Case Information
*1 Before OWEN and HAYNES, Circuit Judges and LEMELLE, District Judge. [*]
IVAN L.R. LEMELLE, District Judge:
Dr. Cassandra Thomas ("Thomas") is a licensed physician in the state of Mississippi who operated Central Mississippi Physical Medicine ("CMPM"), an in-home physical therapy services provider for Medicare patients, from 2002 through 2005. While operating CMPM, Thomas falsely billed Medicare and Medicaid programs for medically unreasonable and unnecessary physical therapy services, failed to directly supervise the administration of the physical therapy, and hired unlicensed personnel to administer the physical therapy. Thomas sent employees with little to no medical background to the homes of elderly Medicare patients to provide "physical therapy services." These non- medical employees traveled to the homes alone, without Thomas' supervision, despite the fact that none was ever licensed as a physical therapist or physical therapist assistant. Thomas then billed these services to Medicare at skilled medical professional rates, while the employees themselves were paid on average just over $11 an hour. Thomas also routinely waived the 20% co-payment she was required to collect from Medicare patients. Thomas also inflated the amount of hours she billed Medicare, billing for several hours a day of services when the employees only spent about an hour with each patient. At the time CMPM ultimately closed, it retained $2.3 million in proceeds in its accounts, which was seized by the Department of Justice.
On December 2, 2008, Thomas was indicted with ten counts of healthcare and Medicare fraud arising from her operation of CMPM, including violation of the Health Care Fraud statute, Wire Fraud statute, and fraudulent billing of Medicaid. At trial, Thomas was represented by Joyce and Tom Freeland. Tom Freeland was charged with misdemeanor conduct in Oxford, Mississippi, shortly before Thomas' trial began, but continued to represent Thomas during trial. Potential jurors were not questioned regarding knowledge of Tom Freeland's misdemeanor charge. Thomas was present throughout the trial, including voir dire , except for an in-chambers conference where the attorneys exercised peremptory challenges and challenges for cause. Thomas was present in the courtroom when the district judge announced an in-chambers conference with attorneys. Thomas remained in the courtroom while the in-chambers conference took place. Thomas had an opportunity to confer with her attorney during a recess between voir dire and the in-chambers conference. Thomas told her trial counsel she wanted "at least one African American male on the jury," prior to the in-chambers conference. During the in-chambers conference, the district court first considered challenges for cause and granted the Government's challenge to Juror No. 19, an African-American male who appeared to be sleeping at times during voir dire . Thomas' counsel conceded "he's been napping." Among the jurors that Thomas' counsel accepted at the in-chambers conference was Juror No. 17, whom Thomas later claimed she would have challenged because the juror had previously worked with federal authorities to investigate mail theft, and Thomas felt he would be biased against her as a result. After all counsel had exercised their strikes, the district judge asked if either side had any objections to the jury or selection process, and none was raised. While in chambers, the judge read the names of the jurors into the record, and had a court security officer seat the jurors in the jury box before court recessed for lunch. After lunch, the jury panel was sworn in and the jurors were given preliminary instructions for the trial, during which Thomas was present in the courtroom. Thomas had an opportunity to consult with her trial counsel both before and after lunch, prior to the panel being sworn in, and raised no objections or concerns about the jury selection process or in-chambers conference. Thomas was also absent from subsequent in-chambers meetings between the judge and particular jurors regarding possible juror intimidation, juror's outside interaction with acquaintances of the defendant, and a note from a juror.
On April 8, 2011, following a week-long trial, a jury convicted Thomas of all ten counts. Thomas was sentenced to 168 months in prison, followed by three years of supervised release, and ordered to pay over $6.9 million in restitution, in addition to a $1000 special assessment fee. Following her conviction, Thomas hired new counsel who moved for new trial, arguing ineffective assistance of counsel, including failure to advise her of her right to be present at the in-chambers conferences regarding jurors. The district court conducted an evidentiary hearing on the motion for new trial and ineffective assistance of counsel claim, at which Tom Freeland testified that he had advised Thomas of her right to be present. The district court denied Thomas' new trial motion, finding that although she had not waived her right to be present, her absence from certain stages of the trial did not substantially affect her right to a fair trial or render her counsel ineffective.
Thomas now appeals her conviction. [1] On appeal, Thomas raises four issues. First, Thomas argues that the district court erred in failing to apply the rule of lenity to dismiss the indictment against her at the pretrial phase. Second, Thomas argues that the district court erred by denying her motion in limine to exclude evidence regarding Mississippi physical therapy licensing requirements as irrelevant, as well as by deciding to exclude an article which discussed the ambiguity of the Medicare regulations, and changes to Medicare regulations which occurred after 2005. Third, Thomas argues that the district court erred by denying her constitutional right to be present at all critical stages of her trial. And lastly, Thomas argues that the district court erred in denying the motion for new trial based on ineffective assistance of trial counsel.
