Opinion ID: 2652557
Heading Depth: 2
Heading Rank: 2

Heading: Loss Calculation and Restitution Award

Text: This court reviews a district court’s application of the Guidelines de novo and reviews its findings of fact at sentencing for clear error. United States v. Klein, 543 F.3d 206, 213 (5th Cir. 2008). A court “review[s] de novo the district 15 Case: 12-31275 Document: 00512524708 Page: 16 Date Filed: 02/06/2014 No. 12-31275 court’s method of determining loss, while clear error review applies to the background factual findings that determine whether or not a particular method is appropriate.” United States v. Isiwele, 635 F.3d 196, 202 (5th Cir. 2011). “The determination of the amount of loss is a factual finding reviewed for clear error,” and “[w]e give the district court wide latitude to determin[e] the amount of loss.” United States v. Cothran, 302 F.3d 279, 287 (5th Cir. 2002). The legality of a restitution order is reviewed de novo. United States v. Adams, 363 F.3d 363, 365 (5th Cir. 2004). A legal restitution order is reviewed for abuse of discretion. Cothran, 302 F.3d at 288. This court “may affirm in the absence of express findings ‘if the record provides an adequate basis to support the restitution order.’” United States v. Sharma, 703 F.3d 318, 322 (5th Cir. 2012) (footnote omitted), cert. denied, 134 S. Ct. 78 (2013).
The district court found that Blue Cross’s actual loss was $200,853 and ordered restitution for the same. Martin asserts that the district court erred in its loss calculation, and consequently also entered an erroneous restitution order, by failing to credit the value of the LPN services she provided. Because her Blue Cross patients received all the care Blue Cross was billed for, Martin argues, the actual loss (and subsequent restitution award) should only have been $31,457—the amount of loss Medicaid suffered from Bayou’s fraudulent billing. Revised thusly, the loss amount would have resulted in an offense level of only 14, instead of 20. Together with a Criminal History Category of I, Martin’s Guidelines sentence range would have been fifteen to twenty-one months, likely resulting in a sentence lower than the thirty-nine months’ imprisonment the district court imposed. 16 Case: 12-31275 Document: 00512524708 Page: 17 Date Filed: 02/06/2014 No. 12-31275 The government asks us to affirm the district court’s loss calculation and restitution order because “the evidence established that no services were actually rendered.” 4 Section 2B1.1 of the United States Sentencing Guidelines (“U.S.S.G.”) increases the offense level of a defendant convicted of fraud based on the actual or intended loss, whichever is greater. U.S.S.G. § 2B1.1 cmt. n.3(A). “Actual loss” is the reasonably foreseeable pecuniary harm that resulted from the offense, while “intended loss” is “the pecuniary harm that was intended to result from the offense.” Id. The district court need only make a reasonable estimation based upon the available information. Cothran, 302 F.3d at 287. The burden is on the government to prove loss by a preponderance of the evidence. United States v. Nelson, 732 F.3d 504, 521 (5th Cir. 2013). However, where “the fraud [is] so extensive and pervasive that separating legitimate benefits from fraudulent ones is not reasonably practicable, the burden shifts to the defendant to make a showing that particular amounts are legitimate.” United States v. Hebron, 684 F.3d 554, 563 (5th Cir. 2012). At sentencing, the government requested that the district court adopt the PSR’s loss calculation of $813,422.50—the total amount Blue Cross paid Martin. The district court rejected the government’s argument. It instead found that Blue Cross suffered the lower actual loss figure of $200,853. This number comported with the amount Martin claimed for services rendered on days when she worked at Morehouse General, or when one of her Blue Cross patients was hospitalized. The exact calculation was based on charts 4 The government also argues that this court should review Martin’s arguments only for plain error, as Martin did not object below to the amount of loss calculated or the amount of restitution imposed. Because we affirm the district court’s sentence, we do not consider this argument, other than to note that Martin, in her objections to the PSR, disputed the loss calculation as to Blue Cross, and, at sentencing, repeatedly made clear that she objected to any finding of loss. 17 Case: 12-31275 Document: 00512524708 Page: 18 Date Filed: 02/06/2014 No. 12-31275 presented by Cowart and Agent Allen. Pursuant to U.S.S.G. § 2B1.1, the district court imposed a twelve-level enhancement for fraud-based losses of more than $200,000, but less than $400,000. It then sentenced Martin to thirty-nine months’ imprisonment. The district court also ordered $200,853 in restitution for Blue Cross. We uphold the district court’s loss calculation and restitution order. First, there was no legal error with the method by which the district court reached the $200,853 loss amount. The district court based this figure on the amount Martin billed Blue Cross for services she herself could not have provided either because she was working at Morehouse General or because a patient was hospitalized. Martin does not challenge this method of calculation, and we conclude that it bears a reasonable relation to the actual harm of the offense. See United States v. Randall, 157 F.3d 328, 331 (5th Cir. 1998). Second, although Martin does not take issue with the district court’s method of calculating loss, she does contend that the calculation was in error because it did not include the value of the services rendered. In making this argument, Martin does not challenge any particular date on which services were or were not provided. Instead, she broadly argues that the loss amount, and the restitution award on which it was based, should be zero because her Blue Cross patients received the billed-for care when Martin visited them, before or after her full-time job, or when another LPN did so. Martin made the same argument, unsuccessfully, in her motions for judgments of acquittal and for a new trial. The district court observed that Martin’s nurse notes represented that she cared for E.D. on certain dates when Martin was on duty at Morehouse General Hospital. Blue Cross . . . was charged for and paid the claims Martin submitted for E.D.’s care, relying on the records that showed Martin was providing the care. The evidence did not bear out Martin’s theories that another Bayou nurse performed these services for E.D. or that she routinely performed these services 18 Case: 12-31275 Document: 00512524708 Page: 19 Date Filed: 02/06/2014 No. 12-31275 before and after her shifts at the hospital, and the jury was entitled to reject these theories accordingly. The district court reached the same conclusion as to Martin’s other Blue Cross patient, C.S. We find no error in the district court’s reasoning. Although a defendant is entitled to a credit for services she performs, see United States v. Jones, 475 F.3d 701, 706 (5th Cir. 2007), Martin’s objection to her sentence is simply a repackaging of the arguments she relies on to challenge the sufficiency of the evidence supporting her conviction. Just as we have found that evidence sufficient to uphold her conviction for health care fraud, we similarly conclude that, in light of all the evidence already discussed, the district court did not err in rejecting her claims that she or another LPN cared for the Blue Cross patients. Martin’s is not a case in which the government’s proposed loss calculation was based on unsubstantiated claims that particular health care services were not rendered. See id. at 705–07. Here, the district court was able to rely on the same evidence heard by the jury, which showed that in signing her name and obtaining an individual provider number, Martin represented that she personally provided the care described in the nurse notes. The district court also heard testimony by Agent Allen at sentencing that, based on the times Martin clocked in and out of work at Morehouse General, Martin could not have provided all the care listed in the nurse notes. Accordingly, we hold that Martin has not shown that the district court’s loss calculation of $200,853 was clearly erroneous or misapplied the law. We thus affirm the district court’s sentence.