Gisela Valladares appeals her convictions and sentences for: (1) a multiple object conspiracy (a) to defraud the United States by impairing the functioning and administration of the Medicare Program in violation of 18 U.S.C. § 371; (b) to knowingly cause the submission of false claims to the Department of Health and Human Services in violation of 18 U.S.C. § 287; and (c) to knowingly solicit and receive cash kickbacks involving a federal health care program in violation of 42 U.S.C. § 1320a — 7b(b)(l); (2) conspiracy to defraud the Medicare Program in violation of 18 U.S.C. § 1349; and (3) three counts of soliciting and receiving cash kickbacks involving the Medicare Program in violation of 42 U.S.C. § 1320a — 7b(b)(l).
This case involves Valladares’ participation in a scheme to defraud the Medicare program. Acting on the instructions of two pharmacies, Valladares would pay Medicare beneficiaries to go to doctors, whom she also bribed, in order to obtain prescriptions for medically unnecessary aerosol medication. In exchange for kickbacks, Valladares would then give these prescriptions to the pharmacies, which would use them to submit fraudulent reimbursement claims to Medicare. Although it was not charged in the indictment, the government also presented evidence at trial indicating that Valladares was independently submitting similar, fraudulent Medicare claims on behalf of hеr company, PRN Home Health Care, which provided aerosol-related medical equipment to Medicare beneficiaries.
After a three-day trial, the jury returned its verdict convicting Valladares on all counts of the indictment. The court then held a hearing on the forfeiture issues involved in the ease, after which it entered a forfeiture order in the amount of $245,351. At her sentence hearing, the district court sentenced Valladares to 120 months imprisonment and ordered restitution in the amount of $1,726,957.18. After filing a timely appeal, Valladares contends that the district court erred by: (1) denying her motions to continue the trial; (2) miscalculating her applicable guidelines range by using the commercial bribery guideline in United States Sentencing Guidelines § 2B4.1 (Nov.2006) to calculate her base offense level, applying an 18-level enhancement under U.S.S.G. § 2B4.1(b)(l)(B), and applying a four-level aggravating-role enhancement under U.S.S.G. § 3Bl.l(a); (3) improperly calculating the amount of restitution; and (4) improperly ordering forfeiture.
I.
We first address Valladares’ contention that the district court abused its discretion by denying her unopposed motions to continue the trial on the ground that she did not have enough time to analyze the voluminous records related to the facts of the case. She was put to trial fifty-four days after the indictment was returned, forty-seven days after she was arrested, and thirty-five days after she was arraigned. That, she argues, was too quickly to permit her to adequately prepare for trial, and the problem was aggravated by the government’s delay in making certain information available to her. According to Valladares, this Court has found an abuse of discretion when the district court denied defense counsel’s motions for a continuance under similar circumstances.
We review a district court’s denial of a motion for continuance only for an abuse of discretion.
United States v. Baker,
Under certain circumstances, denial of a motion for continuance of trial may vitiate the effect of this fundamental right .... There are no mechanical tests for deciding when a denial of a continuance is so arbitrary as to violate due process. The answer must be found in the circumstances present in every case, particularly in the reasons presented to the trial judge at the time the request is denied.
Id.
(quotation omitted). “To prevail on such a claim, a defendant must show that the denial of the motion for continuance was an abuse of discretion which resulted in specific substantial prejudice.”
Id.
“To make such a showing, [the defendant] must identify relevant, non-cumulative evidence that would have been presented if [her] request for a continuance had been granted.”
United States v. Saget,
In
United States v. Gibbs,
After a jury trial the defendant in Gibbs was convicted and he appealed, arguing that the district court erred by denying his motion for a continuance because “more time was necessary to review the Hotel’s records to assemble receipts and invoices substantiating his claim that [the amount of one of the checks] represented reimbursement for personal expenses on behalf of the Hotel.” Id. We concluded that the district court did not abuse its discretion. Id. at 127. We found that the defendant had ample time to prepare his defense, and he had “point[ed] to no critical documents that might have been uncovered with additional time and whose absence prejudiced or impaired his defense.” Id.
