Opinion ID: 64707
Heading Depth: 1
Heading Rank: 9

Heading: Counts 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, and 40

Text: Counts 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, and 40 relate to Mauskar's prescription of motorized wheelchairs to Medicare and Medicaid patients who did not need them. Mauskar first argues that [t]here was no evidence [he] willingly and knowingly assisted [the DME companies] in their scheme to defraud. To the contrary, the record is replete with such evidence. It is undisputed, for example, that Mauskar prescribed a motorized wheelchair to Herman Conway despite the fact Conway was jogging a mile twice a day at the time Mauskar examined him. Conway testified that he used the scooter for recreational purposes. Mauskar next argues that the DME companies' alteration of the certificates of medical necessity he signed forecloses his conviction on all of the above-referenced counts but one. This argument fails for at least two reasons. First, the DME companies' alteration of the certificates does not affect the evidence that Mauskar himself fraudently billed medically unnecessary tests and evaluations irrelevant to the procurement of a motorized wheelchair. Second, the alteration of the certificates for the purpose of ensuring the government would accept them does not diminish Mauskar's responsibility for signing the certificates. If he had not signed them, the government would not have suffered the losses it did. Finally, Mauskar argues that [t]here was no evidence presented that ... Mauskar knew that [the DME companies] were delivering less expensive scooters while billing Medicare for motorized wheelchairs. The record belies this assertion. One of the patients to whom Mauskar prescribed a motorized wheelchair testified that Mauskar asked her if she wanted a scooter: Q. Now, let me show you what's marked with Bates 1217. Did Dr. Mauskar ask you if you needed a motorized wheelchair because you needed help moving in around your home, your house? A. Yes, he asked me did I want a wheela motora scooter. A scooter. Q. He asked if you wanted a scooter? A. Uh-huh. Q. He said specifically a scooter? A. A scooter, uh-huh. Another patient testified she told Mauskar's receptionist that she had come to see the physician about a motor scooter. This, along with other evidence in the record, is sufficient to support an inference that Mauskar knew the DME companies were providing his patients with scooters rather than motorized wheelchairs. Moreover, even assuming Mauskar had been ignorant of the fact the DME companies charged the government for motorized wheelchairs and delivered less expensive scooters, the evidence would be sufficient to support his conviction on the counts at issuethe DME companies' compounding the fraud by delivering scooters did not relieve Mauskar of his responsibility for falsely certifying patients' eligibility for motorized wheelchairs.
The record establishes that before Mauskar's first trial, the government knew Tonya Williams had forged Mauskar's signature on treatment charge sheets, progress notes, and other documents. Williams testified on cross examination during Mauskar's second trial that the government had been aware of the forgery for more than two years: Q: Who did you tell that you had been photocopying Dr. Mauskar's signature? A: Mr. Louis, Mr. McGregor. Q: And was this at a meeting you had at the U.S. Attorney's Office? A: Yes. Q: And it was before the trial began? A: Yes. Q: Is it while you were in prison or before you went to prison? A: Before I went to prison. Q: So, the government has known for at least for the last two years that you photocopied these signatures. A: (Nods head.) Q: Yes or no? A: Yes. The government concedes that at least some of these documents were relevant to some of the charges against Mauskar, and that it failed to disclose the forgeries until after Mauskar's second trial was underway. Following Williams's testimony, Mauskar moved for dismissal of the indictment due to outrageous government conduct and/or violation of the Double Jeopardy Clause, alleging that the government committed an egregious Brady violation by failing to disclose the forgery. To make out a Brady violation, a defendant must show that (1) evidence was suppressed; (2) the suppressed evidence was favorable to the defense; and (3) the suppressed evidence was material to either guilt or punishment. Miller, 520 F.3d at 514 (internal quotation marks and citations omitted). Evidence is material under Brady when there is a `reasonable probability' that the outcome of the trial would have been different if the suppressed evidence had been disclosed to the