United States v. Mansour Sanjar
876 F.3d 725
5th Cir.2017Background
- Spectrum Psychiatric Services, a community mental-health center run 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.
- Evidence at trial showed patients often were not in acute crisis, received minimal physician contact, spent time in recreational activities, and were cycled between higher-paid PHP and lower-paid IOP on fixed timelines.
- A referral-and-kickback network run through office administrator Shokoufeh Hakimi and recruiter Charles Roberts (and later group-home owner Chandra Nunn) funneled patients to Spectrum; Nunn paid residents and generated $28.5 million in claims.
- Physician Assistant Adam Main and others falsified and backdated charts; several employees pleaded guilty and cooperated. Federal agents executed a broad search warrant for patient files after investigative leads from a cooperating witness.
- A jury convicted six defendants of health-care fraud, conspiracy, and Anti-Kickback violations; sentences ranged from 24–148 months. District court ordered restitution and criminal forfeiture; the court offset restitution by forfeiture proceeds.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Validity/scope of search warrant (particularity & probable cause) | Government: affidavit showed widespread fraud in PHP; magistrate could authorize seizure of patient files. | Sanjar: warrant was overbroad and lacked particularity for seizing all patient files. | Warrant provided sufficient notice and probable cause to seize Spectrum’s patient files; suppression denied. |
| Multiplicity/duplicity of indictments | Government: separate statutes (health-care fraud conspiracy and §371 kickback conspiracy) charge distinct offenses. | Sanjar/Nunn: Counts duplicate or compound offenses (multiplicity/duplicity). | No multiplicity; counts charging both paying and receiving kickbacks not reversible because indictment and evidence allocated roles, and single conspiracy can have multiple objects. |
| Admissibility & confrontation (patient lay testimony; agent cross; binder testimony) | Defendants: patient testimony impermissible lay opinion; cross of agent curtailed; binder-location testimony hearsay. | Government: patient statements factual or permissible lay opinions; hearsay rules limit defense use of out-of-court statements; supervising agent had personal knowledge of binder location. | Patient testimony admissible under Rule 701; limiting cross and admitting binder-location testimony not reversible error; Confrontation Clause not violated. |
| Jury instructions (safe-harbor, deliberate ignorance, Pinkerton foreseeability) | Defendants: safe-harbor instruction created mandatory presumption; Pinkerton instruction omitted foreseeability; requested good-faith instruction refused. | Government: instruction properly described legal consequence and deliberate ignorance justified; good-faith argument covered by specific intent charge. | Safe-harbor wording not reversible given full charge; deliberate ignorance and omission of explicit good-faith instruction proper; Pinkerton foreseeability omission not reversible error here. |
| Sufficiency of evidence for fraud and kickbacks | Defendants: needed medical expert to disprove medical necessity; lack of intent proof for some. | Government: patient reports, falsified charts, cycling pattern, payments, and employee conduct establish fraud and intent. | Evidence sufficient for convictions (including Nunn given presence and graded payments). |
| Forfeiture liability & restitution offset | Government: district court may offset restitution with forfeiture proceeds. | Main & others: forfeiture should be limited to proceeds each defendant personally obtained; defendants argued offset was improper. | Honeycutt requires forfeiture limited to property a defendant actually obtained; court vacated Main’s joint-and-several forfeiture and remanded to determine his personal proceeds. Court also held district court erred in offsetting restitution by forfeiture; offset eliminated. |
Key Cases Cited
- Marron v. United States, 275 U.S. 192 (magistrate must define scope of permissible seizures)
- Blockburger v. United States, 284 U.S. 299 (test for multiplicity/double jeopardy)
- United States v. Kunze, 806 F.2d 594 (documents seizure particularity and scope)
- United States v. Aguirre, 664 F.3d 606 (particularity analysis for warrants)
- Pinkerton v. United States, 328 U.S. 640 (co-conspirator liability doctrine)
- Honeycutt v. United States, 137 S. Ct. 1626 (forfeiture limited to property defendant personally acquired)