course then fair he was prohibited from introducing probative and positive testimony concerning his good faith in this particular case the circumstances are somewhat very significant difficulties in the field of cancer period his view of it all was that he owed a duty to patients who he diagnosed with a k that's what we call it in the briefs to discern whether they needed treatment and if they did the nature and extent of the treatment he maintained that from twenty zero three forward based on actually twenty one forward based on a medicare national coverage decision that he had the wherewithal as a board certified dermatologist to discern what treatment was needed how often in the nature and extent of the treatment some of the business of have a thirty of these keratosis on one head so to speak at the same time on things that i would say he pinched the pot a little bit i would say that he may have submitted claims in excess of perhaps what should have been claimed and i say perhaps because i'm using guarded  in substance both testified that eight k comes in a massive barrage hedi of features call those sizes that you have to touch that is a single lesion that you can use the c o two which is the carbon dioxide spray and it's a procedure that's fraught with difficulty for the patient second or so and they do it without worrying about whether it's us seriously precancerous is just there's some risks so they take it off in this protection second it doesn't hurt her an scary talks what you've just described is utterly inappropriate and cannot be done because the treating dermatologist could not go to each of twenty or right i appreciate the court's comments and the jury was not permitted to hear why he felt he was being deprived of the good faith basis for what he was doing and that includes the family in twenty ten and twenty eleven he brought a significant torturous tortious interference claim against blue cross blue shield and it is all we see from the wreck or is there was a confidential settlement what the jury didn't know and still that still confidential but it was a very significant sum up that blue cross blue shield paid to him in lieu in was able to settle that would a geisha now should the jury have heard that when blue cross blue shield offered four separate witnesses who testified among other things that they paid the doctor over one million able to tell the jury wait a second hold everything if i'm such a thief and i'm such a crook then why did this same company pay me x whatever that figure is you know you sure the court is significant in order to conclude in terminate that would a geisha he was deprived of that and he was deprived of more and this has to do with medicare and medicare is a favorite subject of those of us who have reached a mature age because we have the benefit of medicare and mont so we're familiar with the procedure here medicare presented witnesses that said in the period of twenty zero three to twenty t the doctors submitted upwards of ten thousand six hundred claims for our treatment of eight k over that period of time now he may have been seeing twenty patients a day five days a week i don't know but that's what they were able to present however he was precluded from presenting to the jury that from the date of his indictment in  same eight k for me well for his treatment to medicare and up three approval basis and they approved ninety some odd percent of those treatments so what he wanted to express to the jury is wait a second this is what i did before this is what i've done since and the trial court said no and they sustained the government subjection and now i'm going backwards to why some of this is truly unfair in this case in advance of trial the government did a survey of sorts by an dr bob was an outlier meaning he had many more claims than all the other dermatologists in the area well he had the he was the only one with the equipment because he spent hundreds and hundreds of thousands of dollars on laser related equipment and other physicians sent him patients but in advance of trial the government said never mind we're not using that's fine in advance of trial the defense submitted a motion barring seeking an order barring the use of it the government responded to this motion in writing saying we don't well wasn't really moot when the government now during the trial and we point out in our brief fine october one they bring that up and we have this statistical sampling and we're going to use it and we're going to use it because he opened the door in his opening statement by saying hey he may be an outlier meaning the doctor treats more patients than others but you know what he's not a cro so should the government have been about to use it well they did over objection so on the one hand you have the government being able to present medicare in blue cross saying he's a crook and a cheat and on the other hand he's precluded from offering his own evidence that wait a second will crossfade me a small fortune to terminate my good a geisha against him and medicare approve the exact same thing before and after the indictment this year question as something you said earlier about how a settlement that that your client had made was blue cross or someone who was blue cross and who said it was a large settlement but that because it was confidential the amount couldn't be disclosed at the trial isn't true if i was defending kailua cert wouldn't in truth you know i would think you have a trial and it's a it's important to have this information well i have to said i'm sorry i didn't mean to interrupt that is that the practice that these settlements  absolutely sacrosanct i don't know because that's beyond the my understanding so on i know is i would have approached the district court nasa district court in advance of trial to an order permitting the confidential basis to be exuma or some darn thing and getting to confidential basis at the time of sentencing the trial court ordered a very significant order brisket touche and three point eight million dollars and dr bob said wait a second i made a settlement with blue cross i made a settlement with  made a settlement with humana so i may own medicare but i don't know the rest of them because we entered into private settlements the government said well there's no real law on the seventh circuit but the sister circuit say those private agreements confidential or not can be trumped by the trial court or this court saying wait a second those private agreements is going as they don't double enhanced the victim they're ok i think frank i'd ask that the court at the very least billed medicare and those patients private insurers for unnecessary medical services were questions for the jury questions the jury result and the rim there is more the sufficient evidence to support the convictions in this case in particular the jury heard evidence about how the defendant diagnosed black brown spots on patients as young as fifteen years old as being precancerous lesions and then he bil cosmetic treatments as if he was destroying huge numbers of precancerous lesions about four hundred ninety one on the face of that fifteen year old the evidence was more than sufficient support convictions and shield now first i want to correct the record a little bit about what actually happened in terms of the rulings there in fact the government raised the motion prior to trial to preclude mention of the civil civil settlement and that the defendant then informed the district court that it was not going to elicit evidence about the settlement as so the district court denied government's motion as moot later in the course of the trial the defendant did testify about the fact that he had sued blue cross and blue shield during the period covered by the indictment to indicate his good faith in di dia being that he wouldn't have sued blue cross blue shield unless he believed he was in the right and the district court allowed that testimony at the same time the defense counsel from this report that he was not going to seek to ask about the selman about and that distinction was appropriate because the any injured as a result of his treatment methods they were not harmed physically pardon they were not harmed physically well how were they are patients were told that the think the sprouts spot they had on their face and bodies that they thought were frankel's were precancerous lesions they were told that they might be so they might be apt to suffer a cancer that caused that scared patients that help scare some patients into coming back every two weeks for a month to get pre cancerous not the ones that he treated using the intense pulse light or the erbium laser treatments now it may be that when he removed he treated some lesions with liquid nitrogen some of those might actually patients conditions and that he submitted accurate bills and that he no reason to doubt and it was diagnosed treatment methods because medicare and private insurers continue to pay his claims he was able to he was able to that defense for the period covered by the diet he testified about his methods be called a defense experts to supply help supports his claims and he was able to point to some correspondence with blue cross blue shield in the course of his testimony the fact that the additional element  any additional evidence or argument that would've been supported by the admission of the post two thousand and twelve conduct was not relevant and the district court properly did not abuse especially in excluding such evidence which would which rather he was accused of trying to cross blue shield medicare and i thought he made this big settlement was no your honor i think that's i think that is again the record does not go into here and that was an exclusion in the settlement agreement that specifically excluded that specifically allowed if it would cost to shield to receive recovery in the event that there was any kind of later proceeding in did have a medicare contractor do a city school review to compare dr cole this with peer dermatologists but the government did not seek to admit that a trial and we did not a t that at trial what's defense counsel was talking about just now was a simple analysis simply of the defendant's own claims a simple summary of the claims that he himself submitted to medicare in the period covered by the government's suggestion that everything the defense fanned out wanted to present was presented is simply wrong and the record supports it and their explanation appendix that on october one in mid trial they spring up this sampling and they told the court if he presents his the fence we want the opportunity to use it this is after the trial court had held three weeks before trial that they can't use it because they grant the defendants motion to