FI LED U. S . COURT OF AP PE ALS E L E V E N T H C IR C U IT O c t obe r 11, 2005 T HOM AS K. KAHN CL E RK [ DO NO T P UB L I S H] I N THE UN I TE D STATE S C OU RT OF APPE ALS F O R T H E E L E V E N T H C IR C U IT

________________________ N o. 05- 10603 N on -A rgum entC al endar

________________________ D . C . D o c k e tN o . 0 4 - 6 0 0 8 7 - C R - D MM U N I T E D S T A T E S O F A M E R I C A , P la in tif f - A p p e lle e , v ersu s M I L D R E D C R U Z - N A T A L , D e f e n d a n t- A p p e lla n t.

________________________ A pp ea l fr om the U ni t ed S t at es D i stri ctC ou rt f orthe S outhe r n D i s tr i c tof F l or i da

_________________________ ( O c t obe r11, 2005) B efo re B IR C H , B A R K E T T an d H U L L , C i rcu i tJu d g es. P E R C U R I A M: A f t e rpl e a di ng gui l ty , M i l dr e d C ruz - N a t a l appe a l s he r72- m onth s e nt e nc e f orAl l c itatio ns areto t he20 00 vers ion

of theGuide lin e s. 1 2 c ons pi r i ng t o de f

r a ud the gove r nm e ntby f i l i ng f a l s e M e di c a r e c l a i m s , i n vi ol a t i on o f 1 8 U .S .C . § 2 8 6 . A f

te rr e v ie w , w e a f

f ir m th e d is tr ic t c o u r t’s im p o s itio n o f a ll s e n te n c in g e n h a n c e m e n ts e x c e p t f o rth e e n h a n c e m e n t u n d e rU .S .S .G . § 3 B 1 .3 (200 0). B ec ause the di stri ctcourti m prop er l y i m po se d t he enhancem entun der §

1 3 B 1 . 3 , a n d th u s d i d n o tp r o p e r l y c a l c u l a t e th e d e f e n d a n t ’ s Gu i d e l i n e s r a n g e , we va c a t e C ruz - N a t a l ’ s 72- m onth s e nt e nc e a nd r e m a nd f orr e s e nt e nc i ng. I . B AC KG RO UN D D e f e nda ntC ruz - N a t a l de f

r a ude d the U ni t e d S t a t e s D e pa r tm e ntof H e a l th a nd H u m a n S e r v ic e s ( “H H S ” ) b y s u b m ittin g f a ls e c la im s f

o rm e d ic a l e q u ip m e n t to M ed i care. C ru z-N at al su b m i t t ed th e fal se cl ai m s th ro u g h tw o co rp o rat i o n s, n a m e l y , S u p p o r t i v e He a l th S e r v i c e s ( “ S u p p o r t i v e ” ) a n d S &B , I n c . ( “ S &B ” ) . At C ruz - N a t a l ’ s di r e c t i on, A l e j a ndr o V i gor e a ux a c t e d a s the nom i ne e ow ne rof S up po rt i ve, op ened a bank accoun ti n S up po rt i ve’ s nam e, and fun nel ed the m on ey t o C ruz - N a t a l . I n a ddi t i on, C ruz - N a t a l r e c rui t e d he rbr othe r - i n- l a w , C a r l os R a ve l o, t o s e r ve a s the nom i ne e ow ne rof S & B . R a ve l o a l s o f

unne l e d m one y t o the de f e nda nt . C ruz - N a t a l a nd c ode f e nda ntR odol f

o F r e s c oba l di w e r e r e s pons i bl e f or subm i t t i ng the fa l se cl ai m s t o M edi ca re . F rom S ept em ber 3, 19 98 , throu gh D ec em ber 5, 20 00 , S up po rt i ve subm i t t ed3

f a l s e c l a i m s i n the s um of $449, 799. 28 a nd r e c e i ve d r e i m bur s e m e nt s f r om M edi ca re t ot al i ng $2 03 , 76 7. 75 . D uri ng the sa m e t i m e s pan, S & B subm i t t ed f r a u d u le n t c la im s to ta lin g $ 2 ,1 0 4 ,1 2 0 .4 2 a n d r e c e iv e d $ 8 7 7 ,9 4 6 .6 6 in re i m bu rs em ent s f

