[DO N OT PUBLISH] IN THE UN ITED STATES COURT OF APPEALS FOR THE ELE VENTH CIRCUIT

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UNITED STAT ES OF AMERIC A, ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll l l Pl ai nt iff -Ap pe ll ee, vers us J. HARRI S MORGAN, JR ., ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll Defen da nt -Ap pe ll an t.

__ __ __ __ __ __ __ __ __ __ __ __ App eal fro m

th e Uni te d S ta te s Di st ric t Co urt forth e Mi dd le Dis tri ctof Ge or gi a

__ __ __ __ __ __ __ __ __ __ __ __ (No ve m be r 28 , 20 12 ) Befo re MAR CUS, MARTIN an d F AY, Circ ui t J ud ge s. PER CURI AM: J. Harr is Mo rg an , Jr. ap pe al s h is co nv ic ti on s fo r 69 co un ts of h eal th carefrau d, i n v io la ti on of 1 8 U.S.C. § 13 47 . On ap pe al , he a rg ue s tha t: (1) th ere i s

in su ffi ci en t ev id en ce t o uph ol d h is co nv ic ti on s; (2) th e d is tri ctco urt ab us edit s di sc ret io n b y

adm it ti ng ev id en ce o f un ch arg edfal se he al th care cla im s, i n v io la ti on of Fed eral Ru le of Ev id en ce 4 04 (b ); a nd(3) th e co urt ab us edit s d is cret io n b y refu si ng to gi ve th e g oo d fa it h ju ry in st ru ct io n t ha t M or ga n re qu es te d. Fo r th e reas on s s etfor th be lo w, we affi rm Mo rg an ’s con vi ct io ns . I. Mo rg an , a ph arm aci st , own edThri ft C en te r Ph arm acy (“ Thri ft” ) an d Op ti on Care . Thri ft wa s a p ha rm acy pro vi de r wit h Geo rg iaMed ic ai d. Mo rg anwas ch arg edwith 6 9 c ou nt s o f he al th care frau d, i n v io la ti on of § 13 47 . Spe ci fic al ly, 58 of t ho se co un ts all eg edth athe ha d s ub m it te d, an d i ns tru ct edothe rs to subm it , fal se cla im s re gard in g S yna gi s t o Geo rg iaMed ic ai d. Th e in di ct m en t al le ge d t ha t Mo rg ansubm it te d c la im s fo r la rg er d os es of S yna gi s tha n wer e actua ll y di sp en se d, fal se di ag no se s t o o bt ai n app ro va l t o a dm in is te r Syna gi s, an d c la im s fo r Syna gi s m or e o fte n t ha n i t was actua ll y be in g a dm in is te redto th e p at ie nt s. Th e fi na l 1 1 co un ts all eg edth atMo rg ansubm it te d fa ls e cl ai m s fo r Hep at it is C drug s, Nu tro pi n AQ, and“ ot he r dr

ug s.” Th es e co un ts all eg edth atMo rg ansubm it te d t o Geo rg ia Med ic ai d: (1) fal se cla im s s ta ti ng th atlar ge r do se s o f th e dru gs were ad m in is te red th anha d a ctua ll y

be endi sp en se d t o t he pa ti en ts ; (2 ) cl ai m s s ta ti ng th atth e dru gs 2were ad m in is te redat a n e arl ie r da te th anth ey actua ll y were; an d (3 ) cl ai m s fo r th e drug s m or e o fte n t ha n t he y were o rd eredby the pa ti en ts ’ ph y si ci an s. Mo rg anfil eda pr etria l m ot io n fo r di sc lo su re o f ev id en ce t o b e o ffer ed un de r Ru le 40 4( b) . The co urt s eta de ad li ne by whi ch th e g ov ern m en t was to di sc lo se an y

