United States v. Toe Myint, 455 F. App'x 596

Myint was convicted of one count of conspiracy to commit health care fraud under 18 U.S.C. § 1349 in connection with Sacred Hope Center, a Detroit-area clinic; he signed provider forms and med records as part of the scheme.
Sacred Hope recruited patients to attend the clinic, paid patients and recruiters, and used internet-sourced notes to justify prescriptions for overpriced, medically unnecessary drugs.
Vargas-Arias adjusted patient charts and notes; Myint signed notes and forms prepared or altered by others, including backdated and blank forms, after others rewrote treatment notes.
The government presented circumstantial evidence of Myint’s knowledge of the scheme, including his signing of altered files, ordering vitamin infusions, and initial admissions that suggested involvement, though he later denied certain medications and participation.
The jury convicted on the conspiracy count but acquitted on the three Medicare fraud counts; the district court sentenced him to six years, and his Rule 33 motion for a new trial was untimely; on appeal, Myint challenges sufficiency of evidence, the deliberate-ignorance instruction, and ineffective assistance of counsel.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Conspiracy sufficiency	Myint argues no knowledge or voluntary participation in the conspiracy.	Myint contends he was the perfect dupe and did not knowingly join the scheme.	Evidence supported knowledge and voluntary association; conviction affirmed.
Deliberate-ignorance instruction	Instruction improperly suggested knowledge; moved as plain error.	Invited-error doctrine applies; commentators agree instruction was proper.	Plain-error review applied; instruction not plain error; affirmed.
Inconsistent verdicts	Inconsistency between conspiracy conviction and acquittals on fraud counts.	Inconsistent verdicts should be reviewable.	Inconsistent verdicts not reviewable absent arbitrariness; affirmed.
Ineffective assistance of counsel	Counsel was ineffective for not calling Myint and for stipulating unnecessary medications.	Record insufficient on direct appeal to assess effectiveness.	Record inadequate on direct appeal; claim dismissed without prejudice.

United States v. Hunt, 521 F.3d 636 (6th Cir. 2008) (conspiracy knowledge and overt-act framework; tacit agreement sufficient)
United States v. Crossley, 224 F.3d 847 (6th Cir. 2000) (conspiracy knowledge; tacit or mutual understanding suffices)
United States v. Williams, 612 F.3d 500 (6th Cir. 2010) (deliberate-ignorance instruction upheld for knowledge of illegality)
United States v. Stover, 474 F.3d 904 (6th Cir. 2007) (plain-error review framework for jury instructions)
United States v. Beaty, 245 F.3d 617 (6th Cir. 2001) (harmless error standard for unsupported deliberate-ignorance instruction)