UNITED STATES of America, Plaintiff-Appellee, v. Richard B. WHITE; Michael A. Suhadolnik, Defendants-Appellants.
Nos. 05-3403, 05-3442, 06-3239, 06-3240.
United States Court of Appeals, Sixth Circuit.
Argued: Jan. 31, 2007. Decided and Filed: June 11, 2007.
Rehearing Denied July 5, 2007.*
492 F.3d 380
Before: NORRIS, COLE, and CLAY, Circuit Judges.
* Judge Norris would grant rehearing for the reasons stated in his separate opinion.
Thus, because the trial court gave unconstitutional acquittal-first jury instructions, and because Petitioner‘s counsel rendered ineffective assistance at the sentencing phase, I would vacate Petitioner‘s sentence and remand for a new sentencing phase trial.
prove.” The former, it seems, establishes a threshold presumption that the State, in fact, proved its case.
OPINION
CLAY, Circuit Judge.
Defendant Richard B. White appeals his conviction for fourteen separate criminal counts, his sentence of 90-months imprisonment, $7,290,202 in restitution, and two years of supervised release, as well as the district court‘s order denying his motion for new trial. Defendant Michael A. Suhadolnik appeals his related conviction for one count of wire fraud, as well as the district court‘s order denying his motion for new trial. For the reasons that follow, we AFFIRM Defendants’ convictions; VACATE the district court‘s order denying Defendants’ motions for new trial and REMAND for an evidentiary hearing; and VACATE Defendant White‘s sentence and REMAND for resentencing.
BACKGROUND
A. The Medicare Program
This case arises from a complex scheme to defraud Medicare by violating the Medicare “related party” rule. Accordingly, we repeat below a helpful overview of the Medicare program to set the scene before exploring the procedural and substantive facts of this case.1
The Medicare program is codified in
HCFA contracts with experienced insurance carriers in various regions of the country to act for HHS in reviewing, processing, and paying Medicare claims. These insurance carriers are called Fiscal Intermediaries (“FI“). Thus, the Fiscal Intermediary acts as the agent of HHS for purposes of auditing claims for reimbursement and administering payments.
Medicare is divided into two parts, Medicare Part A and Medicare Part B. Part A of the Medicare statute authorizes direct payment for covered hospital services to a hospital or other providers of health services. In essence, a provider of services does not bill eligible patients under Medicare for covered services. Rather, the provider is reimbursed by the government for its reasonable costs in providing services (or the customary charges for those services if the customary charges are lower). Medicare Part B is primarily medical insurance which helps pay for doctors and outpatient services.
Providers under Medicare Part A may include: hospitals providing hospital services; home health agencies providing skilled nursing services to “home-bound” patients; and community mental health centers providing psychiatric services under the Medicare Partial Hospitalization Program. All Medicare providers must execute a written agreement with
Once certified as a Medicare provider, such provider may make claims for reimbursement of its costs of operation in providing necessary services. Providers may receive payments on such claims based upon a pre-determined percentage of costs associated with the provider‘s costs. Claims may be based upon a daily rate of costs per patient or an hourly rate of costs per patient. New providers submit estimates of future costs, and thereafter, the cost report filed by the providers is used to estimate future costs. Medicare reimbursement payments are made on a continuing basis throughout the year based upon claims filed by the provider and are called “interim payments.” Annually, the provider must file a Provider Cost Report with the Fiscal Intermediary to permit the Intermediary to audit the claimed costs and determine whether the costs claimed are proper. Once adjustments are made, the FI determines whether the provider has been overpaid or underpaid for the costs allowable for the year.
Pursuant to its statutory authority, the Secretary of HHS has promulgated regulations, codified at
The Medicare reimbursement program is structured around the concept of allowable “reasonable costs.” “Reasonable costs” are the costs actually incurred by the provider, and excludes any costs found to be unnecessary in the efficient delivery of needed health services.
To prevent unnecessary costs from being claimed, when goods or services are purchased from a party related to the provider, Medicare regulations only permit reimbursement to a provider of the actual costs incurred by that “related party.” Thus, a “related party” cannot make a profit from a transaction with a Medicare provider. A “related party” is defined as including a situation where the provider, to a significant extent, has control or is controlled by the organization furnishing the services, facilities, or supplies. Control exists if an individual or an organization has the power, directly or indirectly, to significantly influence or direct the actions or policies of an organization.
Providers are required to identify any costs attributable to a “related party” on the annual Cost Report and elsewhere to permit the Fiscal Intermediary to determine whether there are any “related party” costs which might be adjusted.
(Pl.‘s Br. at 14-17)
B. Procedural Facts
Defendants Richard B. White (“Defendant White” or “White“) and Michael A.
Prior to trial, Defendants requested a list of the expert witnesses the government planned to call, along with a description of their opinions and the bases therefor. The government responded three weeks after the deadline with a list of intended witnesses and one potential witness, but no information about the opinions to be rendered. Defendants then brought motions in limine to exclude the expert testimony alleging the government had failed to comply with
A jury trial of the charges against Defendants White and Suhadolnik commenced on March 15, 2004. During the trial, the government put forth the testimony of witnesses who discussed their understanding of concepts contained in the Medicare statutes and regulations as they pertained to the case. The government called Luz Reyes (“Reyes“), an audit reimbursement supervisor for one of Medicare‘s fiscal intermediaries.3 Reyes testified to her understanding of various terms used in the Medicare Provider Reimbursement Manual (“PRM“), including “cost-related organization,” “related,” and “control.” (J.A. at 1194-97) The government additionally called several other Medicare auditors who had worked on cost reports for Defendant-affiliated companies to testify to their understanding of Medicare concepts, including Cynthia MacDonald, Stephen Shields and David Eve. The defense called a Certified Fraud Examiner, Eva Jo Sparks (“Sparks“), at trial. Sparks had reviewed the government‘s documents and testified that the Medicare auditors reviewing the case against Defendant White‘s company, Montrose Management (“Montrose“), did not make a determination that Montrose was a “related party” under Medicare. Sparks further put forth her conclusion that Montrose, in fact, was not a “related party.”
