court’s approach) | Court held district court lacked authority to offset forfeiture against mandatory restitution; modified judgment to eliminate offset; restitution and forfeiture remain separate obligations |
Key Cases Cited
- United States v. Aguirre, 664 F.3d 606 (5th Cir.) (warrant particularity analysis)
- United States v. Allen, 625 F.3d 830 (5th Cir.) (magistrate vs executing agents in seizure decisions)
- Marron v. United States, 275 U.S. 192 (1927) (particularity principle for warrants)
- Williams v. Kunze, 806 F.2d 594 (5th Cir.) (particularity and broad seizures of client files)
- Blockburger v. United States, 284 U.S. 299 (1932) (double jeopardy / multiplicity test)
- United States v. Njoku, 737 F.3d 55 (5th Cir.) (elements of health-care fraud and anti-kickback offenses)
- Beech Aircraft Corp. v. Rainey, 488 U.S. 153 (1988) (rule of completeness and cross-examination scope)
- Pinkerton v. United States, 328 U.S. 640 (1946) (vicarious conspiracy liability)
- Iannelli v. United States, 420 U.S. 770 (1975) (conspiracy and substantive crime distinct; Wharton’s Rule)
- United States v. Taylor, 582 F.3d 558 (5th Cir.) (restitution vs forfeiture—no judicial offset)