Opinion ID: 2967751
Heading Depth: 3
Heading Rank: 5

Heading: Abuse of Position of Trust (Ms. Bolden)

Text: Finally, Ms. Bolden contends that the sentencing court erred in applying the abuse of position of trust adjustment (the Trust adjustment) to her sentence. She asserts that, although she may have occupied a position of trust with Emerald Health, she held no such position with respect to Medicaid, and the court erred in applying the Trust adjustment to her. Pursuant to U.S.S.G. § 3B1.3, an adjustment in the base offense level is authorized [i]f the defendant abused a position of public or private trust . . . in a manner that significantly facilitated the commission or concealment of the offense. U.S.S.G. § 3B1.3. The commentary to § 3B1.3 explains that a position of trust is characterized by professional or managerial discretion, and points out that the Trust adjustment applies where the position of trust . . . contributed in some significant way to facilitating the commission or concealment of the offense. U.S.S.G. § 3B1.3, cmt. n. 1. UNITED STATES v. BOLDEN 45 We have observed that ‘the question of whether an individual occupies a position of trust should be addressed from the perspective of the victim.’ United States v. Moore, 29 F.3d 175, 179-80 (4th Cir. 1994) (quoting United States v. Queen, 4 F.3d 925, 929 (10th Cir. 1993)). In order to apply the Trust adjustment to Ms. Bolden, the sentencing court was obliged to first identify the victims of her fraudulent activities. And in this case, the victims were Medicaid and the American taxpayers. See United States v. Adam, 70 F.3d 776, 782 (4th Cir. 1995) (concluding that victims of Medicaid fraud were the American taxpayers). As such, the court could apply the Trust adjustment to Ms. Bolden only if she occupied a position of trust as to Medicaid. The PSR addressed Ms. Bolden’s position of trust only as to Emerald Health. In its Sentencing Memorandum, however, and at the sentencing hearing, the Government maintained that she occupied a fiduciary relationship as to Medicaid, which she abused in committing and concealing the fraud scheme. It took the position that, because of Ms. Bolden’s relationship to Medicaid, the Trust adjustment should be applied to her. The court overruled Ms. Bolden’s objection to the Trust adjustment, and it adopted the remaining portions of her PSR. Thus, the court implicitly adopted the Government’s position that Ms. Bolden occupied a trust relationship as to Medicaid. Ms. Bolden maintains that the court erred in finding that she occupied a position of trust as to Medicaid, asserting that Medicaid conferred no discretionary authority on her. As Director of Operations of Emerald Health, however, she possessed substantial discretionary authority. Medicaid entrusted Ms. Bolden with thousands of dollars in prospective payments to Emerald Health, that were to be used for the benefit of its Medicaid beneficiaries. And her abuse of that authority contributed significantly to the commission and concealment of the fraud scheme. We have upheld application of the Trust adjustment in situations where physicians have defrauded Medicaid. See Adam, 70 F.3d at 782. In Adam, the adjustment was found appropriate for a physician involved in Medicaid fraud because such activity is terribly difficult to detect because physicians exercise enormous discretion. Id.; see also United States v. Hoogenboom, 209 F.3d 665, 671 (7th Cir. 2000) 46 UNITED STATES v. BOLDEN (Medical service providers occupy positions of trust with respect to private or public insurers (such as Medicare) within the meaning of guideline § 3B1.3.). Compellingly, the Second Circuit, in United States v. Wright, 160 F.3d 905, 910-11 (2d Cir. 1998), has upheld application of the Trust adjustment in similar circumstances. In Wright, the defendants had embezzled funds from a Medicaid-funded residence facility. The court observed that public funds were entrusted to the facility, for the benefit of its patients, and the defendants, through their positions at the facility, had embezzled the funds without fear of timely detection by . . . the government, who entrusted them with the funds. Id. at 911. The court concluded that application of the Trust adjustment was appropriate in such a situation, when viewed from the standpoint of the governmental agencies that entrusted the funds to [the facility’s] management to use them properly for the well-being of the intended beneficiaries.41 Id. As in Wright, Ms. Bolden, through her position at Emerald Health, was entrusted by Medicaid with its funds, and she abused the trust placed in her. Thus, the court did not err in finding that Ms. Bolden occupied a position of trust with respect to Medicaid, and we affirm its application of the Trust adjustment.