On March 30, 2004, the jury found Defendant White guilty on all counts. Subsequently, the district court sentenced White to sixty months imprisonment on Counts 1 and 5, ninety months imprisonment on all other counts (to run concurrently), ordered him to pay $7,290,202 in restitution, and imposed a period of two years supervised release. White timely appealed. On that same day, the jury found Defendant Suhadolnik guilty of wire fraud, and acquitted Defendant Suhadolnik of all other counts against him. Suhadolnik was sentenced to
Before their sentencing hearings, however, Defendants learned that Charles Potter (“Potter“), the government‘s “potential” witness in this case, had received an award for fraud examination and, among his list of “successful cases” had cited the convictions of Defendant White and Raul Sanchez DeVarona (“DeVarona“). Defendants White and Suhadolnik brought a motion to compel Potter to produce any documents he reviewed at the government‘s request in preparing to testify and to appear for examination. The district court denied the motion, finding Defendants had no “right to discovery of a witness who was not called at trial absent Brady material.” (J.A. at 40) Defendant White, Sparks, and Defendant Suhadolnik‘s counsel all separately filed Freedom of Information Act (“FOIA“) requests with the Department of Health and Human Services (“HHS“) to obtain documents pertaining to the case which were either prepared or received by Potter. They encountered various obstacles to securing the documents and, in the end, received only some small portion of the documents requested. As a result of new evidence, on two occasions, Defendants filed motions for a new trial and a request for an evidentiary hearing. The district court denied these motions both times. Defendants appeal those denials. This Court consolidated White‘s appeals from his conviction, his sentence, and the denial of his motion for new trial, along with Defendant Suhadolnik‘s appeals.
C. Substantive Facts
Defendant White was extensively involved in healthcare management in the mid-1990s and owned and operated several health-related businesses. As owner of Reliance Healthcare Management, White operated both nursing homes and community mental health centers. In so doing, White participated in the “day-to-day hands-on operation” of Medicare providers. (J.A. at 871-73) At the same time, White owned Montrose, a financial management and consulting company. Facing financial troubles in 1995, Youngstown Osteopathic Hospital (“YOH“) retained Montrose, which agreed to provide management services to YOH in early 1996 and, in exchange, received a monthly fee of $25,000 and an additional $5,000 for expenses. In addition, YOH hired new leadership, naming John Weir (“Weir“) its new Chief Executive Officer, and Defendant Suhadolnik its new Chief Financial Officer (“CFO“).
At some point in 1996, White convened a group of YOH‘s primary care physicians and proposed the formation of a new company, to be known as HealthSecure, Inc. (“HealthSecure“). Each of the participating physicians contributed $2,000 in start up money and became part owners of the company. According to Defendant White, the purpose of the venture was to increase patient admissions and services utilized by those patients at YOH, thereby improving the financial stability of the hospital. The group endeavored to achieve this purpose, White claimed, by establishing subsidiary medical billing and staffing companies. Ultimately, HealthSecure incorporated subsidiaries including HealthSecure Clinical Staffing, Inc. (“HSCS“), Riverlake Home Health, Inc., Cardio-Pulmonary Management, Inc., National Healthcare Solutions (“NHS“), Pathways of Boynton Beach, Inc. (“PBB“), and HealthSecure of Jackson, Inc. Defendants White and Suhadolnik took charge of the underlying operations of this venture. Defendant Suhadolnik was named Secretary-Treasurer of HealthSecure. In addition to the group‘s start up funds, White solicited and gained
Also that year, Defendant White proposed the construction of an independent psychiatric unit at YOH. That facility, known as Pathways Center for Geriatric Psychiatry, Inc. (“Pathways“), was later acquired by Patricia Macejko (“Macejko“) and Maryann Barnett (“Barnett“), sisters who were the principals of a nursing home and who also owned community mental health centers in Florida.4 Macejko and Barnett became owners of Pathways when they executed a promissory note to YOH for between $250,000 and $450,000—the costs to YOH of developing the center. Pathways rented space from YOH for its facility. Although Macejko and Barnett owned Pathways, White—through Montrose—essentially operated and controlled the center. Under a management agreement between Pathways and Montrose, Montrose received $30,000 per month for its management activities. Additionally, Montrose received $16,500 per month to provide billing services. Pathways contracted with NHS, a second healthcare consulting business then owned as a sole proprietorship by Richard Feldman (“Feldman“), for management of its clinical operations. Pathways also had a contract with NHS, under which it payed $55,000 per month for its day-to-day operation of the center. According to Feldman‘s testimony, Defendant White later “took over” operations of NHS and incorporated the company, leaving Feldman in place as nominal head. Defendant Suhadolnik became CFO of NHS.
In connection with the day-to-day operations of Pathways, Feldman prepared an application for certification as a Medicare provider and, therein, indicated that Pathways had no transactions with any related organizations. Feldman did not understand at the time what “related transactions” meant and marked “no” only after asking White. When asked, White expressly indicated there were no “related transactions.” Pathways became a certified Medicare provider in 1997. As a Medicare provider, Pathways submitted the management fees charged by both Montrose and NHS for reimbursement, and Montrose itself prepared the cost reports submitted. Those cost reports specifically disclaimed the inclusion of any related organization costs.
Also in early 1996, DeVarona contacted Defendant White to obtain financial management services from one of White‘s companies for Douglas Mental Health Center (“Douglas“) in Florida. Together, White and DeVarona subsequently became involved with additional Medicare providers via third party service and management agreements. According to DeVarona‘s testimony at trial, he attended a September 1996 meeting called by Defendant White wherein White proposed that a network of Medicare facilities be created which he would control, and stated that the owners of those facilities would enter into agreements at rates he established (along with DeVarona). DeVarona further testified that HSCS, which later provided staffing to Medicare providers controlled by Defendant White and DeVarona, charged providers a 300 percent mark up.
In May or June of 1997, Defendant White also engineered the sale of two Medicare-certified community mental health care facilities in Florida to Macejko and Barnett. The genesis of these deals was a meeting between White, Suhadolnik,
Some time in 1996, two separate community mental health centers in Florida—All Professional and Renaissance—sought Medicare certification, but lacked the financial backing to pay their respective staffs in the interim. DeVarona approached White and proposed that HSCS provide clinical staffing for All Professional and Renaissance until they were certified. White agreed to do so, and the two health centers entered into several agreements, including clinical staffing agreements with HSCS, and contracts with Montrose, Behavioral Billings, Behavior Solutions, and NHS. In return, the suppliers agreed to carry receivables due until the health centers were certified by Medicare. In billing the two health centers, the record indicates that HSCS marked up certain nursing and social work services by a factor of 3.2. When All Professional and Renaissance were finally Medicare certified, they submitted the costs associated with these agreements for reimbursement. Those cost reports were also prepared by Montrose, however Larry Belcher (“Belcher“), and not Defendant White, prepared them on that occasion.
