N O T FO R PUB L ICAT IO N UNITED STATES C OUR T OF APPEALS FOR THE NINTH C IR C U IT
UNITED STATES OF AM ER IC A, Plaintiff - Appe lle e , v. ALEXANDER

POPOV, De fe nda

nt - Appe lla

nt. No. 12-10045

D.C . No. 2:08-c r-00427-M C E-6
M EM O R ANDUM *

UNITED STATES OF AM ER IC A, Plaintiff - Appe lle e , v. R AM ANATHAN PR

AKASH, De fe nda

nt - Appe lla

nt. No. 12-10553

D.C . No. 2:08-c r-00427-M C E-7

UNITED STATES OF AM ER IC A, Plaintiff - Appe lle e , v. LANA Le C HAB R IER , De fe nda

nt - Appe lla

nt. No. 12-10389

D.C . No. 2:08-c r-00427-M C EEFB -5 

# FIL ED
FEB 11 2014 M OLLY C. DW Y E R, CLERK U. S. CO URT O F APPEALS

* This disposition is not appropriate for publication and is not precedent ex cept as provided by

9th Cir. R. 36-3.Appe a l from the Unite d

Stat e s Distric t C ourt for the Ea ste rn Distric t of C a lifornia M o rrison C . Engla

nd, Jr., C hie f Distric t

Judge , Pre siding Argue d an d Subm i tte d

Nove m be r 5, 2013 San Fran c isc o , C a lifornia B e fore : REINHAR

DT a nd WATFORD, C irc uit Judge s, a n d LASNIK, ** Distric t Judge
. R am anatha

n Praka sh a

nd La na Le C h a brie r a p pe a l the ir c onvic tions of
c onspira c y

to c om m it he a lth c a

re fra ud a nd he a lth c a

re fra ud. Pra ka sh a nd Ale xa nde r Popov a

ppe a l the distric t c ourt’ s a p plic a tions of m

ultiplese nte nc ing
e nha nc e m e nts. W e have jurisdic tion pursua n t to 28 U.S.C . § 1291 a

nd a ffirm
. 1 1. Ne ithe r Prak a sh nor Le C ha brie r ha s shown tha

t the distric t c ourt a

buse d its disc re t ion whe n it de nie d the ir m otions to c ontinue the tria l. Unite d Stat e s v. Fly n t, 756 F.2d 1352, 1359 (9th C ir. 1985). B e y ond la be l ing the gove rnm e nt’ s
e xpe rt “ the ke y

gove rnm e nt witne ss,” Pra ka sh ha s not shown tha t his de fe nse suffe re d a c tua l pre

judic e a s a

re sult of thec ourt’ s de c isions de ny i ng him a
c ontinua nc e to obta in a

re b utta l e xpe rt witne ss. Unite d Stat e s v. W ilke s, 662 F.3d 524, 543 (9th C ir. 2011) (“ W he re the de nia l of a c ontinua n c e pre v e n ts the

1 I n a simultaneously

filed published opinion we vacate the district court’s finding s reg ardingthe amount of loss intended by Popov and Prakash for sentencing purposes and remand for resentencing

on that issue only
. 2introduc tion of spe c ific e vide nc e , the pre judic e inquiry

foc use s on the signific anc e of tha t e v ide n c e .” ) (quoting Unite d State s v. R ive ra -Gue rre ro, 426 F.3d 1130, 1142 (9th C ir. 2005)). M ore ove r, the distric t c o urt re a sona

bly c onside re d Praka sh’ s fa ilure to a c t dilige ntly

to pre p a re his c a se for tria l whe n it de nie d his m otions. Se e Fly n t, 756 F.2d a

t 1359. Sim ila rly , in light of Le C ha

brie r’ s a dm issions tha

t she signe d M e dic are
e nrollm e nt form s, ope ne d a ba n k a c c ount to re c e ive M e dic are pa ym e nts, a n d signe d patie nt c ha

rts for the R ic hm ond c linic e ve n though she ne ve r e x am ine d a single pat ie nt, Le C ha

