In the

United States Court of Appeals

For the Seventh Circuit

Nos. 98-3961 & 98-4139

UNITED STATES OF AMERICA,

Plaintiff-Appellee,

v.

CAROL HOOGENBOOM,

Defendant-Appellant.

Appeal from the United States District Court

for the Northern District of Illinois, Eastern Division.

No. 97 CR 123--Milton I. Shadur, Judge.

Argued February 24, 2000--Decided April 4, 2000

 Before POSNER, Chief Judge, and CUDAHY and EVANS,

Circuit Judges.

 EVANS, Circuit Judge. Dr. Carol Hoogenboom’s

scheme to swindle Medicare by filing bills for

services she did not provide to elderly mental

patients hinged on her assumption that "no one

will believe a crazy lady." But the FBI did. More

importantly, so did a federal judge who found

Hoogenboom guilty on a bevy of charges after a

week-long bench trial. In all, Hoogenboom’s

shenanigans led to convictions on 15 counts: 5

for mail fraud, 3 for filing false claims with

Medicare, 6 for money laundering, and 1 for

obstruction of justice. These earned her

concurrent sentences, the top being for 70

months.

 Hoogenboom isn’t your typical chiseler. After

earning undergraduate and master’s degrees in

psychology from Western Michigan University, she

completed a PhD at the Forrest Institute of

Professional Psychology. She then spent 2 years

interning, passed the Illinois state licensing

exam, and received her state psychologist’s

license. With that, after nearly 15 years of hard

work, Hoogenboom founded her own practice.

 When she set up shop, Hoogenboom contracted

with Medicare to become a part B provider. This

meant she could submit reimbursement claims to
Medicare for any medically necessary services she

provided to Medicare beneficiaries. As it turned

out, she preferred submitting claims to providing

services.

 Beginning in June 1995 Hoogenboom filed claims

stating that she frequently visited her

"patients"--a group of elderly, mentally ill

Medicare beneficiaries living in three Chicago

retirement homes--to conduct 45- to 50-minute

individual therapy sessions. To receive payment

for the purported sessions Hoogenboom would fax

"activity sheets" to her sister, Carrie Weldy,

containing the patients’ names, medicare numbers,

the alleged dates of service, and the type of

services allegedly provided. Weldy, who served as

a salaried bookkeeper, would then phone in the

claims to Medicare for reimbursement. Unbeknownst

to Weldy, the services she billed for were either

not performed, or not performed as billed.

 In January 1996 Hoogenboom hired Hanan Shaktah

to help expand her operation. Hanan/1 had an

undergraduate degree in psychology which she

hoped she might put to use in her new job.

Instead, Hoogenboom gave her a list of about 70

patients and told her to visit them once or twice

a week to make sure they were still "alive and

breathing." When Hanan mastered the routine,

Hoogenboom added another 53 patients to her

rounds. The visits lasted only a minute or two,

but on Hoogenboom’s orders Hanan submitted

activity sheets stating that she provided 45- to

50-minute counseling sessions to each of her

patients at least three times a week. In exchange

for her efforts, Hoogenboom gave Hanan a taste of

the Medicare reimbursement money.

 Hoogenboom was so impressed with Hanan’s work

that by June she decided to bring Hanan’s brother

Thaer onto the workforce. Thaer did not have a

degree in psychology, but he had been arrested

for assault and battery on numerous occasions. So

Hoogenboom thought he’d make a fine "therapist,"

and soon enough he, too, was submitting activity

sheets recapping lengthy counseling sessions. In

reality, Thaer performed the same job as his

sister--moving door-to-door within the retirement

homes making sure that the Medicare recipients

were still alive.

 With the Shaktahs taking care of her clients,

Hoogenboom stopped visiting the facilities. And

once Thaer came on board, Hanan also ceased her

visits. Nevertheless, the billing continued on

pace. In all, from June 1995 until October 1996

Hoogenboom submitted approximately 11,000 claims

to Medicare for reimbursement. Based on these

claims, she received $480,617.54, which she

deposited into two accounts at First National
Bank in Chicago.