su ch ev id en ce. Acco rd in g t o t he tri al tes ti m on y , Syna gi s was a m ed ic at io n g iv ento pr em atur e in fan ts an d young ch il dr ento pre ve ntth em fro m co nt ract in g re sp ira to ry syncytial vi ru s (“ RSV”) . It was so ldin 50 an d 1 00 m il li gr am vi al s. Itwas ad m in is te redm on th ly dur in g t he RSV s eas on , whi ch ran fro m Sep te m be r un ti l Apr il du rin g t he ti m e p eri odat i ss ue in th is cas e. Ph arm aci st s o r ph y si ci an s wer e requi redto ob ta in pri orap pr ov al fro m Med ic ai d b efo re ad m in is te rin g S yna gi s t o a Med ic ai d p at ie nt . Whe n d eci di ng whet he r to ap pr ov e th e u se of S yna gi s, Med ic ai d c on si de redth e p at ie nt ’s age , di ag no si s, ri skfact or s fo r RSV, an d o th er di se as es th e p at ie ntha d. If M ed ic ai d d en ie d app ro va l t o a dm in is te r Syna gi s, t he ph arm aci stor p hysic ian h ad72 ho ur s t o upd at e th e in fo rm at io n a ndsee k app ro va l. Jo y ce Sh ep pa rdtes ti fie d t ha t s he was t he bi ll in g c le rkat Th rif t. Sh e d id m os t o f th e Me di cai d S yna gi s b il li ng . Mor gan h adno t g iv enhe r in st ru ct io ns on ho w to subm itSy

na gi s cl ai m s, b uthe di d t el l h er t o b il l i t ev ery 23 da y s. Bi ll in g th atfreque nt ly allo wedThri ft t o p ay it s b il ls an d e ns ur e th atth e p at ie nt s’ 3in su ran ce wo ul d c ov er t he m ed ic at io n. Sh ep pa rdwas c on cern edth atsh e wou ld

subm itto o m an y

Syna gi s b il ls , bu t s he di d n otrem em be r if sh e h adev er t ol d Mo rg anth atitwas h ardto ke ep up wit h t he 23 -d ay bi ll in g c y cl e. Nan cy Pal m er, a re gi st erednu rs e, te st ifi edth atsh e h adpre vi ou sl y work ed as th e nur si ng di rect orat Op ti on Care . Mor ga n was act iv el y in vo lv edin m an ag in g hi s b us in es se s, an d h e d idwhat ev er wo rkwas n eed ed , in cl ud in g wo rk in g i n t he ph arm acy, ta ki ng do ct or ’s ord ers , andke ep in g up wi th adm in is tra ti ve an d b il li ng is su es . He andSh ep pa rdhand le d t he Syna gi s b il li ng . Mor ga n t ol d S he pp ardto subm itth e Syna gi s cl ai m s ev ery 23 da y s, t o b il l as earl y inth e m on th as p os si bl e, an d t o s ub m itth e cl ai m s ev enif s he di d n otkn ow h ow m uc h S yna gi s t he nu rs es ha d a ctua ll y

adm in is te red . This syste m was “ ve ry

ch ao ti c,” b utMo rg an m ai nt ai ne d t ha t i t was ne ces sa ry to en su re t ha t h e was ab le to pa y th e supp li er fo r th e Syna gi s. Pal m er al so tes ti fie d t ha t s he an d h er co worke rs de te rm in edth at pa ti en ts di ag no se d wi th bro nc ho pu lm on ary dysp la si a (“ BPD”) were au to m at ic al ly ap pr ov edto rece iv e Syna gi s. Pal m er l earn edth attwo em pl oyees wer e u si ng a di ag no si s o f BPD t o o bt ai n p rio r ap pr ov al forSy na gi s ev enif t he pa ti en t’s ph y si ci anha d n otin di cat edth atth e p at ie ntha d B PD. Mo rg anto ldPal m er tha t al l of th e p at ie nt s h adBPD an d t ha t t he y wou ldco nt in ue to us e th atdi ag no si s. Rh ia nn a Will ia m s, a l ic en se d p ract ic al nu rs e, te st ifi edth atsh e was th e 4Syna gi s co or di na to r atOpt io n C are. Mo rg anwas a t Th rif t o n ada il y

ba si s, h e ran th e st aff m eet in gs wher e p at ie nt s wer e d is cu ss ed , andW il li am s h adob se rv edhi m bi ll in g S yna gi s. Will ia m s an d P ai ge Sh iv er g en eral ly obt ai ne d p rio r ap pr ov al for Syna gi s. A few t im es when a pa ti en t was de ni edap pr ov al forSy na gi s, M or ga n to ldW il li am s an d S hi ve r to say tha t t he pa ti en t was di ag no se d wi th BPD ev en th ou gh th e p at ie nt ’s do ct orha d n otm ad e th atdi ag no si s. Aft er d oi ng so , th e pa ti en ts were ap pr ov edto rece iv e Syna gi s. When W il li am s an d S hi ve r de ci de d th atth ey wou ldno lo ng er p ro vi de fal se di ag no se s, M or ga n, o n afew o ccas io ns , ob ta in edap pr ov al forpa ti en ts . Both t he go ve rn m en t an d M or gan’s at to rn ey rev ie wedpa ti en t fi le s wi th W il li am s, an d s he tes ti fie d t ha t t ho se fil es sh owe d cl ai m s s ub m it te d a s s oo n a s 4 da y s af te r th e p rio r cl ai m

