Opinion ID: 2982442
Heading Depth: 3
Heading Rank: 3

Heading: Judgment of Acquittal on Conspiracy Charge

Text: Agbebiyi argues that his conviction for conspiracy to commit health care fraud is not supported by sufficient evidence, and that he is entitled to a judgment of acquittal on that charge. Agbebiyi did not move for a judgment of acquittal during or after trial. The standard of review on appeal for an insufficient-evidence challenge is “whether, after viewing the evidence in the light most favorable to the prosecution, any rational trier of fact could have found the essential elements of the crime beyond a reasonable doubt.” Jackson v. Virginia, 443 U.S. 307, 319 (1979)(emphasis in original). However, the failure to make a motion for judgment of acquittal under Fed. R. Crim. P. 29 constitutes a waiver of objections to the sufficiency of the evidence. United States v. Jordan, 544 F.3d 656, 670 (6th Cir. 2008). Where a defendant fails to make the requisite Rule 29 motions, review is “limited to determining whether there was a manifest miscarriage of justice. A miscarriage of justice exists only if the record is devoid of evidence pointing to guilt.” Id. (quoting United States v. Price, 134 F.3d 340, 350 (6th Cir. 1998)); see also United States v. Kennedy, 714 F.3d 951, 957 (6th Cir. 2013). Although Rule 29 now states that “a defendant is not required to move for a judgment of acquittal before the court submits the case to the jury as a prerequisite for making such a motion after jury discharge[,]” see 23 No. 12-2559, United States v. Agbebiyi Fed. R. Crim. P. 29(c)(3), Agbebiyi not only failed to move for a judgment of acquittal during trial, he also failed to so move after the return of the guilty verdict, as permitted under Fed. R. Crim. P. 29(c)(1). Therefore, the “manifest miscarriage of justice” standard applies in this case. The offense of health care fraud under 18 U.S.C. § 1347 is committed by one who “knowingly and willfully executes, or attempts to execute, a scheme or artifice– (1) to defraud any health care benefit program; or (2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program in connection with the delivery of or payment for health care benefits, items, or services[.]” § 1347. To establish a violation under § 1347, the government must prove beyond a reasonable doubt that the defendant “(1) knowingly devised a scheme or artifice to defraud a health care benefit program in connection with the delivery of or payment for health care benefits, items, or services; (2) executed or attempted to execute this scheme or artifice to defraud; and (3) acted with intent to defraud.” United States v. Martinez, 588 F.3d 301, 314 (6th Cir. 2009); see also United States v. Semrau, 693 F.3d 510, 525 (6th Cir. 2012). Proof of intent to defraud does not require direct evidence; a jury may consider circumstantial evidence and infer 24 No. 12-2559, United States v. Agbebiyi intent from evidence of efforts to conceal the unlawful activity, from misrepresentations, from proof of knowledge, and from profits. United States v. Davis, 490 F.3d 541, 549 (6th Cir. 2007). The law also penalizes “[a]ny person who attempts or conspires to commit any offense under this chapter[.]” 18 U.S.C. § 1349. A conspiracy charge requires the government to prove an agreement between two or more persons to act together in committing an offense, and an overt act in furtherance of the conspiracy. United States v. Hunt, 521 F.3d 636, 647 (6th Cir. 2008). The government is not required to show a formal written agreement. Id. “Instead, it is sufficient to demonstrate a tacit or mutual understanding among the parties.” Id. Direct evidence of the conspiracy is not necessary; rather, “[i]t is enough to present ‘[c]ircumstantial evidence which a reasonable person could interpret as showing participation in a common plan....’” Id. (quoting United States v. Crossley, 224 F.3d 847, 856 (6th Cir. 2000)). The government need not prove that the defendant knew every detail of the conspiracy, but only that the defendant knew the object of the conspiracy and voluntarily associated himself with the conspiracy to further its objective. Crossley, 224 F.3d at 856. A defendant’s participation in the conspiracy’s common purpose and plan may be inferred from the defendant’s actions and reactions to the circumstances. United States v. Salgado, 250 F.3d 25 No. 12-2559, United States v. Agbebiyi 438, 447 (6th Cir. 2001). “Although an agreement must be shown beyond a reasonable doubt, the connection between the defendant and the conspiracy need only be slight, and the government is only required to prove that the defendant was a party to the general conspiratorial agreement.” Id. Agbebiyi argues that the government failed to prove that he knowingly and voluntarily became a participant in the conspiracy organized by Hernandez and her cohorts. He claims that he performed valid services for patients, and that he was unwittingly involved in the clinics’ scheme as a pawn. Agbebiyi argues that he legitimately visited with patients, ordered tests and prescribed medications; that he was never told by the clinic owners that they intended to defraud Medicare; that he never ordered tests which his co-workers thought to be unnecessary; that he was not involved in the actual billing of Medicare; and that he received only reasonable compensation for his services. The government’s theory was that Agbebiyi participated in the conspiracy to defraud Medicare by ordering medically unnecessary tests. The government presented evidence that Agbebiyi worked at the clinics for a period spanning twenty months of the twenty-nine months during which the clinics were in operation. When Hernandez interviewed Agbebiyi, she explained what his role would be, namely, to see patients and then to refer them for diagnostic tests. 