United States v. Riyaz Mazkouri, 945 F.3d 293

Background

Dr. Riaz Mazcuri was the attending physician for two Riverside General Hospital partial‑hospitalization programs (Central and Devotions) from 2006–2012 and oversaw admissions and certifications for intensive outpatient psychiatric care.
Evidence showed Mazcuri admitted large numbers of patients after very brief encounters (sometimes about a minute), including nursing‑home residents with severe dementia from Mission Care who could not benefit from partial‑hospitalization.
Mazcuri and Riverside billed Medicare $69,512,730.25 for services; Medicare paid $22,922,199.91. For five specific dementia patients (Counts 2–6) Mazcuri personally billed for 382 visits ($44,500) and Riverside billed 2,713 days ($1,555,100).
A jury convicted Mazcuri of conspiracy to commit healthcare fraud (Count 1) and five counts of aiding and abetting healthcare fraud (Counts 2–6). Co‑conspirators testified against him and some had pleaded guilty.
The district court calculated an offense level of 43 (Guidelines), varied downward, and imposed 150 months’ imprisonment, restitution of $22,922,199.91, and forfeiture of $500,000. Mazcuri appealed.

Issues

Issue	Plaintiff's Argument (Gov't)	Defendant's Argument (Mazcuri)	Held
Admissibility of Rule 1006 summary charts	Charts properly summarize voluminous spreadsheets; originals were available	Charts disclosed late, misleading, included third‑party (Cadwalder) claims	Admitted; timing objection unsupported by Rule 1006; any error harmless given underlying spreadsheets, testimony, and limiting instruction
Admission of co‑conspirators’ convictions	Convictions admissible to explain cooperation and credibility	Irrelevant and unduly prejudicial	Testifying co‑conspirators: admissible with limiting instruction. Non‑testifying convictions: any error harmless due to overwhelming evidence
Deliberate‑ignorance jury instruction on conspiracy (Count 1)	Instruction supported by evidence of purposeful avoidance and suspicious practices	No basis in the evidence for deliberate ignorance	Instruction appropriate; harmless even if erroneous because substantial evidence of actual knowledge existed
Sentencing: loss amount, number/vulnerability of victims, restitution/forfeiture	Loss can be based on billed/intended amount; at least 10 victims and a large number of vulnerable victims; restitution = actual Medicare loss; forfeiture based on proceeds	Loss should be limited to amounts tied to five dementia patients (~$536k); fewer victims; lower forfeiture	District court not clearly erroneous: used actual payments ($22.9M) for loss, enhancements for ≥10 and numerous vulnerable victims upheld, restitution and $500k forfeiture affirmed

Key Cases Cited

Puckett v. United States, 556 U.S. 129 (plain‑error and preservation standard for appellate review)
United States v. Hebron, 684 F.3d 554 (5th Cir. 2012) (when fraud pervasive, defendant must show which claims are legitimate; entire claim may be treated as intended loss)
United States v. Isiwele, 635 F.3d 196 (5th Cir. 2011) (amount billed to Medicare is prima facie evidence of intended loss in healthcare fraud)
United States v. Valdez, 726 F.3d 684 (5th Cir. 2013) (physician’s patients can be victims and justify vulnerability enhancements)
United States v. Barson, 845 F.3d 159 (5th Cir. 2016) (application of §2B1.1 victim concepts in Medicare cases discussed)
United States v. Ainabe, 938 F.3d 685 (5th Cir. 2019) (Application Note 4(E) can apply where identities are used to submit fraudulent Medicare claims)
United States v. St. Junius, 739 F.3d 193 (5th Cir. 2013) (deliberate‑ignorance instruction harmless if substantial evidence of actual knowledge exists)
Gall v. United States, 552 U.S. 38 (2007) (standard of review for sentencing and deference to district court’s assessment)
United States v. Spalding, 894 F.3d 173 (5th Cir. 2018) (factors supporting harmlessness when admitting Rule 1006 summaries)
United States v. Sanjar, 876 F.3d 725 (5th Cir. 2017) (forfeiture limited to property acquired as a result of the crime)