United States v. Rose Umana
713 F. App'x 106
| 3rd Cir. | 2017Background
- Rose Umana operated Vision Healthcare Services, a Medicaid‑approved homecare/staffing provider, and pleaded guilty to health‑care fraud–related offenses including false statements (18 U.S.C. § 1035), identity theft, and monetary transactions in criminally derived property (18 U.S.C. § 1957).
- The Government sought restitution for Pennsylvania Medicaid based on two audits: a BFO audit ($674,996.31) and an MFCU audit ($441,806.12), yielding a PSR restitution figure of $1,116,802.43.
- Umana, via expert David Glusman, disputed the figures: (1) a $9,361.27 misreporting in the BFO audit, and (2) inclusion of legitimate services totaling $115,837 (BFO) and $228,399.03 (MFCU).
- At the loss hearing the Government agreed to the $9,361.27 and $115,837 reductions for the BFO audit but disputed the $228,399.03 MFCU offset and presented witness testimony about falsified records and inadequate documentation.
- The District Court found the Government met its burden to prove loss, rejected Umana’s offsets based on unreliable documentation, and concluded the Government’s loss figure likely understated total loss; it ordered $1,184,224.67 restitution. Umana appealed only the restitution amount.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Proper burden allocation for proving restitution offsets | Umana: once she cast doubt, burden should shift to Government to disprove offsets (cites Evans, Raven) | Government: MVRA places burden on government to prove loss; defendant bears burden to prove offsets per Bryant and §3664(e) | Court: No error; placing burden on Umana to show offsets consistent with Bryant and MVRA |
| Whether court may estimate loss when actual loss is measurable | Umana: court erred by treating loss figure as an understatement when true loss was measurable | Government: restitution based on auditable evidence and defendant failed to prove credits; estimation not used beyond evidence | Court: No clear error; District Court relied on Government evidence and properly denied offsets due to unreliable documentation |
| Whether finding that loss was understated was clear error given Government concessions | Umana: Government stipulated to BFO reductions and MFCU review limited to six patients, so court couldn’t find understatement | Government: concessions were limited (change amounts), audits revealed pervasive record problems and additional billing issues | Court: No reversible error; concessions were narrow and witnesses testified audits showed broader problems, so understatement finding permissible |
| Credit for legitimate services claimed by defendant | Umana: documentation proved legitimate services entitling her to offsets | Government: records were fabricated/inadequate; testimony undermined defendant’s documentation | Court: Held defendant failed to establish offsets; District Court did not clearly err in rejecting credit requests |
Key Cases Cited
- United States v. Fallon, 470 F.3d 542 (3d Cir.) (standards for reviewing restitution orders)
- United States v. Vitillo, 490 F.3d 314 (3d Cir.) (clear‑error standard for district‑court fact finding)
- United States v. Bryant, 655 F.3d 232 (3d Cir.) (defendant bears burden to prove offsets for legitimate services in restitution context)
- United States v. Dickler, 64 F.3d 818 (3d Cir.) (district court cannot substitute alternative estimate when actual loss is measurable)
- United States v. Evans, 155 F.3d 245 (3d Cir.) (loss calculation for sentencing enhancement)
- United States v. Raven, 39 F.3d 428 (3d Cir.) (drug‑weight attribution for sentencing)
- United States v. Williams, 510 F.3d 416 (3d Cir.) (effect of plea agreement stipulations on appeals)