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Parties Involved:
United States of America
Appellee
Rick Van Bryson
Appellant

Document Text:

United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Decided May 15, 2007

No. 05-3212

UNITED STATES OF AMERICA,

APPELLEE

v.

RICK VAN BRYSON,

APPELLANT

Appeal from the United States District Court

for the District of Columbia

(No. 05cr00175-01)

Jon S. Pascale, appointed by the court, was on the brief for

appellant.

Jeffrey A. Taylor, U.S. Attorney, and Roy W. McLeese, III,

Mary B. McCord, and B. Patrick Costello, Jr. were on the brief

for appellee.

Before: ROGERS, GRIFFITH and KAVANAUGH, Circuit

Judges.

Opinion for the Court filed by Circuit Judge KAVANAUGH.

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KAVANAUGH, Circuit Judge: Bryson pleaded guilty to

defrauding Medicare. As part of his sentence, the District Court

ordered him to pay restitution of $30,338.90 to the Government.

Bryson challenges the District Court’s method of calculating the

restitution amount. We affirm.

I

For several years, Bryson, a podiatrist, submitted fraudulent

reimbursement claims to Medicare. On multiple occasions, he

represented to Medicare that he had performed a reimbursable

medical procedure; in fact, he had performed only routine,

non-reimbursable services such as clipping toenails, removing

corns, and applying topical medication. On August 17, 2005,

Bryson pleaded guilty to one count of making false statements

to Medicare. See 18 U.S.C. §§ 2, 1035. As part of the plea, he

admitted to perpetrating a fraudulent reimbursement scheme

from 1998 until 2001, and he identified seven patients for whom

he submitted false information to Medicare. At the sentencing

hearing, the District Court heard extensive testimony on the

amount of loss caused by Bryson’s scheme. The court

sentenced Bryson to three years of probation and ordered him to

pay restitution of $30,338.90 to the Medicare Fraud Unit. On

appeal, Bryson challenges that restitution figure.

In its initial sentencing submission to the District Court, the

Government proposed a restitution figure of $37,417.34. The

Government explained that this amount was calculated based on

four investigative sources: (1) the false claims filed by Bryson

on behalf of the seven patients named in the plea documents; (2)

a review of Bryson’s files by an expert podiatrist, Paul Kinberg,

which revealed information that was inconsistent with Bryson’s

representations to Medicare; (3) a tally of claims submitted to

Medicare for which Bryson had insufficient, incomplete, or

inconsistent notes, despite the Medicare requirement that

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physicians document treatment for which they seek

reimbursement; and (4) surveys and interviews of former

patients about what kind of medical treatment they received

from Bryson. After its initial submission, the Government

slightly lowered its figure to $37,132.61, explaining that the

initial calculation had included restitution for conduct that

occurred outside of the time period covered by Bryson’s guilty

plea. The Government also took pains to ensure that a patient

included in multiple components was not double-counted; for

example, a patient who indicated on a survey that he had

received no treatment and who also was not mentioned in any

notes in the patient’s file was counted only once. 

Bryson argued that the Government substantially overstated

the amount of restitution. In his view, the proper figure was

$20,050.40. This was allegedly an estimate that a prior

prosecutor had suggested to Bryson at some earlier date.

During Bryson’s sentencing hearing, Bryson and the

Government called witnesses to justify their respective

restitution figures. Bryson called two former patients, both in

their 80s, to show that at least some of the interviews and

surveys cited by the Government had not occurred. The first

witness, Martha Feggins, testified that she had never completed

a survey or been interviewed by government agents (although

she repeatedly became confused on the witness stand and gave

contradictory answers at different times during her testimony).

The second witness, Hope Settles, testified that government

agents had not interviewed her son (also one of Bryson’s

patients), as the Government had claimed.

The Government called Jason Marrero, a special agent with

the Department of Health and Human Services who had

investigated Bryson. Agent Marrero presented documentation

showing that he had interviewed both Feggins and Settles’s son

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in connection with his investigation. Agent Marrero also

detailed the steps he had taken in his investigation of Bryson,

which included reviewing Bryson’s medical records, employing

podiatrists to examine both Bryson’s records and the physical

condition of his patients, interviewing Bryson’s patients, and

sending surveys to Bryson’s patients.

Agent Marrero explained the method he used for calculating

the loss to Medicare attributable to Bryson’s fraud. He clarified

that the four-component approach initially described by the

Government was in fact a three-component approach: The first

component (fraudulent claims in connection with the seven

patients named in the plea documents) was actually just a subset

of the fourth component (interviews and surveys of all patients).

Thus, the three components included in Marrero’s final figure

were: (1) Kinberg’s review of Bryson’s files; (2) the government

review of Bryson’s “no notes” files; and (3) patient surveys and

interviews. During his testimony, Marrero re-calculated the

appropriate restitution amount for the period from January 1998

to September 2001 and reached the same figure that the

Government had stated in its revised submission (apart from a

$100 reduction caused by a double-counting error). Agent

Marrero also testified that the loss attributable to Bryson’s entire

scheme through April 2002 was $48,285.39.

The District Court then computed a final restitution amount.