At trial, DeVarona testified that the various third-party service providers carried the receivables until All Professional and Renaissance were certified by borrowing funds from Pathways or from YOH (via HealthSecure or HSCS). During this time, Renaissance incurred $2 million in receivables from HSCS, and Pathways became indebted to YOH in the amount of $2.5 million. Evidence adduced at trial shows that Defendant Suhadolnik approved transfers of funds from YOH to HealthSecure, and from HealthSecure to several other service providers. The government further introduced evidence of a $10,000 wire transfer from HealthSecure to Montrose.
When a member of the Board of Trustees at YOH, Eugene Fox (“Fox“), reviewed the hospital‘s financial statements, he grew concerned and approached Defendant Suhadolnik. Suhadolnik informed Fox that Pathways had been loaning its Medicare revenue to HealthSecure instead of satisfying its obligations to YOH, and that HealthSecure in turn was loaning funds to the two health centers in Florida. Later that evening, Fox further explored the situation by questioning Defendant White at the monthly Board of Trustees meeting. Ultimately, YOH terminated its agreement with Montrose and severed ties with White. Macejko and Barnett also ended their agreement with Montrose. The government introduced evidence at trial that Medicare reimbursed over $14 million in 1997 and 1998 to providers controlled by Defendant White and DeVarona.
DISCUSSION
I. SUFFICIENCY OF THE EVIDENCE
A. Standard of Review
We review sufficiency of the evidence claims to determine whether “any rational trier of fact could find the elements of the crime beyond a reasonable doubt” and, in doing so, we “view[] the evidence in the light most favorable to the prosecution, ... giving the government the benefit of all inferences that could reasonably be drawn from the testimony.” United States v. M/G Transp. Servs., Inc., 173 F.3d 584, 589 (6th Cir.1999) (citing Jackson v. Virginia, 443 U.S. 307, 319 (1979)). “A defendant claiming insufficiency of the evidence bears a very heavy burden.” United States v. Vannerson, 786 F.2d 221, 225 (6th Cir.1986) (quoting United States v. Soto, 716 F.2d 989, 991 (2d Cir.1983)) (internal quotation marks omitted).
B. Sufficient Evidence Supports Defendant White‘s Conviction
Defendant White raises a sufficiency of the evidence challenge to his conviction on Counts 1-5 (Conspiracy to Commit Medicare Fraud (Count 1), Scheme to Defraud the Medicare Program (Counts 2 through 4), and Use of a False Document (Count 5)).5 White insists that his convictions cannot be sustained because nothing in the record suggests that his “interpretation of the related-party regulation ... was incorrect, much less ‘knowingly and willfully’ false or fraudulent,” and accordingly, the evidence was insufficient to show he possessed “the requisite fraudulent intent ... to accomplish the substantive crimes at issue.” (Def. White‘s Br. at 44-45) Additionally, Defendant White challenges his conviction for money laundering and money laundering conspiracy (Counts 6 through 13). Viewing the evidence in the light most favorable to the prosecution, we find that a rational trier of fact could find the essential elements of each of the offenses underlying Defendant White‘s conviction beyond a reasonable doubt.
1. Scheme to Defraud Medicare (18 U.S.C. § 1347 )
A rational finder of fact could conclude beyond a reasonable doubt that Defendant White engaged in a scheme to defraud Medicare.
Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice—
- to defraud any health care benefit program; or
- to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program,
in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both.
On appeal, Defendant White primarily argues he did not have the requisite intent because he apparently did not know the transactions were “related party” transactions under the Medicare statute and regulations. At the outset, it should be noted that “the question of intent is generally considered to be one of fact to be resolved by the trier of the facts ... and the determination thereof should not be lightly overturned.” United States v. Wagner, 382 F.3d 598, 612 (6th Cir.2004) (quoting United States v. Daniel, 329 F.3d 480, 487 (6th Cir.2003)). Moreover, testimony adduced at trial supports more than a reasonable inference that Defendant White intended to defraud Medicare. Specifically, DeVarona‘s trial testimony substantially supports such a view:6
Q. ... [C]an you please outline in very brief terms what exactly you did to make yourself guilty of [conspiracy to defraud Medicare]?
A. We—I, participated in a scheme designed by [Defendant] White to submit inflated contracts to Medicare so the Medicare dollars would flow to our companies.
...
Q. And how was that accomplished ...?
A. By submitting inflated contracts amongst related parties to Medicare and not disclosing the fact that these companies were related parties.
Q. And you said they were related parties. How were they related?
A. Because Mr. White and ourselves controlled these Medicare providers even though we were not the officers nor directors of these companies.
Q. Were any of the other defendants involved in this?
A. ... Barnett and ... Macejko were the nominee [sic] owners of the Medicare licensed facilities, and [Defendant] Suhadolnik was the person in charge of the finances for all the operations here in Ohio to get the money to the companies.
...
[Barnett and Macejko] were placed in an ownership position so that they could sign off on documents that would tell Medicare that these were independent facilities, where in reality they weren‘t. They were placed there and served at the direction of Mr. White.
(J.A. at 924-25) A reasonable jury could certainly have taken DeVarona‘s testimony to establish White‘s intent and knowledge that the Medicare “related party” rule applied to the transactions between companies they controlled.