rom M edi ca re . A l l the fr audu l entcl ai m s i nd i ca t ed thatD r. F r e dne s vi nda G onz a l e z w a s the r e f e r r i ng phy s i c i a n. A s s t a t e d a bove , C ruz - N a t a l e ve ntua l l y pl e a d gui l ty t o c ons pi r a c y t o de f r a ud the gove r nm e ntw i th r e s pe c tt o M e di c a r e c l a i m s , i n vi ol a t i on of 18 U . S . C . § 286. D uri ng C ruz- N at al ’ s s ent enci ng hear i ng , the di stri ctcourtst at ed thatun der U ni t e d S t a t e s v. B ooke r , 125 S . C t . 738 ( 2005) , i tw a s r e qui r e d t o c ons i de rthe r e s ul t i ng G ui de l i ne s r a nge , butw a s a bl e t o de vi a t e f r om tha tr a nge upon the c ons i de r a t i on of

othe rr e l e va ntf

a c t or s . A f

t e rs t a t i ng tha ti tha d c ons i de r e d the pa r t i e s ’ s t a t e m e nt s , the P S I , the obj e c t i ons , a nd othe rf a c t or s s uc h a s the se ri ou snes s of the cr i m e a nd the need t o p rot ec tthe pu bl i c, the di stri ctcourtst at ed thatthe G ui del i nes r ange of 70 -87 m on ths’ i m pri sonm entw as re as on abl e, and t hat i tw ou l d sent ence C ruz- N at al w i thi n t hatra ng e. T he di stri ctcourtse nt ence d C ruzN a t a l t o 72 m onths ’ i m pr i s onm e nt , 3 y e a r s ’ s upe r vi s e d r e l e a s e , a nd r e s t i tut i on t ot a l i ng $1, 081, 714. 41. I I . DI S CUS S I ON A f te rB o o k e r , a n d e v e n u n d e ra n a d v is o r y G u id e lin e s s c h e m e , d is tr ic t c o u r ts4

m u st stil l co rr ec tl y c alcu late th e G u id elin es ra n g e w h en d eter m in in g a d ef en d an t’ s s e nt e nc e . S e e U ni t e d S t a t e s v. C r a w f or d, 407 F . 3d 1174, 1178 ( 11 C i r . 2005) th ( s ta tin g th a t a f

te rB o o k e r , d is tr ic t c o u r ts m u s t c o n s u lt th e G u id e lin e s a n d “[ t]h is c o n s u lta tio n r e q u ir e m e n t, a t a m in im u m , o b lig e s th e d is tr ic t c o u r t to c a lc u la te c or r e c t l y the s e nt e nc i ng r a nge pr e s c r i be d by the G ui de l i ne s ” ) . T hus , e ve n though the di stri ctcourtse nt ence d C ruz- N at al po st -B oo ker, w e s t i l l m ustre vi ew w hether the di s tr i c tc our tpr ope r l y c a l c ul a t e d the de f e nda nt ’ s G ui de l i ne s r a nge . S e e i d. O n app ea l , C ruz- N at al chal l enges s ever al enhancem ent s the di stri ctcourt i m po se d w hen cal cul at i ng her G ui del i nes r ange. S peci fi ca l l y, C ruz- N at al ar gu es tha tthe di s tr i c tc our ti m pr ope r l y : ( 1) c a l c ul a t e d the a m ountof l os s s uf f e r e d by M e di c a r e unde rU . S . S . G . § 2F 1. 1( b) ( 1) ( N ) ; ( 2) appl i e d a tw o- l e ve l e nha nc e m e nt unde r§ 2F 1. 1( b) ( 2) be c a us e the of f e ns e i nvol ve d m or e tha n m i ni m a l pl a nni ng; ( 3) appl i ed a f

ou r- l evel enhancem entpu rs uantt o § 3B 1. 1(a) for a ct i ng as an organi ze r orl e a de rof

a c r i m i na l a c t i vi ty tha ti nvol ve d f i ve orm or e pa r t i c i pa nt s ; a nd ( 4) appl i e d a tw o- l e ve l e nha nc e m e ntunde r§ 3B 1. 3 f orus e of a s pe c i a l s ki l l i n the com m i ss i on of the offens e. A. L o s s Am o u n t Un d e r § 2 F 1 . 1 ( b ) ( 1 ) ( N) O n app ea l , C ruz- N at al ar gu es thatthe di stri ctcourti m prop er l y c al cul at edUn der U .S. S.G . § 2F 1. 1(b) (1 )( N) , a n o ff e ns einv olv ingan amou