was s ub m it te d andas l at e as 29 day s af

te r th e p rio r cl ai m

was s ub m it te d. Ad di ti on al ly, W il li am s re vi ewed fo urpa ti en ts ’ ch art s. Th os e p at ie nt s h adeach rece iv ed8 d os es of S y na gi s, b ut9, 10 , 11 , and12 cla im s wer e subm it te d t o M ed ic ai d fo r th e p at ie nt s re sp ect iv el y . Sh iv er t es ti fie d tha t s he ha d p rev io us ly w orke d a s a p ha rm acy tech ni ci anat Thri ft a ndOpt io n C are. When sh e to ldMo rg anth atsh e wou ldno t p ro vi de fal se di ag no se s t o M ed ic ai d, h e to ldhe r to lea ve th e fi le s wi th hi m be cau se he wou ld ta ke care of the m . She tes ti fie d t ha t To ta l Pa ren te ral Nut rit io n (“ TPN”) was a nu tri ti on al supp le m en t ad m in is te redto pa ti en ts at the ir h om es . Mor ga n o bjec te d 5th atth e g ov ern m en t h adno t n ot ifi edhi m of i ts in te ntto in tro du ce ev id en ce reg ard in g TPN as requi redby Rul e 4 04 (b ). The g ov ern m en t ar gu edth atTPN was an“ ot he r drug ” an d t ha t TPN cl ai m s wer e p artof M or ga n’s s ch em e to de frau d Med ic ai d a s al le ge d i n t he fin al 11 co un ts in th e in di ct m en t. The co urt o ve rru le d th e o bjec ti on , fin di ng th atRu le 40 4( b) di d n otap pl y be cau se th e ev id en ce fe ll wit hi n t he in di ct m en t’s g en eral all eg at io ns . Shi ve r th entes ti fie d t ha t i t was in ap pr op ria te to subm ita cl ai m forTPN fora ho sp it al iz edpa ti en t, b utsh e no ne th el es s s aw su ch cla im s s ub m it te d b y Mo rg an . Mor ga n c on du ct edcli ni cal st aff m eet in gs , at wh ic h t he st aff d is cu ss edwhi ch pa ti en ts were h os pi ta li zedan d th us di d n otne edm ed ic in e p rep ared . Shi ve r sa w TPN ov er-b il li ng s s ub m it te d b y Mo rg anab ou t t wice a m on th . Den is e Co ls on , a st at e h eal th care au di to r, te st ifi edth atThri ft h adbi ll ed Med ic ai d fo r 7,5 24 10 0- m il li gr am vi al s o f Syna gi s, b utitha d o nl y pu rch as ed 5,2 56 10 0- m il li gr am

vi al s o f th e dru g. Cynt hi a Vas se ll , a reg is te rednu rs e an d ast at e h eal th care au di to r, te st ifi ed th atsh e h adrev ie wedMo rg an ’s pat ie ntfil es for pa ti en ts rece iv in g Hep at it is C drug s. Sh e id en ti fie d i ns ta nc es wher e m or e Hep at it is C dr ug s wer e b il le d t ha n t he pa ti en t wo ul d h av e n eed edba se d o n t he pa ti en t’s wei gh t an d o th er i ns ta nc es whe re Me di cai d was bi ll edform or e refi ll s t han wo ul d h av e b een adm in is te red . 6Fo r ex am

pl e, on e p at ie ntwou ldha ve rece iv edon ly 30 wee ks wort h o f a dru g du rin g ati m e p eri odwhen Med ic ai d was bi ll edfor80 week s wo rth of t he dru g. In an ot he r in st an ce, the pa ti en t re fu se d t reat m en t, b utMed ic ai d was bi ll edfor m ed ic at io ns th atwou ldno t h av e b een pre pa redfor or a dm in is te redto th atpa ti en t whe n h e ref