Feldman‘s testimony on the development of Pathways and the Pathways-YOH transactions provides additional support for such a finding. He stated that White had asked Barnett and Macejko to
Viewing the evidence in the light most favorable to the prosecution, a reasonable jury could find Defendant White knowingly and willfully devised this scheme. White had developed a reputation as a “Medicare guru” over years of extensive involvement in health care services and with Medicare providers. He spearheaded the formation of HealthSecure and its various subsidiary medical billing and staffing companies. White proposed the Pathways facility, later acquired by Macejko and Barnett, and then entered into a management agreement (via Montrose) with Pathways. Most directly on point, DeVarona testified about a meeting White called in September 1996 at which he proposed the creation of a network of Medicare facilities. These facilities, according to White‘s proposal, would be owned by third parties but controlled by him, would enter into agreements with third party medical service providers also under his control, and would pay those facilities at significantly inflated rates. The trial record additionally shows that White executed this scheme by actually entering into the transactions, and submitting and receiving reimbursement for management fees billed to the Medicare providers he controlled.
2. Conspiracy to Commit Medicare Fraud (18 U.S.C. § 371 )
A reasonable trier of fact could also find beyond a reasonable doubt that Defendant White conspired to commit Medicare fraud.
First, DeVarona‘s testimony, which we reviewed at length in the preceding discussion, establishes an explicit agreement to criminally defraud the Medicare program. Yet, even if not taken as an express agreement, a reasonable jury could find that the testimony of DeVarona and of Feldman demonstrates the type of “tacit or mutual understanding among the parties” required to establish an implicit conspiracy to defraud. See Ellzey, 874 F.2d at 328.
Third, we have already determined that a reasonable jury could find Defendant White intended to defraud the Medicare program and need not revisit that point here. Of course, an exhaustive recitation of the evidence is neither necessary nor desirable here. Suffice it to say the government put forth a substantial body of evidence, we have reviewed it, and, viewing that evidence in the light most favorable to the government, it amply supports Defendant White‘s conviction for conspiracy to commit Medicare fraud.
3. Use of a False Document (18 U.S.C. § 1001(a)(3) )
Sufficient evidence also supports Defendant White‘s conviction for use of a false document.
The 1998 Medicare cost report submitted on behalf of Pathways contained the false statement that Pathways had no “related party” costs. Belcher had prepared the cost report at White‘s direction and, in so doing—as he testified at trial—had approached White about the “related party” question. Belcher expressed his concern that Montrose and Pathways were related parties and that, accordingly, “the full management fee should not be included in the cost report.” (J.A. at 851) Belcher testified that Defendant White responded by directing him to include the full charge in the report. In view of the foregoing, we find that Defendant White has failed to sustain his “heavy burden” on this issue, and that there was sufficient evidence at trial to support his convictions for Medicare fraud, conspiracy to commit Medicare fraud, and use of a false document.
4. Money Laundering and Conspiracy (18 U.S.C. §§ 1956 , 1957 )
Finally, we find that, viewing the evidence in the light most favorable to the prosecution, sufficient evidence supports Defendant White‘s conviction for money laundering. Here, Defendant White argues that the payments were used not in
Finally,
Viewing the evidence in the light most favorable to the prosecution, a reasonable jury could convict Defendant White of the offense of money laundering under both
Defendant White argues that Sparks‘s testimony at trial shows that Montrose used the funds to pay legitimate business
II. THE GOVERNMENT‘S WITNESS TESTIMONY
A. Standard of Review
We review for abuse of discretion a district court‘s evidentiary rulings, including rulings on witness testimony under
B. Witness Testimony Did Not Affect Defendants’ Substantial Rights
Defendant White assigns error on three bases: first, that the district court improperly denied White‘s motion in limine to exclude the testimony of several government witnesses; second, that the district court abused its discretion in permitting witnesses with specialized knowledge to proffer lay testimony at trial; and third, that the government failed to provide adequate notice under
Defendants requested “a written summary of any expert testimony which the government intend[ed] to offer in evidence under
At the outset, we hold that DeVarona and Feldman properly testified as lay witnesses. Defendant White‘s challenge to the admissibility of DeVarona‘s testimony hinges on DeVarona‘s statement, “All these contracts contained a significant profit margin which rendered them unreasonable.” (Def. White‘s Br. at 66 (citing J.A. at 985-86)) At a sidebar to discuss defense counsel‘s objections to this statement, the district judge admonished the government counsel that DeVarona could “testify as to what he believed he did wrong and the co-conspirators,” but not “in general what a related party is and were there related parties.” (J.A. at 984) Challenging the admissibility of Feldman‘s testimony, Defendant White takes issue with Feldman‘s testimony that White had “control” over certain of the businesses. (Def. White‘s Br. at 66 (citing J.A. at 1040-41)) Defendants’ challenge to the testimony of DeVarona and Feldman, fact witnesses directly involved in the transactions at issue in this case, cannot seriously be sustained. Moreover, the district judge instructed the prosecutor to avoid questioning that would enter the unauthorized waters of expert testimony. Accordingly, we find no abuse of discretion inasmuch as the court properly confined DeVarona and Feldman to lay testimony.
We turn now to the closer question—whether the Medicare auditors properly testified as lay witnesses. Reyes was employed as an audit manager by Adminastar Federal, the Medicare Fiscal Intermediary responsible for Pathways and Ashley Place (a nursing home formerly owned by Barnett and Macejko). As the government described in its Rule 16 response, Reyes was “involved with the Medicare interim rate setting and Medicare cost report auditing” for Pathways. (J.A. at 83) Also in that response, the government indicated that Reyes might be called as a fact witness. Ultimately, Reyes did testify as a fact witness. She testified about the structure of the Medicare program generally, the work performed by her employer as a Fiscal Intermediary, the process for paying claims, her personal contact with Defendant Suhadolnik, and her work on the Pathways audits. Reyes reviewed Pathways’ cost reports on the record, as well as relevant parts of the Medicare Provider Reimbursement Manual. At several points during Reyes’ testimony, defense counsel objected—specifically, when the government asked Reyes: (1) what
“reasonable cost” means; and (2) what constitutes a “related-party transaction.”9 (J.A. at 1182, 1186) With respect to defense counsel‘s objection to the question regarding “related-party transactions,” the district judge conducted a side-bar on the record. She requested that the government explain how such a definition would relate to Reyes’ duties at AdminaStar. The prosecutor replied that, as a part of her auditing duties, Reyes “examin[es] th[e] issue, a question of were there related parties involved.” (J.A. at 1186) The district judge then permitted Reyes to testify to “her own understanding of related parties.” (J.A. at 1187)
MacDonald was an auditor/supervisor employed by Mutual of Omaha, and worked on audits for the Douglas and New Hope facilities. At trial, MacDonald testified to the Medicare provider reimbursement process generally, and more specifically, to “[her] understanding of various Medicare concepts,” including reasonable costs and related party transactions. (J.A. at 1107-09, 1112) MacDonald further reviewed New Hope‘s cost reports in court and discussed related-party searches conducted during the audit process. Shields likewise worked at Mutual of Omaha as an auditor for the Douglas and New Hope facilities. Like MacDonald, Shields testified at trial to “[his] understanding of [various Medicare] concepts as [he] experienced them” while working for Mutual of Omaha. (J.A. at 1251) Shields’ testimony included an overview of the Medicare program and the audit process. Additionally, Shields specifically testified to his understanding of the concept related-party transaction and to his role in auditing the Douglas facility‘s cost reports. Finally, Eve worked as an auditor at AdminaStar Federal along with Reyes. At trial, he described the type of work performed by a Fiscal Intermediary, as well as the parameters of his job as an auditor. Eve testified to his understanding of the Medicare regulations with respect to the basis for reimbursement, the prudent buyer concept, and the term related-party transactions. Eve discussed the initial process for certifying new Medicare providers and the reporting requirements applicable to related-party transactions. Further, he read portions of the Provider Reimbursement Manual applicable to related-party transactions.