nt o f l os s o f at le a st 2 $2 ,5 00 ,0 00 wa

rrants a 13 -l e ve l in c re a sein t

heba seof

fens ele ve l. 5 th e a m o u n t o f lo ss as $ 2 ,5 5 3 ,9 1 9 .7 0 . T h is C o u rt re v iew s a d istrict co u rt’s 2 det erm i nat i on of the am ou ntof l oss i nv ol ved i n an o ff ense for c l ea r e rr or. U ni t ed S t at es v. N ost ar i -S ham l oo , 25 5 F . 3d 12 90 , 12 91 (11 C i r. 20 01 ). th I n thi s c a s e , the di s tr i c tc our tde t e r m i ne d tha tthe c or r e c tc a l c ul a t i on of the a m o u n t o f

lo s s w a s th e a m o u n t th a t C ru z - N a ta l a n d h e rc o - c o n s p ir a to r s in te n d e d to r e c ove rf r om M e di c a r e . T ha ta m ount , a s a l l e ge d i n the i ndi c tm e nta nd s t a t e d i n the P S I , w a s $ 2 ,5 5 3 ,9 1 9 .7 0 . C ru z - N a ta l a s s e r ts th a t s h e s h o u ld b e h e ld a c c o u n ta b le for onl y the $1 , 08 1, 71 4. 41 ac tual l y pai d b y M edi ca re . H ow ever , ac cordi ng t o t he com m ent ary t o U . S . S . G . § 2 F 1. 1, i f the i nt ended l o ss i s cal cu l ab l e an d i s g reat er th an th e actu al l o ss, th e d i stri ctco u rtsh o u l d b ase th e am o u n to f l o ss fo r w h i ch th e d efen d an ti s resp o n si b l e o n th e i n t en d ed l o ss am ou nt . U . S . S . G . § 2 F 1. 1, cm t . n. 8 (“ [I ] f a n i nt ended l oss thatthe defendantw as att em pt i ng t o i nfl i ctca n b e det erm i ned, thi s f i gu re w i l l be used i f i ti s gre at erthan the ac tual l oss. ”) . B ec ause the i nt ended l oss i s e as i l y c al cul at ed and g re at erthan the a c tua l l os s i n thi s c a s e , the di s tr i c tc our tdi d notc l e a r l y e r ri n r e l y i ng on the $2 , 55 3, 91 9. 70 the defendanti nt ended o n rec ei vi ng fr om M edi ca re . B . M i n i m al P l an n i n g P u r s u an t t o § 2F 1. 1( b ) ( 2) C ruz- N at al al so ar gu es thatthe di stri ctcourterroneou sl y det erm i ned t hatherI f a f raud of fenseinvolved more than minimal planning , the Guidelines re quire a two- 3 level increasein the base of fenselevel. U.S.S.G. § 2F1.1(b)(2) (A). “ ‘Morethan minimal pla nn ing ’ m e ans morepla

nn ingtha n is ty pic a l f or c ommiss ion

of theof fens ein a sim ple fo rm . . . . [It] is de e me d p re sent in a ny c a seinv olvingrepe ate d ac ts o ver a peri od of tim e , unle ss it is clear that e ach instanc e wa s purely opportune.”U.S.S.G. § 1B1.1, cmt. n.1(f ). 6 o ffen se o f co n v i ct i o n req u i red m o re th an m i n i m al p l an n i n g . A fi n d i n g b y a 3 d is tr ic t c o u r t a s to w h e th e ra n o f f e n s e in v o lv e d m o r e th a n m in im a l p la n n in g is r e vi e w e d f

