United States v. Richard Paulus
894 F.3d 267
6th Cir.2018Background
- Dr. Mark Paulus, a high‑volume cardiologist, was indicted for healthcare fraud (18 U.S.C. §1347) and making false statements to a health care benefit program (18 U.S.C. §1035) for allegedly overstating coronary artery stenosis on angiograms to justify unnecessary stenting.
- Government presented ~100 angiograms and testimony from nine cardiologists (three retained experts and six treating/reviewing physicians) who concluded Paulus repeatedly recorded severe (≥70%) stenosis when images showed much lower blockage.
- Paulus’ practice generated unusually high procedure volumes and compensation; prior administrative reviews (Medicare/Anthem, Kentucky Medical Board) had audited samples and questioned necessity of many stents, and Paulus later surrendered his medical license.
- A jury convicted Paulus on ten false‑statement counts and the healthcare fraud count; acquitted on five counts. The district court entered judgment of acquittal and conditionally granted a new trial, holding angiogram interpretations are subjective opinions not provable as true/false and therefore cannot support fraud/false‑statement convictions.
- The government appealed; the Sixth Circuit reversed the judgment of acquittal, vacated the conditional new‑trial order, and remanded for further proceedings consistent with its opinion.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether angiogram stenosis readings can be "false statements" supporting convictions | Angiogram readings measure a factual medical condition (degree of stenosis); experts can prove a defendant misreported those facts, so readings are provable true/false | Angiogram interpretation is a subjective medical opinion with substantial inter‑observer variability, thus not provable true/false and cannot support fraud/false‑statement charges | Readings are factual and capable of proof/disproof; jury may find falsity — court reversed acquittal (Persaud controlling) |
| Whether the government proved fraudulent intent (willfulness to defraud) | Circumstantial evidence (abnormal billing, salary, multiple auditor opinions, patient testimony, pattern across many cases) supports an inference of intent to defraud | Differences in medical judgment or honest mistakes explain the discrepancies; no direct proof of willful deception | Evidence was sufficient for a reasonable jury to infer intent; district court erred to grant acquittal on intent ground |
| Admissibility of lower‑resolution/archived angiogram images | Archived duplicates were authenticated by witnesses as accurate, diagnostic, and the same images Paulus viewed (albeit lower resolution) | Archived images differed from originals and should have been excluded as inaccurate duplicates | Authentication satisfied Rule 901; defendant forfeited any Rule 1003 challenge; no abuse of discretion in admitting duplicates |
| Admissibility/use of KBML settlement/order (prior administrative resolution) | The stipulated KBML order and related statements were admissible under Rule 408(a)(2) where negotiations involve a public regulatory authority; statements included admissions/conduct probative of intent | Admission of the order improperly relied on compromise/settlement communications (Rule 408) and prejudiced the jury | Admission was not plainly erroneous; Rule 408(a)(2) permits use in criminal cases involving public enforcement negotiations; no reversible abuse of discretion |
Key Cases Cited
- United States v. Persaud, 866 F.3d 371 (6th Cir. 2017) (angiogram interpretation is provable fact; jury decides expert credibility)
- Daubert v. Merrell Dow Pharm., 509 U.S. 579 (1993) (trial court gatekeeping on expert admissibility)
- United States v. Kurlemann, 736 F.3d 439 (6th Cir. 2013) (false‑statement standard requires capability of confirmation or contradiction)
- United States v. Waechter, 771 F.2d 974 (6th Cir. 1985) (government demonstrates falsity by showing asserted proposition untrue)
- Gertz v. Robert Welch, Inc., 418 U.S. 323 (1974) (distinction between fact and opinion in defamation law)
- Muscarello v. United States, 524 U.S. 125 (1998) (textual/semantic interpretation can affect criminal liability)
- Heimer v. Companion Life Ins. Co., 879 F.3d 172 (6th Cir. 2018) (credibility and factual disputes are for the jury)
- United States v. Marshall, 908 F.2d 1312 (7th Cir. 1990) (resolving interpretive disputes is often a factual/jury question)
- Richardson v. United States, 526 U.S. 813 (1999) (reasonable doubt suffices to prevent conviction; jury decides credibility)
- United States v. LaVictor, 848 F.3d 428 (6th Cir. 2017) (standard of review for new‑trial motions)
- United States v. Munoz, 605 F.3d 359 (6th Cir. 2010) (abuse of discretion review for district court determinations)
- United States v. Lutz, 154 F.3d 581 (6th Cir. 1998) (district court as thirteenth juror on new‑trial motions)
- Tamraz v. Lincoln Elec. Co., 620 F.3d 665 (6th Cir. 2010) (Daubert exception: fundamentally unsound expert opinion may warrant exclusion)