brie r ha s not e sta

blishe d tha

t the ve rdic t would ha

ve be e n diffe re nt ha d she be e n gra nte d a c ontinua nc e to se c ure a

ha n dwriting e xpe rt’ s te stim ony . W ilke s, 662 F.3d a t 543. B e c a

use the pa rtie s ha d be e n in tria l for a
m onth whe n Le C ha

brie r m ove d for a

c ontinua nc e , the c ourt prope rly c onside re d the i nc onve nie nc e to the c ourt a nd the gove rnm e nt in de ny ing the re que s t. Se e Fly n t, 756 F.2d a

t 1359. 2. This c o urt re vie ws a

distric t c ourt’ s form

ulation of jury

instruc tions for
a buse o f disc re tion, unle ss the de fe nda nt fa ile d to obje c t

at tria l , in whic h c a se , the instruc tions a

re re vie we d for pla in e rror. Unite d State s v. C hi M ak, 683 F.3d 1126, 1133 (9th C ir. 2012). A distric t c ourt’ s finding tha t a fa c t ua l founda

tion doe s not
e xist to support a

jury instruc t ion propose d by

the de fe nda

nt is re vie w e d for a

n
3a

buse o f disc re tion. Unite d State s v. C a ste lla nos-Ga rc ia , 270 F.3d 773, 775 (9th C ir. 2001). Pra

ka s h a rgue s tha t the distric t

c o urt e rre d by

not giving a

4 m ultiple
c onspira c ie s instruc t ion be c a use the re wa s e vide nc e from whic h the jury

c o uld have c o nc lude d

tha t he wa s pa

rt of a sm a lle r c onspira c y

involving just one

c linic
. W he the r Pra ka sh wa s a

ware of the othe r c linic s or othe r phy sic ia ns involve d in the
ove ra l l sc he m e is not de te rm i native , howe ve r, be c a use “ a single c onspira c y

c an inc l ude subgroups or suba gre e m e nts.” Unite d Stat e s v. M inc off, 574 F.3d 1186, 1196 (2009) (interna l quota t ions a nd c ita tion omitte d). Although the distric t c ourt de c line d to givethe m u ltiple c o nspira c ie s instruc tion, thec ourt ga

ve the sta nda rd c onspira c y

instruc tion se tting forth the
e le m e nts of a c onspira c y , a s we ll a s Ninth C irc uit M ode l C rim ina l Jury Instruc tion 8.23, Knowle dge of a

nd Assoc iation with Othe r C onspira

tors. The se instruc tions
we re suffic ie n t

to a ddre ss Praka sh’ s de fe nse the ory tha t he wa s not involve d in the
c onspira c y

a lle ge d in the indic tm e nt be c a use he wa s not a

ware of the othe r c linic s or the othe r doc tors who subm itte d M e dic are c la im s on be ha lf of those c l inic s. The distric t c ourt the re fore did not a buse its disc re tion whe n it de nie d Praka sh’ s
re que s t to givethe m

u l tiple c o n spira c ie s instruc tion. Unite d State s v. Fe rnande z , 388 F.3d 1199, 1248 (9th C ir. 2004). 3. W e re je c t Praka sh’ s a

rgum e nt tha

t the distric t c ourt punishe d him for
4going to trial by c a lc ulating theam ount of loss for sente nc ing purpose s ba se d on the t ota l a m ount bille d to M e d i c are . Eve n though the gove rnm e nt’ s loss
c a lc ulat ions in the ple a

a gre e m e nts 2 in this c a se are dram a tic a lly diffe re nt from

its loss c a lc ulations for de fe nda nts who e xe rc ise d the ir c onstitutiona l rights to trial, “ a
se nte nc ing dispa

rity ba s e d on c oope ra tion is not unre a sona ble .” Unite d State s v. C arte r, 560 F.3d 1107, 1121 (9th C ir. 2009) (“ [S] o long a s the re is no indic a tion the d e fe nda

