[PUBLIS H] IN THE UN ITED STATES COURT OF APPEALS FOR THE ELE VENTH CIRCUIT

__ __ __ __ __ __ __ __ __ __ __ _ No. 1 2- 14 30 2

__ __ __ __ __ __ __ __ __ __ __ _ D.C. Dock etNo. 4 :1 0- cr-0 00 12 -HLM-WEJ-1 UNITED STAT ES OF AMERIC A, Pl ai nt iff - App el le e, ve rs us GEORGE D. HOUSER, Defen da nt- App el la nt .

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

th e Uni te d S ta te s Di st ric t Co urt fo r th e North ernDis tri ctof Ge or gi a

__ __ __ __ __ __ __ __ __ __ __ _ (Jun e 1 9, 2 01 4) Case: 12-14302 Date Filed: 06/19/2014 Page: 1 of 40Befo re MAR CUS, BLACK, an d R IPPLE, Cir cu itJu dg es . * RIPP LE, Circu itJu dg e: Fo ll owi ng a fo ur -weekbe nc h t ria l, Geo rg e D. Hou se r was co nv ic te d o f on e co un t o f co ns pi rin g wi th hi s wi fe, Rh on daW as hi ng to n Ho us er (“ W as hi ng to n” ), to co m m ithe al th care frau d, i n v io la ti on of 1 8 U.S.C. § 13 49 , of e ig htco un ts of pa yro ll tax frau d, i n v io la ti on of 2 6 U.S.C. § 72 02 , andof two co un ts of f ai lu re t o ti m el y fil e in co m e ta x re tu rn s, i n v io la ti on of 2 6 U.S.C. § 72 03 . The d is tri ctco urt se nt en cedMr. Ho us er t o 2 40 m on th s’ im pr is on m en t an d o rd eredhi m to pa y ne arl y $7 m il li on inres ti tu ti on to Med ic are a ndMed ic ai d a ndm or e th an$8 70 ,00 0 t o t he In te rn al Rev enue Serv ic e (“ IRS” ). Forth e rea so ns setforth inth e fo ll owi ng op in io n, we af

firm th e jud gm en t o f th e d is tri ctco urt.

I A. Facts 1 Dur in g t he earl y

19 90 s, a p eri odbe fo re the ev en ts gi vi ng ris e to hi s co nv ic ti on , Mr. Hou se r ha d o pe rat edtwo nu rs in g h om e fac il it ie s i n R om e,

Honora ble Kenne th F. Ripple, United States Circuit J udg e for the Seventh Circuit, * sitti ngby designation. We rec ite below the f

acts a s found by

the district court followingMr. Houser ’s benc h 1 trial. See R.290. 2

Case: 12-14302 Date Filed: 06/19/2014 Page: 2 of 40Geo rg ia . After h e fai le d t o p ay pa yro ll tax es forem

pl oyees, the IRS s ei zedon e faci li ty, an d t he Sta te of Ge or gi a rev ok edMr. Ho us er’s l ic en se to op erat e nur si ng ho m es . The IR S al so pl acedtax li en s o n t he nu rs in g h om es . Duri ng th e te n years whe n the li en s wer e act iv e, Mr. Ho us er o ccas io na ll y wentto th e lo cal IRS o ffi ce to in qu ire ab ou t the pa y -o ff am ou nt s. Fu ll pa ym en t o f th e am ou nt s o wedne ve r was m ad e. Whe n t he li en s ex pi redin20 03 , Mr. Hou se r so ug htto rees tabl is h h is co nt ro l ov er the two faci li ti es , Mo un t Be rry Co nv al es cen t Ce nt er an d M or anLake Co nv al es cen t Ce nt er (“ Mo un t Be rry ” an d “ Mo ranLake ,” res pe ct iv el y ). He crea te d F orum

Heal th care Group, In c. (“ FHG”), an d F HG ass um edm an ag em en t o f th e fac il it ie s. St at e rec or ds an d t he Med ic are a ndMed ic ai d p ro vi de r ap pl ic at io ns li stW as hi ng to n, M r. Hou se r’s th en -g irl fri en d, as th e o wne r, pr es id en t an d o ffi ce m an ag er o f FHG. In Se pt em be r 20 03 , FHG als o a ss um edm an ag em en t o f 2 W il dwo odParkNurs in g a ndReh ab il it at io n C en te r (“ W il dwo od ”) i n B runs wick , Geo rg ia .

Mr. Houser

and Washington eventually marrie d, but the rec ord does not re veal whe n 2 the marriag e took place . 3

Case: 12-14302 Date Filed: 06/19/2014 Page: 3 of 401.

Dur in g t he pe rio d c ov eredby the in di ctm en t, Mo un t Be rry , Mo ranLake an d W il dwo odwere al l l ic en se d c are f aci li ti es an d c ert ifi edreci pi en ts of M ed ic are a nd Med ic ai d fu nd s. Th e fac il it ie s’ to ta l capa ci ty w as 40 4 re si de nt s, an d o ccupanc y rat es ran ge d b etweensev en ty-fiv e an d n in ety pe rcen t. Of th es e res id en ts , ap pr ox im at el y

eig ht y to ni ne ty perce ntha d the ir c are f un de d b y Med ic are o r Med ic ai d. InJu ly 200 4, M r. Hou se r fo rm al ly ass um edco nt ro l o f th e th ree h om es . New Med ic are p ro vi de r ap pl ic at io ns li st eda ch an ge of o wne rs hi p fr om W as hi ng to n t o M r. Hou se r, an d M r. Hou se r was li st edas p res id en t an d c hi ef ex ecu ti ve off

ic er. Med ic ai d app li cat io ns li st edMr. Ho us er, al on g wi th FHG and Lou is e K. Hou se r--M r. Hou se r’s m ot he r--a s the own ers . On th e Me di care en ro ll m en t fo rm , Mr. Hou se r certi fie d (1 ) th athe “ ag ree[ d] to ab id e b y th e Med ic are l aws , reg ul at io ns , andpro gr am in st ru ct io ns th atap pl y

to th is pro vi de r,” (2 ) th athe “un de rs t[o od ] [t]ha t p aym en t o f a cl ai m by Medi care is co nd it io ne d up on th e cl ai m

an d t he un de rlyin g t ran sa ct io n c om pl y in g wi thsu chlaws , reg ul at io ns , andpro gr am in st ru ct io ns . . . , andon th e p ro vi de r’s co m pl ia nc e wit h al l ap pl ic ab le co nd it io ns of p art ic ip at io n i n M ed ic are,” an d (3 ) th athe “ w[o ul d] no t kno win gl y

pre se ntor c au se to be pre se nt eda fal se or f rau du le ntcla im

for 4 Case: 12-14302 Date Filed: 06/19/2014 Page: 4 of 40pa ym en t b y

Med ic are, an d w[o ul d] no t s ub m itcla im s wi thde li be rat e ig no ran ce o r reck le ss di sr eg ardof t he ir t ru th or f al si ty.” Mo reo ve r, on subm is si on s fo r

3 rei m bu rs em en t, the pro vi de r ackno wled ge d “ th atpa ym en t wi ll be fro m fed eral an d st at e fu nd s an d t ha t an y

fal si fic at io n o r co nc eal m en t o f a m at eri al factm ay be pr os ecu te d u nd er fe de ral an d s ta te laws .” 4

2. As nur si ng faci li ti es go ve rn edby 42 U.S.C. § 13 96 r, th e fac il it ie s wer e requi redto pro vi de res id en ts with acle an , saf e an d s an it ary en vi ro nm en t t o m ai nt ai n o r supp ort “ th e h ig he stpra ct ic ab le lev el of p hysic al , m en ta l, an d ps y ch os oc ia l wel l-b ei ng to ev ery res id en t.” Duri ng th e p eri odfro m 20 03 to 20 07 , 5 whe n the faci li ti es were wi th in Mr. Ho us er’s co nt ro l, the co nd it io ns were, i n s ho rt,

“ba rb ari c” an d “ un ci vi li zed .” 6 The reco rddi sc lo se s co un tl es s i ss ue s wi thbo thth e co nd it io n o f th e p hysic al Gov’t’s Trial Ex . 110 (Medica re F eder al Hea lth Care Provider/Supplier Enr ollment 3 Application for F HG) at 21. See, e.g ., Gov’t’s Trial Ex . 116 (Ge org ia Dep’ t of Cmty . Hea lth Div. of Med. 4 Assistance Provider

Enrollment Application) at 13. R.290 at 24 (interna l quotation marks omitted); see also 42 U.S.C. § 1396r(b) (2) ( “A 5 nursingfac ility

must provide service s and ac tiviti es to attain or maintain the highest prac ticable phy sical, mental, a

nd psychosocia l well-beingof ea ch re sident . . . .”). R.341 at 4 (SentencingTr.). 6 5 Case: 12-14302 Date Filed: 06/19/2014 Page: 5 of 40pl an ts an d t he pro vi si on of s erv ic es at a ll of t he faci li ti es . By way of e xa m pl e on ly, ro of s atth e fac il it ie s l eak edso pro fu se ly as to flo odres id en ts ’ ro om s, da m ag e th ei r pe rs on al pro pe rty, andcau se cei li ng ti le s t o fa ll inres id en ts ’ ro om s an d c omm on area s. Adm in is tra to rs sen t M r. Hou se r an d Wash in gt on urg en t fa xe s ap pr is in g t he m

of t he pro bl em s an d o f th e p ot en ti al ha zard s t o re si de nt s. Fo r in st an ce, o n Dec em

be r 22 , 20 06 , an a dm in is tra to r se nta fax to Mr. Ho us er an d W as hi ng to n tha t re ad : “ ‘ WE H AVE CEIL ING TI LES AND ROO F LEAKS ON RESI DENTS’ B EDS AND CLOTH ES. I NE ED SOME ONE TO EI THE R TAKE CARE OF I T OR BRI NG MONEY FOR J AMIE [Yo un g] TO DO S OMET HI NG!!! ’” 7 The di ni ng roo m

at M or anLake ha d n o h eatfor th e win te r of

20 06 to 20 07 ; th e sa m e fac il it y

ha d n o a ir c on di ti on in g i n a n e nt ire win g fr om Ju ly 200 6 t o J un e 20 07 . The Wildwoo d fa ci li ty w as witho utairco nd it io ni ng forth ree m on th s du rin g t he sp rin g andsu m m er o f 20 07 , du rin g wh ic h t im e th e in te rio r te m pe ratur e reac he d n in ety

de gr ees . Mr. Hou se r an d Wash in gt on si m il arl y were i nf orm edof th es e is su es . 8

R.290 at 39 (alter ation in orig inal) (quotingGov’t’s Trial Ex . 487 (collec tion of faxed 7 memoranda

from fa cility

administrator to Mr. Houser and Washing ton)). See id. at 53, 54. 8 6 Case: 12-14302 Date Filed: 06/19/2014 Page: 6 of 40The ho m es su ffer edfro m “ sh orta ge s o r a co m

pl et e la ckof c le an in g supp li es ” b ecau se ve nd or s’ bi ll s wen t u np ai d. Bathr oo m faci li ti es went 9 un at te nd ed , and , as ares ul t, the ho m es “ ha d astro ng od orof u rin e an d fe ces .” 1 0 The lau nd ry

faci li ti es freque nt ly w ere i no pe rab le du e to lac k o f po wer o r di sr ep ai r. Whe n apo wer o ut ag e o ccu rred , so il edli ne ns co ul d n otbe ch an ge d i n t he res id en ts ’ ro om s. Adm in is tra to rs co m pl ai ne d fr eque nt ly to M r. Hou se r an d W as hi ng to n abo utth e la ckof c le an in g a ndsan it iz in g s up pl ie s. Tras h s erv ic e was st op pe d due to Mr. Ho us er’s fai lu re t o p ay wast e rem ov al bi ll s. “ Whe n t he wast e rem ov al servi ces refu se d t o e m pt y th e dum ps te rs at t he nu rs in g h om es , em

pl oyees l eftga rb ag e n ear t he du m ps te r, whi chatt ract edfli es an d o th er i ns ect s, ro de nt s, an d d og s, an d g en erat edod or s.” All of t he faci li ti es 1 1

“ ex pe rie nc edfly inf

es ta ti on s. Witn es se s d es cri be d s eei ng fli es inth e res id en ts ’ ro om s, i n t he di ni ng roo m s, o n t he res id en ts ’ fo od ,” as well as s warm in g a ro un d

“ th e res id en ts an d t he ir s or es .” 1 2 Res id en ts ’ ph y si cal an d m ed ic al ne ed s re gu la rly were no t m et .