In
United States v. Gossett,
Defendants in this case have suggested nothing to this Court, nor can we find anything in the record that would indicate the possibility of a different outcome if the defendants had been given
*1263 an additional seven days to prepare for trial. Defendants have failed to show the specific and substantial prejudice required to obtain relief. There is no basis to find an abuse of discretion in the denial of any further continuance.
Id.
In
Saget,
a large drug conspiracy case, the defendants argued that the district court had abused its discretion by denying their motions for a continuance on the ground that two weeks before trial, the government had disclosed to them substantial new evidence.
Saget,
In
Verderame,
the defendant was indicted for two separate drug conspiracies in Florida, one involving marijuana and one involving cocaine, and the district court set his trial date for thirty-four days after he was arraigned on the charges.
Verderame,
After he was convicted of conspiracy to possess with intent to distribute marijuana, Verderame appealed, arguing that the district court committed reversible error by denying his motions for a continuance. Id. at 250. We stated that, in оrder to refute the IRS agent’s testimony that Ver-derame had understated his income, “Ver-derame needed time to compile evidence demonstrating that he had bought and sold several businesses over the years, some generating cash payments and other proceeds, others requiring him to borrow money from time to time.” Id. at 251-52. Verderame argued that “the 34 days between arraignment and trial were simply insufficient for his counsel, with the assistance of two lawyers and a paralegal, to gather the requisite financial information, obtain pertinent travel papers, interview witnesses, and review documents the gov *1264 ernment continued to provide up to the day of trial.” Id. at 252. We agreed, stating:
We find that the 34 days failed to provide defense counsel with sufficiеnt time to defend against a case which the government spent years investigating, a case which grew during the 34-day interval to encompass further property subject to forfeiture, a case which abruptly shifted focus away from the cocaine conspiracy a mere four days before trial. We also find that the 34 days faded to provide the government with sufficient time to supply Verderame with copies of all the documents it had seized and to which he was entitled.
Id.
Although we recognize that Valladares’ counsel had only thirty-five days after arraignment to prepare her defense, we nevertheless conclude that the district court did not abuse its discretion by denying her motions for a continuance. In denying the motions, the district court stated that defense counsel had more than a month to prepare, and that the government had identified all of the documents it intended to use. Valladares has not pointed to any specific documents or relevant, non-cumulative evidence she would have presented, nor have we found anything in the record that would “indicate a different result had the motions been granted.”
See Saget,
In her reply brief, Valladares does state that PRN did not file any claims on behalf of approximately twenty percent of the Medicare beneficiaries that the government attributed to her in the pharmacy scheme. She then argues that the Medicare billing records of the pharmacies “would have assisted the defense to demonstrate a lack of association between many [of those Medicare beneficiaries] and Mrs. Valladares.” She also asserts that the Medicare “Explanation of Benefits” for the PRN claims from 2000 through 2007 “clearly were relevant to the defense.” However, in light of the extensive testimony by the pharmacy owners and two Medicare beneficiaries implicating Valladares in the Medicare fraud scheme, it is unlikely that presentation of these records would have changed the outcome of her case.
See Saget,
This situation is distinguishable from
Verderame,
where the government’s case was based primarily on an IRS agent’s testimony about the defendant’s financial records and defense counsel argued that there were specific financial records that he needed to refute the agent’s testimony but did not have time to obtain and review before the trial began.
