ladakh confessed the defense has never argued that the evidence was insufficient to support a finding that mary has participated in her employer's fraud even after the district court invited the defense to  post conviction motions of the fence never argued that the evidence was insufficient to support that conviction if that were our appellate issue as the op allee's briefs suggest i would have been obligated to file an andersen brief which i have done dozens of times the poll issue is not whether the evidence was sufficient to support a finding that mr laga participated in her employer's fraud in fact the issue is whether the evidence is sufficient to support the district court's finding that married to either participated in her employer's fraud from day one from the first day that she started working reason that's important honest because society of course demands that criminal defendants pay for the extent of their crimes and as this court has pointed out before the fact that a criminal defend about a conspiracy today on a tuesday it establishes that that criminal defendant was aware of that conspiracy the following day on wednesday it doesn't establish that that can that that defendant was aware and participated in that fraud the previous day on monday so during this time to face the defense asked the district court to make a finding about when mr lago biggie became aware of her employer have known have participated in that fraud from from day one from the very first day that she began working there and that finding cannot be supported by the record the government will certainly cite the three facts in the record that one can easily confused for being sufficient to support a finding that mr law they knew about the fraud from day one from the very first first that she started working there however when this court most more closely examine these facts the court will see that they actually cannot support that finding number one medicare of course requires medical bill or has to make a certification that their physicians have contemporaneously documented their the physician's treatments to to their patients and merits waga made the certification that she had contemporary contemporaneous documentations from the physicians when in fact she knew that she didn't have the this documentation and that this report stated that it was relying on her false certification in order to make a finding that she must have known about the fraud from day one however the only evidence we respect to her false sort of occasion about this contemporaneous documentation is an e mail that she wrote in two thousand and ten which was several years after she began working for her employer and only a few months before she stopped working for that employer so that e mail that evidence cannot support the finding that she must have known about the fraud and participated in that fraud several years earlier fraught immediately and it's absolutely true with the law that did have expertise in the medical field even before she started working for this role of an employer however that expertise pertained to medical  billing that expertise didn't have did not pertain to medical doctors appropriate treatments are under patients and i would i would ask the court to consider our own field in the legal field federal courts often rates in court reimbursements for expenses and statutory maximums but wouldn't one wouldn't expect these laypeople c j d administrators to immediately recognize if  had ministre her whereas the doctors the physicians were like that the c j a council so the district courts finding that because she had some expertise in the medical field can't support cannot support conclusion that she must have recognized that these doctors were not providing appropriate medical services from day one especially when her only expertise in the medical field prior to having worked for this employer was having taken an numbers didn't add up because there are only twenty four hours in one day and it's true that mr y got billed medicare for her physicians as having performed more than twenty four hours of a particular service called a care plan oversight on one particular day and of course not even lawyers can work more than twenty four hours in a day however the evidence established and it was unrefuted that the twenty four plus hours built in the day is not represent twenty four hours of work in one day it represents the total amount of hours that had been worked in in the month before i asked the court to consider testimony from the government's own witness who was an expert who represented herself as an expert in medicare believe she was asked when they submit that hew they submitted to us having occurred on one particular day isn't that right and she responded that's how they're submitting it that's how they're billing it to us yes another witness the second witness was asked what this type of building is it possible for a doctor to build one in twenty four hours in one day and she responded yes it is because it doesn't total that day it totals the entire month's worth of work now that that evidence was under a few would it not even the government question its own witnesses testimony and it's very possible that the district or discounted that evidence the district court respect to this issue was a truck driver a fact and it was free to find that that evidence is not credible however one should expect that if the district court were to find that two witnesses including a government witness perjured themselves with respect to an issue that for more than twenty four hours in one day for care plan and oversight this particular medical treatment cannot support its conclusion that she would have known about this flawed immediately especially given this unre testimony your honour's is that as i started mentioning society demands that a criminal