I d. at 65 (e mphasis added) . 9 I d. at 67. 1 0 I d. at 90. 1 1 I d. at 101. 1 2 7 Case: 12-14302 Date Filed: 06/19/2014 Page: 7 of 40“ [M]ed ic at io ns were n otav ai labl e fo r res id en ts be cau se [Mr. Ho us er] hadno t p ai d

th e p ha rm acy bil l. Onso m e o ccas io ns , th e nur se s ‘bo rro wed ’ th e m ed ic at io ns fro m on e res id en t an d g av e th os e to an othe r res id en t[] . . . . On o th er o ccas io ns , th e res id en ts ne ve r rec ei ve d t he m ed ic at io ns th ey were s up po se d t o h av e.” 1 3

“Num ero us witne ss es tes ti fie d t ha t al l thr ee nur si ng ho m es freque nt ly ran o utof di ap ers , wou ndcare supp li es , andba si c nur si ng supp li es .” Labo rat ory servi ces 1 4 th atha d b eenord eredby a ph y si ci an , in cl ud in g t ho se forpa ti en ts on di al y si s, were no t p erfo rm edbe cau se th e b il ls forsu chservi ces wentunpa id . The h om es went 1 5 witho utbl oo d s ug ar t es ti ng de vi ces an d s tri ps ne ces sa ry to m on it ordi ab et ic pa ti en ts . Pati en ts wentwitho utdi al y si s b ecau se th e tr an sp orta ti on co m pa ny refu se d t o s erv ic e th e h om es du e to unpa idbi ll s. Faci li ti es als o wer e wit ho ut 1 6 m ed ic al di rect or s an d p hysic al th erap y servi ces for

si gn ifi can t p eri od s o f ti m e. The adm in is tra to rs at t he faci li ti es in fo rm edMr. Ho us er an d Wash in gt on th at fai lu re t o p ay

th e b il ls forth es e se rv ic es was p la ci ng th e p at ie nt s atris k a ndth e ho m es injeop ardy

of c lo su re.

I d. at 144 (e mphasis added) (citations omitted). 1 3 I d. at 160 (e mphasis added) . 1 4 See id. at 173. 1 5 See id. at 219. 1 6 8 Case: 12-14302 Date Filed: 06/19/2014 Page: 8 of 40The faci li ti es were g ro ss ly und ers ta ffeddu e to st affi ng cu ts m an da te d b y

Mr. Ho us er an d t o p ayro ll di ffi cu lt ie s atall th ree h om es . Alth ou gh Mr. Ho us er an d Wash in gt on rep eat ed ly ass ur edadmin is tra to rs th atpa yro ll ob li ga ti on s wo ul d be m et , th is freque nt ly didno t o ccu r. On o ne oc cas io n, t o p la cat e ups etst aff m em be rs , Mr. Hou se r an d Wash in gt on ha nd edou t fi fty do ll ar b il ls to em pl oyees who co ul d n otcas h t he ir p ay ch eck s. Res id en t ca re d ire ct ly suf fere d a s a r es ul t o f st affi ng sh orta ge s. Re si de nt s an d t he ir b ed s wer e so ak edwith u rin e o r cak edinfece s b ecau se di ap ers were n ot ch an ge d. “ The sh ort s ta ffi ng pro bl em be cam e m or e se ve re o n p ay da y s, wh en em pl oyees ra cedto th e b an k o r st oo d i n l in e to cas h t he ir c he ck s atth e m on ey va n.” 1 7 In su ffi ci en t fo odwas asi gn ifi can t p ro bl em be cau se Mr. Ho us er fa il edto pa y foo d v en do rs . Res id en ts were g iv ensm al l, nut rit io na ll y in ad equa te m eal s an d of te n l ittl e o r no m il k. “ Res id en ts with s pe ci al di et ary ne ed s o fte n d idno t re cei ve pr ot ei n s ha ke s, o th er d ie ta ry supp le m en ts , or re qu ire d t he rap eu ti c m eal s.” 1 8 Res id en ts reg ul arl y

co m pl ai ne d t o b ot h t he st aff andrel at iv es th atth ey were hu ng ry . I d. at 208. 1 7 I d. at 264-65 (e mphasis added) . 1 8 9 Case: 12-14302 Date Filed: 06/19/2014 Page: 9 of 40A form er m ed ic al di rect or an d o th er s ta ff rep orte d s ig ni fic an t wei gh t l os s am on g t he res id en ts . W ei gh t l os s an d m al nu tri ti on m ak e nur si ng ho m e res id en ts m or e su sc ep ti bl e to di se as e, in fect io n, an d a gg rav at e[] th e ch ro ni c il ln es se s th atth ey alr eady ha ve . Nurs in g h om es m us t k eep tra ck

of t he ir res id en ts ’ weig ht s, an d m us t i nv es ti ga te when a res id en t l os es fiv e pe rcen t o r m or e o f hi s o r he r bo dy weig htdu rin g aon e-m on th pe rio d. [ 1 9 ] Mr. Ho us er, h owe ve r, in st ru ct edst aff t o s to p re co rd in g p at ie ntweig htlo ss , pr es um ab ly to av oi d s us pi ci on ina su rv ey . Fam il ie s o f res id en ts be gan t o b rin g i n fo odso th atth ei r fam il y

m em be rs wou ldrece iv e ad equa te nu tri ti on . Staf f m em be rs als o wo ul d p ur ch as e b readan d m il k fr om th ei r own fun ds so th at res id en ts wou ldha ve so m ethi ng to eat . 3. Dur in g t he rel ev an t p eri od , st at e o ffi ci al s co nduc te d s urve y s o n a n a nn ua l ba si s an d a ls o i n re sp on se to sp eci fic co m pl ai nt s. Mr . Hou se r ap pe aredto ha ve so m e adva nc e n ot ic e o f su rv ey ti m es , andhe pl acedcal ls to faci li ti es in stru ct in g th em to in crea se servi ces an d s ta ffi ng lev el s dur in g t ho se ti m es . The reco rdrefl ect s tha t M r. Hou se r an d Wash in gt on term in at edin di vi du al s wh o ra is ed

I d. at 222 (a lteration in orig inal) (c itation omit ted) (inter nal quotation marks omitted). 1 9 10 Case: 12-14302 Date Filed: 06/19/2014 Page: 10 of 40is su es of n on co m pl ia nc e o r rep orte d t he m

to th e au th or it ie s. St aff b el ie ve d t ha t i f th ey rev eal edth e true co nd it io ns at t he nu rs in g h om es to st at e su rv ey or s, “ th ey wou ldbe ‘ imm ed ia te ly term in at ed .’ ” 2 0 Des pi te Mr. Ho us er’s eff orts , th e fac il it ie s re gu la rly were ci te d fo r vi ol at io ns , and , eve ntua ll y , in20 07 , th e fac il it ie s ea chwere g iv enrat in gs so lo w-- on th e b as is of a n i m

m ed ia te ris k t o t he he al th an d s afet y of r es id en ts --tha t cl os ur e was requi red . In Jun e 2 00 7, the Geor gi a Offi ce o f Reg ul at ory Serv ic es (“ ORS”) ga ve no ti ce tha t i t was term in at in g t he Med ic ai d p ro vi de r ag reem en ts forMo un t Berry an d M or anLake “be cau se of n um ero us pro bl em s, i nc lu di ng un sa ti sf act ory ph y si cal en vi ro nm en ta l co nd it io ns , st affi ng sh orta ge s, an d i rreg ul ari ti es in vo lv in g res id en t tru stfun d a cco un ts .” Three m on th s l at er, the ORS g av e n ot ic e th atit 2 1 was clo si ng th e Wildwoo d fa ci li ty for the same reaso ns . Whe n t he faci li ti es cl os ed , res id en ts were tran sf erre d t o o th er nur si ng ho m es . At ne w faci li ti es , th e arri vi ng res id en ts ha d n o m ed ic al hi st or ie s s en t wi th th em . They were u nk em pt an d c om pl ai ne d o f hu ng er, an d m an y ho ard edfoo d.

I d. at 131. 2 0 I d. at 16. 2 1 11 Case: 12-14302 Date Filed: 06/19/2014 Page: 11 of 404.