 Despite the fact that she was bilking the

federal government out of nearly $50,000 a month,

and frequently billed for more than 24 hours in

a day, Hoogenboom confidently predicted that she

would never get caught. She told Hanan that when

it came to filing false Medicare claims "the

sky’s the limit." She further explained to Thaer

that even if some of the patients became aware of

the scam it would never put her in jeopardy,

since no one would take the word of a "crazy

lady" over that of her psychologist.

 Unfortunately for Hoogenboom, the FBI did not

operate on the same assumption. Thus, when a few

of Hoogenboom’s more nimble-witted patients

reported to Medicare that they were receiving

statements detailing counseling services that had

not been performed, the FBI launched an

investigation and quickly began to uncover

evidence of Hoogenboom’s scheme.

 Bureau agents confronted Hoogenboom about her

billing discrepancies on October 2. She told them

that she and her assistants had in fact performed

the services claimed, that they had provided

mostly psych testing services and very little

therapy, that she was always present when her

assistants conducted the testing, that she

visited all the facilities three to four times

per week, and that her assistants both had

undergraduate degrees in psychology.

 When the interview ended, the cover-up began.

Hoogenboom immediately met with Hanan and

instructed her not to speak to the FBI. She then

called Weldy and told her to tell the FBI that

the two didn’t know each other. The next day,

Hoogenboom withdrew $101,000 from First National,

explaining to Thaer that she feared the Bureau

would "freeze her accounts."

 By October 21 Hoogenboom had become desperate.

She sent the following fax to Weldy, written in

print so small Weldy had to blow it up on her

copier to read it:

Ner,/2 immediately burn all logs, time sheets of

everyone. Make sure only ashes are left. Burn

this page, too. I will explain later. Tell Mommo

and Conco/3 to talk to no one about me. If the

FBI visits them they are to say nothing. Even

that they don’t know me./4 Tell them the same

thing. . . . You guys are to talk to no family or

relatives about me, no neighbors, and no new

friends.

Weldy, the hero of our story, not only refused to

comply, but immediately gave the FBI the fax and

all the materials she was supposed to burn.
 The Shaktahs, who flipped following their arrest

(they pled guilty to charges and received

probation), also reported that Hoogenboom

attempted to thwart the FBI. At trial they

testified that during the investigation

Hoogenboom tried to persuade Hanan not to

cooperate, instructed Hanan to prepare fake

progress notes for the services covered in the

indictment, attempted to convince a real

psychologist to falsely testify that she treated

the patients, and threatened Thaer that if he

ever testified against her she would press

charges against him for forging her checks.

 Hoogenboom told a markedly different story. She

testified that she performed all the work she

billed up until she hired Hanan, but that from

then on she assumed a purely supervisory role.

She said that, after initially supervising

Hanan’s activities quite closely, she was fooled

into believing that Hanan was still treating the

patients. She also said that Hanan convinced her

to hire Thaer and that Hanan was responsible for

supervising his work. Finally, she reported that

once she became aware that the two were conning

her, she immediately fired them both.

 The judge was underwhelmed by this defense. He

said Hoogenboom’s "preposterous effort to

rationalize" her conduct and "prevail on the

balance of her own perjury" could hardly "avoid

the crushing impact . . . [of] the overwhelming

evidence that the government provided with

respect to her guilt."

 On appeal, Hoogenboom attacks three of her four

convictions and argues that the judge erroneously

applied a couple of 2-point adjustments to his

calculus of her sentence under the guidelines.

Interestingly, she does not contest her

conviction for obstruction of justice--the crime

for which she drew the longest concurrent

sentence. This means that even if Hoogenboom

prevails--gets her money laundering, false

claims, and mail fraud convictions overturned and

both 2-point adjustments set aside--she stands to

gain only mild relief. But she is entitled to

seek what she can, so with the limited prospects

for a real major victory in mind, we turn to her

contentions.

 We begin with Hoogenboom’s first challenge to

her money laundering conviction. To violate the

federal money laundering statute the government

must prove, inter alia, that a defendant engaged

in or attempted to engage in "a monetary

transaction." 18 U.S.C. sec.1957. As defined by

the statute, a monetary transaction "does not

include any transaction necessary to preserve a
person’s right to representation as guaranteed by

the Sixth Amendment to the Constitution." 18

U.S.C. sec.1957(f)(1)./5 Hoogenboom argues that

since she testified that she eventually used the

money she removed from her bank accounts to pay

her attorneys, the withdrawals were not "monetary

transactions."