nt ha s be e n re ta lia

te d a ga inst for e xe rc ising a c onstitutiona

l right, the gove rnm e nt m ay

e nc oura ge ple a

ba rga ins by a ffording le n ie nc y to thosewho e nte r ple a s. Fa ilure to a fford le n ie nc y to thosewho ha

ve not de m onstra

te d those
a ttribute s on whic h le nie n c y is ba se d is une quivoc a lly . . . c onstitutiona

lly prope r.” ) (inte rna l quota

tion m arks a

nd c ita tion omitte d ). 4. W e re vie wa

distric t c ourt’ s c onstruc tion a nd inte rpre tation of theUnite d Stat e s Se nte nc i ng Guide line s M anua l (“ Guide line s” ) de novo, thedistric t c ourt’ s
a pplic a tion of the Guide l ine s to the fa c ts of the c a se for a buse of disc re tion, a

nd the distric t c o urt’ s fa c tua l findings for c le ar e rror. Unite d State s v. Kim bre w, 406 F.3d 1149, 1151 (9th C ir. 2005). C ontra ry to Praka sh’ s a

nd Popov’ s a

rgum e nts, the Guide line s’ sophistic a te d m e ans e nha nc e m e n t “ prope rly

a pplie s to c onduc t le ss sophistic a te d tha

n the list a

rtic ulate d in the a

pplic a tion note .” Unite d State s v.

2 Prakash’s arg

ument is based entirely

on the g overnment’s representations in plea ag reements and not on the sentences actually imposed by

the court. 5Je nnings, 711 F.3d 1144, 1147 (9th Cir. 2013).

B a se d on the e vide nc e in the re c ord tha t Praka sh a

nd Popov a

pplie d for M e d ic are provide r num

be rs, ope ne d ba

nk a c c ounts to use

a s pa rt of the sc he m e , re vie we d and signe d patie nt c ha

rts tha t re fle c t signific an t te sting e ve n though
ne ithe r doc tor sa

w a single p atie nt, a

nd signe d M e dic a

re re im burse m e nt form s a

nd bla n k re de te rm ination re que st form s for a c linic involve d in the ove ra ll sc he m e , the distric t c o urt re a s ona

bly c ould ha ve c o nc lude d tha

t the sc he m e wa s signific antly
m ore c om ple x tha n a routine M e dic are fraud c a se . 5. The distric t c ourt did not err in a pply ing a two-le ve l se nte n c e
e nha nc e m e nt unde r U.S.S.G. § 3C 1.1 for obstruc tion of justic e . Eve n a s sum ing that the fa ilure to disc lose Pra ka sh’ s trust a sse t s to the Unite d Stat e s proba

tion offic e r a nd the distric t c ourt wa s the re sult of his a ttorne y s ’ e rrors, Pra ka sh
ne gle c ts the im

pa c t of the re c orde d ja il c a lls during which Praka sh (1) dire c te d his son to ta ke ste ps to hidehis a sse ts from the gove rnm e nt, (2) a gre e d to m o ve a sse ts to a v oid de te c tion, a

nd (3) a gre e d to m ak e fa lse sta te m e n ts to thec ourt a

bout his fa iling he a lth a

nd we ight loss. The

distric t c ourt prope rly

found tha

t Prak a sh provide d fa lse an d m isle a d ing inform a tion to the probation offic e r and the c ourt,
and tha t he e nc oura ge d a

nd dire c te d the obstruc tive c onduc t of othe rs. Se e Unite d Stat e s v. R e y e s , 577 F.3d 1069, 1083 (9th C ir. 1996) (“ [T] he de fe nda nt is
6a c c ounta

ble for his own c o nduc t a nd for c onduc t

tha t he a ide d or a

be tte d,
c ounse le d, c o m

m a nde d, induc e d, proc ure d, or willfully c a use d.” ) (quoting U.S.S.G. § 3C 1.1 c m

t. 9). 6. W e re je c t Praka sh’ s c ha lle nge to the two-le ve l se nte nc ing e nha nc e m e nt that the distric t c ourt a