us edtre at m en t. Jo e Mc Gall ia rd , a ph arm aci stat Th rif t an d Op ti on Care , id en ti fie d two labe ls forHepa ti ti s C dru gs th atbo re h is in it ia ls . He ackno wled ge d t ha t t he lab el s di d n otaccu rat el y

refl ectth e d oc to rs ’ pr es cri pt io ns , andth e labe ls pe rta in edto two co un ts in th e in di ct m en t. Bet h An ne Teag ue , a nu rs e an d ast at e h eal th care au di to r, te st ifi edth atsh e ha d re vi ewed22 7 o f Thr ift ’s cha rts forpa ti en ts rece iv in g S yna gi s an d o th er dru gs . The ch art s co nt ai ne d o ve r 2,0 00 cla im s. Mo re t ha n h al f of th os e cl ai m s wer e ov er-b il le d a ndles s t ha n 1 % were u nd er-b il le d. As to Co un t 7 0 s pe ci fic al ly, th e pa ti en t’s p res cri pt io n was for si x v ia ls of Nu tro pi n AQ, wit h t hr ee re fil ls . Thri ft ha d b il le d M ed ic ai d fi rs t fo r 14 vi al s, the n fo r 12 vi al s, the n fo r 14 vi al s, an d fin al ly for 7 vi al s o f Nut ro pi n AQ fo r th is pa ti en t. Fo ll owi ng th e cl os e o f th e g ov ern m en t’s ca se an d a ga in aft er h e res te d wit ho utpre se nt in g e vi de nc e, Mo rg anm ov edfora jud gm en t o f acq ui tt al . The co urt re se rv edit s d eci si onun ti l t he jury ha d re ach eda ve rd ic t. 7At t he ch arg e co nf eren ce, Mo rg anreque st edth atth e co urt i ns tru ctth e jury on hi s g oo d fa it h t he ory

of d efen se . The co urt d en ie d t he reque st , fin di ng th at th ere was in su ffi ci en t ev id en ce i n t he reco rdto warran t t he in st ru ct io n. Th e co urt’s jury

ch arg e sp eci fie d t ha t, fo r Mo rg anto be fou ndgu il ty, th e jury hadto fin d t ha t h e h adact edwil lfu ll y an d wi th anin te ntto de frau d. Anin te ntto de frau d m ean t ac ti ng “ kn owi ng ly andwit h t he sp eci fic in te ntto de cei ve so m eo ne .” An act io n was tak enkn owi ng ly if it“ was do ne vo lu nt ari ly andin te nt io na ll y an d n ot be cau se of m is ta ke or a cci de nt .” An ac ti on was t ak enwil lfu ll y if i t was do ne vo lu nt ari ly andwith the sp eci fic in te ntto di so be y th e la w. The co urt fu rth er ch arg edth atif M or ga n “ wil lfu ll y di rect edor aut ho riz ed ” an em pl oyee orot he r as so ci at e o r wil lfu ll y

joi ne d wi th anem

pl oyee orass oc ia te to co m m ita cri m e, th en he was re sp on si bl e fo r th atin di vi du al ’s con du ctas t ho ug h h e h aden ga ge d i n t he co nduc t h im se lf. Th e jury fou ndMo rg angu il ty of al l 6 9 c ou nt s o f he al th care frau d. Mo rg anm ov edfora jud gm en t o f acq ui tt al , or i n the alt ern at iv e, a n ew tr ia l. The co urt d en ie d t hi s m ot io n. II. W e rev ie w cha ll en ge s t o t he su ffi ci en cy of t he ev id en ce de no vo . Uni te d St at es v. W

il li ams , 52 7 F .3d12 35 , 12 44 (11 th Cir . 20 08 ). In r ev ie win g the su ffi ci en cy

of t he ev id en ce, we v ie w “ th e ev id en ce i n t he li gh t m os t fa vo rab le to 8th e g ov ern m en t,” r es ol vi ng “ an y co nf li ct s i n fa vo r of

th e g ov ern m en t an d acce pt [in g] all reas on ab le in fere nc es th atten d t o s up po rt the go ve rn m en t’s ca se .” Id. “ [W] e wil l n otdi stur

