NOT RECOMMENDED FOR PUBLICATION

File Name: 21a0133n.06

No. 20-1393

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

UNITED STATES OF AMERICA,

Plaintiff-Appellee,

v.

DOMINIQUE TRUMBO,

Defendant-Appellant.

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ON APPEAL FROM THE 

UNITED STATES DISTRICT 

COURT FOR THE EASTERN 

DISTRICT OF MICHIGAN

BEFORE: BATCHELDER, MOORE, and BUSH, Circuit Judges.

ALICE M. BATCHELDER, Circuit Judge. A jury convicted defendant Dominique 

Trumbo of one count of conspiracy to defraud the United States, in violation of 18 U.S.C. § 371, 

and three counts of receiving illegal renumeration in a federal healthcare program, in violation of 

42 U.S.C. § 1320a-7b(b)(1)(A), and 18 U.S.C. § 2, stemming from his participation in a healthcare 

kickback scheme. On appeal, Trumbo argues for reversal of his conviction because (1) the trial 

court improperly admitted character evidence and gave faulty jury instructions, and (2) the 

prosecutor’s conduct denied him a fair trial. Finding no merit in Trumbo’s arguments, we affirm

his conviction. 

I.

Medicare Part A covers inpatient services, including home healthcare for individuals who 

are disabled or over 65 years old. To qualify for home healthcare services, the eligible patient 

must obtain a referral from a physician. After that, the patient chooses a home healthcare agency 
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to provide the prescribed services. If the agency providing the home healthcare wants Medicare 

reimbursement, it must abide by certain Medicare rules and regulations, including the federal antikickback statutes. The anti-kickback statutes protect consumers’ rights to choose their healthcare

service providers by punishing providers and individuals who participate in schemes that hinder

consumers’ ability to choose. 

In this case, a jury convicted Trumbo of conspiring with home healthcare agencies to 

receive kickbacks and of receiving kickbacks (money) from a home healthcare agency called U.S. 

Home Health Care, in exchange for consumer information.

Trumbo owned and operated Trumbo Consulting Agency (TCA), a telemarketing company 

that targeted Medicare beneficiaries in several states, including Michigan. TCA sought to enroll 

its eligible clientele with various home healthcare agencies. To expedite the process, TCA 

contracted with doctors who provided home healthcare prescriptions for new enrollees. TCA even

offered current patients certain perks, such as free housekeeping, to entice reluctant patients to 

continue their home healthcare services. 

Pertinent to this case, after TCA enrolled the new patients, the prescribing doctors referred 

the patients to U.S. Home Health, owned by Tasadaq Ali Ahmad. In exchange, U.S. Home Health 

paid Trumbo between $200 and $500 for each new patient who successfully billed Medicare. 

Ahmad testified that to cover up his per-patient kickback scheme, TCA would bill U.S. Home 

Health for hours worked, and U.S. Home Health would use false notations on the checks, such as 

“community liaison service” and “patient coordinator.” 

From 2005 to 2016, Trumbo recruited 376 patients. From 2013-2017, Medicare paid U.S. 

Home Health $524,752 for 87 patients that Trumbo recruited. During that time, Trumbo deposited 

$101,360 worth of checks from U.S. Home Health. 
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In 2018, the government charged Trumbo with conspiring with Ahmad and others to 

commit healthcare and wire fraud, in violation of 18 U.S.C. § 1349; conspiring with Ahmad and 

others to pay and receive healthcare kickbacks, in violation of 18 U.S.C. § 371; and three counts 

of receipt of kickbacks in connection with a federal healthcare program, in violation of 42 U.S.C. 

§ 1320a-7b(b)(1)(A), and 18 U.S.C. § 2. 

Before trial, the government notified the district court that it planned to introduce other-act 

evidence under Federal Rule of Evidence 404(b). R. 41. Specifically, to prove knowledge and 

lack of mistake, the government planned to introduce evidence that Trumbo received illegal 

healthcare kickbacks from two other home healthcare agencies. The evidence included testimony 

from Rommel Perez, the owner of Premium Home Health, who told authorities that he paid 

Trumbo for referrals on a per-patient basis. The district court ruled, over Trumbo’s objection, that 

the evidence as it pertained to Trumbo’s “allegedly receiving money in exchange for patients 

receiving medical treatment” was admissible under Rules 404(b) and 403 to show “intent, plan, 

knowledge, and absence of mistake or accident.”