First, the court concluded that the time period for which Bryson

should pay restitution was January 1998 to April 2002, even

though Bryson had pleaded guilty to submitting fraudulent

claims only through September 2001. The court explained that

the Guidelines require the sentencing judge to consider all

relevant conduct, and it was therefore appropriate to award

restitution for Bryson’s conduct “before and after [the] time

period [pled to] and [which] is related and connected to the

scheme that was pled to.” Tr. of Dec. 15, 2005, Hr’g at 160. As

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Agent Marrero had testified, the restitution over this period was

$48,285.39. Second, the court concluded that although the

interviews of patients were reliable, the surveys “pose problems

in that they do not provide the . . . same opportunity for the

face-to-face discussion between the patient and the agent.” Id.

at 164. The court therefore subtracted the amount attributable

only to the surveys ($15,040.70) from the total. Id. at 165-66.

Third, the court excluded the restitution amount attributable to

Bryson’s false claims on behalf of Feggins ($2,905.79), because

her “memory faults” threw into question the accuracy of her

statements to investigators. Id. at 164, 167. The final figure was

$30,338.90. Id. at 167.

II

The Government must prove at sentencing that its proposed

restitution figure is supported by a preponderance of the

evidence. 18 U.S.C. § 3664(e). We review the District Court’s

restitution determination under an abuse of discretion standard.

United States v. Rezaq, 134 F.3d 1121, 1141 (D.C. Cir. 1998).

We examine the factual findings underpinning the restitution

award only for clear error. United States v. Lawrence, 189 F.3d

838, 846 (9th Cir. 1999); see also United States v. Leonzo, 50

F.3d 1086, 1088 (D.C. Cir. 1995). 

Bryson raises five objections to the restitution calculation.

First, Bryson argues that it was improper to rely on Agent

Marrero’s analysis because he is “not a medical professional.”

Appellant’s Br. at 19. At the time of his testimony, Agent

Marrero had seven years of experience as an HHS special agent

and had received training in Medicare regulations and billing.

See Tr. of Dec. 6, 2005, Hr’g at 33. Moreover, Agent Marrero

consulted expert podiatrists such as Kinberg throughout his

investigation. It would be odd, to say the least, if a district court

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could not rely on testimony of a trained Medicare fraud

investigator as the court determined the magnitude of a

Medicare fraud. 

Second, Bryson claims that the District Court erred by

relying on a restitution figure submitted by the Government,

because the District Court was presented with “a number of

possibilities” during the sentencing hearings. Appellant’s Br. at

14-15. Bryson cites United States v. George, 403 F.3d 470 (7th

Cir. 2005), in which the Seventh Circuit invalidated a restitution

award when different witnesses had submitted widely varying

estimates of restitution to the District Court. See id. at 473-74.

But Bryson’s reliance on George is mistaken. The problem in

George was not the wide range of estimates itself, but rather the

fact that the sentencing judge selected a seemingly arbitrary

figure within that range without “mak[ing] findings of fact or

articulat[ing] his reasons.” Id. at 473. By contrast, here the

District Court carefully explained its analysis, making an effort

to ensure accuracy by excluding the amount attributable both to

the surveys and to the Feggins interview. 

Third, Bryson contends that the District Court unreasonably

relied on interviews of Feggins and Settles’s son, even though

Bryson presented testimony that they were never interviewed.

With respect to Feggins, the District Court in fact excluded from

the final restitution award everything attributable to her

interview. And with respect to Settles’s son, the District Court

reasonably credited the testimony and documentation of Agent

Marrero and another agent (Agent Tucker) indicating that they

had interviewed him.

Fourth, Bryson argues that the rest of the surveys and

interviews the Government cited were unreliable because of the

faulty memories of elderly patients and the technical nature of

the questions asked. The District Court shared some of these

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concerns – which is precisely why it excluded all the survey

results from the final calculation. As the District Court put it, a

survey “doesn’t provide an opportunity for the patient to ask a

question” or “for the agent to see that there may be some

hesitation on the part of the patient in regard to the proper

answer to a question.” Tr. of Dec. 15, 2005, Hr’g at 164. The

District Court concluded, however, that the same problems

generally do not exist with the interviews, during which there is

face-to-face interaction between the agents and the patients. Id.

The District Court’s assessment was eminently reasonable, and

we will not disturb it.

Fifth, Bryson asserts that the District Court erred by relying

on the lack of notes in a patient’s file as evidence of Medicare

fraud. We are not convinced. Given Bryson’s guilty plea to a

scheme of Medicare fraud, the overwhelming evidence against

him, and the documentation requirements for Medicare

reimbursements, it was logical for the District Court to conclude

that the lack of any documentation in a patient’s file for a

procedure indicates that Bryson did not perform the procedure.

Finally, Bryson has not argued that the restitution amount

could have been incorrect because it was based in part on

conduct that occurred outside the period covered by his guilty

plea. We therefore do not consider that issue. See Cruz v. Am.

Airlines, Inc., 356 F.3d 320, 333-34 (D.C. Cir. 2004). 

We affirm the judgment of the District Court.

So ordered.

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