See Verderame,
Federal Rule of Criminal Procedure 33(b)(2) provides that a defendant may file a motion for new trial within seven days after the verdict or finding of guilty. If that was not enough time for Valladares to examine the documents in order to make the required showing of prejudice, or to obtain any new documents she thought would have been helpful in showing prejudice, she could have filed a motion under Federal Rule of Criminal Procedure 45(b)(1) for an extension of time to file a motion for a new trial. See Fed.R.Crim.P. 33 advisory committee’s note to 2005 amend. (“[T]here is nothing to prevent the court from granting the defendant a significant extension of time”). Or she could have filed the motion for a new trial and then asked the court to permit her time to submit evidence and argument in support of it. She did not do that.
Because Valladares has not identified any specific documents or other non-cumulative evidence that would indicate a different outcome if her motions had been granted, she has failed to show “specific, substantial prejudice.”
See Saget,
II.
Valladares next contends that the district court erred by improperly calculating her sentencing guidelines range. After
United States v. Booker,
A.
Vallаdares argues that the district court erred by using the commercial bribery guideline in U.S.S.G. § 2B4.1 instead of the fraud guideline in U.S.S.G. § 2B1.1 to determine her base offense level because, according to her, the government argued that the ultimate purpose of the conspiracy was to defraud the Medicare program. According to Valladares, § 2B4.1 should only be used when a Medicare kickback scheme does not involve fraud claims and, in this case, the kickbacks were used to accomplish Medicare fraud.
We review
de novo
the district court’s determination of the applicable guideline.
United States v. Starks,
The commentary to § 2B4.1 provides that it “covers commercial bribery offenses and kickbacks that do not involve officials of federal, state, or local government.” U.S.S.G. § 2B4.1 cmt. n.l. Similarly, the background comments to § 2B4.1 state *1266 that it “applies to violations of various federal bribery statutеs that do not involve governmental officials.” U.S.S.G. § 2B4.1 cmt. background.
In
Starks
one of the defendants entered into a contract with a Medicaid-providing hospital to run a chemical dependency unit in exchange for a share of the hospital’s profits earned from the program.
Starks,
In
United States v. Poirier,
We conclude that the district court did not err by using § 2B4.1, the commercial bribery guideline, to calculate Valladares’ base offense level. The evidence at trial established that Valladares bribed Medicare beneficiaries and doctors in order to obtain the prеscriptions that allowed the pharmacies to submit the fraudulent Medicare reimbursement claims. As a result, this case involved “fraud achieved through bribery” of the Medicare recipients rather than “straight fraud,” and the district court therefore correctly applied the § 2B4.1 commercial bribery guideline. See id.
B.
Valladares next argues that, even if the district court was correct in applying § 2B4.1, it erred by applying an 18-level enhancement under U.S.S.G. § 2B4.1(b)(l) because, according to her, for purposes of the enhancement the “greater value of the bribe or the improper benefit to be conferred” includes only the amount of money that Medicare paid to the pharmacies, or $245,310. Valladares argues that the district court incorrectly used the total intended loss of more than $3 million and, if it had used the improper benefit conferred on the pharmacies, she would have received only a 12-level enhancement.
We review the district court’s determination under § 2B4.1(b)(l) only for clear error.
United States v. Liss,
The parties do not dispute that the value of the improper benefit to be conferred on the pharmacies was between $200,000 and $400,000. Valladares also does not challenge the district court’s finding that the amount of loss from the PRN scheme was $2.7 million, so she has abandoned this issue.
See United States v. Cunningham,
As the government contends, it was proper for the district court to consider relevant conduct when calculating this enhancement, see U.S.S.G. § lB1.3(a)(ii) (stating that specific offense characteristics shall be determined based on relevant conduct). And as will be discussed further below, the district court did not clearly err by finding that the PRN scheme was relevant conduct. Accordingly, we conclude that the distriсt court did not err by applying an 18-level enhancement under § 2B4.1(b)(l).
C.
Valladares also argues that the district court erred by applying a four-level aggravating-role enhancement under U.S.S.G. § 3Bl.l(a) based on her role in the PRN scheme because, according to her, that scheme was not a valid basis for the enhancement. Furthermore, Valladares contends that the district court improperly failed to make a specific factual finding on this issue.