 To the extent Hoogenboom challenges the

sufficiency of the evidence supporting her

conviction, we review to determine whether the

fact finder’s take on the evidence was wholly

irrational when viewed in the light most

favorable to the government. See United States v.

Thornton, 197 F.3d 241, 253-254 (7th Cir. 1999),

cert. denied sub nom. Reynolds v. United States,

___ S. Ct. ___, 2000 WL 190036 (Mar. 6, 2000). To

the extent that she asks us to interpret the

federal money laundering statute, we review the

district court’s determinations de novo. See

United States v. Shriver, 989 F.2d 898, 901 (7th

Cir. 1992).

 Hoogenboom’s claim that she used the money she

withdrew on October 3 to pay her lawyers is

supported only by her conclusory testimony at

trial. She did not specify the dates or the

number of payments she made, nor did she

introduce any records or other evidence to show

how she used the money. She simply stated that at

some point, well after the transaction, she paid

her attorneys with the funds. This evidence in no

way undermines the district court’s findings.

Standing alone, Hoogenboom’s testimony, rejected

as it was by the district court, could not show

that she used the funds in the manner she

claimed.

 But even if Hoogenboom were believed, the same

result would follow. She does not contest Thaer’s

statement that she made the October 3 withdrawals

to prevent the FBI from freezing her accounts.

She rather argues that since she later spent the

money on lawyers the transactions should be

covered by the statute’s Sixth Amendment

exception.

 This is preposterous. Under Hoogenboom’s

conception of the statute, every defendant

charged with money laundering under 18 U.S.C.

sec.1957 could, at any time, beat the charge by

funneling the proceeds which constituted the

initial, illegal transaction toward their

defense. Since this interpretation would render

the statute useless in the face of any money

launderer armed with a minimally competent

attorney, we reject it. Congress would not bother

passing such an easily circumvented law. Instead,

the exception appears to have been inserted to

prevent the broad reach of the statute from
criminalizing a defendant’s bona fide payment to

her attorney. See United States v. Rutgard, 116

F.3d 1270, 1291 (9th Cir. 1997); see also, 134

Cong. Rec. S17630 (daily ed. Nov. 10, 1988)

(statements of Sens. Biden and Kennedy).

 Correctly read, the statute offers a defense

where a defendant engages in a transaction

underlying a money laundering charge with the

present intent of exercising Sixth Amendment

rights. This allows a defendant to preserve her

rights without undermining the prosecution of

those the statute seeks to punish. Since

Hoogenboom did not clear out her accounts to pay

her attorney--the evidence is that she engaged in

the transaction to prevent the FBI from seizing

the money--she cannot squeeze within the slim

Sixth Amendment exception to the statute’s broad

definition of what constitutes a monetary

transaction.

 Hoogenboom next contends that the government

failed to show that she possessed the requisite

mens rea to support her convictions on all crimes

except obstruction of justice. She argues that

since the prosecution’s only evidence of her

intent came from the testimony of the Shaktahs,

and this directly conflicted with her own more

believable testimony, the prosecution failed to

prove its case beyond a reasonable doubt.

 Again, preposterous. The district court called

the evidence against Hoogenboom "crushing" and

"overwhelming." Indeed, the court noted that even

without the Shaktahs’ testimony Hoogenboom was

proven guilty beyond a reasonable doubt. Plus,

the judge expressly found that Hoogenboom’s

testimony was perjured. Viewing the case in any

light--let alone that most favorable to the

government--there was ample evidence to support

the finding that Hoogenboom intended to commit

her crimes.

 This brings us to the sentencing issues which

are not presented, by either side, with great

clarity. And that’s not surprising since the

sentencing hearing itself was not a model of

clarity as everyone, in a desultory fashion,

engaged in long musings which led to a rather

confusing record.

 On appeal, the parties have confused several

concepts, using terms of art like "upward

departures" interchangeably with "adjustments."