b agu il ty verd ic t u nl es s, g iv enth e ev id en ce i n the reco rd , no tri er o f fac t co ul d h av e fo un d g ui ltbe y on d areas on ab le do ub t.” Uni te d Sta te s v. Si lv es tr i , 40 9 F .3d13 11 , 13 27 (11 th Cir . 20 05 ) (quo ta ti on om it te d) . “ A jury is free to ch oo se am on g t he co ns tru ct io ns of t he ev id en ce,” andth e ev id en ce n eed no t “ ex cl ud e ev ery reas on ab le hypo th es is of i nn oc en ce o r be who ll y in co ns is te nt wit h e ve ry

co nc lu si on ex cep t t ha t o f gu il t.” Uni te d Sta te s v. McDo wel l , 25 0 F .3d 13 54 , 13 65 (11 th Cir . 20 01 ) (quo ta ti on om it te d) . To s up po rt aco nv ic ti on for he al th care frau d u nd er 1 8 U.S.C. § 13 47 , th e go ve rn m en t m

us t p ro ve th atth e d efen da nt : (1 ) kn owi ng ly andwil lfu ll y ex ecu te d, oratt em pt edto ex ecu te , a sc he m e to (2) de frau d ahe al th care pro gr am or t o o bt ai n by fals e o r frau du le ntpre te ns es m on ey or p ro pe rty un de r th e cu st od y or c on tro l o f a h eal th care pro gr am , (3) “ in co nn ect io n wi th th e d el iv ery of or p aym en t fo r he al th care be ne fit s, i te m s, o r se rv ic es .” 18 U.S.C. § 1 34 7. Th e g ov ern m en t m us t sh ow t ha t t he de fen da ntkn ew th atth e subm it te d c la im s wer e fal se . Uni te d Sta te s v. Medin a , 48 5 F .3d12 91 , 12 97 (11 th Cir . 20 07 ). The g ov ern m en t m ay rel y on ci rcu m st an ti al ev id en ce t o e st ab li sh th e d efen da nt ’s in te nt . Uni te d Sta te s v. S ub a , 13 2 F .3d66 2, 6 75 (11 th Cir . 19 98 ). 9A def en da ntm ay

be co nv ic te d a s a p rin ci pa l i f he : (1 ) co m m it s t he off

en se hi m se lf; (2) “ ai ds , abe ts , cou ns el s, co m m an ds , in du ces or p ro cu res ” th e co m m is si on of an o ffen se ; o r (3 ) “ wil lfu ll y cau se s” anoff

en se to be co m

m it te d. 18 U.S.C. § 2 . To su ccee d u si ng anaid in g a ndab et ti ng th eo ry , th e g ov ern m en t m us t p ro ve th atth e d efen da nt : (1 ) “ as so ci at edhi m se lf wi th th e cri m in al ve ntur e”; (2 ) wis he d t o b rin g abo utth e cri m in al off en se ; an d (3 ) “ so ug htby his act io ns to m ak e itsu ccee d.” Uni te d Sta te s v. Br oa dw el l , 87 0 F .2d59 4, 6 08 (11 th Cir . 19 89 ). The de fen da ntdo es no t n eedto ha ve co m m it te d “ th e o ve rt a ctth atserve d t o acco m pl is h t he off

en se ” to be co nv ic te d u nd er anaid in g a ndab et ti ng th eo ry . Id. Here, t he re was su ffi ci en t ev id en ce fo r th e jury to fi ndMo rg angu il ty of he al th care frau d. Se e W il li ams , 52 7 F .3dat 1 24 4. Onap pe al , Mo rg anon ly arg ue s t ha t t he re was in su ffi ci en t ev id en ce t ha t h e kno win gl y an d wi ll fu ll y ex ecu te d asch em e to de frau d M ed ic ai d. The tes ti m on y

at t ria l s ho wedth atMo rg anact iv el y m an ag edThri ft a nd Opt io n C are, t ha t h e was in vo lv edin th e b il li ng pro ces s, an d t ha t h e subm it te d a t le as t s om e Syna gi s cl ai m s. Th e ev id en ce fu rth er s ho wedth athe di rect edW il li am s an d S hi ve r to subm itfal se di ag no se s t o M ed ic ai d t o o bt ai n app ro va l t o a dm in is te r Syna gi s. When th ey