“We review for clear error the district court’s determination of [the defendant’s] role in the scheme and
de novo
its application of the guidelines to that role.”
United States v. Njau,
Under U.S.S.G. § 3B1.1, a defendant’s offense level is increased by four levels if she “was an organizer or leader of a criminal activity that involved five or more participants or was otherwise extensive.” U.S.S.G. § 3Bl.l(a). However, “[i]f the defendant was a manager or supervisor (but not an organizer or leader) and the criminal activity involved five or more participants or was otherwise extensive,” her offense level is increased by only three levels. U.S.S.G. § 3Bl.l(b).
In distinguishing a leadership and organizational role from one of mere management or supervision, .... [fjactors the court should consider include the exercise of decision making authority, the nature of participation in the commission of the offense, the recruitment of accomplices, the claimed right to a larger share of the fruits of the crime, the degree of participation in planning or organizing the offense, the nature and scope of the illegal activity, and the de *1268 gree of control and authority exercised over others.
U.S.S.G. § 3B1.1 cmt. n.4.
Adjustments under chapter three of the guidelines are based on the defendant’s relevant conduct, as defined under § 1B1.3. U.S.S.G. § 1B1.3(a). For offenses where the commercial bribery guideline applies, relevant conduct includes “all acts and omissions ... that were part of the same course of conduct or common scheme or plan as the offense of conviction.” U.S.S.G. § 1B1.3(a)(2) (cross-referencing U.S.S.G. § 3D1.2(d)). “For two or more offenses to constitute part of a common scheme or plan, they must be substantially connected to each other by at least one common factor, such as common victims, common accomplices, common purpose, or similar
modus operandi.”
U.S.S.G. § 1B1.3, cmt. n.9(A). Accordingly, we consider “whether there are distinctive similarities between the offense of conviction and the remote conduct that signal that they are part of a single course of conduct rather than isolated, unrelated events that happen only to be similar in kind.”
United States v. Maxwell,
With respect to whether the court made a sufficient finding on the role enhancement, although the court adopted the PSR and the portion of the PSR addendum on this issue, the court also explicitly made a finding that the probation officer correctly applied the enhancement based on the facts presented at trial. The district court’s adoption of the probation officer’s findings indicates that the court applied the enhancement based on Valladares’, role in the PRN scheme. Valladares does not dispute that she was the organizеr or the leader of this scheme or that it involved five or more participants. Instead, her primary argument is that the PRN scheme was not relevant conduct for the purposes of the aggravating-role enhancement, so her role in that scheme could not be used to justify the four-level enhancement.
We conclude that the district court did not clearly err by finding that the PRN scheme was relevant conduct under § 1B1.3. First, the government presented evidence that the pharmacies and PRN each knowingly defrauded the Medicare program, which means that the victim and the purpose of each scheme were the same. Second, there was testimony at trial that the twо schemes involved the same modus operandi of submitting fraudulent claims to Medicare for reimbursement. Third, according to Special Agent Hernandez’s testimony, both schemes used many of the same patients to bill Medicare. In fact, Valladares conceded at her sentence hearing that there were forty-three overlapping patients who were billed on behalf of both PRN and the pharmacies. Finally, the government presented testimony at trial that the aerosol medication billed by the pharmacies was commonly ingested through the aerosol durable medical equipment billed by PRN and that Medicare would only reimburse aerosol medication taken thrоugh that type of equipment. All of these similarities show that the pharmacy and PRN schemes were part of a common plan or scheme,
see
U.S.S.G. § 1B1.3, cmt. n.9(A);
Maxwell,
III.
