Opinion ID: 2789925
Heading Depth: 2
Heading Rank: 1

Heading: Sufficient evidence supports the verdicts

Text: Moreira argues that the Government did not present sufficient evidence of her knowing participation in a scheme to defraud Medicare and in laundering the proceeds of the unlawful scheme. Our review of the record convinces us otherwise. To sustain the Medicare fraud conspiracy conviction, the Government had to prove beyond a reasonable doubt that (1) a conspiracy existed; (2) the defendant knew of it; and (3) the defendant knowingly and voluntarily joined it. United States v. Vernon, 723 F.3d 1234, 1273 (11th Cir. 2013). The Government may prove these elements by circumstantial evidence because conspiracy is “predominantly mental in composition.” Id. The Government does not have to show that the defendant knew all of the details of the conspiracy or participated in every aspect of the conspiracy. Id. Rather, the Government’s burden is to prove “that the defendant knew of the essential nature of the conspiracy.” Id. (quoting United States v. Miranda, 425 F.3d 953, 959 (11th Cir. 2005)). 10 Case: 14-10530 Date Filed: 03/30/2015 Page: 11 of 17 For the money laundering charge, the Government had to prove that an agreement between two or more persons to commit a money laundering offense existed, and the defendant knowingly and voluntarily participated in that agreement. United States v. Broughton, 689 F.3d 1260, 1280 (11th Cir. 2012). To sustain the conviction for paying kickbacks in connection with Medicare, the Government had to show that Moreira made payments of money to persons “in return for referring an individual to a person for the furnishing . . . of any item or service for which payment may be made in whole or in part under a Federal health care program.” 42 U.S.C. § 1320a‒7b(b)(1) and (2). The Government presented sufficient evidence to support these convictions. The testimony, recordings, and documents seized by the FBI are sufficient proof that Moreira reached agreements with patients to sign for alleged home health therapy in return for a cash kickback. She instructed Frank Hurst to recruit Medicare beneficiaries as patients of Anna Nursing, and she paid him in cash for each of the recruits he obtained. Evidence showed that Moreira paid Jimenez for his patient referrals, and Torres testified that Moreira told him that she needed cash to pay her patients and patient recruiters. She paid doctors and clinics for providing prescriptions for home health services and retrieved the prescriptions for Anna Nursing to submit claims for the services to Medicare. There was more than sufficient evidence from which the jury could infer, beyond a reasonable doubt, 11 Case: 14-10530 Date Filed: 03/30/2015 Page: 12 of 17 that Moreira was directly involved in the patient recruiting and payment of kickbacks so that Anna Nursing could submit fraudulent claims to Medicare. Additionally, there was sufficient evidence to support the money laundering convictions. Torres testified that he received the checks from Moreira, written on the Anna Nursing bank account, and gave her cash in the amount of the checks less his ten percent fee. Alejo witnessed Torres bringing Moreira a bag of cash one time. Torres testified that he laundered between $10,000 and $15,000 per week for Moreira. Moreira’s defense that she gave Torres the checks for an investment are nonsensical. She was unable to provide the name of the club in which she was investing, or its location, or its business, and she did not present any documentary evidence to substantiate any club investment. In addition to the aforementioned evidence of guilt, Moreira elected to take the stand and to testify in her own defense. In this circuit, “when a defendant chooses to testify, [s]he runs the risk that if disbelieved the jury might conclude the opposite of h[er] testimony is true.” United States v. Brown, 53 F.3d 312, 314 (11th Cir. 1995) (internal quotation marks omitted). Where the Government has presented some corroborative evidence of guilt for the charged offenses, and the defendant takes the stand in her own defense, her testimony professing innocence may establish, by itself, the elements of the offense. Id. at 315. “This rule applies with special force where the elements to be proved for a conviction include highly 12 Case: 14-10530 Date Filed: 03/30/2015 Page: 13 of 17 subjective elements: for example, the defendant’s intent or knowledge.” Id.; see also United States v. Williams, 390 F.3d 1319, 1325‒26 (11th Cir. 2004). The record is replete with evidence supporting Moreira’s convictions. The jury was free to believe the Government’s witnesses rather than Moreira’s mythomania. When a defendant testifies, she runs the risk of bolstering the Government’s case if the jury chooses not to believe her. The jury had the opportunity to listen to Moreira and judge her credibility and demeanor. It was free to choose among reasonable interpretations, and it did so. Accordingly, we conclude from the record that there was more than sufficient evidence to support Moreira’s convictions. B. Striking Moreira’s witness list was not abuse of discretion Moreira contends that the district court severely hampered her presentation of relevant evidence by striking her list of 75 witnesses. The district court has wide discretion in ruling on evidentiary issues as to relevance and materiality, and we will not disturb its rulings absent a clear