Pri orto th ei r cl os ur e, Med ic are a ndMed ic ai d h adpa idFHG $3 2,9 14 ,30 4.6 6 fo r res id en t care. Bet ween20 03 an d 2 00 7, “ $2 ,28 2,4 39 was de po si te d o r tr an sf

erre d d ire ct ly int o M r. Hou se r’s pe rs on al ba nk [] acco un ts , $4 67 ,94 9 was de po si te d o r tr an sf erre d d ire ct ly int o Wash in gt on ’s per so na l b an k[ ] acco un ts ,” an d $ 1,7 45 ,62 0 was de po si te d o r tr an sf erre d i nt o t he op erat in g a cco un t of Mr. Ho us er’s co ns tru ct io n c om pany, “ The Gui ld ”; ne arl y all of t he se fun ds cam e fro m

anFHG so ur ce. Duri ng th e sa m e ti m e p eri od , Mr. Hou se r pu rch as ed 2 2 ov er $ 4 m il li on inreal est at e; “ [a] nu m be r of ch eck s, s ig ne d b y

[Mr. Ho us er] and W as hi ng to n andda te d fr om Octo be r 20 04 th ro ug h M ay 20 05 , were drawnon FHG orFo rum Group M an ag em en t Se rv ic es ’ acco un ts ” to m ak e p aym en ts forth es e pr op ert ie s. In J ul y

20 04 , Mr. Hou se r pu rch as eda ho m e fo r hi s ex -wif e ata co st 2 3 of $1 .4 m il li on ; “ ap pr ox im at el y si x wee ks earl ie r, [Mr. Ho us er] [had ] tra ns ferr ed $1 .4 m il li on fro m

th e FHG ba nkacco un t t o ape rs on al acco un t i n [h is ] na m e.” 2 4 Em pl oyees o f hi s o th er b us in es se s, n on e o f whi chha d i nd ep en de ntrev enue , were so m et im es pa iddi rect ly by FHG. Mr. Hou se r’s al im on y pa ym en ts , as wel l as

I d. at 352-53. 2 2 I d. at 364-65. 2 3 I d. at 366. 2 4 12 Case: 12-14302 Date Filed: 06/19/2014 Page: 12 of 40pa ym en ts forna nn y servi ces an d t hr ee l ux ury au to m ob il es , als o wer e drawnfro m FHG fun ds . 5. Mr. Ho us er wi th he ldpa y ro ll tax es bu t, b eg in ni ng with t he las t qua rte r of 20 03 , fai le d t o turn o ve r th e wit hh el d a m ou nt s t o the IRS (h e al so pe rio di cal ly did no t re m ithe al th in su ran ce p rem iu m s, d is ab il it y in su ran ce p rem iu m s an d c hi ld supp ort g arn is hm en ts ). The IR S rep eat ed ly info rm edMr. Ho us er an d Wash in gt on ab ou t the fai lu re t o p ay

th e ta xe s. In20 05 , W as hi ng to n g av e Rev enue Offic er Ode ll Ju st ic e te n c he ck s drawnfro m th e FHG op erat in g a cco un t t o p ay , inpa rt, the pa st -due pa yro ll tax es ; Wash in gt onals o g av e Offi cer Jus ti ce i ns tru ct io ns as t o whe n the ch eck s co ul d b e d ep os it ed . The fi rs t two ch eck s cl eare d; ho wev er, wh en Offi cer Jus ti ce at te m

pt edto de po si t the th irdan d fo urth ch eck s, the y were re tu rn ed fo r in su ffi ci en t fu nd s, an d Off ic er J us ti ce d idno t at te m ptto de po si t the rem ai nd er of th e ch eck s. Co ns eque nt ly, in Feb ru ary 20 05 , Offic er J us ti ce n ot ifi ed Mr. Ho us er an d Wash in gt on “ th atth e IRS wou ldim po se pa yro ll tax reco ve ry pe na lt ie s, o r trus t fu ndreco ve ry pe na lt ie s, ag ai ns t [t he m ] fo r th e ta xe s due fro m

13 Case: 12-14302 Date Filed: 06/19/2014 Page: 13 of 40th e fo urth qu art er o f 20 03 .” Laterth atm on th , Offic er J us ti ce re cei ve d t wen ty 2 5 ch eck s s ig ne d b y

W as hi ng to n i n v ari ou s amoun ts with n ot at io ns th atth ey rep res en te d p ayro ll tax es forth e fo urth qu art er o f 20 04 . Ten o f th os e ch eck s cl eare d; th e rem ai nd er, t ot al in g $ 15 7,0 00 , bo un ced . Office r Ju st ic e th enrefe rred th e m at te r to th e IRS cri m in al in ve st ig at io n d iv is io n. On No ve m

be r 17 , 20 05 , IRS cri m in al in ve st ig at or s ex ecu te d asea rch warra nton th e FHG of

fic es . Duri ng lat e 2 00 6 a nd20 07 , att orne y s fo r Mr. Ho us er m ad e p art ia l p aym en ts to wardtax es du e fo r th e fo urth qu art er o f 20 04 an d t he se co ndqu art er o f 20 05 . As of th e cl os e o f th e d is tri ctco urt re co rd , $8 06 ,30 5 s ti ll was owedforth e fi rs t qua rte r of 20 04 , th e fo urthqu art er o f 20 04 , andth e se co nd qu art er o f 20 05 . Inad di ti on to th e p ay

ro ll tax de fic ie nc ie s, M r. Hou se r fai le d t o fi le hi s 2 00 4 pe rs on al tax return u nt il Apri l 2 00 8, thr ee years af te r itwas due an d two -an d- on e-h al f y ears aft er the IRS i ni ti at edit s cr im in al in ve st ig at io n. Acco rd in g t o t he di st ric t co urt re co rd , Mr. Hou se r ha s yet to fil e a 2 00 5 re tu rn . B. Proc eedi ng s i n the Di st ri ct Co urt In20 11 , th e Gov ern m en t ch arg edMr. Ho us er an d Wash in gt on inan I d. at 398. 2 5 14 Case: 12-14302 Date Filed: 06/19/2014 Page: 14 of 40el ev en -co un t i nd ic tm en t. Co un t On e al le ge d t ha t b ot h d efen dant s h aden te redin to

a co ns pi racy to c omm ithe al th care frau d i n v io la ti onof 1 8 U.S.C. § 13 49 . Count s Two thr ou gh Nin e al le ge d tha t, o n e ig htoc cas io ns oc cu rri ng du rin g the fir stan d fo urth qu art ers of 2 00 4 a ndth e se co ndqu art er o f 20 05 , Mr. Hou se r ha d fa il edto pa y ov er t o t he IRS s om e $ 80 6,0 00 inpa y ro ll tax pa ym en ts , invi ol at io n o f 26 U.S.C. § 7 20 2. Co un ts Ten a ndElev enall eg eda fai lu re b y Mr. Ho us er t o t im el y fil e p ers on al in co m e ta x re tu rn s fo r ta x years 2 00 4 a nd20 05 , invi ol at io n o f 26 U.S.C. § 7 20 3. Mr. Ho us er p le ad edno t g ui lt y an d m ov edto di sm is s the in di ctm en t. His m ot io n was de ni ed , andth e cas e p ro ceed edto a be nc h t ria l o n asupe rs ed in g in di ctm en t. Wash in gt onwas d is m is se d fr om th e cas e an d p erm it te d t o p le ad gu il ty to an ot he r in di ctm en t al le gi ng m is pr is io n o f a fel on y . Mr. Ho us er’s fo ur -weektri al in cl ud edth e te st im on y of e ig ht y Gov ern m en t witne ss es an d n earl y

sev enhu nd redex hi bi ts . Mr. Hou se r m ov ed , at the clo se of th e Gov ern m en t’s ev id en ce an d a ga in at t he clo se of a ll of t he ev id en ce, fo r a jud gm en t o f acqui tt al , whi chth e d is tri ctco urt d en ie d. 2 6 On Ap ril 2, 2 01 2, the di st ric t co urt en te reda 47 1- pa ge ord er tha t i nc lu de d

Mr. Houser

then filed a

pro se motion for a

mistrial and, in the alterna tive, for a new 2 6 trial. The c ourt order ed Mr. House r’s pro semotion and attache d exhibi ts stricken fr om the rec ord. 15

Case: 12-14302 Date Filed: 06/19/2014 Page: 15 of 40de ta il edfin di ng s co nc ern in g t he ne gl ect edst at e o f th e p ro pe rti es , th e la ckof

se rv ic es an d a tt en ti on to th e res id en ts , andMr. Ho us er’s ap pr op ria ti onof Med ic are a ndMed ic ai d p aym en ts to FHG forhi s o wn u se . The d is tri ctco urt fo un d M r. Hou se r gu il ty on a ll co un ts . Spe ci fic al ly, with re sp ectto Co un t On e o f th e in di ctm en t, ch arg in g M r. Hou se r wit h c on sp iri ng with Wash in gt on to co m m it he al th care frau d, the di st ric t co urt d et erm in edth at [t]he Gov ern m en t h a[d ] pr ov edbe y on d areas on ab le do ub t tha t the th ree F orum

nu rs in g fa ci li ti es , Mt. B erry, Mora n Lak e, an d W il dwo od , un de r th e d ire ct io n o f Defen da nt , subm it te d o r cau se d t o be subm it te d, dur in g t he co ur se of t he co ns pi racy, fals e o r frau du le nt cl ai m s t o t he Med ic are a ndGeor gi a Me di cai d p ro gr am s fo r se rv ic es th atwere wo rth le ss inth atth ey were n otpro vi de d o r ren de red , were de fic ie nt , in ad equa te , subs ta nd ard , anddi d n otpro m ot e th e m ai nt en an ce o r en ha nc em en t o f th e qua li ty of li fe o f th e res id en ts of th e Nur si ng Faci li ti es , andwere o f a qua li ty tha t fa il edto m eet pr of es si on al ly recog ni zedst an dard s o f he al th care . [ 2 7 ] Turn in g t o C ou nt s Two th ro ug h Ni ne , th e co urt fo un d tha t M r. Hou se r wil lfu ll y ha d fa il edto pa y

ov er t ax es withh el d fr om th e wag es of e m

pl oyees i n t he cal en da r qu art ers all eg edinth e in di ctm en t. Itde te rm in edth atth e la te pay m en ts m ad e b y Mr. Ho us er’s at to rn ey

“ were i ne ffec ti ve , aft er the factatt em pt s t o re du ce Defen da nt ’s cri m in al li ab il ity .” Fin al ly, th e co urt fo un d t ha t M r. Hou se r 2 8

I d. at 428 (e mphasis added) . 2 7 I d. at 465. 2 8 16 Case: 12-14302 Date Filed: 06/19/2014 Page: 16 of 40wil lfu ll y

ha d fa il edto ti m el y

fil e h is in co m e ta x re tu rn s fo r 20 04 an d 2 00 5. Ag ai n, itco nc lu de d t ha t M r. Hou se r’s act io n o f fi li ng a pe rs on al in co m e ta x re tu rnfor20 04 inApri l 2 00 8, aft er Defe nd an t l earn edth athe was the subjec t o f anIRS cr im in al in ve st ig at io n, was anin effe ct iv e, aft er the factatt em ptby D efen da nt to av oi d c riminal li ab il it y forhi s p rev io us fai lu re t o fi le a pe rs on al in co m e ta x re tu rn . [ 2 9 ] At h is sen te nc in g h eari ng , Mr. Hou se r sp ok e o n h is ownbe ha lf a nd , whi le ackno wled gi ng so m e o f th e fac ts pro ve d a t tria l, co nt in ue d t o a rg ue th atm uc h o f wha t the co urt h adco nc lu de d re ga rd in g h is nurs in g h om es was fa ls e. The d is tri ct co urt s en te nc edMr. Ho us er t o 1 20 m on th s’ im pr is on m en t-- th e st atut ory m ax im um --o n C ou ntOne. Th e co urt s en te nc edhi m to 60 m on th s’ im

pr is on m en t on each of C ou nt s Two th ro ug h El ev en , whi chwere s ta gg eredsu chth atth e res ul ti ng sen te nc e o n a ll tax -rel at edco un ts was a n a dd it io na l 1 20 m on th s’ im pr is on m en t, fo r a t ot al of 2 40 m on th s, a s en te nc e withi n t he advi so ry gu id el in es ran ge . The co urt al so ord eredMr. Ho us er t o p ay res ti tu ti on to Med ic are a nd Med ic ai d i n t he am ou ntof $ 6,7 42 ,80 7.8 8. Th e co urt arriv edat t hi s fi gu re af te r co nc lu di ng th atap pr ox im at el y twen ty to twen ty-fiv e p erce ntof t he servi ces Mr. Ho us er p ro vi de d u nd er tho se pro gr am s wer e “ worth le ss .” The co urt o rd ered 3 0

I d. at 469. 2 9 R.341 at 4. 3 0 17 Case: 12-14302 Date Filed: 06/19/2014 Page: 17 of 40res ti tu ti on to th e IRS inth e am ou ntof $ 87 2,5 15 . The co urt al so en te redanord er

of for fei tu re. Mr. Ho us er t im el y

ap pe al edhi s co nv ic ti on , as wel l as th e co urt’s fo rfei tu re or de r.

