United States v. Umawa Oke Imo
2014 U.S. App. LEXIS 280
| 5th Cir. | 2014Background
- CNS, a Houston clinic owned by Imo, billed Medicare and Medicaid ~ $30 million (2006–2009) for physical-therapy services despite lacking registration and licensed physical therapists; claims were often false, for deceased patients, or for services by unlicensed aides.
- Clardy, an anesthesiologist, signed CNS’s Medicare/Medicaid applications and employment contracts, was listed as medical director/billing number holder, and received salary; Medicare billing under her number produced large volume claims.
- Imo, Clardy, and Anokam were indicted and convicted on conspiracy to commit health-care fraud, multiple counts of health-care fraud, mail fraud; Imo and Anokam faced additional financial-count convictions; each received multi-year sentences and large restitution orders.
- At trial the government introduced regulatory-violation evidence (Medicare/Medicaid rule breaches) and cross-examined Clardy about prior acts (blank prescription forms, cash-only clinics, anonymous letter). Defendants requested limiting jury instructions which the district court denied.
- On appeal the Fifth Circuit affirmed convictions and sentences, rejecting challenges to the denial of a limiting instruction, sufficiency of evidence (Clardy), admission of impeachment evidence, and the district court’s intended-loss and mass-marketing sentencing enhancements.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Denial of requested limiting instruction re: civil/regulatory violations | Gov: Regulatory evidence was admissible to show intent, scheme, and help jury understand the fraud; no limiting instruction required as jury charge covered elements. | Defs: Absence of a FRE 105 limiting instruction risked bootstrapping civil Medicare/Medicaid violations into criminal guilt; requested instruction necessary. | Court: No abuse of discretion. Instructions as a whole limited use; regulatory evidence permissibly used for intent and context. |
| Sufficiency of evidence (Clardy) for conspiracy, health-care fraud, mail fraud | Gov: Circumstantial and direct evidence (signatures, contracts, involvement, payments, timing) supported knowledge, voluntary participation, and scheme causing mailed payments. | Clardy: At worst negligent/naïve; signatures forged or billing was a mistake; lacked knowing intent. | Court: Evidence sufficient. Jury could reasonably infer agreement, knowing participation, and reliance on mailings. |
| Admission of specific-act impeachment evidence on cross-exam (prescription forms, cash-only clinics, anonymous letter) | Gov: Cross-examination on acts probative of truthfulness/untruthfulness permitted under Rule 608(b); limiting instructions given. | Clardy: Admission violated Rules 401/403/404(b)/405 and was unfairly prejudicial. | Court: No abuse of discretion. Evidence probative of credibility; Rule 608(b) controlled; any prejudice mitigated by instructions and overwhelming evidence. |
| Sentencing: intended-loss and mass-marketing enhancements | Gov: Use billed amounts during defendants’ periods of involvement as prima facie evidence of intended loss; mass-marketing enhancement supported by scheme scope. | Defs: Amount billed overstates individual intent; court conflated knowledge with intent; mass-marketing not applicable (or foreclosed for Anokam). | Court: No clear error. District court reasonably estimated intended loss by preponderance; mass-marketing enhancement properly applied (Anokam acknowledged foreclosed issue). |
Key Cases Cited
- United States v. Davis, 609 F.3d 663 (5th Cir. 2010) (abuse-of-discretion review for jury-charge limiting instruction)
- United States v. Peterson, 244 F.3d 385 (5th Cir. 2001) (standards for requested jury instructions and reversal)
- United States v. Christo, 614 F.2d 486 (5th Cir. 1980) (warning against bootstrapping civil regulatory violations into criminal convictions)
- United States v. Brechtel, 997 F.2d 1108 (5th Cir. 1993) (permitting regulatory evidence for limited purposes)
- United States v. Jones, 664 F.3d 966 (5th Cir. 2011) (regulatory evidence may be used for context/intent where jury instructions make limits clear)
- United States v. Girod, 646 F.3d 304 (5th Cir. 2011) (a defendant need not submit fraudulent claims personally to be guilty of health-care fraud or conspiracy)
- United States v. Isiwele, 635 F.3d 196 (5th Cir. 2011) (fact-specific inquiry for intended-loss sentencing in health-care fraud; billed amounts are prima facie evidence)
- United States v. Akpan, 407 F.3d 360 (5th Cir. 2005) (mail-fraud element satisfied where scheme depends on mailings; limits on impeachment questioning under Rule 608)
- United States v. Sanders, 343 F.3d 511 (5th Cir. 2003) (cross-examining testifying defendant on specific dishonest acts relevant to credibility)