Similar misstatements pop up where, for instance,

Hoogenboom says in her brief that the judge set

"the base offense level" at "27" which reflected

"the following four upward enhancements." This

statement is then followed by a list of five, not

four, adjustments. Also, the "base offense level"

in this case was not "27." It was "6" for two of
Hoogenboom’s crimes (mail fraud and false

claims), "12" for the obstruction charge, and

"17" for money laundering. But because the mail

fraud and false claim counts ended up a little

higher after various adjustments, we need only

focus on them. And here’s how the sentence was

built:

6 points--Base offense level

9 points--A specific offense characteristic

adjustment under guideline sec.2F1.1(b)(1)(J)

because the fraud exceeded $350,000

2 points--A specific offense characteristic

adjustment under sec.2F1.1(b)(2) because "more

than minimal planning" was involved.

 To these computations, four 2-point

"adjustments" were added to bring the "adjusted

offense level" to 25, which yielded a sentencing

range of 57 to 71 months. With 5 years as the

statutory maximum penalty for all crimes except

obstruction (which is 10 years), Hoogenboom

received 60-month terms on all the charges except

obstruction, for which she drew a 70-month

sentence. The sentences were ordered to be served

concurrently.

 The four 2-point adjustments were for:

(1) Vulnerable Victim--sec.3A1.1(b)(1)

(2) Abuse of Trust--sec.3B1.3

(3) Role in the Offense--an Organizer--

sec.3B1.1(c)

(4) Obstruction of Justice--sec.3C1.1

 Hoogenboom challenges two adjustments:

vulnerable victim and abuse of trust. Although we

have spent quite some time laying out the

framework of this sentence, we will tarry only a

moment on Hoogenboom’s objections, which we find

to be without merit.

 The best argument against the "vulnerable

victim" enhancement might have been that the

victim was really the government, not the infirm

nursing home patients who were denied services.

But that argument wasn’t made below, so it’s

waived on appeal. And even if not waived, in

these circumstances the elderly and infirm

residents were so closely involved with the

scheme that it does no violence to the guidelines

to conclude that they were victims. One of the

reasons for increasing a criminal penalty based

on the type of victim is that vulnerable ones are

less likely to report that they have been
cheated, so crimes against them are more

difficult to uncover. Here, Hoogenboom’s choice

of victims allowed her to go undetected for more

than a year. In fact, if she had made sure all of

her patients were incoherent, she might not have

been caught. The vulnerable victim enhancement,

accordingly, was correctly applied.

 Ditto for the abuse of trust enhancement.

Medical service providers occupy positions of

trust with respect to private or public insurers

(such as Medicare) within the meaning of

guideline sec.3B1.3. See United States v. Geiger,

190 F.3d 661 (5th Cir. 1999), and United States

v. Ntshona, 156 F.3d 318 (2d Cir. 1998). Medicare

providers such as Dr. Hoogenboom enjoy

significant discretion and consequently a lack of

supervision in determining the type and quality

of services that are necessary and appropriate

for their patients. This forces Medicare to

depend, to a significant extent, on a presumption

of honesty when dealing with statements received

from medical professionals. The adjustment here

was properly invoked.

 For all of these reasons, the judgment of the

district court is AFFIRMED.

/1 Hanan’s brother enters the scene in a moment, so

we’ll refer to Ms. Shaktah by her first name.

/2 Weldy’s family pet name.

/3 Weldy and Hoogenboom’s parents.

/4 By this point, it seems Hoogenboom really should

have been giving the FBI a little more credit. To

think that they’d be thrown off by tiny print and

parents who claim they do not know their own

child suggests Hoogenboom could have used some

counseling herself.

/5 In full, this section of the statute reads:

[T]he term "monetary transaction" means the

deposit, withdrawal, transfer, or exchange, in or

affecting interstate or foreign commerce, of

funds or a monetary instrument (as defined in

section 1956(c)(5) of this title) by, through, or

to a financial institution (as defined in section

1956 of this title), including any transaction

that would be a financial transaction under

section 1956(c)(4)(B) of this title, but such

term does not include any transaction necessary

to preserve a person’s right to representation as

guaranteed by the Sixth Amendment to the

Constitution[.]