Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1410_1an2.pdf
Page Number: 18

14 

XIULU RUAN v. UNITED STATES 

Opinion of the Court 

(quoting  Rogers  v.  United  States,  422  U. S.  35,  47  (1975) 
(Marshall, J., concurring)).  We believe the same of the Gov-
ernment’s proposed standard here.

The  Government  asserts  that  we  held  to  the  contrary,
and  “effectively  endorsed”  its  honest-effort  standard,  in 
United  States  v.  Moore,  423  U. S.  122  (1975).    Brief  for 
United States 26.  But the question in Moore was whether 
doctors could ever be held criminally liable under §841.  423 
U. S., at 124.  Moore did not directly address the issue be-
fore us here regarding the mens rea required to convict un-
der the statute. 

Further, the Government, citing Yermian, notes that the 
authorization clause precedes the words “knowingly or in-
tentionally.”  And, the Government argues, grammatically
speaking, that fact prevents the latter mens rea provision 
from  modifying  the  former  clause.    See  Brief  for  United 
States  24–25.  But  Yermian  based  its  holding  on  the  fact
that the clause preceding the mens rea provision set forth a 
jurisdictional criteria, which is typically not subject to a sci-
enter requirement.  468 U. S., at 68–69; see also Rehaif, 588 
U. S., at ___ (slip op., at 4).  Yermian did not base its holding 
on the grammatical positioning of the statutory language. 
Finally, the Government argues that requiring it to prove
that  a  doctor  knowingly  or  intentionally  acted  not  as  au-
thorized will allow bad-apple doctors to escape liability by 
claiming  idiosyncratic  views  about  their  prescribing  au-
thority.  See, e.g., Brief for United States 33.  This kind of 
argument, however, can be made in many cases imposing
scienter requirements, and we have often rejected it on ba-
ses similar to those we have set forth in Part II of this opin-
ion.  See, e.g., Rehaif, 588 U. S., at ___ (slip op., at 8); Lipa-
rota, 471 U. S., at 433–434. 

We  do  the  same  here.    The  Government,  of  course,  can 
prove knowledge of a lack of authorization through circum-
stantial evidence.  See ibid.  And the regulation defining the
scope of a doctor’s prescribing authority does so by reference