26 No. 12-2559, United States v. Agbebiyi Agbebiyi never expressed any concerns about ordering the tests or the fact that the tests would be sent elsewhere for interpretation. Agbebiyi was originally paid a salary of $100 per hour. However, when Hernandez opened the Manuel Clinic, Agbebiyi told her he wanted an additional fifteen percent of the total billed by the three clinics. Although Agbebiyi did not process the Medicare claims at the clinics, he signed a certificate which put him on notice of Medicare rules which rendered him responsible for claims submitted under his provider number. Because the clinics were required to have a doctor on site in order to bill Medicare, it was Agbebiyi’s signature on the test orders which allowed the clinics to submit the claims. See Hunt, 521 F.3d at 648 (noting that because the health care benefit programs would not have paid for the procedures but for the doctor’s signature on the orders, the doctor was the direct and proximate cause of the harm suffered by those entities). Dr. Teener testified that as a neurologist specializing in nerve problems, he only referred one-half to two-thirds of his patients for nerve conduction studies, and that the unreliable Doppler test was used only in rare circumstances. The nerve conduction and transcranial Doppler tests are used by neurologists and physiatrists specializing in rehabilitative medicine. The nerve conduction study is given in conjunction with a painful 27 No. 12-2559, United States v. Agbebiyi needle electromyography test. Teener is also typically present when the test is being given so that he can monitor the test and explain the results to the patient immediately after the test. Dr. Acosta, a general practitioner like Agbebiyi, testified that he always referred patients to a specialist for tests such as the nerve conduction study. In contrast, Agbebiyi, a general practitioner, ordered the nerve conduction study for ninety-three percent of his patients. All but one of the 537 patients seen by Agbebiyi were referred either for a nerve conduction study or a transcranial Doppler test. There is no evidence that Agbebiyi ever referred anyone for the painful needle electromyography test. He was occasionally absent from the building when the tests were administered; Agbebiyi informed Oliver that the tests could be given before he arrived for the afternoon. Teener’s technicians typically trained for nine to ten months before they were permitted to give a nerve conduction test independently. Oliver, who had no medical training other than a phlebotomy class, received ten to twelve hours of training from Juan and Santiago Villa, who also had no medical training, on how to operate the clinics’ equipment. There is no evidence that Agbebiyi ever expressed any concern about the fact that Oliver, who interviewed patients, took their vital signs, and administered 28 No. 12-2559, United States v. Agbebiyi tests, had no medical training in these areas. Dr. Acosta, who only worked at the clinics a few months, was quickly troubled by the fact that Hernandez and other clinic employees pressured him to order tests. In contrast, Agbebiyi readily ordered the tests suggested by Oliver, Juan Villa, and Hernandez. Teener also testified concerning a sample of patient records he reviewed, where the test results for the nerve conduction studies were physiologically impossible, indicating that the test procedures were invalid. He stated that even a family practice doctor who received these results would be worried and request additional testing. Agbebiyi was given the patient files to review after test results came in, yet he never expressed concern about the practice of sending the test results to Florida for interpretation. Agbebiyi directed Hee to give ultrasound tests to patients whose test results from previous ultrasounds had not yet come back. Agbebiyi also ordered her to perform ultrasounds on patients who objected to taking the tests. Agbebiyi contends that there is no evidence that he knew that patients were being paid to come to the clinics. However, there is evidence that Agbebiyi knew that food was being provided for the patients, as he was present when Juan Villa delivered the food and would eat some of the food himself. After he had seen the patients, Agbebiyi gave a list of ordered tests and any 29 No. 12-2559, United States v. Agbebiyi prescriptions to Oliver, rather than giving the prescriptions to the patients after he visited them, because if the patients received the prescriptions directly, they would leave without taking the tests. Madden, a patient who received eighteen nerve conduction studies at Alpha & Omega, testified that she went to the clinic not because she was sick, but because she received food and prescriptions. When she objected to taking the tests, Agbebiyi told here that it was part of her treatment, although he and other people at the clinic never called her to talk about her test results. Isaac Carr, one of the drivers for the clinics, testified that Agbebiyi stated on one occasion that he wanted to get out once he found out what they were doing at the clinics, yet Agbebiyi worked at the clinics over a twenty-month period. Based on the government’s evidence, a rational trier of fact could come to the conclusion that Agbebiyi tacitly agreed to the scheme to defraud Medicare, and committed overt acts in furtherance of the scheme by ordering tests which were not medically necessary. This is not a case in which there was no evidence of guilt of Agbebiyi’s knowing and voluntary participation in the conspiracy. Agbebiyi has failed to show grounds for setting aside his conspiracy conviction. 30 No. 12-2559, United States v. Agbebiyi