orc l e a re r r or . C r a w f

or d, 407 F . 3d a t1177. T hi s C our t“ c a nnotf i nd cl ea r e rr or un l es s [ i ti s] l ef tw i th a defi ni t e a nd fi rm conv i ct i on thata m i st ake has been com m i t t ed. ” I d. (quo t at i on m arks om i t t ed). T hi s C our tha s c onc l ude d tha ta pr e s um pt i on of m or e tha n m i ni m a l pl a nni ng a r i s e s w he n the gove r nm e nte s t a bl i s he s tha tthe of f e ns e i nvol ve d a s e r i e s of re peat ed ac t s over aperi od of t i m e. Id. at11 80 . “ If , for e xam pl e, se vera l fr audu l enttra nsac t i on s occ ur ov era per i od of tw o yea rs , m ore than m i ni m al pl anni ng w i l l be deem ed pres entun l es s i ti s c l ea r thatea ch on e of the se vera l tr a ns a c t i ons w a s pur e l y oppor tune . ” I d. I n thi s c a s e , C ruz - N a t a l pl e d gui l ty t o as c he m e t o de f r a ud the gove r nm e nt f r o m S e p t e m b e r1 9 9 8 th r o u g h De c e m b e r2 0 0 0 . Ov e rth i s p e r i o d o f m o r e th a n two y e a r s , C ru z - N a ta l f

ile d th e n e c e s s a r y p ap e r w o r k s o th a t S u p p o r tiv e a n d S & B c o u ld b e u sed i n th e frau d u l en tsch em e, recru i t ed n o m i n ee o w n ers o f b o th co rp o rat i o n s, di r e c t e d othe r s t o ope n ba nk a c c ount s f orthe purpos e of

de pos i t i ng theThe factors that a sentencingcourt c onsiders in deter mining whe ther a

n enhanc ement 4 under § 3B 1.1(a) is warranted a re: “ (1) e x erc ise of dec ision-making a uthority , (2) nature of participation in the commissi on of the off ense, ( 3) re cruitment of accomplice s, (4) c laimed right to a larg er sha

re of the fruits of the crime, (5) degreeof par ticipation in planning or

org anizing theof fens e , ( 6) natureand

sc op eof theill e g a l a c tiv ity, a

nd (7 ) de gre eof

c ontrol a nd a uth ority exercised over others.”United States v. Vallejo, 297 F .3d 1154, 1169 (11 Cir. 2002) (citing th U.S.S.G. § 3B1.1, cmt. n.4). 7 r e im b u r s e m e n ts r e c e iv e d f r o m M e d ic a r e , a n d f

ile d n u m e r o u s f

a ls e c la im s to M ed i care. T h e reco rd d o es n o ti n d i cat e, an d C ru z-N at al d o es n o targ u e, th atan y a c t w a s p u r e ly o p p o r tu n e . S e e id . ( h o ld in g th a t a n a c t is p u r e ly o p p o r tu n e if it is

“ s purof the m om e ntc onduc t , i n r e s pons e t o a s udde n f or tui t ous oppor tuni ty of w hi c h the de f

e nda ntt ook a dva nt a ge w i thoutde l i be r a t i on” ( quot a t i on m a r ks o m itted )) . A cc o rd in g ly, th e d istrict co u rt’s d eter m in atio n th at C ru z- N atal’s c o n s p ir a c y o f

f e n s e in v o lv e d m o r e th a n m in im a l p la n n in g w a s n o t c le a r ly erro n eo u s. C . O r gan i z e r or L e ad e r P u r s u an t t o § 3B 1. 1( a) A de f e nda nt ’ s of

f e ns e l e ve l m a y be i nc r e a s e d by f ourl e ve l s “ [ i ] f

the de f e nda ntw a s a n or ga ni z e rorl e a de rof a c r i m i na l a c t i vi ty tha ti nvol ve d f i ve or m ore part i ci pant s or w as ot herw i se ext ensi ve. ” U . S . S . G . § 3 B 1. 1(a) . W i th regard 4 t o th i s fo u r-l ev el en h an cem en tu n d er § 3 B 1 . 1 (a), C ru z-N at al m ak es tw o arg u m en t s, w hi c h w e a ddr e s s i n tur n. F i r s ts he a s s e r t s tha tthe di s tr i c tc our te r r e d i n i m pos i ng a n e nha nc e m e nt unde r§ 3B 1. 1( a ) be c a us e the r e w e r e onl y f ourpa r t i c i pa nt s i nvol ve d i n theA district court’s de cision whether to impose an ag gravating role enha ncement pursuant 5 to § 3B1.1(a) is reviewed f or cle ar error . United States v. Poirier, 321 F .3d 1024, 1036 (11 Cir. th 2003). Cruz-Natal did not raise this argument before the district cour t. Where the c laim or 6 argument is raised for