wou ldno lo ng er p ro vi de fal se di ag no se s, M or ga n t ol d t he m th athe wou ldhand le th e Syna gi s p rio r ap pr ov al s h im se lf. Th e ev id en ce al so 10sh owe d t ha t M or ga n t ol d S he pp ardto bi ll Syna gi s ev ery 23 da y s ev enif s he di d

no t kno w ho w m

uc h S yna gi s t he nu rs e h adactua ll y adm in is te redan d t ha t t he cl ai m s wer e so m et im es subm it te d e ve n m or e fre qu en tl y th anth at . Becau se Syna gi s was on ly adm in is te redev ery 30 da y s, u nd er Mo rg an ’s system , She pp ard wou ldsubm itcla im s m or e o fte n t ha n t he dru g was actua ll y adm in is te red . The jury was free to di sb el ie ve Mo rg an ’s ass ert edreas on forth is syste m an d i ns te ad co nc lu de th athe to ldSh ep pa rdto subm itcla im s ev ery 23 da y s kno win g a nd in te nd in g t ha t i t wo ul d l eadto ov er-b il li ng Med ic ai d. Se e id. Mo reo ve r, Co ls on te st ifi edth atThri ft b il le d M ed ic ai d fo r m or e th an2,0 00 m or e 1 00 -m il li gr am vi al s of Syna gi s t ha n i t h adactua ll y pu rch as ed . As t o t he Hepa ti ti s C co un ts , th e ev id en ce s ho weda pa tt ern of o ve r-b il li ng Med ic ai d, i nc lu di ng on e in st an ce wh ere M ed ic ai d was bi ll edfor80 week s wo rth of th e dru g wh enon ly 30 wee ks wort h o f th e dru g wo ul d h av e b een adm in is te red to th e p at ie nt—n earl y

a y ear’s wo rth of o ve r-b il li ng . Ano th er p at ie ntha d re fu se d tre at m en t, b utMed ic ai d was no ne th el es s b il le d fo r m ed ic at io ns th atwou ldno t ha ve be enpre paredforor a dm in is te redto th atpa ti en t. As t o t he Nutro pi n AQ co un t, Teag ue tes ti fie d tha t Th rif t h adbi ll edMed ic ai d fo r 23 m or e v ia ls of Nut ro pi n AQ tha n t he pa ti en t’s p res cri pt io n aut ho riz ed . Fin al ly, th ere was ev id en ce o f th e ex te ns iv e sc op e o f Thr ift ’s andOpt io n C are’s o ve r-b il li ng : Tea gu e 11te st ifi edth atm or e th anha lf o f th e 2 ,00 0 c la im s s he rev ie wedwere o ve r-b il le d, b ut

le ss th an1% were un de r-b il le d. Thu s, t he jury ha d b efo re i t ev id en ce o f Mo rg an ’s in st ru ct io ns an d a ct io ns reg ard in g s ub m it ti ng fal se di ag no se s t o M ed ic ai d t o o bt ai n S yna gi s ap pr ov al , th e reas on ab le in fere nc e th athe in te nt io na ll y setup th e Syna gi s b il li ng syste m to res ul t i n o ve r-b il li ng , andev id en ce o f th e ex te ns iv e sc op e o f Thr ift ’s andOpt io n Care ’s ov er-b il li ng of M ed ic ai d a s t o S yna gi s, Hep at it is C drug s, an d Nu tro pi n AQ. Base d o n t hi s ev id en ce, t he jury co ul d re as on ab ly infe r th atMo rg anwil lfu ll y cau se d h is em

pl oyees t o e xe cu te hi s s ch em e to de frau d M ed ic ai d t hr ou gh th e subm is si on of f

al se di ag no se s, cl ai m s fo r m or e dru gs th anwere ac tu al ly ad m in is te redto pa ti en ts , andcla im s fo r drug s wh enno dru gs were ad m in is te redat al l. Se e 18 U.S.C. §§ 2, 1 34 7. III. W e rev ie w evi de nt ia ry

rul in gs fora cl ear abu se of d is cret io n. Uni te d Sta te s v. McLea n , 13 8 F .3d13 98 , 14 03 (11 th Cir . 19 98 ). Fed eral Ru le of Ev id en ce 40 4( b) pro hi bi ts th e adm is si on of e vi de nc e o f ot he r cri m es or a ct s “ to pro ve th e ch arac te r of

a pe rs on in ord er t o s ho w act io n i n c on fo rm it y th erewi th .” Fed .R.Evi d. 4 04 (b ). Evi de nc e o f ot he r cri m es or a ct s m ay be adm it te d fo r ot he r reas on s, h owe ve r, su chas t o s ho w th e d efen da nt ’s in te nt , pl an , kn owl ed ge , or 12ab se nc e o f m is ta ke . Id. Befo re i nt ro du ci ng su ch ev id en ce fo r on e o f th es e o th er

pu rp os es , th e g ov ern m en t m us t n ot ify the de fen dant , up onth e d efen da nt ’s reque st ,