Valladares next contends that the district court improperly calculated the *1269 restitution award by including all of the money that Medicare paid to PRN from 2000 to May 2007 because that scheme was not charged in the indictment. Valladares argues that restitution may be ordered only for losses attributable to the offense of conviction and that there was no direct or proximate cause between the Medicare payments to PRN and the false claims submitted by the pharmacies. According to her, restitution should not have been awarded in excess of $245,351.21, the amount that Medicare paid to the pharmacies. Valladares also argues that the district court failed to make a sufficient finding on the restitution issue. 2
“We review
de novo
the legality of an order of restitution, but review for abuse of discretion the determination of the restitution value of lost or destroyed property. We review for clear error factual findings underlying a restitution order.”
United States v. Robertson,
[A] person directly and proximately harmed as a result of the commission of an offense for which restitution may be ordered including, in the case of an offense that involves as an element a scheme, conspiracy, or pattern of criminal activity, any person directly harmed by the defendant’s criminal conduct in the course of the scheme, conspiracy, or pattern.
18 U.S.C. § 3663A(a)(2). “The court is required to order restitution ‘in the full amount of each victim’s losses.’ ”
United States v. Hasson,
In
Dickerson,
this Court interpreted the statutory definition of “victim” in § 3663A(a)(2) with respect to the crime of wire fraud and held that the district court “must ... order the defendant to pay restitution to all victims for the losses they suffered from the defendant’s conduct in the course of the scheme, even where such losses were caused by conduct outside the statute of limitations.”
Dickerson,
With respect to whether the district court made appropriate findings, we note that Valladares did not object before the district court to the PSR’s calculation of the actual losses sustained by Medicare, instead objecting only generally to the inclusion of the losses from the PRN scheme. In addition, the district court affirmatively stated that the probation officer had correctly calculated the amount of restitution, and the court broke down the amount of restitution that was owed individually by Valladares for the PRN scheme and the amount that was owed jointly and severally with the pharmacy owners based on the pharmacy conspiracy. Thus, contrary to Valladares’ contention, the district court did make findings on this issue.
We conclude that the cоurt did not err with respect to its restitution award. As we have already noted, the district court’s finding that the PRN scheme was relevant conduct was not clearly erroneous. Because the PRN scheme could be considered relevant conduct, when calculating restitution the district court was permitted to consider the losses Medicare incurred from that scheme.
See Dickerson,
IV.
Valladares finally contends that the district court lacked statutory authority under 18 U.S.C. § 982(a)(7) to impose forfeiture for her conspiracy convictions. She also argues that the district court’s forfeiture order violated the Ex Post Facto Clause by including Medicare payments made before July 2002, the effective date of the statute in count two of the indictment, 18 U.S.C. § 1349.
“We review
de novo
the legality of an order of forfeiture.”
United States v. Foley,
As used in this title, the term “Federal health care offense” means a violation of, or a criminal conspiracy to violate—
(1) section 669, 1035, 1347, or 1518 of this title;
(2) section 287, 371, 664, 666, 1001, 1027, 1341, 1343, or 1954 of this title, if the violation or conspiracy relates to a health care benefit program.
18 U.S.C. § 24(a).
“The
ex post facto
clause prohibits the enactment of laws which increase punishment for a crime
after
its commission.”
United States v. Terzado-Madruga, 897
F.2d 1099, 1124 (11th Cir.1990). In
United States v. Futrell,
18 U.S.C. § 24(a) defines “federal health care offense” to include conspiracies to violate 18 U.S.C. §§ 287 and 1347, the offenses Valladares was charged with in
*1271
counts one and two of the indictment. As a result, § 982(a)(7) gave the district court the statutory authority to enter its forfeiture order. In addition, because the pharmacy conspiracy continued after July 2002, when § 1349 became effective, the court’s forfeiture order did not violate the Ex Post Facto Clause.
See Futrell,
AFFIRMED.
Notes
. In our en banc decision
Bonner v. City of Prichard,
. Valladares also argues for the first time in her reply brief that the district court incorrectly calculated the losses Medicare sustained with respect to the PRN scheme. However, because she failed to raise this issue in her initial brief, we will not address it.
See United States v. Magluta,