At trial, the government presented seven witnesses, including Ahmad and Perez, and 

introduced numerous exhibits, including recorded telephone calls between Ahmad and Trumbo, 

emails between Trumbo and the home healthcare agencies, and bank records. Trumbo’s defense 

comprised only his testimony and financial records. 

The jury convicted Trumbo on the kickback-related charges and acquitted him on the 

healthcare-fraud charge. He timely appeals. 

II.

On appeal, Trumbo argues that we must reverse his conviction for four reasons: (1) the 

district court improperly admitted Rule 404(b) evidence; (2) the district court permitted the 
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government to impeach Trumbo improperly; and (3) the district court refused to give Trumbo’s 

proposed good-faith jury instruction; and (4) the prosecutor’s conduct unfairly prejudiced 

Trumbo’s defense. None of his arguments warrants reversal of his conviction.

a. Federal Rule of Evidence 404(b)

Trumbo argues that the district court improperly admitted under Federal Rule of Evidence 

404(b) evidence relating to Trumbo’s kickback agreements with Premium Home Health and 

Maxicare Home Health Agency. Specifically, Trumbo argues that the prejudicial effect of the 

404(b) evidence outweighed any probative value. We disagree.

Rule 404(b) bars evidence of a defendant’s prior bad acts when offered only to prove

character. Fed. R. Evid. 404(b)(1). A court may, however, admit prior-bad-acts evidence if it is 

relevant to prove a defendant’s “motive, opportunity, intent, preparation, plan, [or] knowledge,”

Fed. R. Evid. 404(b)(2), so long as any unfair prejudicial effect does not substantially outweigh 

the evidence’s probative value under Federal Rule of Evidence 403. We review for abuse of 

discretion the district court’s Rule 403 determination. United States v. Pritchard, 964 F.3d 513, 

523–24 (6th Cir. 2020). “District courts enjoy ‘broad discretion’ in making the prejudice 

determination.” United States v. Asher, 910 F.3d 854, 860 (6th Cir. 2018).

Under both 42 U.S.C. § 1320a-7b(b)(1)(A), and 18 U.S.C. § 2, the government had to prove 

that Trumbo “willfully” received kickbacks from U.S. Home Health in exchange for patient 

referrals. In other words, it had to prove that Trumbo knew that he was receiving kickbacks 

unlawfully. See United States v. Roth, 628 F.3d 827, 834 (6th Cir. 2011) (“Generally . . . in 

criminal cases, in order to establish a ‘willful’ violation of a statute, the Government must prove 

that the defendant acted with knowledge that his conduct was unlawful.” (cleaned up)). Trumbo’s 

defense was that he did not have the requisite mens rea because he was not aware of U.S. Home 
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Health’s illegal conduct. Trumbo’s testimony, therefore, made the prior-bad-act evidence highly 

probative to show that he did have the requisite mens rea, i.e., that he willfully received kickbacks 

and that he was not mistakenly entangled in U.S. Home Health’s illegal scheme. 

We are not convinced that the evidence was more unfairly prejudicial than probative. 

Limiting instructions diminish “any unfair prejudice by reducing the risk that the jury would put 

the evidence to an improper purpose.” United States v. Potter, 927 F.3d 446, 452 (6th Cir. 2019). 

Here, the district court instructed the jury that it could use the evidence “only as it relates to the 

Government’s claim on the Defendant’s intent, knowledge, or absence of mistake” and that it 

“must not consider it for any other purpose.”

