Opinion ID: 2775600
Heading Depth: 3
Heading Rank: 3

Heading: Payment of Health Care Kickbacks

Text: Sosa also contends that the government introduced insufficient evidence to sustain his three convictions for payment of health care kickbacks under § 1320a7b(b)(2)(A). Specifically, Sosa argues that the government failed to establish that 20 Case: 13-13171 Date Filed: 02/02/2015 Page: 21 of 42 Sosa knew that the check he signed for Milian Martinez was reimbursement for illegal payments paid to “patients” brought to Discovery, rather than payment for the service of transporting the patients. The Anti-Kickback statute makes it a criminal offense if a person “knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person . . . to refer an individual to a person for the furnishing or arranging 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)(2)(A). The § 1320a-7b statute “is not a highly technical tax or financial regulation that poses a danger of ensnaring persons engaged in apparently innocent conduct. Indeed, the giving or taking of kickbacks for medical referrals is hardly the sort of activity a person might expect to be legal.” United States v. Starks, 157 F.3d 833, 838 (11th Cir. 1998). In order to find that a person acted willfully in violation of § 1320a-7b, the person must have acted “‘voluntarily and purposely, with the specific intent to do something the law forbids, that is with a bad purpose, either to disobey or disregard the law.’” Vernon, 723 F.3d at 1256 (quoting Starks, 157 F.3d at 838). However, 21 Case: 13-13171 Date Filed: 02/02/2015 Page: 22 of 42 the defendant need not have known that a specific referral arrangement violated the law. Id. In this case, sufficient evidence demonstrates that Sosa willfully committed the payment of kickbacks on or around July 11, 2011, August 1, 2011, and August 8, 2011. The government introduced evidence that Sosa wrote checks for Milian Martinez for $2,250 on July 11, 2011; for $2,400 on August 1, 2011; and for $2,400 on August 8, 2011. In an interview with law enforcement, Sosa admitted that he knew that Milian Martinez was in charge of bringing patients to the clinic, that the check was payment to Milian Martinez for bringing those patients to the clinic, and that the patients also were being paid and that it was illegal to pay the patients. Nonetheless, Sosa signed Milian Martinez’s checks and included memo lines that indicated they were for “transport.” Given this and the other trial evidence recounted above, a reasonable jury could find beyond a reasonable doubt that Sosa’s payments to Milian Martinez, on behalf of Discovery, constituted kickbacks for the referral of patients. The amounts of each check, combined with their frequency, support the inference that Sosa knew the checks were not merely payment for driving patients to and from the clinic. Furthermore, Sosa’s admission in an interview that he knew the patients were being paid and that it was illegal to pay the patients supports the jury’s conclusion that Sosa made the payments not for Milian Martinez’s livery services 22 Case: 13-13171 Date Filed: 02/02/2015 Page: 23 of 42 but as kickbacks for the referral of patients—that is, “voluntarily and purposely, with the specific intent to do something the law forbids.” See Vernon, 723 F.3d at 1256. Accordingly, the government introduced sufficient evidence to support Sosa’s three convictions for payment of kickbacks.