“ of th e g en eral na tu re o f an y su ch ev id en ce i t i nt en ds to in tro du ce attri al .” Id. Evi de nc e d oe s n otfal l wi th in Ru le 40 4( b) ’s con fin es “ if i t i s (1 ) an un ch arg ed of fen se whi ch aro se ou t o f th e sa m e tr an sa ct io n o r se rie s o f tr an sa ct io ns as t he ch arg edoff

en se , (2) ne ces sa ry

to co m pl et e th e st ory

of t he cri m e, or(3) in ex tri cab ly int ertwin edwith t he ev id en ce re ga rd in g the ch arg edoff en se .” Uni te d St at es v. Veltman n , 6 F.3 d 1 48 3, 1 49 8 (1 1t h C ir. 1 99 3) . If a co urt co m m it s erro r un de r Ru le 40 4( b) , we “ de te rm in e whe th er t he erro r was ha rm le ss .” Uni te d Sta te s v. Bra dl ey , 64 4 F .3d12 13 , 12 73 (11 th Cir . 20 11 ). “ Adm is si on of u nn ot ic edRu le 40 4( b) ev id en ce p reju di ces a de fen da ntwher e th e ev id en ce h ada subs ta nt ia l in flu en ce o n t he ou tc om e o f th e tr ia l.” Id. at 1 27 3- 74 . Inth is cas e, th e co urt erredin adm it ti ng th e TPN ev id en ce, b utth e err orwas ha rm le ss . The g ov ern m en t ar gu edth atth e TPN ev id en ce co ns ti tu te d u nc ha rg ed of fen se s b ecau se TPN was an “ ot he r drug ” wit hi n t he sco pe of t he fin al 11 co un ts of th e in di ctm en t. Ho wev er, tho se co un ts all eg edth atMo rg ansubm it te d c la im s fo r a l arg er qua nt it y

of t he dru gs th anpre sc rib edan d a dm in is te red , subm it te d cl ai m s b efo re t he dru gs were ad m in is te red , andsubm it te d c la im s m or e fre qu en tl y th anth e dru gs were p res cri be d. Acco rd in g t o S hi ve r’s te st im on y , th e TPN cl ai m s 13were i m

pr op er b ecau se th ey

were s ub m it te d wh il e p at ie nt s wer e h os pi ta li zed , no t be cau se th e cl ai m s the m se lv es were i na ccu rat e, subm it te d t oo earl y , or s ub m it te d to o o fte n. Th is ev id en ce t hu s d idno t co ns ti tu te anun ch arg edoff en se wit hi n t hi s sc he m e, itwas n otne ces sa ry to ex pl ai n t he cri m e, an d i t was no t “ in ex tri cab ly in te rtwi ne d” wit h t he sch em e to subm itin accu rat e cl ai m s t o d efraudMed ic ai d. Veltman n , 6 F.3 d a t 1 49 8. Th eref or e, th e TPN ev id en ce d idno t fa ll un de r Ru le 40 4( b) , andth e co urt erredin adm it ti ng itdu e to th e g ov ern m en t’s l ackof n ot ic e. Se e Fed .R.Evi d. 4 04 (b ). Howev er, an y

erro r was ha rm le ss be cau se th e TPN ev id en ce d idno t pr ejud ic e Mo rg anor s ub st an ti al ly infl ue nc e th e v erd ic ts . Se e Bra dl ey , 64 4 F .3dat 12 73 -7 4. Th ere was su ffi ci en t ev id en ce o f Mo rg an ’s gu il t ev enwit ho utth e TPN ev id en ce, as di sc us se d abo ve . Onl y on e wit ne ss bri efl y

tes ti fie d abo utth e TPN cl ai m s, wh il e num ero us wit ne ss es ga ve ex te ns iv e te st im on y ab ou t t he ov er-b il li ng of Syna gi s, Hep at it is C drug s, an d Nu tro pi n AQ. Fi na ll y , bec au se th e TPN ev id en ce was pre se nt edinth e g ov ern m en t’s ca se in ch ie f, Mo rg anco ul d h av e pr es en te d ade fen se cas e to att em ptto reb utth e ev id en ce. IV.