II A. Hea lth Care Frau d Cou nt Co un t On e o f th e Sec on d S up ers ed in g In di ctm en t ch arg edMr. Ho us er an d W as hi ng to n wi th co ns pi rin g t o c omm ithe al th care frau d i n v io la ti on of 1 8 U.S.C. § 1 34 9. Sect io n 1 34 9 re qu ire s an ag reem en t t o c omm itth e und erl y in g o ffen se ,

3 1 na m el y th atth e d efen da nt(1) “ kn owi ng ly andwil lfu ll y ex ecu te [d ], or a tt em

pt [ed ] to ex ecu te , a sc he m e o r art ifi ce” ( 2) “ to de frau d a ny heal th care be ne fitpro gr am ” or“ to ob ta in , by m ean s o f fal se or f rau du le ntpre te ns es , rep res en ta ti on s, o r pr om is es , any of the m on ey or p ro pe rty owne d b y , or u nd er the cu st ody or c on tro l of , any heal th care be ne fitpro gr am ,” (3 ) “ in co nn ect io n wi th th e d el iv ery of or pa ym 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. The di stric t co urt fo un d t ha t M r. Hou se r an d Wash in gt on , work in g t og ethe r, Section 1349 of Title 18 provides: “Any person who attempts or conspires to commit 3 1 any offe nse under

this chapter sha ll be subject to the same pe nalties as those pre scribed f or the offe nse, the c ommissi on of which w as the objec t of the attempt or c onspiracy .” 18 Case: 12-14302 Date Filed: 06/19/2014 Page: 18 of 40kn owi ng ly sub m it te d t o M ed ic are a ndGeor gi a Me di cai d c la im s fo r se rv ic es th at

ha d n otbe enren de red . The d is tri ctco urt s ta te d: Sp eci fic al ly, th e Gov ern m en t h as pro ve d b ey on d areas on ab le do ub t th atth e th ree F orum

nu rs in g fa ci li ti es , Mt. B erry, Mora n Lak e, an d W il dwo od , un de r th e d ire ct io n o f Defen da nt , subm it te d o r cau se d t o be subm it te d, dur in g t he co ur se of t he co ns pi racy, fals e o r frau du le nt cl ai m s t o t he Med ic are a ndGeor gi a Me di cai d p ro gr am s fo r se rv ic es th atwere wo rth le ss inth atth ey were n otpro vi de d o r ren de red , were de fic ie nt , in ad equa te , subs ta nd ard , anddi d n otpro m ot e th e m ai nt en an ce o r en ha nc em en t o f th e qua li ty of li fe o f th e res id en ts of th e Nur si ng Faci li ti es , andwere o f a qua li ty tha t fa il edto m eet pr of es si on al ly recog ni zedst an dard s o f he al th care . [ 3 2 ] On ap pe al , Mr. Hou se r do es no t co nt es t the de pl or ab le co nd it io ns of h is nu rs in g h om es ; i nd eed , he r eci te s, i n d et ai l, tho se co nd it io ns inhi s o pe ni ng bri ef. He adm it s tha t Fo ru m rou ti ne ly fail edto pa y

th e ex pe ns es of t he nu rs in g fa ci li ti es , in cl ud in g b il ls forcli ni cal lab or at ory servi ces , ph y si cal th erap y , tra ns po rt s erv ic es , tel ep ho ne servi ce, m ob il e x -ray serv ic es , ph arm acy se rv ic es , andva rio us m ed ic al , nu rs in g a ndcle an in g s up pl ie s, as well as rep ai r co st s fo r was hi ng m ach in es an d dry ers , di sh was he rs , air co nd it io ne rs an d h eat ers , m ed ic al equi pm en t, an d l eak in g ro of s. [ 3 3 ] He al so adm it s tha t “ [t]he adm in is tra to rs of t he nu rs in g fa ci li ti es an d o th er s ta ff warn edMr. Ho us er, thr ou gh tel ep ho ne cal ls , e-m ai ls an d fa xe s, o f th es e

R.290 at 428 (emphasis adde d). 3 2 Appellant’s B r. 18-19 ( citations omitt ed). 3 3 19 Case: 12-14302 Date Filed: 06/19/2014 Page: 19 of 40de fic ie nc ie s.” Ins te ad , Mr. Hou se r m ai nt ai ns th atth e d is tri ctco urt erredin 3 4 em pl oyin g a“ worth le ss servi ces ” co nc ep t i n e va lu at in g h is gu il t u nd er the he al th care frau d s ta tu te . Mor eo ve r, he m ai nt ai ns th atth e rec or d d oe s n otsupp ort a fin di ng th athe co ns pi redwith Wash in gt on --o r an y on e el se --t o v io la te 18 U.S.C. § 1 34 7. We eva lu at e eac h o f th es e arg um en ts intu rn . 1. W or thl es s Se rv ic es Mr. Ho us er fi rs t t ak es is su e with t he di st ric t co urt’s u se of t he “ worth le ss se rv ic es ” co nc ep t. Mr . Hou se r cl ai m s tha t “ [t]he co nc ep t o f ‘worth le ss servi ces ’ de riv es fro m

civ il su it s b ro ug htun de r th e Fal se Cla im s Act .” Acco rd in g t o 3 5 Mr. Ho us er, “ [a] clai m

of ‘worthl es s s erv ic es ’ canbe th e b as is fora fal se cla im s act io n, i f th e p la in ti ff can s ho w th at‘ th e p erfo rm an ce o f th e se rv ic e is so de fic ie nt th atforall pra ct ic al pu rp os es itis th e equi va le ntof n o p erfo rm an ce atall .’ ” 3 6 Mr. Ho us er s ub m it s, h owe ve r, th at“ en gr aft in g a‘ worth le ss servi ces ’ co nc ep t o nt o t he fed eral he al thcare frau d s ta tu te ren de rs th e st atut e un co ns ti tu ti on al ly vag ue an d, the refo re, v oi d” be cau se “ de te rm in in g a t wh atpo in t

I d. at 18. 3 4 I d. at 34. 3 5 I d. (quotingMikes v. Straus, 274 F.3d 687, 703 ( 2d Cir. 2001)). 3 6 20 Case: 12-14302 Date Filed: 06/19/2014 Page: 20 of 40he al th care servi ces ha ve cro ss edth e li ne fro m m erel y ba d t o c riminal ly w orth le ss wou ldlea ve m an y

m enof c omm on in te ll ig en ce g ue ss in g.” Mr. Hou se r 3 7 di st in gu is he s h is cas e fro m th os e in whi ch“ th e se rv ic e fo r whi cha pr ov id er s eek s rei m bu rs em en t was ne ve r pr ov id ed , see Uni te d S ta te s v . Hoffm an -Vai le , 56 8 F .3d 13 35 (11 th Cir . 20 09 ), orun ne ces sa ry , see Uni te d S ta te s v . Mat eo s, 6 23 F.3d13 50 (1 1t h C ir. 2 01 0) , or n otco ve red , see [Uni te d S ta te s v .] Med in a, 48 5 [F .3d12 91 ,] 12 99 [(1 1t h C ir. 2 00 7) ]. ” The d is tri ctco urt’s d efi ni ti on of wo rth le ss servi ces , 3 8 Mr. Ho us er co nt in ue s, s tra y s fr om th es e si tu at io ns inth atitin tro du ces th e id ea o f de si rab il it y

in to th e cal cu lu s. Inhi s v ie w, th e co nc ep t h as no pl ace i n a n ev al ua ti onof wo rth le ss ne ss be cau se whatis to ta ll y un de si rab le to on e p ers on ne ve rth el es s m ay

have va lu e fo r an ot he r.

“ W e rev ie w whet he r a cri m in al st atut e is un co ns ti tu ti on al ly vag ue de no vo .” Uni te d S ta te s v . W ay ers ki , 62 4 F .3d13 42 , 13 47 (11 th Cir . 20 10 ). W e d o n ot be li ev e th atMr. Ho us er’s co nv ic ti on requi res us to dra w th e p ro ve rb ia l l in e in th e sa ndfor pu rp os es of d et erm in in g wh encle arl y subs ta nd ardservi ces be co m e

“ worth le ss .” Altho ug h t he in di ctm en t i n t hi s ca se so m et im es de sc rib es “ th e car e, se rv ic es an d e nv iro nm en t p ro vi de d b y th e Nur si ng Faci li ti es ” as be in g “ so
I d. at 35-36 (inter

nal quotation marks omitted). 3 7 I d. at 41. 3 8 21 Case: 12-14302 Date Filed: 06/19/2014 Page: 21 of 40in ad equa te or d efi ci en t as to co ns ti tu te wort hl es s s erv ic es ,” Mr. Ho us er was no t 3 9 pr os ecu te d s ol el y

onth e b as is of t he de fic ie ntna tu re o f so m e o f th e se rv ic es pr ov id ed . It i s cl ear b ot h fr om th e in di ctm en t an d t he di st ric t co urt’s o rd er o f co nv ic ti on th atMr. Ho us er al so was p ro se cu te d a ndco nv ic te d fo r fai li ng to pr ov id e se rv ic es th athe ha d c ert ifi edto Med ic are a ndGeor gi a Me di cai d h adbe en pr ov id edto th e res id en ts inhi s h om es . The in di ctm en t al le ge s tha t “ [f]ede ral st atut es an d re gu la ti on s m an da te th at nu rs in g fa ci li ti es co m

pl y with fe de ral requi rem en ts rel at in g t o the pro vi si on of se rv ic es an d qua li ty of care . 42 U.S.C. § 1 39 6r (b ).” The i nd ic tm en t co nt in ue s: 4 0