We affirm the conviction for reasons below.
I. Challenge to the indictment
Thomas' argument challenging the district court's denial of her motion to
dismiss indictment is reviewed
de novo
.
United States v. Fontenot
,
In
Jones
, the defendants challenged their convictions for theft of
government funds under 18 U.S.C. §641.
Thomas attempts to distinguish the instant case from Jones , by arguing that unlike in Jones , the Government relied solely on Thomas' use of unlicensed physicians and failure to directly supervise to support the counts in the indictment. However, Thomas' argument is without merit. As in Jones , even excluding the facts alleging use of unsupervised, unlicensed service providers, sufficient independent facts existed to clearly state an offense in the indictment– namely, the factual allegation that Thomas knew the physical therapy services were medically unreasonable and unnecessary under Medicare guidelines. Accepting the allegations in the indictment as true, the district court properly recognized this independent factual basis, mooting the need to address Thomas' "rule of lenity/ambiguity" challenge to the other facts underlying her conviction. Accordingly, we affirm the district court's denial of Thomas' motion to dismiss the indictment.
II. Admission of Evidence
Thomas' challenge to the district court's denial of her motion
in limine
is
reviewed for plain error because she failed to renew her motion during trial.
United States v. Duffaut
,
As to the article published in 2009 in U.S. Attorney's Bulletin which discussed ambiguity in Medicare regulations and subsequent changes to Medicare regulations, the article was never offered into evidence during trial, and the district court excluded the changes to Medicare regulations as irrelevant, as they occurred after 2005 and could not have informed Thomas during her operation of CMPM. The district court did not commit clear error in excluding evidence that was not available for Thomas to rely on during the period of her fraudulent conduct. Therefore, we affirm the district court's denial of Thomas' motion in limine and exclusion of the articles and Medicare regulations changes.
III. Right to be present
Thomas' claim that she was excluded from critical stages of the trial is also
subject to plain error review, because she failed to raise an objection
contemporaneously.
United States v. Curtis
,
Thomas asserts that she was excluded from critical stages of the trial on four occasions: (1) exercise of peremptory challenges and jury impanelment; (2) questioning a juror about possible jury intimidation; (3) questioning a juror about a situation happening outside the courthouse; and (4) an in-chambers meeting about how to address a note from the jury. Because Thomas failed to object to her exclusion contemporaneously, this Court reviews this issue under the following test for plain error: (1) There must be "some deviation from a legal rule" that has not been waived by the defendant; (2) "the legal error must be clear or obvious, rather than subject to reasonable dispute;" and (3) the error must have affected the defendant's substantial rights, i.e., it "affected the outcome of the district court proceedings." Puckett v. United States , 556 U.S. 129, 135 (2009). Finally, even if all of the above criteria are met, it remains within this Court's discretion to remedy the error, a discretion which should be exercised only if "the error 'seriously affect[s] the fairness, integrity or public reputation of judicial proceedings.'" Id . at 135.
A. Deviation from a legal rule without waiver.
A criminal defendant's right to be present at trial is protected under the
Constitution and the Federal Rules of Criminal Procedure.
See United States v.
Gagnon
,
1. Jury impanelment
"It is a well-settled principle of constitutional law that a criminal
defendant has a right 'to be present at all stages of the trial where his absence
might frustrate the fairness of the proceedings ... [and that] 'the impaneling of
the jury is one such stage."
Cohen v. Senkowski
,
"Federal Rule of Criminal Procedure 43 codifies the requirement of the
Sixth and Fifth Amendments that a criminal defendant must be present at every
stage of his trial, "including jury impanelment."
Curtis
,
In
United States v. Curtis
, the defendant asserted that the district court
committed plain error by allowing his attorney to exercise his peremptory
challenges in his absence.
Id
. at 714. However, this Circuit held that because
the defendant was present for counsel's exercise of challenges for cause, the
court's allocation of peremptory challenges to the two sides, and when the
peremptory challenges were given formal effect, no error was committed.
Id
.,
("In this case, the district court did not err – much less plainly err – in its
conduct of the jury-selection process."). Other circuits have similarly held that
"if a defendant is given an opportunity to register his opinions with counsel after
juror questioning and is present when the exercise of strikes is given formal
effect, then his constitutional right to be present is satisfied."
Cohen v.
Senkowski
, 290 F.3d 485, 490 (2d Cir. 2002)(emphasis added), citing
United
States v. Fontenot
,
Here, Thomas was not present when trial counsel exercised peremptory challenges or when the court read the list of jurors who were not struck into the record. Therefore, Thomas' absence from the exercise of peremptory challenges was in deviation from her rights both under the Fifth Amendment Due Process Clause and under the express provisions of Fed. R. Crim. P. 43.