We find the district court erred in part in allowing Reyes, MacDonald, Shields, and Eve (collectively, “the Fiscal Intermediary witnesses“) to testify as lay witnesses.
[i]f the witness is not testifying as an expert, the witness’ testimony in the form of opinions or inferences is limited to those opinions or inferences which are (a) rationally based on the perception of the witness, (b) helpful to a clear understanding of the witness’ testimony or the determination of a fact in issue, and (c) not based on scientific, technical, or other specialized knowledge within the scope of
Rule 702 .
To distinguish lay witness testimony from expert testimony, the Advisory Committee incorporated the Tennessee Supreme Court‘s treatment of the issue in State v. Brown, 836 S.W.2d 530, 549 (Tenn. 1992). Under Brown, lay testimony “results from a process of reasoning familiar in everyday life,” whereas “an expert‘s testimony results from a process of reasoning which can be mastered only by specialists in the field.” Brown, 836 S.W.2d at 549 (citation omitted). Accordingly, a lay witness could testify, for example, that “a footprint in snow looked like someone had slipped, or that a substance appeared to be blood.” Id. at 550 (internal citations omitted). Yet, lay testimony is improper where it encompasses opinions that “call[] for specialized skill or expertise“—such as a paramedic‘s testimony that skull trauma caused the bruises on a victim‘s face. Id. at 550. The distinction is far from clear in cases where, as here, a witness with specialized or technical knowledge was also personally involved in the factual underpinnings of the case. See United States v. Ayala-Pizarro, 407 F.3d 25, 28 (1st Cir. 2005) (citation omitted) (observing that “[t]he line between expert testimony under
Since the effective date of the 2000 amendment, we have had few opportunities to explore this distinction. In United States v. Ganier, 468 F.3d 920, 922 (6th Cir.2006), the government challenged the district court‘s decision to exclude a government computer specialist‘s expert testimony at trial for failure to provide adequate notice under
Our sister circuits have also probed the issue. In United States v. Cruz, 363 F.3d 187, 189 (2d Cir.2004), the Second Circuit held that the district court improperly admitted expert testimony of a Special Agent for the Drug Enforcement Administration (DEA). Because the DEA agent participated in surveillance of the drug operation at issue, the government called him as a
In United States v. Garcia, 413 F.3d 201, 215 (2d Cir.2005), the Second Circuit explored the 2000 amendment to
The Fourth Circuit considered whether police officers properly testified as lay witnesses, having observed the defendant (a fellow officer) kick and injure a motorist who fled from a routine traffic stop, in United States v. Perkins, 470 F.3d 150, 151-52, 156 (4th Cir.2006). The officers testified “in terms of their eyewitness observations and particularized experience” to matters common in nature, which “required ... a limited amount of expertise.” Id. at 156 (internal brackets and quotations omitted). Thus, the Perkins court held the testimony properly admitted under R. 701. In United States v. Griffin, 324 F.3d 330, 347 (5th Cir.2003), the Fifth Circuit considered claims that the district court erred in permitting the former director of the Texas Department of Housing and Community Affairs (TDHCA) to testify to the applicability of state law. The challenged witness “testified as to her understanding of the state ethics rules and what TDHCA employees were instructed about those rules.” Id. at 347. The court found that although the witness‘s testimony met with the requirements of
Finally, in Tampa Bay Shipbuilding & Repair Co. v. Cedar Shipping Co., Ltd., 320 F.3d 1213, 1217-18 (11th Cir.2003), the defendant shipping company objected to
As the precedent clarifies, the Federal Rules of Evidence distinguish between lay and expert testimony, not witnesses. See
Nonetheless, the district court erred when it allowed the Fiscal Intermediary witnesses to testify without being qualified as experts. Often times, the testimony elicited from the Fiscal Intermediary witnesses “require[d] [them] to apply knowledge and familiarity ... well beyond that of the average lay person.” See Ganier, 468 F.3d at 925; see also Brown, 836 S.W.2d at 550 (lay testimony is improper where it encompasses opinions that “call[] for specialized skill or expertise“). The Medicare program operates within a complex and intricate regulatory scheme and we cannot say that the average lay person, including any Medicare beneficiary, commands a working knowledge of Medicare reimbursement procedures. Cf. United States v. Strange, 23 Fed.Appx. 715, 717 (9th Cir.2001) (observing that testimony regarding Medicare regulations and reimbursement procedures was “entirely appropriate for an expert“). The Fiscal Intermediary witnesses relied to a significant degree on specialized knowledge acquired
Yet, such error is not in all cases reversible; rather, reversible error occurs only where the district court‘s erroneous admission of evidence affects a substantial right of the party.