“ A nu rs in g fa ci li ty m

us t ca re fo r it s re si de nt s i n s uc h am anne r an d i n su chanen vi ro nm en t as wil l p ro m ot e m ai nt en an ce o r en ha nc em en t o f th e qua li ty of li fe o f eac h re si de nt .” 42 U.S.C. § 1 39 6r (b )(1 )(A). Add it io na ll y , nurs in g fa ci li ti es “ m us t p ro vi de servi ces an d a ct iv it ie s to att ai n o r m ai nt ai n t he hi gh es t p ract ic ab le ph y si cal , m en ta l an d ps y ch os oc ia l wel l-b ei ng of e ach res id en t i n a cco rd an ce wi th a pl anof care whi ch. . . de sc rib es th e m ed ic al , nu rs in g, an d p sycho so ci al ne ed s of th e res id en t an d h ow s uc h n eed s wi ll be m et. . . [.] 42 U.S.C. § 1 39 6r (b )(2 )(A); 42 C.F.R. § 48 3.2 5. [ 4 1 ] The in di ctm en t g oe s o n t o d es cri be ho w Mr. Hou se r’s nu rs in g fa ci li ti es fai le d t o pr ov id e requi redservi ces : “ On n um ero us oc cas io ns , th e d efen da nt s o wed R.139 at 12-13, ¶ 36. 3 9 I d. at 6, ¶ 17. 4 0 I d. at 6-7, ¶ 17 ( alteration in original). 4 1 22 Case: 12-14302 Date Filed: 06/19/2014 Page: 22 of 40co ns id erab le su m s t o m an y Nurs in g F aci li ty ven do rs th ro ug h c on si st en t de li nque nc y

inpa ym en t o r fai lu re t o p ay de sp it e p ro m is es an d re pr es en ta ti on s t o th e co nt rary. Defen da nt s cu rta il edcru ci al servi ces pro vi de d t o re si de nt s b y fai li ng to pa y th e v en do rs who pro vi de d s uc h s erv ic es .” The fr au du le ntact iv it y all eg ed 4 2 in th e in di ctm en t was ba se d o n t he subm is si onof c la im s fo r bo th th e la ckof se rv ic es , as wel l as servi ces th atwere “ de fic ie nt , in ad equa te , [or ] subs ta nd ard ”:

92 . The Nu rs in g F aci li ti es subm it te d o r cau se d t o b e subm it te d, dur in g t he co ur se of t he co ns pi racy, fals e o r frau du le nt cl ai m s t o t he Med ic are a ndGeor gi a Me di cai d p ro gr am forservi ces th atwere wo rth le ss inth atth ey were n otpro vi de d o r ren de red , were de fic ie nt , in ad equa te , subs ta nd ard , anddi d n otpro m ot e th e m ai nt en an ce o r en ha nc em en t o f th e qua li ty of li fe o f th e res id en ts of th e Nur si ng Faci li ti es , andwere o f a qua li ty tha t fa il edto m eet pr of es si on al ly recog ni zedst an dard s o f he al th care . [ 4 3 ] And , aga in , a few p arag rap hs lat er: “ Dur in g the co ur se of t he co ns pi racy, de fen da nt s GEORGE D. HOUSER andRHONDA HOU SER fraudul en tl y cau se d cl ai m s t o b e p ai d b y

Med ic are a ndGeor gi a Me di cai d fo r car e an d s erv ic es th at were ei th er n otren de redor we re s o i na de qu at e o r de fic ie ntas t o c on st itut e worth le ss servi ces .” 4 4 The di stric t co urt’s o rd er o f co nv ic ti on als o re st ed , at l eas t i n p art , onth e I d. at 17, ¶ 55 (e mphasis added) . 4 2 I d. at 29, ¶ 92 (e mphasis added) . 4 3 I d. at 30, ¶ 95 (e mphasis added) . 4 4 23 Case: 12-14302 Date Filed: 06/19/2014 Page: 23 of 40faci li ti es ’ fai lu re t o p ro vi de ne ces sary servi ces . The d is tri ctco urt ex pl ic it ly found th atth ere wer e o ccas io ns when“ res id en ts ne ve r rec ei ve d t he m ed ic at io ns th atth ey were s up po se d t o h av e,” res id en ts wentwitho utdi ap ers an d m ed ic al care for 4 5 th ei r wou nd s, lab or at ory servi ces were n otpe rfo rm ed , an d re si de nt s wer e n ot 4 6 4 7 tra ns po rte d fo r di al y si s or p ro vi de d wi th ph y si cal th erap y . Mo reo ve r, itis cle ar 4 8 4 9 fro m th e co urt’s o rd er tha t the co m pl et e la ckof s om e se rv ic es serve d a s o ne of t he ba se s fo r th e d is tri ctco urt’s d et erm in at io n tha t the Gov ern m en t h adm etit s b ur de n of pro of with re sp ectto th e co ns pi racy char ge : 13 . For t he fol lo win g re as on s, the Co urt fi nd s tha t the Gov ern m en t h as pro ve d b ey on d areas on ab le do ub t tha t Def en da nt co ns pi redwith h is wife , W as hi ng to n, t o d efraudth e Me di care an d Geo rg iaMed ic ai d p ro gr am s an d t o o bt ai n b y m ean s o f m at eri al fal se an d fr au du le ntpre te ns es , rep res en ta ti on s an d p ro m is es , m on ey an d pr op erty own edby, an d und er the cu st od y an d c on tro l o f, th e Med ic are p ro gr am

an d Geo rg iaMed ic ai d, i n c on ne ct io n wi th th e de li ve ry of a ndpa ym en t fo r he al th care be ne fit s an d s erv ic es , in vi ol at io n o f 18 U.S.C. §§ 13 47 an d 1 34 9. 14 . Spe ci fic al ly, th e Gov ern m en t h as pro ve d b ey on d a reas on ab le do ub t tha t the th ree F orum nu rs in g fa ci li ti es , Mt. B erry, Mo ranLake , andW il dwo od , un de r th e d ire ct io n o f Defen da nt , R.290 at 144. 4 5 See id. at 160. 4 6 See id. at 173. 4 7 See id. at 219. 4 8 See id. at 195. 4 9 24 Case: 12-14302 Date Filed: 06/19/2014 Page: 24 of 40subm it te d o r cau se d t o b e subm it te d, dur in g t he co ur se of t he

co ns pi racy, fals e o r frau du le ntcla im s t o t he Med ic are a ndGeor gi a Med ic ai d p ro gr am s fo r se rv ic es th atwere wo rth le ss inth atth ey were no t p ro vi de d o r ren de red , were d efi ci en t, i na de qu at e, subs ta nd ard , an d d idno t p ro m ot e th e m ai nt en an ce o r en ha nc em en t o f th e qua li ty of li fe o f th e res id en ts of t he Nurs in g F aci li ti es , andwere o f a qua li ty th atfai le d t o m eetpro fes si on al ly recog ni zedst an da rd s o f he al th care . . . . 15 . The Go ve rn m en t h as pro ve d b ey on d areas on ab le do ub t th at , du rin g t he co ur se of t he co ns pi racy, D efen da ntfrau du le nt ly cau se d c la im s t o b e p ai d b y Med ic are a ndGeor gi a Me di cai d fo r car e an d s erv ic es th atwere ei th er n otren de redor we re s o i na de qu at e o r de fic ie ntas t o c on st itut e worth le ss servi ces . [ 5 0 ] Altho ug h a ckno wled gi ng th atso m e se rv ic es si m pl y were n otpro vi de d t o res id en ts , Mr. Hou se r ne ve rth el es s ar gu es th at , forpu rp os es of M ed ic are a nd Geo rg iaMed ic ai d re im

bu rs em en ts , th es e se rv ic es are “ bu nd le d.” Con se qu en tl y , he urg es , we m

us t ev al ua te th e p ro vi si on of s erv ic es as awho le an d c an no t ev al ua te whet he r res id en ts were d ep riv edof asi ng le , altho ug h n eces sa ry , servi ce. I d. at 427-29 (e mphasis added) . At oral a rgument, Mr. Houser ’s counse l maintained 5 0 that the Gover

nment proce eded only

on a wor thless service s theory , that it had not prosecute d Mr. Houser

for se ekingreimburse ment from Medic are and Ge org ia Medica id for ser vices that the nursinghomes had fa iled to provide, and that, if the failure to provide ser vices we re the basis for the prosec ution, Mr. Houser ha d not been g iven ade quate notice . Counsel pointed specifically to the district court’s c omments at sentencing(conc erningthe ca lculation of loss) to support this contention. See R.341 at 3-4. We believe that the c ited passag es of the indictment c learly put Mr. Houser on notice that the Gover nment considere d his fraudule nt scheme to include the submission of claims for service s that were not rende red a s well as the submission of claims for se rvice s that wereso substandard a s to constitute worthless service s. Moreove r, the c ited passag es of the c onviction order establish that the district court re sted its determination of guilt on C ount One, at lea st in part, on Mr. H ouser’ s complete fa ilure to provides some se rvice s. 25 Case: 12-14302 Date Filed: 06/19/2014 Page: 25 of 40Mr. Ho us er m ai nt ai ns th atth is ap pr oa chis m an da te d b y Uni te d S ta te s ex rel . San ch ez-S m ith v . AHS Tuls a Reg io na l M ed ic al Cen te r, LLC, 75 4 F . Sup p. 2 d 12 70 (N.D. Okla . 20 10 ), an d Un it edSta te s ex rel . Swanv. Co ve na ntCare , Inc ., 27 9 F . Sup p. 2 d 1 21 2 (E.D. Cal . 20 02 ). Eve n i f we were b ou ndto fol lo w th es e cas es , andwe are n ot , we cou ldno t co nc lu de th atth ey

requi re re ve rs al of t he di st ric t co urt’s jud gm en t. Turni ng fir st to San ch ez-S m it h, the co urt h el d t ha t, fo r pu rp os es of b rin gi ng a qu i t am act io n un de r th e Fal se Cla im s Act , a pl ai nt iff co ul d “ reac h ajury on a factua l fa ls it y th eo ry inth e co nt ex t o f ‘bun dl ed ’ pe r di em Med ic ai d b il li ng ” b y

“pr es en t[i ng ] fact s amoun ti ng to (1) th e p ro vi si on of e nt ire ly w orth le ss servi ces , or (2 ) ata m in im um , th e p ro vi si on of g ro ss ly neg li ge ntservi ces with re ga rdto a pa rti cu la r st an da rdof c are o r reg ul at ory requi rem en t.” 7 54 F. Sup p. 2 d a t 1 28 7 (c it at io n om itte d) (in te rn al qu ot at io n m ark s o m it te d) . The co urt the n c on cl ud edth atth e rel at or s h adfai le d t o “ de m on st rat e th e p ro vi si on of wo rth le ss servi ces or a nyth in g am ou nt in g t o g ro ss ne gl ig en ce” b ecau se , inth e m os t eg reg io us cas e, on e p at ie nt ha d re cei ve d 6 77 .25 of t he 84 0 h ou rs of r equi redth erap y . Id. Un de r th os e ci rcu m st an ces , th e co urt co nc lu de d t ha t “ [n ]o reas on ab le jury co ul d c on cl ud e th at TRMC bi ll edMed ic ai d fo r worth le ss servi ces pro vi de d t o P at ie nt19 , andno reas on ab le jury co ul d c on cl ud e th atTRMC b il le d M ed ic ai d fo r ev en‘ gr os sl y 26 Case: 12-14302 Date Filed: 06/19/2014 Page: 26 of 40ne gl ig en t’ servi ces pro vi de d t o P at ie nt19 .” Id . Here, ho wev er, the fact s ar e v ery

di ffer en t. The in di ctm en t al le ge d, an d t he di st ric t co urt fo un d, tha t p at ie nt s wen t en ti rel y witho utne ces sa ry

servi ces su chas p hysic al th erap y , m ed ic at io n, d ia lysis an d wo un d c are. Mo reo ve r, we no te th atth e d is tri ctco urt co nc lu de d tha t Mr. Ho us er h adactua l kno wled ge of t he co nd it io ns an d l ackof s erv ic es inhi s nu rs in g h om es “ th ro ug h a n a lm os t d ai ly barra ge of t el ep ho ne cal ls , em ai ls , and fax es fro m

