United States v. Mesquias, 29 F.4th 276

Rodney Mesquias (owner-president) and Henry McInnis (CEO) ran the Merida Group home‑health and hospice network in Texas and were indicted for a multi‑year Medicare fraud scheme.
Jury convicted both after a 12‑day trial on multiple counts: six substantive health‑care fraud counts, conspiracy to commit health‑care fraud, conspiracy to launder money, and conspiracy to obstruct justice; Mesquias also faced a kickback conspiracy charge.
Government evidence showed systematic certification and recertification of ineligible patients, fabricated medical records, compliant medical directors, and use of financial incentives and intimidation to enforce participation.
The scheme submitted over 47,000 claims for ~9,000 patients, billed over $152 million to Medicare, and received about $124 million.
Plaintiffs presented testimony from cooperating medical directors, employees, and harmed patients; many hospice patients stayed on services far beyond six months.
District court treated the entire billed amount as intended loss (finding pervasive fraud) and sentenced Mesquias to 240 months and McInnis to 180 months; convictions and sentences were affirmed.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Sufficiency of evidence for health‑care fraud convictions	Govt: abundant direct and circumstantial evidence showing scheme, intent, and involvement by Mesquias and McInnis	Defs: no proof they knew patients were ineligible; limited roles or lack of involvement in false certifications	Affirmed — a rational jury could find defendants knowingly executed the fraud based on pervasive documentary and witness evidence
Proof of patient ineligibility / need for expert proof of "objective falsity"	Govt: co‑conspirator admissions, fabricated records, and surrounding facts permit jury to find certifications were false without categorical expert proof	Defs: clinical‑judgment determinations (eligibility/terminal prognosis) require expert proof to show falsity	Rejected — court held no categorical expert‑testimony rule; co‑conspirator testimony and circumstantial evidence were sufficient
Sentencing loss amount — use of entire billed amount	Govt: pervasive fraud made it impractical to separate legitimate from fraudulent claims; burden shifts to defendants to identify legitimate billings	Defs: loss should be limited to amounts tied to the six substantive counts (~$20,000) because pervasive fraud not proven	Affirmed — district court did not clearly err in finding pervasive fraud and using total billed amount as intended loss

United States v. Sanjar, 876 F.3d 725 (5th Cir. 2017) (defining elements of health‑care fraud and relevance of intent)
United States v. Bowen, 818 F.3d 179 (5th Cir. 2016) (standard for sufficiency review: deferential to jury)
United States v. Hebron, 684 F.3d 554 (5th Cir. 2012) (government ordinarily bears burden to prove loss at sentencing)
United States v. Barnes, 979 F.3d 283 (5th Cir. 2020) (pervasive‑fraud doctrine permits using total billed amount when separation of legitimate claims is impractical)
United States v. McClaren, 13 F.4th 386 (5th Cir. 2021) (co‑conspirator testimony can suffice if not incredible)
AseraCare, Inc. v. United States, 938 F.3d 1278 (11th Cir. 2019) (civil False Claims Act decision contrasting cases that lack evidence of intentional falsity)
United States v. Mazkouri, 945 F.3d 293 (5th Cir. 2019) (upholding pervasive‑fraud finding on less extensive evidence)