The district court did not abuse its discretion by finding that any unfair prejudice resulting 

from the admission of the Rule 404(b) evidence did not substantially outweigh that evidence’s 

probative value.

b. Rule 607 Impeachment Evidence

Trumbo next argues that the trial court plainly erred by allowing the government to 

introduce prior-bad-acts evidence when it cross-examined Trumbo about his 2014 and 2015 tax 

returns. At trial, Trumbo used his tax returns to refute the government’s claim that he received 

approximately $100,000 from U.S. Home Health. Trumbo testified that in 2014, he reported 

income of $34,027, and in 2015 he reported income of $23,968. Trumbo claimed that he 

“[a]lways” reported “all” his wage income and denied that he was paid on a per-patient basis. To 

bolster his testimony, Trumbo introduced into evidence his 2014-2017 tax returns. On crossexamination, the government questioned Trumbo about his reported income and about thousands 

of dollars in payments he received from home healthcare agencies but did not report on his 2014-
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and 2015-income tax returns. Trumbo had no explanations for those omissions, stating only that 

he needed to talk to his tax consultant. 

Because Trumbo did not object to that line of questioning at trial, and instead raises it here 

for the first time, we review for plain error. United States v. Crawford, 943 F.3d 297, 311 (6th 

Cir. 2019). “To establish plain error, a claimant must show: (1) error, (2) that is plain, (3) that 

affects the defendant’s substantial rights, and (4) that ‘seriously affect[s] the fairness, integrity, or 

public reputation of the judicial proceedings.’” United States v. Brown, 332 F.3d 363, 370 (6th 

Cir. 2003).

Trumbo’s argument fails on the first prong. Even if we assume that the unreported-income 

evidence is evidence of prior bad acts under Rule 404(b), Trumbo opened the door to its admission 

when he testified about the accuracy of his tax returns and entered them into the record. As we 

said in United States v. Ross, 502 F.3d 521, 529 (6th Cir. 2007), “the government is allowed to 

impeach any statement made by [the defendant] in his direct examination through crossexamination under Federal Rule of Evidence 607.” Moreover, we have “consistently recognized 

the broad scope of allowable impeachment evidence.” United States v. Markarian, 967 F.2d 1098, 

1103 (6th Cir. 1992). In fact, “[a] defendant’s introduction of evidence may render his prior acts 

relevant for impeachment purposes, ‘thus making admissible what may not have been admissible 

otherwise’ under Fed. R. Evid. 404(b).” United State v. Clingman, 521 Fed App’x 386, 395 (6th 

Cir. 2013). That is precisely what happened here. The government sought to impeach Trumbo 

only after he testified that he accurately reported his income on his 2014 and 2015 tax returns.
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Trumbo argues in the alternative that the court plainly erred by failing to sua sponte instruct 

the jury that it could consider that evidence for impeachment purposes only. But this argument 

fails too. The district court is under no obligation to sua sponte limit evidence to which a party

does not object. United States v. Henderson, 626 F.3d 326, 338 (6th Cir. 2010). After all, Federal 

Rule of Evidence 105 requires the objecting party to “timely request” the limiting instruction. 

The district court did not plainly err by allowing the government to cross-examine Trumbo 

about his tax returns. 

c. Good-Faith Jury Instruction 

Trumbo argues that the district court abused its discretion when it declined to give his 

proposed instruction of “good faith” regarding his four anti-kickback charges. 

We review for abuse of discretion the district court’s denial of a proposed jury instruction. 

United States v. Maddux, 917 F.3d 437, 447 (6th Cir. 2019). We consider the instructions “as a 

whole in order to determine whether they adequately inform the jury of relevant considerations 

and provide a basis in law for aiding the jury to reach its decision.” United States v. Godofsky, 943 

F.3d 1011, 1027–28 (6th Cir. 2019) (internal quotation marks omitted). “A district court’s refusal 

to give a proposed jury instruction is an abuse of discretion only if the proposed instruction (i) 

correctly states the law, (ii) is ‘not substantially covered’ by the instructions actually given, and 

(iii) concerns a point so important ‘that failure to give it substantially impairs the defendant’s 

defense.’” Maddux, 917 F.3d at 447. Here, the court’s instructions substantially covered Trumbo’s 

proposed instruction.

Trumbo requested that the district court instruct the jury on his “good-faith defense to 

willfulness” as to each count. But because the good-faith instruction is limited to charges of fraud, 

the district court gave it only for Count 1, the healthcare-fraud conspiracy charge. See Sixth Circuit 
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Pattern Jury Instruction § 10.04 (2019). The court nonetheless instructed the jury that “[t]he word 

willfully means that the act was done voluntarily and purposefully with the intent to violate a 

known legal duty; that is, with the intent to do something the law forbids.” 