th e adm in is tra to rs at a ll th ree n ur si ng ho m es du rin g t he en ti re p eri odof th e co ns pi racy, y etDefen dantaffi rm at iv el y ch os e to ig no re the se ale rts .” In 5 1 sh ort, the reco rdrefl ect s n otsi m pl y “ gr os s n eg li ge nc e” i n t he pro vi si on of requi redservi ces , bu t anin te nt io na l d is reg ardof t ho se requi rem en ts . Swanals o d oe s l it tl e to ass is t M r. Hou se r. In t ha t ca se , a pl ai nt iff ina qu i ta m act io n a ll eg edth ata nu rs in g fa ci li ty w as “ so sev erel y un de rs ta ffed. . . th at pa ti en ts were o fte n d en ie d t he m os t b as ic care su chas r ep os it io ni ng , feed in g, ba th in g, an d wo un d t reat m en t.” Swa n, 2 79 F. Sup p. 2 d a t 1 21 6. Th e d is tri ctco urt gr an te d s umm ary jud gm en t fo r th e d efen da nt , Cov en an t Ca re, o n the gro un d t ha t th e co urt l ack edsubjec t m at te r juri sd ic ti on ov er the act io n b ecau se th e es se nt ia l el em en ts of t he pl ai nt iff’s cla im s h adbe endi sc lo se d i n apre vi ou s ac ti on . See i d. at12 17 -2 0. Th e co urt the n wen t o n t o s ta te th at , eve n i f itha d ju ris di ct io n, R.290 at 435. 5 1 27 Case: 12-14302 Date Filed: 06/19/2014 Page: 27 of 40“ Co ve nantCare wou ldst il l b e en ti tl edto su m m ary jud gm en t o n [t he ] fal se reco rd s cl ai m .” Id . The co urt o bs erv edth at“ Co ve na ntCare do es no t b il l the go ve rn m en t se pa rat el y

forin di vi du al act s o f pa ti en t care s uc h a s fe ed in g, turni ng , or b athi ng . In st ead , th e g ov ern m en t p ay s C ov en an t Ca re a p er d ie m rat e fo r pr ov id in g ro om an d b oa rd , in cl ud in g t he pro vi si on of s uc h ro ut in e se rv ic es . . . .” Id . at 1 22 1. Th e co urt the n c on cl ud edth at“ [b ]ecaus e Swando es no t al le ge th atCo ve na ntCare ’s ne gl ectof i ts pa ti en ts was s o s ev ere t ha t, fo r al l p ract ic al pu rp os es , th e p at ie nt s were re cei vi ng no roo m

an d b oa rdservi ces or r ou ti ne care at a ll , herFCA cl ai m do es no t fi t wi th in th e worth le ss servi ces cat eg ory .” Id . (em ph as is ad de d) . W it ho uten do rs in g o r ad op ti ng th e st an da rdsetforth inSwan , we no te th at Mr. Ho us er’s s itua ti on is m ark ed ly diff eren t. Inth e p res en t ca se , th e d is tri ct co urt’s jud gm en t d oe s n otsi m pl y res t o n t he factth atso m e se rv ic es were s ev erel y subs ta nd ard ; i t re st s o n t he factth atcert ai n s erv ic es , in cl ud in g t ho se m an da te d b y st atut e, were n otpro vi de d t o re si de nt s atall .

5 2 5 3 By way of example only , 42 U.S.C. § 1396r(b)(4) (A) states that “a nursingfac ility 5 2 must provide . . . (i) . . . re habilitative service s . . . ; (iii) pharmac eutical se rvice s . . . ; [ and] (iv) dietary service s that . . . meet the da ily nutritional and specia l dietary needs of eac h resident.” Be cause the Gover

nment proce eded, a

nd the district court’s c onviction rested, at least 5 3 in part, on the nursingfac iliti es’ c omplete fa ilure to provide some ne cessa ry service s to the residents, we need not c onsider whe ther the c oncept of worthless ser

vices ba sed on inade quacy or undesira

bility is unconstituti onally

vague. See A

ppellant’s B r. 35-39. In his reply

brief, Mr . Houser sug g ests that the Gover nment used his profit marg in of twenty-five pe rce nt to establish the element of w illfulness. This strategy , he continues, (continued...) 28 Case: 12-14302 Date Filed: 06/19/2014 Page: 28 of 40W e b el ie ve th is co nc lu si on is co ns on an t wi thth atreac he d b y th e Co urt o f App eal s fo r th e Si xt h C irc ui t i n C he sb ro ug h v . VPA, P.C., 65 5 F .3d46 1 (6 th Cir . 20 11 ), on whi chMr. Ho us er re li es . In Ch es br ou gh , rel at or s h adfil eda Fal se Cl ai m s Actact io n a ga in stVPA all eg in g “ th atVPA def rau de d the go ve rn m en t b y subm it ti ng Med ic are a ndMed ic ai d b il li ng s fo r de fect iv e rad io lo gy stu di es .” Id . at 46 4. Th e co urt h el d t ha t the rel at or s’ act io n c ou ldno t g o fo rwardon th e b as is of (...continued) 5 3 contributed to the va gueness of the statute bec ause “ it is i mpossible to st ate with any degree of cer tainty that a ‘pe rson of ordina

ry intelligenc e’ ne cessa

rily would rea liz e that he c ould be prosec uted criminally

for he alth car e fraud if he runs his nursinghome for- profit and take s what the Gover nment considers to be too much in profits.” Reply Br . 5. Ag ain, Mr. House r’s argument misses the mark. The Gover nment did not charg e Mr. House r with takingan excessive profit; it charg ed him, and the district cour t found him guilty

of, a sc heme whe rein he consciously

disreg arde d his leg al obligations to provide basic ser vices to Medica

re a nd Medica id benef iciarie s, while simultaneously divertingsubstantial funds to personal use s. His purcha ses evidenc e that he ha d funds ava ilable to pay for those se rvice s, but that he intentionally used those funds for othe r purpose s. Mr. Houser ’s brief

does not raise a fa cial vagueness objec tion to the health car e fr aud statute under which he wa s prosec uted. See Reply Br . 9 (“Mr . Houser[] . . . does not challeng e the clarity of § 1347 as a

statute . . . .”). Mor eover , we do not believe Mr. Houser rea sonably could argue that the statute is unconstitutionally vague bec ause it criminaliz es the c omplete failure to provide some ser vices. As the Court of

Appea ls for the Six th Circuit recognized in United States v. Semrau, 693 F .3d 510 (6th Cir. 2012), “[a]lthough the hea lth care fra ud statute does not (and c ould not) specify the innumera

ble fra ud scheme s one may

devise, it is difficult to imag ine a more obvious way to commit healthcar e fr aud than billing f or ser vices not ac tually rende red.” I d. at 530 (c itation omit ted) (inter nal quotation marks omitted). More over, the mens rea require ment contained in the statute, see 18 U .S.C. § 1347 (“Whoever knowing ly and willfully executes, or attempts to ex ecute , a sche me or a rtifice- - . . . shall be f

ined under

this ti tle or imprisoned not more than 10 year s, or both.” (e mphasis added) ), larg ely mitigates a

ny ambiguity , see United States v. Conner, 752 F .2d 566, 574 (11th Cir. 1985) (“ ‘The r equire ment that the ac t must be willful or purposeful may not rende r ce rtain, for

all purposes, a

statutory definition of the crime which is in some respe cts unce rtain. B ut it does relieve the statute of the objection that it punishes without warningan off ense of which the a ccuse d was una war e.’” (quotingScrew s v. United States, 325 U.S. 91, 102, 65 S.C t. 1031, 1036, 89 L . Ed. 1495 (1945) (plurality opinion))). 29 Case: 12-14302 Date Filed: 06/19/2014 Page: 29 of 40VPA’s rei m

bu rs em en t cl ai m s fo r th e x -ray stu di es th atwere “ ‘sub op ti m al ’ orof ‘poo r qu al it y .’ ” Id . at 4 67 -6 8. Nev erthe le ss , th e co urt d et erm in edth atth e rel at or s co ul d g o fo rwardonth e b as is of f iv e stud ie s tha t wer e “ no nd ia gn os ti c.” Id . at 4 68 (in te rn al qu ot at io n m ark s o mitte d) . It rea so ne d t ha t, “ [i]f VPA so ug ht rei m bu rs em en t fo r se rv ic es th atitkn ew were n otjus t o f po orqu al it y bu t h adno m ed ic al va lu e, th enitwou ldha ve effe ct iv el y subm it te d c la im s fo r se rv ic es th at were n otactua ll y

pro vi de d. Th is wou ldam ou ntto a ‘fals e o r frau du le nt ’ cl ai m withi n t he m ean in g o f th e FCA.” Id . As th e d efen da nt s i n C he sb ro ug h d id , Mr. Ho us er s ou gh t re im

bu rs em en t fr om

Med ic are a ndGeor gi a Me di cai d fo r requi redservi ces --p ha rm aceu ti cal , di ag no st ic , m ed ic al an d d ie ta ry --tha t s im pl y were n otpro vi de d.

2. Pro of of Co ns pi ra cy Mr. Ho us er al so ch al le ng es hi s co nv ic ti on onCo un t On e o n t he gro un d t ha t th e “ ev id en ce d idno t es tabl is h t ha t M r. Hou se r co ns pi redeithe r wit h Rho nd a Hou se r orwith a nyon e el se .” Acco rd in g t o M r. Hou se r, “ [n ]eith er Rh on da 5 4 Hou se r no r an y on e el se ha d a ny con tro l o r au th or it y ov er h ow the fun ds were

Appellant’s B r. 43. 5 4 30 Case: 12-14302 Date Filed: 06/19/2014 Page: 30 of 40al lo cat edor h ow the nu rs in g h om es were ru n.” 5 5

W e typi cal ly “rev ie w cha ll en ge s t o t he su ffi ci en cy of t he ev id en ce i n cri m in al cas es de no vo , vi ewin g t he ev id en ce i n the li gh t m os t fa vo rab le to th e [G]ove rn m en t.” Un it edSta te s v . Dom in gu ez, 6 61 F.3d10 51 , 10 61 (11 th Cir . 20 11 ). Here, h owe ve r, Mr. Ho us er n ev er ch al le ng edth e su ffi ci en cy of t he ev id en ce b efo re the di st ric t co urt. The on ly bas is forhi s m ot io n fo r acqui tt al on th e co ns pi racy cou ntwas h is va gu en es s ch al le ng e. [W] he re a d efen da ntfai ls to pre se rv e anarg um en t as to th e su ffi ci en cy

of the ev id en ce i n t he tri al co urt, the pre do m in an t ru le in th is cir cu it --es tabl is he d b y a lo ng an d u nc ha ll en ge d l in e o f cas es --i s be tt er s ta te d a s re qu iri ng th atwe up ho ldth e co nv ic ti on un le ss to do so wou ldworka “ m an ife stm is carr ia ge of ju st ic e.” Uni te d S ta te s v . Frie s, 7 25 F.3d12 86 , 12 91 n.5 (11 th Cir . 20 13 ) (quo ti ng Uni te d St at es v. Pe rez, 6 61 F.3d56 8, 5 73 -7 4 (1 1t h C ir. 2 01 1) (pe r curia m)). Reg ard le ss of th e st an dardap pl ie d, h owe ve r, Mr. Ho us er’s s uf fic ie nc y ch al le ng e fai ls . W e fre qu en tl y

ha ve no te d t ha t “ di rectev id en ce o f anag reem en t i s un ne ces sary ; the ex is te nc e o f th e ag reem en t an d ade fen da nt ’s parti ci pa ti on inth e co ns pi racy m ay

be pro ve n e nt ire ly from

cir cu m st an ti al ev id en ce.” Un it edSta te s v . McNa ir, 6 05 F.3d11 52 , 11 95 (11 th Cir . 20 10 ). Here the reco rdis rep le te with ev id en ce tha t Wash in gt on kn ew of th e la ck of p ro vi si on s an d s erv ic es inth e I d. at 44. 5 5 31 Case: 12-14302 Date Filed: 06/19/2014 Page: 31 of 40nu rs in g h om es ; th atsh e h adacce ss to an d c on tro l o ve r nu rs in g h om e fu nd s; an d 5 6 5 7 th atsh e was in vo lv edineffo rts to pl acat e em pl oyees, m as k t he po orco nd it io ns

