Source: http://openjurist.org/468/f3d/308/united-states-v-j-triana
Timestamp: 2014-07-23 06:01:34
Document Index: 752977464

Matched Legal Cases: ['§ 371', '§ 1347', '§ 1001', '§ 1344', '§ 1014', '§ 1347', '§ 1320', '§ 3583', '§ 2', '§ 2', '§ 3', '§ 3', '§ 2', '§ 2']

468 F3d 308 United States v. J Triana | OpenJurist
468 F. 3d 308 - United States v. J Triana	Home468 f3d 308 united states v. j triana
468 F3d 308 United States v. J Triana 468 F.3d 308
UNITED STATES of America, Plaintiff-Appellee,v.Nicholas J. TRIANA, Jr., Defendant-Appellant.
On March 3, 2004, in a five-count indictment, a federal grand jury charged Nicholas J. Triana (hereinafter, "Triana" or "Defendant") with various fraudulent acts: (1) Count 1 charged Triana with conspiring, under 18 U.S.C. § 371, with unindicted co-conspirators—his sister, Jolynn Peck ("Peck"), and his attorney, Brian Salvagni ("Salvigni"), and "others"—to defraud the Medicare and Medicaid programs and the United States District Court for the Northern District of Ohio, including the United States Probation Office; (2) Count 2 alleged that Triana committed health care fraud by "fraudulently" trying to circumvent the exclusion provision of his settlement agreement in violation of 18 U.S.C. § 1347; (3) Count 3 alleged that Triana violated the federal false statement statute, 18 U.S.C. § 1001, by allegedly failing to "notify" and/or by "conceal[ing]" from his probation officers that he had a "de facto ownership, interest and control" of two companies—FootCare Consultants, Inc. ("Footcare"), a company providing podiatric services to patients in nursing homes around Ohio, and Podiatry Administration, LLC ("Podiatry Admin."), a business allegedly performing marketing and other administrative services for Footcare; (4) Count 4 charged Triana with one count of bank fraud under 18 U.S.C. § 1344, for causing Peck, to file a loan application for a second home containing materially incorrect information; and (5) Count 5 charged Triana with making a false statement in an application for an automobile loan in violation of 18 U.S.C. § 1014. Triana went to trial, and a jury convicted him on Counts 1 through 4.
A. Triana I
Between 1987 and 1998, Defendant-Appellant, Triana, worked as a Doctor of Podiatric Medicine in Ohio, specializing in the treatment of elderly patients housed in nursing homes throughout the state. On September 28, 1998, Triana executed a plea agreement with the government under which he pled guilty to one count of health care fraud for inflated Medicare billing, in violation of 18 U.S.C. § 1347 (hereinafter referred to as "Triana I"). Under the terms of Triana's plea agreement, he agreed that he would not "personally, or through any entity he controls, i.e. through a direct or indirect ownership interest of five percent or more or an officer, agent, or managing employee (as defined in 42 U.S.C. § 1320a 5(b)) submit claims or cause claims to be submitted for program payment." Triana also reached a settlement with the United States Department of Health and Human Services ("HHS"), excluding him from participation in "Medicare, Medicaid and all other federal health care programs" for a period of eight years. According to the exclusion notice he received from HHS, Triana could receive "no program payment ... for any items and services ... including administrative and management services," and such restrictions on payment would occur whether he served as an employee, administrator, operator, or in any other capacity.
Pursuant to the above agreements, on January 29, 1999, the district court sentenced Triana to six months of imprisonment in Oriena House, a half-way house with work release privileges located in Akron, Ohio, to be followed by a two-year period of supervised release, pursuant to 18 U.S.C. § 3583. As a condition of Triana's sentence, he was required to "notify [his] probation officer any time he had an interest of five percent or more in any entity or practice which submits claims or causes claims to be submitted to ... Medicaid or Medicare reimbursement." In addition, Triana was required to pay a fine of $10,000.00 and restitution in the amount of $83,644.00 "to be paid at a minimum rate of 15% of defendant's gross monthly earnings." In addition, effective June 11, 1999, the State of Ohio Medical Board permanently revoked Triana's podiatry license.
Because of his exclusion from Medicare and Medicaid programs, Triana was unable to obtain a Medicare or Medicaid provider number for any entity that he owned or controlled. Nonetheless, with the help of Salvagni, his corporate attorney and friend, Triana was able to create two new companies, Footcare and Podiatry Admin., and use them in a scheme that would enable him to participate, benefit from, and control a podiatry practice that billed Medicare. Although both Footcare and Podiatry Admin. were, in actuality, operated by Triana, Triana placed Dr. Stephen Castor ("Castor") at the helm of Footcare, and made his own sister, Peck, the owner and sole shareholder of Podiatry Admin.
Salvagni also assisted Triana in creating Podiatry Admin., an Ohio limited liability company. Podiatry Admin. received a high percentage of Footcare's monthly gross profits, ostensibly in return for providing Footcare with both management and administrative services. In order to hide his control of the company, however, Triana recruited his younger sister, Peck, to serve as the owner and sole shareholder of the company. Peck was a recently-divorced, financially strapped elementary school teacher in Florida, who had no background in either health care or medicine. At trial, Peck testified that both Triana and Salvagni had assured her that after signing the appropriate paperwork, she would be "relieved of all responsibilities" regarding Podiatry Admin., including ever having to visit the company headquarters in Ohio. In return for permitting Triana to use her name, Peck received a $500 monthly stipend from the Podiatry Admin. account.
