United States v. Vega
2016 U.S. App. LEXIS 3908
| 1st Cir. | 2016Background
- Luz M. Vega was director of Preferred Medical Equipment (Preferred), a DME supplier in Puerto Rico; Preferred submitted Medicare claims for equipment that often lacked legitimate physician orders.
- Preferred paid equipment coordinators commissions and paid a doctor (Garrastegui) to generate or backfill prescriptions to obtain Medicare reimbursement; Vega set/authorized payments and signed checks.
- Vega was indicted on conspiracy and multiple counts of health care fraud, 28 counts of aiding/abetting receipt of kickbacks, three counts of aggravated identity theft (use of beneficiaries' IDs), and two counts of money laundering (large transactions from Preferred’s account used for personal expenses).
- At trial two cooperator witnesses (Acevedo and Sárraga) testified against Vega; the jury convicted Vega on all counts and the court sentenced her to 2 years + 1 day imprisonment and 3 years supervised release.
- On appeal Vega raised Napue/due-process claims (alleged false testimony by cooperators), evidentiary objections to lay-vs-expert testimony (Rule 701/702), jury instruction errors (anti‑kickback and safe‑harbor), and sufficiency challenges to identity‑theft and money‑laundering convictions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Napue / false testimony by cooperators | Vega: Acevedo and Sárraga understated benefits of plea deals, preventing jury from assessing bias | Gov: Plea agreements were in evidence; any ambiguity could be explored by cross | No Napue violation — no preserved objection; plea agreements available for impeachment; even if reviewable, testimony not shown false or not prejudicial |
| Admissibility of testimony about kickbacks (Rule 701/702) | Vega: Stone and agent Ayala gave legal/regulatory opinions without expert qualification | Gov: Their job experience furnished particularized lay knowledge | Court: Some lay inferences (chart interpretation) OK; but testimony that commissions violated Medicare law required expert foundation — admission of that legal opinion was error but harmless given defense strategy |
| Jury instructions re: anti‑kickback and definition of remuneration | Vega: Instructions omitted explicit "solicit or receive remuneration" element and definition of "remuneration" | Gov: Charge as a whole made elements plain; term was used in ordinary sense (payments to coordinators) | No plain error — instruction adequate in context; omission not prejudicial |
| Requested safe‑harbor instruction | Vega: Should have been allowed to argue payments met 42 C.F.R. §1001.952(d) safe harbor | Gov: Trial record lacks evidence (written contracts, set salary, >1 yr term) to support safe‑harbor theory | Denial proper — insufficient evidence to plausibly support safe‑harbor instruction |
| Sufficiency of evidence: aggravated identity theft | Vega: Govt only proved she knew of fraud by Dec 2010 (doctor visit); earlier use of beneficiaries’ IDs not tied to a predicate felony she knew about | Gov: Circumstantial evidence (complaints by beneficiaries, Vega’s control of operations, coordinator testimony, commission scheme) permitted inference of earlier knowledge | Affirmed — reasonable jury could infer Vega knew of fraud prior to the beneficiary usages |
| Sufficiency of evidence: money laundering (§1957) | Vega: Didn’t know funds were proceeds; transactions within same bank so no interstate commerce effect; amounts possibly from post‑knowledge clean funds | Gov: Transactions occurred after she knew of fraud; source funds (Medicare payments) affected interstate commerce; amounts exceeded $10,000 | Affirmed — evidence supported knowledge, interstate‑commerce element satisfied, and transaction amounts met threshold |
Key Cases Cited
- Napue v. Illinois, 360 U.S. 264 (Napue prohibits prosecutors from knowingly presenting false testimony)
- Giglio v. United States, 405 U.S. 150 (prosecutor must disclose and correct witness-credit bargains; materiality standard)
- United States v. Maher, 454 F.3d 13 (lay-witness experiential knowledge under Rule 701)
- United States v. Ayala-Pizarro, 407 F.3d 25 (law enforcement lay‑testimony limits)
- United States v. White, 492 F.3d 380 (limitations on lay testimony about Medicare/regulatory meaning)
- United States v. Riddle, 103 F.3d 423 (expert qualification required where witness offers authoritative statements about regulatory/industry standards)
- United States v. Benjamin, 252 F.3d 1 (de minimis interstate‑commerce effect sufficient for §1957)