5 8 atth e h om es an d s ta ve off go ve rn m en t en fo rcem en t ac ti on s. W e b el ie ve th at 5 9 6 0 th is is m or e th ansu ffi ci en t ci rcu m st an ti al ev id en ce t o e st ab li shW as hi ng to n’s ag reem en t t o p art ic ip at e in th e co ns pi racy to d efraudMed ic are a ndGeor gi a Med ic ai d. 6 1 See, e.g ., Gov’t’s Trial Ex . 487 at 2 (fax apprisingMr. Houser and Washing ton of 5 6 numerous issues includingthe state of the roof, lac k of transpor tation service s and lac k of laboratory

service s); Gov’t’s Trial Ex . 492 (fax to Washington complainingof broke n dishwasher

and pest c ontrol problems); Gov’t’s Trial Ex . 499 (fax apprisingWashington that Medica re Par t A patients would have to be discharg ed bec ause the home did not have suff icient whee lchairs to conduc t phy sical thera py ); Gov’t’s Trial Ex . 504 (fax apprisingWashington of the lack of nursingsupplies). See, e.g ., R.223 at 28 (testimony conce rningWashington’s use of the re sidents’ trust 5 7 acc ount); R.225 at 68-69 (testimony conce rningWashington’s c ontrol over the nur sing home ’s operating a ccount) . See R.242 at 844 (testimony conce rningMr. Houser

and Washing ton handingout fifty 5 8 dollar bills to employ ees) . See R.260 at 64-69 ( testimony conce rningWashington bring ing in f ood to satisfy

the 5 9 Inspector G ener al for Me dicaid for the Depa rtment of Community

Hea lth that a home had enough food to last through the wee kend). See R.244 at 81-82 ( testimony conce rningWashington’s de livery of, and instruc tions 6 0 for depositing, pay

roll tax chec ks to Office r Jus tice). It is of no moment that the Governme nt dismi ssed the conspira cy charg e ag ainst 6 1 Washington. “[A]s a simpl e matter of log ic, the g overnme nt’s voluntary dismiss al of a conspirac y

charg e ag ainst a def

endant’ s only

alleg ed coc onspirator doe s not preclude proof beyond a re asonable doubt, at defe ndant’s trial, that the de fenda nt conspired with that same alleg ed coc onspirator.” United States v. L opez, 944 F.2d 33, 40 (1st Cir. 1991). Indeed, e ven if Washington had be en tried a nd acquitted of

the conspira cy

charg e, it would not have a ffe cted the validity of Mr. House r’s c onviction. See United States v. Andre ws, 850 F.2d 1557, 1561 ( 11th (continued...) 32 Case: 12-14302 Date Filed: 06/19/2014 Page: 32 of 40B. Fai lu re to Fil e Qua rter ly Pay ro ll Ta xe s

Mr. Ho us er ch al le ng es th e su ffi ci en cy of t he ev id en ce wi th res pe ctto Co un ts Two th ro ug h Ni ne , whi chch arg edhi m with p ayro ll tax frau d, i n v io la ti on of 26 U.S.C. § 7 20 2. Inev al ua ti ng Mr. Ho us er’s s uf fic ie nc y cla im , we in qu ire whe th er “ an y

rat io na l trie r of

factco ul d h av e fo un d t he ess en ti al ele m en ts of t he cri m e b ey on d areas on ab le do ub t.” Un it edSta te s v . Min tm ire , 50 7 F .3d12 73 , 12 89 (11 th Cir . 20 07 ) (i nt ern al qu ot at io n m ark s o mit te d) . W e v ie w th e ev id en ce in th e li gh t m os t favo rab le to th e Gov ern m en t an d draw al l re as on ab le in fere nc es in fav orof s up po rti ng th e v erd ic t. Id . Sect io n 7 20 2 o f Tit le 26 of t he Uni te d S ta te s C od e p ro vi de s: Any pers on requi redun de r th is ti tl e to co ll ect , acco un t fo r, an d pa y ov er an y tax im po se d b y th is ti tl e who wil lfu ll y

fai ls to co ll ector tru th fu ll y acco un t fo r an d p ay

ov er s uc h t ax sh al l, i n a dd it io n t o o th er pe na lt ie s p ro vi de d b y

law, b e g ui lt y

of afel on y

an d, upo n c on vi ct io n th ereo f, sh al l b e fi ne d n otm or e th an$1 0,0 00 , or i m pr is on edno t m or e th an5 years, o r bo th , to ge th er wi th th e co st s o f pr os ecu ti on . Here, the Gov ern m en t al le ge d, an d t he di st ric t co urt fo un d, tha t M r. Hou se r wil lfu ll y fai le d t o p ay

pa yro ll tax es forhi s h om es du rin g v ari ou s qua rte rs of 2 00 4 an d 2 00 5. W it h re sp ectto th es e co un ts , Mr. Hou se r adm it s tha t h e fai le d t o s at is fy hi s (...continued) 6 1 Cir. 1988). 33

Case: 12-14302 Date Filed: 06/19/2014 Page: 33 of 40ta x l iabi li ty for the qu art ers at i ss ue . He m ai nt ai ns , ho wev er, tha t “ th e

Gov ern m en t fa il edto est ab li sh th e cri ti cal ele m en t o f ‘will fu ln es s.’” He 6 2 co rrec tl y ob se rv es th at“ th e te rm

‘ wil lfu ll y ’ as us edinth e In te rn al Rev enue st atut es ‘ ge ne ral ly con no te s a v ol un ta ry , in te nt io na l v io la ti on of akn own leg al du ty.’ ” He con te nd s tha t h is “ freque ntvi si ts to th e Rev enue Offic er, earne st

6 3 rep res en ta ti on s o f bo th pro bl em s an d p ro gr es s- -m ad e to a rev enue off ic ia l accu si ng hi m

of f rau d- -an d l arg e rem ed ia l p aym en ts ” b el ie th e d is tri ctco urt’s co nc lu si on th athi s co nduc t i n fa il in g t o turn o ve r pa yro ll tax es to th e IRS was wil lfu l. W e can no t ac cep t thi s ar gu m en t.

6 4 Altho ug h M r. Hou se r m ad e fre qu en t v is it s t o Off ic er Jus ti ce, the ev id en ce rev eal s tha t tho se vi si ts were an effo rt t o s ta ve off furth er i nv es ti ga ti on an d pr os ecu ti on , as o pp os edto aneffo rt t o c orrectanin no cen t m is take . Firs t, the re i s no qu es ti on th atMr. Ho us er u nd ers to odbo th hi s re sp on si bi li ty to p ay pa yro ll ta xe s an d t he co ns eque nc es for fai lu re t o d o s o : Mr . Hou se r on ly regai ne d 6 5 co nt ro l o f hi s n ur si ng ho m es aft er wai ti ng ou t a t en -y ear t ax li enpl acedon th e Appellant’s B r. 47. 6 2 I d. (quotingUnited States v. Pomponio, 429 U.S . 10, 12, 97 S. Ct . 22, 23, 50 L . Ed. 2d 6 3 12 (1976) (per c uriam)) . I d. at 51. 6 4 Mr. Houser

is a graduate of Ha

rvar d College and Ha

rvar d L aw School and a

member 6 5 of the Ge org ia B ar, a lthough he did not actively prac tice law during the rele vant period. 34 Case: 12-14302 Date Filed: 06/19/2014 Page: 34 of 40ho m es forhi s p rio r fai lu re t o p ay ov er p ayro ll tax es . Seco nd , inhi s d eal in gs with Offi cer Jus ti ce, h e was les s tha n fo rth co m in g. Du rin g i nt erv ie ws wi th Offi cer Jus ti ce, Mr . Hou se r bo thm is rep res en te d h is ass et s an d g av e co nt rad ic to ry in fo rm at io n c on cern in g h is fin an ci al po si ti on . He ask edforan d re cei ve d p ay ou t am ou nt s an d, wi th in m on th s o f do in g s o, wo ul d p ur ch as e ad di ti on al lan d fo r in ve st m en ts as o pp os edto pa y in g h is tax es . Fin al ly, Mr. Ho us er o nl y be ga n m ak in g “ in crea si ng ly larg e rem ed ia l p aym en ts ,” aft er a s earc h warran t was 6 6 ex ecu te d a t h is off

ic e, rev eal in g t ha t the Gov ern m en t h adin it ia te d acri m in al in ve st ig at io n o f hi s ac ti vi ti es . W e b el ie ve th atth is reco rd , tak enas awho le , rev eal s tha t M r. Hou se r ap pr eh en de d h is ob li ga ti on to pa y ov er p ayro ll tax es , bu t vo lu nt ari ly andin te nt io na ll y ch os e to sp en d a va il ab le fun ds on th e acqui si ti on of pe rs on al go od s an d i nv es tm en t p ro pe rti es as o pp os edto sat is fy in g h is leg al ob li ga ti on s. Th e rec or d, the refo re, am pl y supp orts th e d is tri ctco urt’s co nv ic ti on . C. Fail ure t o Fi le Inc ome Ta x Ret urns W it h re sp ectto Co un ts Ten a ndElev en , Mr. Hou se r was co nv ic te d o f vi ol at in g 2 6 U.S.C. § 72 03 , whi chpro vi de s i n re le va ntpa rt:

Any pers on requi redun de r th is ti tl e to pa y an y est im at edtax or I d. at 50. 6 6 35 Case: 12-14302 Date Filed: 06/19/2014 Page: 35 of 40ta x, . . . who wil lfu ll y fai ls to pa y

su chest im at edtax or t ax , . . . at t he ti m e o r ti m es requi redby law orreg ul at io ns , sh al l, i n a dd it io n t o o th er pe na lt ie s p ro vi de d b y

law, b e g ui lt y

of am is de m ean oran d, upo n co nv ic ti on th ereo f, sh al l b e fi ne d n otm or e th an$2 5,0 00 ($1 00 ,00 0 i n th e cas e o f a co rp or at io n) , or i m pr is on edno t m or e th an1 year, or bo th , to ge th er wi th th e co st s o f pr os ecu ti on . Mr. Ho us er m ai nt ai ns th atth e Gov ern m en t d idno t p ro ve th e st atut ory el em en ts as t o e it he r Co un t Ten , con cern in g h is fai lu re t o t im el y fil e h is 20 04 in co m e ta x re tu rn , or C ou ntElev en , con cern in g h is fai lure t o fi le hi s 2 00 5 re tu rn . Bec au se Mr. Ho us er m ak es arg um en ts un ique to each of t he se co un ts , we se pa rat el y

ad dr es s ea chco un t.