"What suffices for waiver depends on the nature of the right at issue.
[W]hether the defendant must participate personally in the waiver; whether
certain procedures are required for waiver; and whether the defendant's choice
must be particularly informed or voluntary, all depend on the right at stake."
United States v. Gonzalez
,
This Circuit addressed the issue of waiver of the right to be present in the
context of jury selection in
United States v. Alikpo
, where the district court
commenced trial and
voir dire
in the defendant's absence.
The instant facts present some critical differences from Alikpo . First, the defense counsel in Alikpo never directly addressed whether his client waived his right (the Court called counsel's statement "ambiguous"). In the present case, when the issue of waiver was raised post-trial, Mr. Freeland indicated to the district judge that Thomas had affirmatively waived her right to be present at jury impanelment. But this appears nowhere in the trial record. Unlike the defense counsel's transcribed statement in Alikpo , Mr. Freeland's statement of Thomas' alleged waiver is not in the transcript of the peremptory challenge proceeding. Second, unlike Alikpo , the Government does not expressly concede that Thomas did not waive her right. However, in a more unusual and perhaps more telling fact, the district court itself found that "Thomas did not waive the right to be present," following a post-evidentiary hearing on Thomas' motion for new trial based on ineffective assistance of counsel. These facts, particularly the district court's finding that there was no waiver, tend to show less evidence of an "informed and voluntary waiver" than the facts in Alikpo . Accordingly, Thomas' challenge based on her absence from jury impanelment satisfies the first prong of the plain error test: a deviation from her legal rights under the Constitution and Rule 43, which she did not waive.
2. Other in chambers discussions
The other instances where Thomas claims she was excluded include two
instances where a juror was brought in for an in-chambers conference with the
judge and counsel and a discussion about how to answer a question in a note
from the jury. None of these instances were "critical stages" of the trial such
that they were subject to constitutional protection. The last instance, involving
how to respond to a juror note, involved a question of law where Thomas was
unlikely to provide "meaningful assistance to counsel.
" See United States v.
Alikpo
,
B. Clear or obvious error
As stated supra , it is well-established in this Circuit that a juror's presence during jury impanelment is expressly protected by the Fifth Amendment Due Process Clause. The district court itself recognized the Due Process right to be present. The district court further stated that"[t]he Court finds ... that Thomas did not waive the right to be present." However, the district court failed to engage in an analysis under the Fifth Amendment, and instead focused on the implications under Thomas' Sixth Amendment right to effective assistance of counsel. The legal error of denying Thomas her constitutional right to be present, when the district court acknowledged that she had not waived that right, cannot be said to be "reasonably in dispute." Therefore, a finding of clear error is warranted.
However, "[r]eversal for plain error is necessarily a fact-specific inquiry
and ... a finding that there was an error that was plain will not automatically
lead to reversal."
United States v. Escalante-Reyes
,
C. Impact on Thomas' substantial rights
To establish that the clear error in the jury selection process affected her
substantial rights, Thomas must "make a specific showing of prejudice."
United
States v. Wilson
,
Here, Thomas argues that she was not able to provide meaningful assistance in jury selection, because she would have used a peremptory challenge to strike Juror No. 17, who Mr. Freeland allowed to remain on the jury. [3] Thomas also stated that she would have asked Mr. Freeland to rebut the Government's challenge for cause to Juror No. 19, who was accused of napping during the voir dire process, because she wanted "at least one black male" on the jury panel, and expressed this desire to Mr. Freeland.
Undoubtedly, if Juror No. 17 had been struck using a peremptory challenge, the makeup of the jury panel would have been different. Thomas has met the burden to prove that there would have been an impact on jury deliberations if she had been allowed to participate in peremptory challenges – but her burden is to prove a prejudicial impact . Considering the record as a whole, as the Supreme Court mandates, she has failed to show that the impact would necessarily have been prejudicial. Further, Thomas admits that she "expressly requested trial counsel [make] every effort to select at least one black male juror to serve on the panel." Therefore, by her own admission, Thomas' absence from jury impanelment had little to no impact as to Mr. Freeland's actions with regard to Juror No. 19, since he was made aware of Thomas' desire to keep him on the panel prior to jury impanelment. [4] Because Thomas has failed to establish that her absence from jury impanelment affected the outcome of the district court proceedings, we need not consider whether to exercise discretion under plain error review. Accordingly, none of Thomas' absences from in- chambers conferences constitute reversible error.
IV. Right to effective assistance of counsel
The Sixth Amendment accords a right of effective to assistance of counsel
to criminal defendants.
