United States v. Mark Willner, M.D.
795 F.3d 1297
| 11th Cir. | 2015Background
- Multiple defendants (physicians and program directors) were convicted for conspiring to submit fraudulent Medicare claims through American Therapeutic and American Sleep by admitting ineligible patients, manufacturing documentation, and using kickbacks and patient brokers to inflate billing. Total alleged billings approached $200 million.
- First trial: Drs. Willner, Ayala, and Abreu convicted on Count 1 (health-care fraud conspiracy); Morris convicted on Count 13 (anti-kickback conspiracy); Ward and Morris had mixed verdicts and retrial outcomes. Court affirmed most convictions but reversed Abreu’s.
- Scheme mechanics: Medlink funneled monthly funds to pay referral sources and patient brokers; Program/clinical directors routinely signed charts they did not review; medical extenders (ARNPs, PAs) saw patients while physicians signed records.
- Abreu (Program Director/Corporate Director) was charged only with conspiracy; indictment alleged she caused alteration of patient files and therapist notes to falsely show eligibility/treatment. Conviction rested entirely on circumstantial evidence of her role in documentation and training.
- Trials featured contested evidentiary issues: requested Florida-law instructions on use of medical extenders; a deliberate-ignorance (willful blindness) jury charge; and admission of testimony by Stephen Quindoza (government Medicare-fraud educator) without expert disclosure and limits on cross-examining his bias/basis.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of evidence for Dr. Abreu's conspiracy conviction | Gov: circumstantial evidence (chart alterations, training, knowledge of red flags) supports inference Abreu knew of and willfully joined conspiracy | Abreu: no direct evidence she falsified records, admitted ineligible patients, or willfully joined; only speculative/circumstantial links | Reversed — conviction vacated; record insufficient for any reasonable juror to find beyond a reasonable doubt that Abreu knowingly and willfully joined the conspiracy |
| Florida-law medical-extender instructions (Ayala & Willner) | Doctors: requested instructions explaining ARNP/PA scope under Florida law to support defense that use of extenders was lawful | Gov: irrelevant to charged fraud; jury already instructed on good faith; state-law delegation doesn’t permit misrepresenting physician care to Medicare | Affirmed — district court did not abuse discretion in refusing detailed state-law instructions because federal fraud charged misrepresentations (physician saw patient) regardless of state delegation rules |
| Deliberate-ignorance (willful blindness) jury instruction | Defendants: instruction inappropriate for conspiracy because it could allow conviction absent proof of joining | Gov: permissible to prove knowledge of unlawful purpose (not joining) | Affirmed — instruction allowed only to establish knowledge of unlawful purpose (not willful joining); circuit split resolved consistent with other circuits permitting limited use |
| Admission & cross-exam of Quindoza (undisclosed expert) | Defendants: Quindoza testified as an expert without Rule 16 disclosure; they were improperly limited in exploring basis/bias in cross-exam (Sixth Amendment) | Gov: Quindoza was a fact witness with personal knowledge; redirect permissible to rehabilitate after defense elicited opinions | Mixed — court erred in admitting some of Quindoza’s expert-style testimony without disclosure and erred in limiting cross-examination on bias/basis; but errors were harmless as to Ayala/Willner (overwhelming evidence) and harmless for Ward on the record |
Key Cases Cited
- United States v. Mankani, 738 F.2d 538 (2d Cir.) (discussed re: willful blindness instruction in conspiracy cases)
- United States v. Fletcher, 928 F.2d 495 (2d Cir.) (conscious-avoidance charge appropriate to prove knowledge of conspiracy goals)
- United States v. Diaz, 864 F.2d 544 (7th Cir.) (approving limited willful-blindness instruction for knowledge)
- United States v. Brandon, 17 F.3d 409 (1st Cir.) (willful-blindness instruction can be permissible on knowledge element)
- United States v. Warshawsky, 20 F.3d 204 (6th Cir.) (distinguishing Mankani; permitting conscious-avoidance for knowledge)
- Kotteakos v. United States, 328 U.S. 750 (1946) (harmless-error standard for non-constitutional errors)
- Chapman v. California, 366 U.S. 18 (1967) (constitutional error must be harmless beyond a reasonable doubt)
- Davis v. Alaska, 415 U.S. 308 (1974) (cross-examination on bias is constitutionally important)
- United States v. Hornady, 392 F.3d 1306 (11th Cir.) (harmless-error analysis where erroneous jury instruction had no influence)
- United States v. Medina, 485 F.3d 1291 (11th Cir.) (standard for Rule 29 sufficiency review)