the first time on appe al, we review f or plain er

ror only . United States v. Rodrigue z, 398 F.3d 1291, 1298 (11 Cir. 2005) (conc luding that where a defendant raises on th 8 conspi ra cy offe nse, nam el y, hers el f, F re sc ob al di , R avel o, and V i go re aux, she w as nota n or ga ni z e rof

a n of f e ns e i nvol vi ng a tl e a s tf i ve “ pa r t i c i pa nt s . ” T he 5 G ui de l i ne s de f

i ne “ pa r t i c i pa nt ” a s “ a pe r s on w ho i s c r i m i na l l y r e s pons i bl e f orthe c om m i s s i on of

the of f e ns e , butne e d notha ve be e n c onvi c t e d. ” U . S . S . G . § 3B 1. 1, c m t. n .1 ; s e e U n ite d S ta te s v . R e n d o n , 3 5 4 F .3 d 1 3 2 0 , 1 3 3 2 ( 1 1 C ir . 2 0 0 3 ) , c e r t. th deni ed, 54 1 U . S . 10 35 , 12 4 S . C t . 21 10 (200 4). I n thi s r e ga r d, the di s tr i c tc our tc onc l ude d tha tD r . G onz a l e z , w hi l e not i nd i ct ed for the conspi ra cy , w as cr i m i nal l y c ul pabl e bec ause she w ou l d h ave had know l e dge tha the rr e que s t s f orthe m e di c a l e qui pm e nt , f orw hi c h S uppor t i ve a nd S & B s o u g h t r e im b u r s e m e n t, w e r e n o t le g itim a te . C ru z - N a ta l d o e s n o t d is p u te th is fi nd i ng . B ec ause C ruz- N at al do es no tdi sput e the di stri ctcourt ’ s f i nd i ng thatD r. G o n z a le z w a s in v o lv e d in th e c o n s p ir a c y , th e d is tr ic t c o u r t w a s n o t c le a r ly e r r one ous i n de t e r m i ni ng tha tthe c ons pi r a c y i n que s t i on i nvol ve d f i ve “p a r tic ip a n ts .” S ec on d, C ruz- N at al ar gu es thatthe di stri ctcourterroneou sl y e nh ance d h er se nt ence beca use s he w as no ta l ea der or organi ze r of the conspi ra cy . H ow ever , 6a

pp e a l an is su eno t ob

je c te d toin t

hedis tric t c ourt , this C ourt reviews fo r p lain error

and wi ll revers eon ly

if (1 ) a n error , ( 2) that is plain, (3 ) a ff e c ts s ub sta

nti a l rights , a

nd (4 ) s e ri ou sly aff ects the f airne ss, integrity , or public reputation of the judicial proc eeding s), cert. denied, 125 S. Ct . 2935 (2005). 9 C ruz - N a t a l a dm i t t e d t o r e c rui t i ng m e m be r s of the c ons pi r a c y a nd di r e c t i ng s om e of the i ra c t i ons . T hi s C our tha s r e c ogni z e d tha t“ [ t ] he de f e nda ntdoe s notha ve t o be the sol e l ea der or ki ng pi n o f the conspi ra cy i n o rdert o b e c on si dere d an o rgani ze r orl e a de rw i thi n the m e a ni ng of the G ui de l i ne s . ” U ni t e d S t a t e s v. V a l l e j o, 297 F . 3d 1154, 1169 ( 11 C i r2002) . F ur the r m or e , a de f e nda ntdoe s notha ve be a l e a de ror th organi ze r of a l l fi ve part i ci pant s f or an enhancem entun der U . S . S . G . § 3 B 1. 1; that is , th e e n h a n c e m e n t is w a r r a n te d if th e d e f e n d a n t w a s a le a d e ro ro r g a n iz e ro f o n ly one of the othe rpa r t i c i pa nt s . S e e U ni t e d S t a t e s v. Y e a ge r , 331 F . 3d 1216, 1226 ( 11 C i r . 2003) . B a s e d on C ruz - N a t a l ’ s a dm i s s i ons tha ts he r e c rui t e d m e m be r s of th the c ons pi r a c y a nd di r e c t e d s om e of the i ra c t i ons , i tw a s note r r or , pl a i n or othe r w i s e , f