See Strickland v. Washington
,
Thomas raised her ineffective assistance of counsel claim in a post-
conviction motion for new trial. The district court received submissions from
counsel and held an evidentiary hearing on the motion for new trial. The district
court denied the motion for new trial in a written ruling. On appeal, Thomas
reurges her ineffective assistance of counsel claim on four grounds: (1) failure
of the Freelands to inform the Court of criminal charges pending against Tom
Freeland; (2) trial counsel's failure to object to evidence of seized bank accounts;
(3) failure to object to the Government's appeal to class prejudices; and (4)
cumulative error. Thomas' claim of ineffective assistance of counsel presents a
mixed question of law and fact, and therefore "[t]he district court's findings of
fact are reviewed for clear error, and its conclusions of law are reviewed
de
novo
."
United States v. Fuchs
,
A. Voir dire
As to Thomas' first argument, that the Freelands' failure to disclose Mr. Freeland's assault charges to the jury was objectively unreasonable, Thomas' logic is counterintuitive. She argues that "[b]ecause the Freelands are well- known in North Mississippi, the charges against Tom Freeland and his subsequent conviction received extensive publicity in news, print, and electronic media." However, Thomas then argues that because the Freelands didn't inform her or the district judge of these charges, she was denied the opportunity to explore potential juror bias about the issue during voir dire . Under the first prong in Strickland , it hardly seems "objectively unreasonable" for counsel to decline to inform a potential jury pool of his own criminal charges, where being informed for the first time during voir dire would likely render them more prejudiced than if they had remained uninformed. Further, if the news of the charges was as pervasive as Thomas asserts, it could hardly be considered objectively unreasonable for the Freelands to assume that the district judge and Thomas were aware of the charges without the need to disclose it personally. Finally, even assuming that the Freelands' actions were objectively unreasonable, if the charges against Freeland were not newsworthy enough to catch his own client's attention, it is unlikely that potential jury bias was so great that the failure to address it in voir dire resulted in prejudice to Thomas sufficient to meet the second prong under Strickland . Accordingly, the district court did not commit clear error in making a factual determination that the Freelands' actions during voir dire were neither objectively unreasonable nor prejudicial to Thomas' defense.
B. Seized bank accounts
Thomas next claims that the Government repeatedly violated the district court's order bifurcating the trial into liability and forfeiture phases, by referring to seized CMPM checking accounts totaling $2.3 million. Thomas asserts that Mr. Freeland's failure to object to these alleged violations amounted to ineffective assistance of counsel. During the post-trial hearing on this claim, Mr. Freeland stated that he did not object to the evidence to demonstrate, at Thomas' insistence, "good faith ... that she was not stripping money out of these accounts ... it demonstrated that once she saw there was questions [about the billing of Medicare] .. she'd have the money to give back." The district court made a factual determination that Mr. Freeland's decision not to object to evidence concerning the seized bank accounts was a strategic choice . [5] Thomas makes no argument that this factual finding by the district court was clear error. Accordingly, Thomas fails to satisfy the first prong of Strickland requiring objective unreasonableness.
C. Class prejudices
Thomas next cites trial counsel's failure to object to Government
questioning regarding her income, value of her home, and her husband's income.
Thomas alleges that this line of questioning was an "appeal to class prejudices."
Although prosecutorial appeals to class prejudice are highly improper and can
be prejudicial, this Circuit has recognized that such evidence of a defendant's
wealth can still be admissible if it is relevant to the crimes at issue.
United
States v. Aldredge
,
D. Cumulative errors
Finally, we reject Thomas' fourth argument for ineffective assistance of
counsel due to "cumulative error." Thomas presents this as an argument in the
alternative, in the event that the other three errors which Thomas alleges fail
to rise to the level of ineffective assistance of counsel. Thomas provides no legal
basis for this argument in a conclusory, three-sentence briefing. Further, there
is no precedent supporting the idea that a series of "errors" that fail to meet the
standard of objectively unreasonable can somehow cumulate to meet the high
burden set forth in
Strickland
.
Strickland
,
* * *
AFFIRMED.
Notes
[*] District Judge of the Eastern District of Louisiana, sitting by designation.
[1] However, Thomas does not challenge her sentence.
[2] Prior to opening CMPM, Thomas served as medical director for the physical therapy service provider at issue in Jones .
[3] Thomas contends that this juror was biased because as a former postmaster, he had previously worked with the Office of Inspector General ("OIG") to catch an employee stealing mail, and two of the Government's witnesses in the instant case against Thomas were OIG agents.
[4] Further, even assuming Thomas' request was not communicated to Mr. Freeland
before jury impanelment, her race-based request would go against the selection of a jury
pursuant to "nondiscriminatory criteria," as the district court properly noted in the post-
trial hearing on motion for new trial due to ineffective assistance of counsel.
See Wilson
,
[5] The district court also found that the second prong of prejudice was not satisfied.