Footcare's podiatrists, allegedly "unaffiliated" with Triana, derived significant income from Medicare billing. The income passing from Medicare to Footcare and Podiatry Admin., was funneled to Triana in a number of ways. Because Footcare and Podiatry Admin. both maintained office space in a building owned by Triana, Podiatry Admin. credited Triana for thousands of dollars in rental expenses. Triana's office building contained four separate and nearly identical suites, and although the two other renters testified that they paid roughly $6,000 per year in rent, Podiatry Admin.'s rent was inexplicably higher, totaling approximately $80,000 per year. Podiatry Admin. also charged Footcare considerable sums for "administration" and "management" costs; such costs usually amounted to at least 57% of Footcare's monthly earnings. At trial, however, Podiatry Admin.'s former President, Theresa Kripinsky ("Kripinsky"), testified that despite Podiatry Admin.'s high management fees, Podiatry Admin.'s services to Footcare were actually quite limited in scope. For instance, though Podiatry Admin. charged Footcare to perform its Medicare billing, in reality, Northcoast Medical Billing Service ("North Coast"), not Podiatry Admin., submitted all of Footcare's claims to Medicare. Kripinsky testified that Triana consistently instructed her to issue Podiatry Admin. checks to take care of his personal expenses. While serving as Podiatry Admin.'s President, Kripinsky used Podiatry Admin. checks to make Triana's restitution payments as well as monthly mortgage payments on his two condos. Further, Kripinsky used Podiatry Admin. funds to settle a number of Triana's bills from various stores such as Sam's Club, Kaufman's and Pier 1 Imports. On occasion, Triana also asked Kripinsky for blank checks from the Podiatry Admin. account to use for his own purposes. At trial, Kripinsky claimed that she quit because she was upset that between his salary and his various personal expenses, Triana consumed approximately 45% of all of Podiatry Admin.'s funds.
At trial, Triana presented a proposed theory of defense jury instruction on entrapment by estoppel. Triana asserted that because there was ample evidence at trial to show that he had been forthcoming about his involvement in both Footcare and Podiatry Admin., he should not now be punished for his reliance on his USPOs' implied ratification of his actions. The district court denied the jury instruction, finding both that there was no evidence in the record to support Triana's claim that he had informed his USPOs that he had any interest in either Footcare or Podiatry Admin. and that Triana had been "indirectly" receiving funds from Medicare since being sentenced in Triana I.
Triana was found guilty, and the government's sentencing memorandum recommended numerous sentence enhancements from the Federal Sentencing Guidelines (the "Guidelines"), that, when combined, raised Triana's offense level from a base level of 7 to at least a 33. The government urged the following enhancements: (1) a two-level enhancement under U.S. S.G. § 2B 1.1(b)(1)(7)(C) for Triana's violation of a prior court order; (2) a two-level enhancement under U.S.S.G. § 2B2.2(b)(8)(C) for Triana's use of sophisticated means in concealing his involvement in Footcare and Podiatry Admin.; (3) a two-level enhancement under U.S.S.G. § 3A1.1 for Triana's knowledge that a victim of the offense, nursing home patients, was a "vulnerable victim"; (4) a two-level enhancement under U.S.S.G. §§ 3B1.3 and 3B1.3(c) for a person who both "abuses a position of trust during the course of illegal activity" and is the "leader, manager, or supervisor of criminal activity." Although Triana objected to each of the government's proposed enhancements, the district court overruled his objections.
The government also argued for an 18-point enhancement under U.S.S.G. § 2B1.1 for the substantial loss to Medicare caused by Triana's fraud. The government recommended that the district court adopt the $2,922,967.90 in bills Footcare submitted to Medicare—the "intended loss"—as the loss attributable to Triana under the Guidelines. Triana objected and argued that because all of Footcare's services were legitimate services to Medicare-eligible patients, the appropriate "loss" under U.S.S.G. § 2B1.1(a)(1) was zero. In its discretion, the district court adopted the $1,764,199.36 Footcare received from Medicare—the "actual loss"—adding 16 points to Triana's base offense level, instead of the government's recommended 18.
At trial, Triana submitted a proposed jury instruction, which raised an entrapment by estoppel defense for Counts 1 through 5.1 Triana's based his proposed instruction on his assertion that there was ample evidence to show that because he was consistently forthcoming about his involvement in both Footcare and Podiatry Admin., he should not be punished for his reliance on his probation officers to inform him of any potential violations. The district court found Triana's theory untenable, and refused to present his requested theory of defense instruction to the jury. The district court explained that there was "[n]o evidence ... that the Government or an agent thereof affirmatively informed the Defendant that his conduct was legal," or that Triana relied on any such announcement. Further, the district court noted that it had "repeatedly g[iven] [Triana] the opportunity to provide any evidence to support this [entrapment-by-estoppel] defense" and did not require him to take the stand in order to present such evidence. Triana's first assignment of error is that the district court's decision not to adopt his defense instruction was an abuse of discretion entitling him to a new trial on Counts 1 through 4.2
A district court must grant an instruction on the defendant's theory of the case if the theory has some support in the evidence and the law. United States v. Duncan, 850 F.2d 1104, 1117-18 (6th Cir. 1988). An instruction which lacks evidentiary support or is based upon speculation should not be given. United States v. Lindo, 18 F.3d 353, 356 (6th Cir.1994). The proposed instruction must adequately submit the issues and applicable law to the jury. United States v. Brown, 946 F.2d 1191, 1194 (6th Cir.1991).3
This Court reviews a district court's decision not to give a jury instruction for abuse of discretion. See United States v. Ursery, 109 F.3d 1129, 1136 (6th Cir.1997); see also, United States v. Colon, 268 F.3d 367, 373 (6th Cir.2001). When conducting such review, this Court reverses the trial court if it finds that: (1) the proposed instruction is substantially correct; (2) the proposed instruction is not substantially covere