“ W e rev ie w a di st ric t co urt’s re fu sa l t o g iv e a req ue st edjury in st ru ct io n fo r ab us e o f di sc ret io n.” Uni te d Sta te s v. Ma rt in el li , 45 4 F .3d13 00 , 13 09 (11 th Cir . 1420 06 ) (quo ta ti onom it te d) . The d efen da ntbe ars a lo w bu rd ento ob ta in an

in st ru ct io n o n h is th eo ry

of d efen se : h e is en ti tl edto su ch anin st ru ct io n i f “ th ere i s an y fo un da ti on [fo r th e in st ru ct io n] in th e ev id en ce.” Id. at 1 31 5 (quo ta ti on om it te d) . A cou rt abu se s i ts di sc ret io n i n re fu si ng to gi ve a reque st edin st ru ct io n whe re: (1) th e in st ru ct io n c orrect ly stat edth e la w, (2) the in st ru ct io n’s “ subjec t m at te r was no t s ub st an ti al ly cov eredby oth er i ns tru ct io ns ,” an d (3 ) th e ref us al

“ se rio us ly im

pa ire d t he de fen da nt ’s abi li ty to d efen d h im se lf.” Id. at 1 30 9 (quo ta ti onom it te d) . In Mar ti ne ll i , th e co urt d idno t ab us e it s d is cret io n wh enit refu se d t o g iv e a g oo d fa ith i ns tru ct io n b ecau se item ph as iz edin it s jury

ch arg e th atth e d efen dantha d t o a ctkn owi ng ly to b e fo un d g ui lt y . Id. at 1 31 5. Mo reo ve r, th e co urt h adex pl ai ne d t ha t t o a ctkn owi ng ly m ean t t o a ct“ vo lu nt ari ly and in te nt io na ll y

an d n otbe cau se of a cci de ntor m is ta ke .” Id. at 1 31 6 (quo ta ti on om it te d) . Bas edon th e co urt’s jury ch arg e, “ th e jury pla in ly hadto rul e o utth e po ss ib il it y

th at ” th e d efen da ntact edin go odfai th to fin d h im gu il ty. Id. The di stric t co urt d idno t ab us e it s d is cret io n i n re fu si ng to in stru ctth e jury on go odfai th . Se e id. at 1 30 9. Fi rs t, t he re was in su ffi ci en t ev id en ce o f go odfai th to warran t t he in st ru ct io n. Se e id. at 1 31 5. Th e ev id en ce s ho wedth atMo rg an in st ru ct edW il li am s an d S hi ve r to subm itfal se di ag no se s t o M ed ic ai d a ndth athe im pl em en te d abi ll in g s y st em forSyna gi s t ha t wo ul d n atur al ly resu ltin

15ov er-b il li ng . Howev er, ev enif M or ga n h adm etth is bu rd en , th e co urt d idno t

ab us e it s d is cret io n b ecau se it s ju ry in st ru ct io ns ad equa te ly cov eredth e subjec t m at te r of go odfai th . Se e id. at 1 30 9. Lik e th e co urt i n Mar ti ne ll i , th e co urt i n t hi s cas e in st ru ct edth e jury tha t M or ga n h adto actkn owi ng ly, wil lfu ll y , andwit h t he sp eci fic in te ntto de frau d t o b e fo un d g ui lty . Se e id. at 1 31 5. Al so li ke th e co urt i n Mar ti ne ll i , th is co urt em

ph as iz edth atMo rg anha d t o a ct“ vo lu nt ari ly and in te nt io na ll y

an d n otbe cau se of m is ta ke or a cci de nt .” Und er t he se in st ru ct io ns , th e jury hadto fin d tha t M or ga n d idno t ac t i n g oo d fa ith a ndth athe in st ead in te nd edto di so be y

th e la w. Fo r th e fo reg oi ng reas on s, we af firm Mo rg an ’s con vi ct io ns . AFFIRMED.

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