1. W it h re sp ectto Co un t Ten , Mr. Hou se r m ai nt ai ns th atth e Gov ern m en t d id no t es tabl is h t ha t h e h adfai le d t o fi le hi s re tu rn . Mr. Hou se r in vi te s o ur att en ti on to th e fac t tha t h e d idfil e h is 20 04 pe rs on al return, al be iton Apri l 8 , 20 08 . He no te s tha t i n Un it edSta te s v . Goet z, 74 6 F .2d70 5, 7 07 (11 th Cir . 19 84 ), we reci te d t he fol lo win g e le m en ts fora vi ol at io n o f § 7 20 3: “ [T]he ta xp ay er was requi redto fil e anin co m e ta x re tu rn ; the tax pa y er fa il edto fil e su chreturn; an d t he ta xp ay er’s v io la ti on was wi ll fu l.” Be cau se , he c on ti nu es , th e Gov ern m en t d idno t pr ov e th athe fai le d t o fi le a return, h is co nv ic ti onon Co un t Tencan no t b e

36 Case: 12-14302 Date Filed: 06/19/2014 Page: 36 of 40su st ai ne d.

Sect io n 7 20 3 o f Tit le 26 cle arl y requi res th e ti m el y

fil in g o f pe rs on al in co m e ta x re tu rn s; itcri m in al iz es th e wil lfu l fa il ur e to pa y in co m e ta xe s “ atth e ti m e o r ti m es requi redby law orreg ul at io ns .” Id . (em ph as is ad de d) . Sect io n 60 72 (a) o f Tit le 26 set s fo rth th e g en eral rul e th at“ returns m ad e o n t he ba si s o f th e cal en da r y ear s ha ll be fil edonor b efo re the 15 th day of Ap ril fol lo win g t he clo se of th e cal en da r y ear.” Mr. Hou se r’s pe rs on al in co m e ta x re tu rnforcal en da r y ear 20 04 was t he refo re due on Apri l 1 5, 2 00 5. He d idno t fi le hi s 2 00 4 re tu rn , ho wev er, u nt il ne arl y

th ree years l at er o n Ap ril 8, 2 00 8. As th e Supr em e Co urt h as ob se rv ed , “ [p ]unc tu al it y

is im po rta ntto th e fi sc al syste m ,” an d t he san ct io ns set fo rth in§ 7 20 3 a re d es ig ne d “ to ass ur e p un ctua l as well as f ai th fu l p erfo rm an ce o f th es e dut ie s.” Sp ie s v . Uni te d S ta te s, 3 17 U.S. 49 2, 4 96 , 63 S.Ct . 36 4, 3 67 , 87 L.Ed. 41 8 (1 94 3) . “ The st atut e in qu es ti on wou ldbe m ean in gl es s i f a t axpa y er co ul d fi le be y on d t he requi redda te an d n otbe subjec t t o l eg al san ct io ns .” Uni te d St at es v. Gree nl ee, 3 80 F. Sup p. 6 52 , 66 0- 61 (E.D. Pa. 19 74 ); s ee al so Uni te d St at es v. Mi ng , 46 6 F .2d10 00 , 10 05 (7t h C ir. 1 97 2) (ho ld in g tha t a “ la te fil in g a nd la te tax pa ym en t ar e imm at eri al on th e is su e o f wil lfu ln es s i n aSect io n 7 20 3 pr os ecu ti on ”). The lan gu ag e we em pl oyed i n Go et z d oe s n ot , in de edco ul d n ot , al te r th e st atut ory

requi rem en t o f ti m el in es s. Tim el in es s s im pl y was n otat i ss ue in 37 Case: 12-14302 Date Filed: 06/19/2014 Page: 37 of 40Goe tz , andou r sh orth an d re ci ta ti on of t he ele m en ts of t he off en se su ffi cedforth e pu rp os es of a dd res si ng th e arg um en ts m ad e in th atcas e. Mr. Ho us er al so m ai nt ai ns th atth e Gov ern m en t fa il edto est ab li shth athi s fai lu re t o t im el y

fil e a 2 00 4 re tu rnwas wi ll fu l. As n ot edpre vi ou sl y , “ th e st an da rd fo r th e st atut ory

wil lfu ln es s re qu ire m en t i s the vo lu nt ary, in te nt io na l v io la ti on of a kn own leg al du ty.” Chee k v . Uni te d S ta te s, 4 98 U.S. 19 2, 2 01 , 11 1 S .Ct. 6 04 , 61 0, 1 12 L.Ed.2d61 7 (1 99 1) (in te rn al qu ot at io n m ark s o m it te d) . Here, no th in g i n th e rec or d s ug ge st s tha t M r. Hou se r’s fai lure t o fi le hi s 2 00 4 re tu rnby Apr il 15 , 20 05 , was i nv ol un ta ry

or n eg li ge nt . 2. Turn in g t o h is arg um en ts with re sp ectto Co un t El ev en , Mr. Hou se r subm it s th atth e Gov ern m en t fa il edto est ab li sh th athi s fa il ur e to fil e h is 20 05 tax return was “wil lfu l.” He re li es on Edward s v . Uni te d S ta te s, 3 75 F.2d86 2 (9 thCir . 19 67 ), as supp ort fo r hi s p os it io n t ha t the Gov ern m en t fa il edto est ab li shth is el em en t. W e p erce iv e a num

be r of pro bl em s wi th Mr. Ho us er’s arg um en t. Fi rs t, at cl os in g a rg um en ts , Mr. Hou se r’s co un se l co nc ed edth atth e Gov ern m en t h adm et it s b ur de n o f pr oo f with re sp ectto Co un t El ev en : “ The ’ 05 was adi ffer en t s to ry , 38 Case: 12-14302 Date Filed: 06/19/2014 Page: 38 of 40he di dn ’t fil e th em , sh ou ldha ve , andth e Gov ern m en t p ro ve d i t. Let ’s no t wo rry

ab ou t tha t. He s ho ul d b e fo un d g ui lt y of t ha t.” Altho ug h, “ in th e ev en t o f erro rs

6 7 in th e tr ia l o r jury ins tru ct io ns , a co nc es si on of g ui ltwou ldno t h in de r th e de fen da nt ’s rig htto ap pe al ,” Fl or id a v . Nix on , 54 3 U.S. 1 75 , 18 8, 1 25 S.Ct . 55 1, 56 1, 1 60 L.Ed.2d56 5 (2 00 4) , Mr. Hou se r is no t ra is in g t ria l erro rs or e rro rs in le ga l s tand ard s; he ch al le ng es on ly the su ffi ci en cy of t he ev id en ce. Mr. Ho us er’s co un se l i nv it edth e co urt t o c on cl ud e th atth e Gov ern m en t h adm etit s b ur de n o f pr oo f with re sp ectto all of t he ele m en ts of C ou ntElev en ; h av in g d on e so , he can no t n ow cl ai m

erro r inth e co urt’s d et erm in at io n t ha t the Gov ern m en t d id , in fact , m eetth atbu rd en . See Un it edSta te s v . Ros s, 1 31 F.3d97 0, 9 88 (11 th Cir . 19 97 ) (“ It i s a c ard in al rul e o f ap pe ll at e rev ie w th ata pa rty m ay no t ch al le ng e as erro r a ru li ng or o th er tria l p ro ceed in g i nv it edby tha t p arty .” (i nt ern al qu ot at io n m ark s o mit te d) ). Eve n i f we were t o c on si de r Mr. Ho us er’s arg um en t, h owe ve r, itha s n o m eri t. The lan gu ag e in Edward s o n wh ic h M r. Hou se r rel ie s co nc ern s a d iff eren t se ct io n o f th e ta x s ta tu te s than t ha t wh ic h s erv es as t he ba si s fo r Mr. Ho us er’s co nv ic ti on . Addres si ng Edward s’s ch al le ng e to th e su ffi ci en cy of the Gov ern m en t’s s ho win g o f wil lfu ln es s wi th res pe ctto hi s co nv ic ti on s fo r vi ol at io ns R.340 at 37 (emphasis adde d). 6 7 39 Case: 12-14302 Date Filed: 06/19/2014 Page: 39 of 40of

26 U.S.C. § 7 20 1, th e Nin th Cir cu itst at ed : 6 8 The tro ub le inth is cas e is init s l ackof p ro of of wi ll fu ln es s i n th e se ns e o f a s pe ci fic in te ntto ev ad e o r de featth e ta x o r it s p aym en t. Eva si on an d d efea t, as we un de rs ta ndth ei r us e in th is sec ti on , co nt em pl at e anesc ap e fro m

tax an d n otm erel y

a po stpo ne m en t o f di sc lo su re o r pa ym en t. . . . Tax ev as io n, h owe ve r, fo cu se s o n the accu se d’s i nt en t t o d ep riv e th e Gov ern m en t o f it s t ax m on ey s, an d th is requi res m or e th anjus t d el ay . Edwar ds , 37 5 F .2dat 8 67 (em ph as is ad de d) (fo ot no te om it te d) . Mr. Hou se r, ho wev er, was no t co nv ic te d o f “ at te m pt [in g] to ev ad e o r de featan y tax ” und er § 7 20 1; he was c on vi ct edof f ai lu re t o fi le a return u nd er § 72 03 . The Ni nt h Ci rcu it ’s in te rp ret at io n o f “ [e]vas io n a ndde feat ,” th eref or e, ha s n o app li cat io n t o Mr. Ho us er. 6 9 Con cl us io n Fo r th e fo reg oi ng reas on s, the jud gm en t o f th e d is tri ctco urt i s af firm ed . AFFIRMED. At the time Edwar ds v. United States, 375 F.2d 862 ( 9th Cir. 1967), was dec ided, 26 6 8 U.S.C. § 7201 (1964) provided:

Any person who w illfully

attempts in any

manner to evade or def

eat a ny tax i mposed by

this ti tle or the pa

y ment there of shall, in addition to other pena lties provided by

law, be guilty

of a f elony and, upon convic tion thereof, sha ll be fined not more than $10,000, or imprisoned not more than 5 year s, or both, toge ther with the costs of prose cution. On appe al, Mr. House r also cha lleng es the for feiture order . His sole argument, 6 9 howeve r, is that the forf

eiture or der must be va cate d beca use it is premised on the health care fra ud charg e conta ined in Count One. See Appe llant’s Br . 54-55. B eca use weuphold Mr. Houser ’s conviction on Count One, we also uphold the district court’s f orfe iture orde r. 40 Case: 12-14302 Date Filed: 06/19/2014 Page: 40 of 40