Defendants preserved their objections for appellate review by filing a motion in limine before trial to exclude expert testimony from the Fiscal Intermediary witnesses, and by renewing their objections outside the hearing of the jury at trial. See
To assess the error‘s effect, we consider the relation of the wrongfully admitted (or excluded) evidence to the critical question for the jury, the importance of the evidence, and the closeness of the case. Field, 386 F.3d at 736. The improperly admitted evidence here largely consisted of background information apparently intended to aid the jury in devel
First, the bulk of the Fiscal Intermediary witnesses’ testimony properly constitutes lay testimony since they discussed the facts as they personally perceived them while auditing the Medicare cost reports submitted by Defendants on behalf of the providers. Those witnesses testified concerning various government exhibits, including cost reports and supporting documentation submitted for Medicare audits of Pathways, Douglas, and New Hope. The Fiscal Intermediary witnesses additionally read from the Medicare Provider Reimbursement Manual, which had previously been admitted into evidence, those portions intended to clarify and explain the related-party rule. Second, Feldman and De Varona testified at some length about the transactions between the Medicare providers and the various third party staffing and supply companies, and about Defendants’ involvement in those transactions and in making representations to the Medicare Fiscal Intermediaries. Third, many additional witnesses gave proper lay testimony describing the parties’ interactions. Further, the government tendered a list of over three hundred exhibits to the district court prior to trial. In view of the overwhelming evidence adduced at trial, even “stripping the erroneous action from the whole,” we find “the judgment was not substantially swayed by the error.” See Kotteakos v. United States, 328 U.S. 750, 765 (1946). We turn next to the question of compliance with
The district court did not rule on Defendants’ claims that the government rendered insufficient notice under
The government‘s notice provided Defendants pursuant to
They are familiar with Medicare rules, regulations, and procedures with respect to cost reporting and costs allowable as reimbursement to providers of medical
services to Medicare patients. Costs reimbursed under the Medicare program include the reasonable costs actually incurred but excludes any costs unnecessary to the efficient delivery of needed health services. “Related Party” costs are only allowed for the actual cost to the party related to the provider if otherwise reasonable and necessary. A related party may include a person or entity which has significant influence over the provider. Medicare is keenly interested in knowing whether there were any costs attributable to a “related party” in order to determine what costs would be properly allowed to the provider.
(J.A. at 82) For each Fiscal Intermediary witness, the government indicated their title and employer, their contact information and, with respect to Reyes and Eve, their experience in Medicare cost report auditing. The government did not attach their resumes or any additional documentation.
The record clearly reflects that the government‘s
Here, we find the government failed to comply with
Notwithstanding this failure to comply, we find nothing to support reversal. See
III. DEFENDANTS’ MOTIONS FOR NEW TRIAL
A. Standard of Review
We review the district court‘s decision to deny a motion for new trial on the basis of newly discovered evidence or Brady violations under an abuse of discretion standard. Frost, 125 F.3d at 382; United States v. Jones, 399 F.3d 640, 647 (6th Cir.2005). The district court abuses its discretion when it relies on clearly erroneous findings of fact, uses an erroneous legal standard, or improperly applies the law. United States v. Heavrin, 330 F.3d 723, 727 (6th Cir.2003).
B. Motion for New Trial
On appeal, Defendants argue that the district court erred in denying their motions for new trial, made on the basis of newly discovered evidence. In the alternative, Defendants argue that the district court erred in declining to hold an evidentiary hearing on their Brady claim.13 Defendant White refers to (1) allegedly exculpatory information Weir (former CEO of YOH) communicated to the government during the trial, and (2) information reviewed and produced by Potter, the fraud examiner who had purportedly worked on Defendants’ case but who was not introduced as a government witness (“the Potter materials“). Defendant Suhadolnik primarily relies on the Potter materials. We find the district court abused its discretion in failing to conduct an evidentiary hearing to explore the nature of the Potter materials.
Following conviction but before sentencing, Defendants learned that Potter, the government‘s “potential” witness in this case, had received an award for fraud examination and, among his list of “successful cases” had cited the convictions of Defendant White and DeVarona. Defendants White and Suhadolnik brought a motion to compel Potter to produce any documents he reviewed at the government‘s request in preparing to testify and to appear for examination. The district court denied the motion, finding Defendants had no “right to discovery of a witness who was not called at trial absent Brady material.” (J.A. at 40) Post-trial, Defendant White filed a FOIA request with HHS seeking any documents “created, prepared by or received by IntegriGuard [Potter‘s employer] ... [or] Charles Potter” with respect to Defendants’ cases. (J.A. at 247) Defendant White received a response on January 10, 2005 indicating that the request yielded 57,436 pages of documentation, which White could not afford to obtain because of the duplication fee.
On February 4, 2005, Defendants White and Suhadolnik filed a motion for new trial on the basis of newly discovered evidence. The district court denied this motion. On
Working in conjunction with Defendants even after their convictions, Sparks avers that she made a FOIA request with IntegriGuard, to which it identified 400 responsive documents. Of those, IntegriGuard sent only a few. In the documents produced to Sparks, she identified that the version of her expert report provided by CMS to Potter had been edited to exclude opinions, bases, and testimony exculpatory to Defendants. Sparks further filed FOIA requests with CMS. CMS responded by sending 16 of 70 pages to Sparks and withholding 54 pages entirely. A letter from CMS indicates that 46 documents were withheld due to privilege, as they “constitute internal agency communications that are both predecisional ... and deliberative.” (J.A. at 407-08) CMS further withheld 8 pages which contained Potter‘s resume and biography, citing an exemption set forth in
Among the documents Sparks received was the allegedly edited version of her expert report. When Sparks contacted CMS to obtain the additional 8 pages of the report—or an explanation—she received a phone call from CMS indicating that the agency had provided her “with the exact same expert report that IntegriGuard provided [their] office.” (J.A. at 429) Apparently, after following up with IntegriGuard, Sparks learned that the edited version had been given to them by the Assistant U.S. Attorney working with CMS. On that basis, Defendants again moved for a new trial, and in the alternative for an evidentiary hearing, alleging Brady violations. The district court again denied the motion, and Defendants appeal that denial.
Prosecutorial suppression of evidence favorable to the accused implicates the Due Process Clause of the
However, in camera review of the evidence sought may be appropriate upon a lesser showing. In Pennsylvania v. Ritchie, 480 U.S. 39, 43 (1987), a defendant charged with sexually abusing his daughter sought access to her Children and Youth Services (CYS) records during pretrial discovery. The state refused access, and the defendant charged that the state thereby violated his
At this stage, of course, it is impossible to say whether any information in the CYS records may be relevant to Ritchie‘s claim of innocence, because neither the prosecution nor defense counsel has seen the information, and the trial judge acknowledged that he had not reviewed the full file. The Commonwealth, however, argues that no materiality inquiry is required, because a statute renders the contents of the file privileged.