Because “the good-faith requirement is effectively bundled into the willfulness 

instruction,” the district court substantially covered Trumbo’s request. United States v. Damra, 

621 F.3d 474, 502 (6th Cir. 2010). Therefore, the court did not abuse its discretion. 

d. Prosecutorial Misconduct

Trumbo argues on appeal that the prosecutors committed misconduct by (1) portraying him 

as a “bad man” and (2) improperly vouching for the credibility of Ahmad and Perez. Trumbo did 

not object to any of this at trial, so we review for plain error. See United States v. Gonzalez, 512 

F.3d 285, 292 (6th Cir. 2008). Both arguments fail.

To evaluate a claim of prosecutorial misconduct, we must first determine whether the 

statements at issue were improper. United States v. Henry, 545 F.3d 367, 376 (6th Cir. 2008). If 

the statements were improper, we next assess whether they were “so ‘flagrant’ as to warrant 

reversal.” Id. When the defendant fails to object at trial to the conduct at issue, he must show that 

the prosecutor’s comments were “exceptionally” flagrant. Gonzalez, 512 F.3d at 292.

Trumbo argues that the government’s closing argument misled the jury by resorting to 

“exaggeration and hyperbole in an effort to overwhelm the jury” with “large numbers” and 

improperly admitted evidence. But the government did not say anything that was not supported 

by the record. For example, the closing argument reflected the number of patients that Trumbo 

recruited for U.S. Home Health, the amount of money that he received as illegal kickbacks, and 

the amount of money that Medicare paid to U.S. Home Health as a result of those referrals. 

Furthermore, the government did not exaggerate in stating that Trumbo deposited $121,000 in 
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kickback checks. The record supports that portion of the government’s argument, which directly 

refuted Trumbo’s testimony that he received only $15,000 to $30,000 of home healthcare 

payments each year. Moreover, the government’s mentions of Trumbo’s tax returns were likewise 

proper responses to Trumbo’s testimony that he accurately reported his income in 2014 and 2015. 

Considering the government’s closing argument “in the context of the trial as a whole,” we find 

no plain error. See Henry, 545 F.3d at 377.

Next, Trumbo argues that the government improperly vouched for Ahmad’s and Perez’s 

credibility by asking them about the terms of their plea agreements, specifically whether they 

agreed to testify truthfully against Trumbo in exchange for a possible lower sentence. This claim 

also fails. 

“Improper vouching occurs when a prosecutor supports the credibility of a witness by 

indicating a personal belief in the witness’s credibility thereby placing the prestige of the office of 

the United States Attorney behind that witness.” United States v. Francis, 170 F.3d 546, 550 (6th 

Cir. 1999). We have held that “it is not improper vouching for the prosecutor to refer to the plea 

agreements of cooperating witnesses in the expectation that their credibility will be at issue.” 

United States v. Reid, 625 F.3d 977, 983 (6th Cir. 2010). It also is not improper “to elicit testimony 

that the plea agreement contains a promise to testify truthfully.” Id.; see also United States v. 

Trujillo, 376 F.3d 593, 608–09 (6th Cir. 2004) (The prosecutor did not engage in improper 

vouching when his questions and comments “merely encompassed the terms of [the cooperating 

witnesses’] plea agreements.”).

Here, the government did nothing more than ask Ahmad and Perez about the terms of their 

plea agreements. It did not imply that agreements guaranteed truthfulness, and it made clear that 

the judge, not the government, would determine Ahmad’s and Perez’s sentences. See Reid, 625 
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F.3d at 983–84 (finding no improper vouching where the prosecutor “made sure to emphasize that 

it was the judge who would decide whether to grant any reduction in sentence for providing 

substantial assistance” and “did not imply any special knowledge regarding the credibility or 

truthfulness of the cooperating witnesses”). The government’s colloquy was appropriate.

Trumbo’s prosecutorial misconduct arguments do not satisfy the plain-error standard. 

III.

For the foregoing reasons, we AFFIRM the judgement of the district court.