defendant pay for the extent of their fraud and misty was convicted and she will pay for this conviction for the rest of her life she has already had to surrender interests in a pool in her in a hole in order to begin paying restitution she has never been accused or charged with a crime before and she will have to serve a lengthy prison sentence and even after  she completes her prison sentence and she's in her sixty's the government will probably corniche her income in order for her to finish pain restitution and that's because i did the society the man is that she pay for sentenced to eighty seven months in prison a little over seven years in sentencing him the judge said there were four reasons the amount of money involved the generation of the offen the fact that the judge thought he did not accept responsibility and the need for a general to turn and although the judge didn't and didn't need to parse out how much weight for each of those prongs he did say very clearly that this was a significant factor the only factor not the most important factor but a significant factor he went on to talk about how health care fraud is and demick in our society there is a low likelihood of being caught he said and therefore the sentence must be severe to send a signal he then went on to say that he wholeheartedly on this point agreed with the prosecutor who had said health care fraud is a huge problem and there's a substantial and overwhelming need to have a lengthy sentence for general deterrence purposes but the government gave the judge no citations no specific information other than these blanket assertions about the extent of health care fraud and the importance of general deterrence at sentencing even though we know it is the government's burden on these pro put forward some evidence which the government did when it was talking about last early on in the sentencing the studies done will show the opposite they intuitively know the idea is or at least in my experience somebody will say well i never thought i would get caught i don't hear people saying well i weighed whether it was five years or ten years but i think that cost benefit analysis goes to whether of caught not how long i'm going to go to jail and that is the difference the other piece of they had it is the court said there is a low likelihood of getting convicted but i never thought i would say this to this court but the government has done a really fantastic job in prosecuting health care fraud in two thousand and fifteen alone they issued two hundred forty three press releases on people getting caught for health care fraud now it's true we don't know the extent of the universe that's not knowable but people know that there is a higher likelihood of being caught for healthcare the court did not as the government side consider and reject these points the court simply accepted the statements of the any reliable evidence to support the way i was in sentence seems to me there needs to be something more or every judge in the country can pick a factors one by one after going through those factors including general deterrence the district court reached its its conclusion about the appropriate sentence now with regard to general  district court did say as my friend pointed out that medicare fraud was endemic in this country and that those who are in the medical field who are tempted to engage in this fraud must know that the penalties are severe  and that the sentence needed to send a signal to home health care practitioners in particular the district court was on firm footing in reaching those conclusions relying on common sense which includes the the the nature of the offense itself as far as evidence in the record the nature of the offenses was was the whole point of the trial the district court could see and confirm what this court has stated in previous cases that those commonsense conclusions are are completely appropriate when dealing with general the turns in the context of white collar crimes with the district court did here is exactly what you would want any district court to do which in using its commonsense and way of the thirty five fifty three factors including the nature of the offense the history in characteristics of the defendant s and then measuring that against among other things the need for general deterrence in these cases with regard to mr a lot of the the district court i think did not clearly there in concluding that she was responsible or artist began participating in the conspiracy from the outset of her employment and it gave it gave a number of reasons at sentencing but there are also a number of reasons and there's also evidence within the trial record that would support a finding that the district court did not clearly  continue in some in some detail just to just to make it clear with regard to our education mr law the record indicated in the court relied on the fact that she was a seasoned biller from the outset she took a number of courses that were geared toward preparing for poor becoming a medical bill or an encoder and this included training on the same billing software that the company was using medicine off on the same type of care that quickly and expertly and said that if a claim were rejected it was too large it would just change the building code to make it look like something else that's in the transcript at three forty sixty three fifty so there is evidence that the about her education for a month with the district court actually said and this is that the sense in transcripts twenty nine is that the number of hours that each position was putting in for care plan oversight which was going to realistic and there's certainly evidence in the  anything further ms burke well thank you very much the case is taken under advisement and mr cameron and we appreciate your willingness to accept the appointment in this case