Id. at 57. As a result, the Court found remand for in camera review of the file appropriate and necessary to the district court‘s “determin[ation] whether it contains information that probably would have changed the outcome of [the defendant‘s] trial.” Id. at 58. Notably, the Court did not hold that the government must give defense counsel unbridled access to the information; only that the court be permitted to examine it. Id. at 58-59. Accordingly, once a defendant “establish[es] a basis for his claim that [the records sought] contain[] material evidence,” even though he cannot articulate with specificity the materiality of those records, remand for in camera review may be appropriate.14 See id. at 58 n. 15.
Hernandez and Carmichael do not control the instant case. Very clearly, the prosecutor here made misrepresentations to the district court. Prior to trial, the government did not provide Defendants with any documents produced by or given to Potter because, the government says, they were not “material.” Defendants learned of Potter‘s assistance to the government only after trial when industry publications touted his successful investigation in their case. Defendants promptly brought a motion to compel production of “any and all information surrounding Mr. Potter‘s services” regarding their cases at that time. In his response to Defendant White‘s Motion to Compel, the government responded that it “(to the best recollection of [the Assistant United States Attorney (‘AUSA‘)]) contacted Mr. Potter to discuss the potential of his rendering an opinion regarding ‘related parties,’ but never asked him to review evidence.” (J.A. at 617 (emphasis added)) The AUSA later reversed course, indicating in his response to Defendant White‘s second motion for a new trial
The government did, in fact, inaccurately state, in its response (filed on October 6, 2004) to the defendant White‘s Motion to Compel production of records, that it had sent no material to Charles Potter. At that time, the undersigned counsel had simply forgotten that he had sent a redacted version of the report prepared by Eva Jo Sparks to Mr. Potter.
(J.A. at 812) Notwithstanding the AUSA‘s admission, the government and Potter alike have persistently given incomplete responses to Defendants’ FOIA requests citing privilege as the reason.
Over the course of a complex fraud trial, it is not beyond the pale that the AUSA inadvertently failed to disclose the material at issue. Having failed to disclose the material it sent to Potter—whether inten
the United States Attorney is ‘the representative not of an ordinary party to a controversy, but of a sovereignty whose obligation to govern impartially is as compelling as its obligation to govern at all; and whose interest, therefore, in a criminal prosecution is not that it shall win a case, but that justice shall be done.’
Strickler, 527 U.S. at 281 (quoting Berger v. United States, 295 U.S. 78, 88 (1935)); see also Kyles, 514 U.S. at 439 (noting that proper “disclosure will serve to justify trust in the prosecutor“). The United States Attorney‘s word is worth considerably less when, as here, it is manifest that he made conflicting representations to the court below.15
In United States v. Alexander, 748 F.2d 185, 187, 191 (4th Cir.1984), the Fourth Circuit considered the Brady claim of a doctor convicted of submitting fraudulent claims to various insurers, including Medicaid and the military health plan. The doctor‘s pretrial discovery request broadly sought “all documents ‘which refer or relate to the claim forms of Blue Cross/Blue Shield.‘” Id. at 191. The government had command of a Blue Cross/Blue Shield patient survey which, among other things, contained “patient responses ... concerning whether services ... submitted [for payment] ... had actually been performed.” Id. The survey revealed that only thirteen out of forty-eight patients reported the services submitted had not been performed. Id. Following the doctor‘s conviction, he again requested the survey or, alternatively, the identity of the patients surveyed. Id. at 192.
Attempts to secure voluntary disclosure failed, and the district court denied a subsequent motion for discovery, proceeding to hear the doctor‘s motion for new trial. Id. Before hearing on that motion, the government represented to the doctor that it never had the survey results in its possession. Id. During the hearing, however, the government changed course, telling the court that it did, in fact, have the survey results at the time the doctor requested them, but that they had given the doctor access to the survey results in files open for the doctor‘s counsel to inspect. Id. The government told yet another story at oral argument on appeal, then representing that Blue Cross/Blue Shield maintained control of the survey at the relevant time. Id. In an investigative case summary submitted at the court‘s request, the Fourth Circuit then learned that the government did have the survey materials at the relevant times. Id.
The Fourth Circuit in Alexander found “the Government‘s equivocation in making critical factual representations to defense counsel and to the district court concerning its possession of certain of the requested materials fatally compromised the integrity of the proceedings on the new trial motion.” Id. at 191. Accordingly, they remanded to the district court, directing it to reconsider the doctor‘s motion for new trial. Id. Importantly, they did so notwithstanding some question as to whether the survey actually constituted Brady material, noting “that neither the defendant, nor this court, nor the district court could
Here, the supporting evidence detailed the government‘s rather great lengths to deny Defendants access to the requested documents. Because Defendants succeeded in obtaining only relatively few of the documents notwithstanding their persistent and diligent attempts, the government effectively foreclosed them from making the requisite showing that the documents were material and favorable (whether exculpatory or impeaching), and that the suppression prejudiced them.16 Admittedly, “the prosecutor is not required to deliver his entire file to defense counsel, but only to disclose evidence favorable to the accused that, if suppressed, would deprive the defendant of a fair trial.” Bagley, 473 U.S. at 675. Defendants have established a sufficient basis for their claim that the Potter documents constitute “material” ev-
Accordingly, we find the district court abused its discretion in failing to hold an evidentiary hearing to more carefully consider the nature of the documents and the information contained therein. We vacate the district court‘s order denying the motion for new trial and remand this matter to the district court with instructions that the court conduct an evidentiary hearing wherein Defendants may properly probe the nature of the Potter evidence. The hearing should include an in camera inspection of additional documents withheld on grounds of asserted privilege. Following the evidentiary hearing, of course, it is up to the district court in the first instance to determine whether a Brady violation actually occurred. Insofar as Defendant White appeals the district court‘s denial of his motion for new trial on the basis of the purported Weir testimony, we find no abuse of discretion.17 Further, because we
IV. DEFENDANT WHITE‘S SENTENCE
Defendant White raises several challenges to his sentence on appeal, including claims that (1) the district court failed to rule on a disputed portion of his Presentence Report (“PSR“) in contravention of
A. Standard of Review
We review the district court‘s compliance with
B. Rule 32(i)(3)(B) and Loss Calculation
Defendant White posits that the “district court failed to meet its obligations under
At sentencing, the district judge began by reviewing Defendant White‘s PSR. There were two versions of the PSR prepared for sentencing—one based on the fraud counts, and the other based on the money laundering counts. The first PSR “used the fraud counts to establish a base offense level of 6, with an increase of 15 levels, due to the alleged loss of over $14 million, specifically, $14,604,754.”18 (J.A.