showing of an abuse of discretion. Moreira fails to make such a showing. Prior to the commencement of the trial, the parties agreed that the case would take three to four days to complete. Because of the agreed upon trial time, the district court found that Moreira’s list of 75 witnesses was baseless and unrealistic. Even though defense counsel reduced the list of witnesses, the district 13 Case: 14-10530 Date Filed: 03/30/2015 Page: 14 of 17 court commented that most of the remaining witnesses’ testimony was not relevant. [R. DE 220: 51‒52.] However, Moreira presented numerous witnesses in her defense, and she cannot show that the district court prevented her from presenting any relevant testimony. Hence, we conclude that the district court did not abuse its discretion in striking the list of 75 defense witnesses and having the defense reduce its number of witnesses. C. Excluding evidence of Medicare rules compliance was not erroneous Moreira argues that the district court abused its discretion by excluding evidence of her compliance with Medicare rules and regulations because this evidence supported her defense that she did not intend to defraud Medicare. Moreira makes this argument for the first time on appeal; thus, our review is for plain error. Edouard, 485 F.3d at 1343. Generally, “[e]vidence of good conduct is not admissible to negate criminal intent.” United States v. Camejo, 929 F.2d 610, 613 (11th Cir. 1991); see also United States v. Ellisor, 522 F.3d 1255, 1270‒71 (11th Cir. 2008) (affirming the exclusion of evidence of defendant’s legitimate business activities in order to negate evidence of his fraudulent intent). The Government did not charge and did not argue that there was no legitimate business conducted at Anna Nursing. Thus, evidence that some of the claims filed by Anna Nursing may have been for services legitimately provided to eligible patients without the payment of 14 Case: 14-10530 Date Filed: 03/30/2015 Page: 15 of 17 kickbacks was irrelevant. Accordingly, we conclude that the district court did not err in excluding such evidence. D. There was no plain error at sentencing Moreira contends that the district court effectively deprived her of her right to allocute because it warned her that any statement she made at the sentencing hearing could be used later if there were a new trial after appeal. She did not object at sentencing. Thus, we review for plain error her claim of a denial of the right of allocution. Prouty, 303 F.3d at 1251; see also United States v. Quintana, 300 F.3d 1227, 1231‒32 (11th Cir. 2002) (stating that review of a district court’s denial of a defendant’s right to allocute is for manifest injustice, which is equivalent to plain error review). At sentencing, the district court had a discussion with Moreira’s counsel concerning the lack of an interpreter at the sentencing because Moreira’s native language was Spanish. [R. DE234, p.15‒17.] An interpreter had been present during the trial, and counsel assumed that the interpreter would be present at the sentencing as well. Counsel acknowledged that Moreira understood English but communicated better in Spanish. The district court cautioned counsel that Moreira should be careful if she wanted to allocute in case she appealed and received a new trial because anything she said could be used at a retrial. The district court emphasized, however, that it was not trying to stop her from making any 15 Case: 14-10530 Date Filed: 03/30/2015 Page: 16 of 17 statements, and it would listen to her speak on her behalf no matter how long it took. Counsel consulted with Moreira, and she decided not to speak. “Allocution is the right of the defendant to make a final plea on his own behalf to the sentencer before the imposition of sentence.” Prouty, 303 F.3d at 1251. This right is protected under the Federal Rules of Criminal Procedure. See Fed. R. Crim. P. 32. The rule provides that the court, prior to imposing sentence, must “address the defendant personally in order to permit the defendant to speak or present any information to mitigate the sentence.” Fed. R. Crim. P. 32(i)(4)(A)(ii). The district court failed to address Moreira personally before it sentenced her. Thus, there was error, and it was plain. Prouty, 303 F.3d at 1252. Although the district court plainly erred by not addressing Moreira personally, regardless of whether its warning deprived her of the right to allocute, Moreira still has the burden of demonstrating that the error affected her substantial rights. See id. She cannot meet this burden because the district court sentenced her at the bottom of the sentencing guideline range. “We have held that the denial of the right of allocution presumptively affects a defendant’s substantial rights only where the possibility of a lower guidelines sentence exists.” United States v. Perez, 661 F.3d 568, 583 (11th Cir. 2011); see also Quintana, 300 F.3d at 1231‒32 (holding that denial of right to allocute was not prejudicial because district court sentenced defendant to low end of guideline range). 16 Case: 14-10530 Date Filed: 03/30/2015 Page: 17 of 17 Moreira’s guideline sentencing range was 235 to 293 months, and the district court sentenced her to 235 months, the lowest end of the sentencing guideline range. Hence, she suffered no prejudice, and her substantial rights were not affected by the court’s error. Accordingly, she is entitled to no sentencing relief, and we affirm her sentence.