orthe di s tr i c tc our tt o c onc l ude tha tC ruz - N a t a l w a s a n or ga ni z e ror l ead er o f th e co n sp i racy. F o ra ll th e a b o v e r e a s o n s , w e c o n c lu d e th a t th e d is tr ic t c o u r t p r o p e r ly appl i ed the four-l evel enhancem entun der § 3B 1. 1(a) . D . U s e o f

a S p e c ia l S kill P u r s u a n t t o § 3 B 1 .3 S e c tio n 3 B 1 .3 p r o v id e s f o ra tw o - le v e l e n h a n c e m e n t “[ i]f th e d e f e n d a n t . . . us e d a s pe c i a l s ki l l [ ] i n a m a nne rtha ts i gni f i c a nt l y f a c i l i t a t e d the c om m i s s i on or10

conceal m entof the offens e. ” U . S . S . G . § 3 B 1. 3. A l tho ug h an account ant , C ruzN at al arg u es th atn o sp eci al sk i l l s w ere req u i red t o co m m i th er o ffen se an d , th u s, th e d is tr ic t c o u r t e r r o n e o u s ly ap p lie d a tw o - le v e l e n h a n c e m e n t p u r s u a n t to § 3 B 1 .3 . W e n e e d n o t a d d r e s s th e s p e c if ic s o f C ru z - N a ta l’s a r g u m e n t b e c a u s e § 3 B 1 .3 pr ovi de s tha tthe e nha nc e m e ntf orus e of a s pe c i a l s ki l l i s una va i l a bl e i f the defe nd anthas a l re ady r ec ei ved an enh ance m entfor bei ng a l ea der or organi ze r unde r§ 3B 1. 1( a ) . S e e U . S . S . G . § 3B 1. 3 ( “ [ I ] f thi s a dj us tm e nti s ba s e d s ol e l y on the us e of

a s pe c i a l s ki l l , i tm a y notbe e m pl oy e d i n a ddi t i on t o a n a dj us tm e nt un der § 3B 1. 1. ”) . B ec ause C ruz- N at al re ce i ved a four-l evel enhancem entun der § 3 B 1. 1(a) for bei ng a l ea der or organi ze r, she s ho ul d n othave rec ei ved a tw o-l evel e n h a n c e m e n t u n d e r§ 3 B 1 .3 f o ru s e o f a s p e c ia l s k ill. B e c a us e C ruz - N a t a l s houl d notha ve r e c e i ve d a tw o- l e ve l e nha nc e m e nt unde r§ 3B 1. 3, the di s tr i c tc our te r r e d i n c a l c ul a t i ng he rG ui de l i ne s r a nge a s 70- 87 m onths ’ i m pr i s onm e nt . T hus , w e va c a t e the de f e nda nt ’ s 72- m onth s e nt e nc e a nd re m and t hi s c as e f

or re se nt enci ng w i tho utthi s tw o-l evel enhancem ent . W e, h o w e v e r , a f

f ir m th e d is tr ic t c o u r t’s im p o s itio n o f a ll o th e re n h a n c e m e n ts in th is c a s e , w hi c h r e s ul ti n a n a dj us t e d ba s e of f e ns e l e ve l of

24 a nd a G ui de l i ne s r a nge of 57 -71 m on ths’ i m pri sonm ent(w i th a C ri m i nal H i st ory C at egory I I) . T hu s, on re m and, the di stri ctcourti s r equi re d t o sent ence C ruz- N at al un derWe do not mean to sug g est by our holdingthat the district court must impose any 7 particula r sentenc e on remand. We also do not attempt to decide nowwhether a par ticular sentenc e on remand might berea sonable in this case . 11 a n a dvi s or y G ui de l i ne s r e gi m e , a nd s ha l l c ons i de rthe G ui de l i ne s r a nge of 57- 71 m o n th s ’ im p r is o n m e n t a n d “o th e rs ta tu to r y c o n c e r n s a s w e ll, s e e [ 1 8 U .S .C .] § 3553( a ) ( S upp. 2004) . ” B ooke r , 125 S . C t . a t757. 7 V A CA TED a n d REM A N D ED W I TH I N STRU CTI O N S.