1. Federal Rule of Criminal Procedure 32(i)(3)(B)
We hold that the district court erred in failing to explain its determination that Defendant White be held accountable for loss in the amount of $7,290,202. Defendant White initially objected to the loss calculations put forth in his Sentencing Memorandum. (See J.A. at 161 (“Defen
2. Calculating the Amount of Loss
We also find that the district court erred in calculating the loss.
In United States v. Triana, 468 F.3d at 310, the defendant was convicted of health care fraud, conspiracy to defraud both the Medicare and Medicaid programs, and use of a false statement, among other things. On appeal, the defendant challenged the district court‘s loss calculation under
On appeal, this Court found no error in the district court‘s calculation of loss. Id. at 322. However, because the facts underlying the defendant‘s fraud conviction in Triana are readily distinguishable from the instant case, Triana cannot be taken for the proposition that the total amount paid by the Medicare program necessarily constitutes the loss amount for sentencing purposes. There, the defendant had previously pled guilty to one count of health fraud for submitting inflated bills to Medicare for reimbursement. Triana, 468 F.3d at 311. His plea agreement and corresponding settlement agreements with the Department of Health and Human Services (HHS) essentially precluded further participation in federal health care programs for a specified period of time. Id. Notwithstanding the terms of these agreements, upon release from a halfway house, the defendant formed two new companies, acquired “puppet” owners, and through them, obtained new Medicare and Medicaid provider status. Id. Accordingly, because the defendant expressly violated agreements forbidding his participation as a Medicare provider, the entire amount reimbursed was improper gain. Id. at 322.
In our view, the Fifth Circuit recently adopted a more appropriate approach to the specific question at hand in United States v. Jones, 475 F.3d 701 (5th Cir.2007), and one more closely aligned with Application Note 7 to
We agree with the Fifth Circuit‘s rationale in Jones and, to the extent practicable, adopt the “net gain” method for calculating loss where a party is convicted of Medicare fraud due to violations of the “related party” rule. See Jones, 475 F.3d at 706;
In any event, the government expressly concedes on appeal that the loss amount proposed and adopted by the district court
C. Loss Calculation—Restitution
We review the amount of a restitution award for abuse of discretion. United States v. Adams, 214 F.3d 724, 730 (6th Cir.2000); Wood, 364 F.3d at 714 (citation omitted).
As previously noted, the government concedes on appeal that the loss amount proposed and adopted by the district court was in error and, instead of the $7,290,202 figure employed by the district court, now claims the correct loss amount should have been $6,754,885. The district court‘s restitution order therefore relied upon a fact that the government now admits was clear error. Because it was based on clearly erroneous facts, and because a restitution award may not exceed the “loss caused by the conduct underlying the offense,” see Hughey, 495 U.S. at 420, we also find the district court abused its discretion in determining the amount of restitution.
D. Reasonableness under Booker
Having determined remand for resentencing is necessary on other grounds, we decline to engage in a protracted discussion of the reasonableness of Defendant White‘s sentence under Booker and its progeny. We note, however, our view that the district court properly acknowledged the advisory nature of the Guidelines, and the need to take the
Nevertheless, because the district court erred in failing to explain the factual determination supporting its loss calculation, Defendant White‘s sentence cannot be deemed “properly calculated” under the Guidelines. Even though the district court engaged in thorough review and consideration of Defendant‘s
CONCLUSION
For the foregoing reasons, we AFFIRM Defendants’ convictions; VACATE the district court‘s order denying Defendants’ motions for new trial and REMAND for an evidentiary hearing; and VACATE Defendant White‘s sentence and REMAND for resentencing.
ALAN E. NORRIS, Circuit Judge, concurring in part, dissenting in part.
I concur in the result reached by the majority with one exception: I do not believe that remand for an evidentiary hearing with respect to the “Potter materials” is required, and I would therefore affirm the district court‘s denial of the motion for a new trial. While it would have undeniably been preferable for the government, in an abundance of caution, to have turned over the disputed material, as the district court pointed out in its opinion denying the motion, “it is impossible to conclude that the government‘s failure to turn over the altered report somehow undermines the confidence in the outcome of the trial,” nor is there any indication that “Mr. Potter would have testified favorably to the defendants had he been called as a witness.” Memorandum of Opinion and Order, Feb. 2, 2006, at 7.
We review the denial of a motion for a new trial based on Brady violations under an abuse of discretion standard. United States v. Graham, 484 F.3d 413, 416 (6th Cir. Apr. 20, 2007) (citing United States v. Jones, 399 F.3d 640, 647 (6th Cir.2005)). Under normal circumstances, a defendant seeking a new trial based upon new evidence must show inter alia that the evidence would “likely produce an acquittal.” United States v. Frost, 125 F.3d 346, 382 (6th Cir.1997) (citing United States v. O‘Dell, 805 F.2d 637, 640 (6th Cir.1986)). When a Brady violation is alleged, however, the standard is less onerous: a defendant must only show that the favorable evidence was “material,” which “does not depend upon ‘whether the defendant would more likely than not have received a different verdict with the evidence, but whether in its absence he received a fair trial, understood as a trial resulting in a verdict worthy of confidence.‘” Id. at 382-83 (quoting Kyles v. Whitley, 514 U.S. 419, 434 (1995)).
Like the district court, I believe that defendants have not shown that the materials that came belatedly to light would have undermined confidence in the verdict. On the contrary, it is more likely than not, as the district court explained, that the opinion of Mr. Potter and the materials