pplie d for c onduc t involving “

the c onsc ious or re c k le ss risk of de a th or se rious bodily injury .” U.S.S.G. § 2B 1.1(12) (2007). Although Pra ka s h did not supervise the e xam inations pe rform e d or the se rvic e s provide d at the Sa c ra m e nto c linic , he signe d the pat ie nt c ha

rts a nd the M e dic a

re
re im burse m e nt form s indic a ting tha t he ha d a nd the re wa s e v ide nc e tha t the se
se rvic e s produc e d a

se rious risk to the

patie nts’ he a lth. “ In light of our de fe re ntia l sta nda rd of re vie w, we c annot sa y tha t the distric t c ourt c le arly

e rre d in finding tha

t [Pra ka sh’ s] c onduc t pose d a risk of se rious bodily

injury or de at h, e ve n if we would not ha

ve m a de the sa

m e finding.” Unite d State s v. Awa d , 551 F.3d 930, 941-42 (2009) (upholding distric t c ourt’ s a pplic a tion of e nha

nc e m e nt for c o nsc ious
or re c kle ss risk in he a lth c are fra ud c a se whe re de fe nda

nt’ s c onsiste nt fa i lure to supe rvise je opa

rdiz e d patie nts’ he a lth). 7. B e c a use the re c ord be low is suffic ie nt for us to re v ie w Le C ha b rie r’ s lim ite d c la im

of ine ffe c tive a s sista

nc e , we c onside r an d re

j e c t he r c la im that
c ounse l’ s fa ilure to obta i n a ha ndwriting e xpe rt c onstitute d ine ffe c t ive a s sista nc e
7of c ounse l unde r Stric kla nd v. W a shington, 466 U.S. 668 (1984). Unite d State s v. R ive ra -Sa nc he z , 222 F.3d 1057, 1060 (9th C ir. 2000) (“ W e will only re v ie w ine ffe c tive a ssista

nc e c la im s on dire c t

a p pe a l whe re the re c ord is suffic ie ntly de ve lope d to pe rm it re vie wand de te rm ination of the issue , or the le ga l
re pre se ntation is so ina

de quat e tha

t it obviously

de nie s a de fe nda nt his Sixth Am e ndm e nt right to c ounse l.” ) (inte rna l quota tion m a rks a n d c ita tion omitte d). He re , Le C ha

brie r’ s tria l c ounse l’ s fa ilure to pursue a ha n dwriting e xpe rt wa s not de fic ie nt be c a

u se she told c ounse l tha

t she did, in fa c t, sign M e dic are form s
and the re wa s no re a son to que stion he r state m e nts. Se e Stric kla nd, 466 U.S. a

t 691 (“ [W ] he n a

de fe nda nt ha s give n c ounse l re a son to be lie ve tha t pursuing c e rta in inve stiga tions would be

fruitle ss or e ve n

ha rm ful, c o unse l’ s fa ilure to pursue those inve stiga tions m ay not la te r be c ha l le nge d a s unre a sona ble .” ). Nor wa s this fa ilure pre j udic i a l to he r de fe nse . The re c ord shows tha t Le C ha brie r a dm itte d signing M e d ic are e nrollm e nt form s, ope ne d a ba nk a c c ount to re c e ive M e dic are pa ym e nts,
and signe d patie n t

c ha rts for one of the c linic s without e ve r se e ing a patie nt. Thus,
we c onc lude tha

t Le C ha brie r ha s fa ile d

to de m onstra

t e tha t she wa s de prive d of the
e ffe c tive a s sista

n c e of c ounse l. 8. During ora l a

rgum e n t, Le C ha

brie r c onc e d e d tha

t she wa ive d a

ny c la im she m ay have ha d unde r the Spe e dy Tria l Ac t by fa i ling to m ove for dism issa l prior
8to tria l. Se e 18 U.S.C . § 3162(a )(2); Unite d State s v. Ta nh Huu La

m , 251 F.3d 852, 860 (9th C ir. 2001). W e the re fore de c line to c onside r he r argum e nts re late d to the Spe e dy

Tria l Ac t. AFFIRM E D.

9