defendant. United States v. Runyan, 290 F.3d 223, 245 (5th Cir.2002). Mauskar, however, fails on appeal to identify the forged documents with any specificity, or to explain to which charges the documents were relevant. In fact, Mauskar acknowledges that he was acquitted on some of those charges. Without this information, we cannot conduct the analysis necessary to determine whether the documents were material within the meaning of Brady. See Kyles v. Whitley, 514 U.S. 419, 437, 115 S.Ct. 1555, 131 L.Ed.2d 490 (1995) ([S]howing that the prosecution knew of an item of favorable evidence unknown to the defense does not amount to a Brady violation, without more.); see also Smith v. Black, 904 F.2d 950, 967 (5th Cir.1990) (observing that [t]he materiality of Brady material depends almost entirely on the value of the evidence relative to the other evidence mustered by the [government]), vacated, 503 U.S. 930, 112 S.Ct. 1463, 117 L.Ed.2d 609 (1992), abrogated on other grounds by Stringer v. Black, 503 U.S. 222, 112 S.Ct. 1130, 117 L.Ed.2d 367 (1992). Nor has Mauskar established the existence of outrageous government conduct that required dismissal of his indictment, a question we review de novo. United States v. Asibor, 109 F.3d 1023, 1039 (5th Cir. 1997). Government misconduct does not mandate dismissal of an indictment unless it is `so outrageous' that it violates the principle of `fundamental fairness' under the due process clause of the Fifth Amendment. United States v. Johnson, 68 F.3d 899, 902 (5th Cir.1995) (citing United States v. Russell, 411 U.S. 423, 431-32, 93 S.Ct. 1637, 36 L.Ed.2d 366 (1973)). Such a violation will only be found in the rarest circumstances. Id. (citing United States v. Yater, 756 F.2d 1058, 1066 (5th Cir.1985)); see also United States v. Childs, 447 F.3d 541, 545 (7th Cir.2006) (observing that dismissing criminal charges against a defendant because of government misconduct is an extreme step). We are deeply concerned by the government's failure to disclose Williams's forgery of Mauskar's signature on documents relating to the charges against him. [3] The duty of a prosecutor, as the representative of the sovereign in a criminal case, is not that it shall win a case but that justice shall be done. Dickson v. Quarterman, 462 F.3d 470, 479 (5th Cir.2006) (internal quotation marks and citations omitted). Nonetheless, we cannot say on the record before us that the nondisclosure in the present case is so shocking to the universal sense of justice, Russell, 411 U.S. at 432, 93 S.Ct. 1637 (quoting Kinsella v. United States ex rel. Singleton, 361 U.S. 234, 246, 80 S.Ct. 297, 4 L.Ed.2d 268 (1960)), that the government should have been deprived for all time of the opportunity to prosecute Mauskar. In so concluding, we note that contrary to Mauskar's assertion, the government did not suborn perjured testimony from Tonya Williams regarding the authenticity of signatures on the forged documents. Williams testified during Mauskar's first trial that she had never written Dr. Mauskar's name on any Medicare application form that was submitted to Medicare. This testimony is not inconsistent with her subsequent testimony during Mauskar's second trial that she forged treatment sheets, progress notes, and other documents. Had the government suborned perjury regarding the authenticity of signatures on the forged documents relating to the charges against Mauskar, the outcome of this appeal may have been different.
Mauskar objects to numerous alleged sentencing errors in the district court. In considering these objections, we review the district court's factual findings for clear error and its interpretation of the Guidelines de novo. United States v. Angeles-Mendoza, 407 F.3d 742, 747 (5th Cir. 2005). A factual finding is not clearly erroneous so long as it is plausible in light of the record as a whole. United States v. Holmes, 406 F.3d 337, 363 (5th Cir.2005) (quoting United States v. Powers, 168 F.3d 741, 752 (5th Cir.1999)).
U.S.S.G. § 2B1.1(b)(2)(A) provides for a two-level enhancement if the offense ... was committed through mass-marketing. The commentary to section 2B1.1 defines mass-marketing as a plan, program, promotion, or campaign that is conducted through solicitation by telephone, mail, the Internet, or other means to induce a large number of persons to (i) purchase goods or services; (ii) participate in a contest or sweepstakes; or (iii) invest for financial profit. U.S.S.G. § 2B1.1 cmt. n.4(A). Mass-marketing is not limited to the mass-communication methods listed in the commentary, as the definition explicitly contemplates `other means' of mass-marketing. United States v. Magnuson, 307 F.3d 333, 335 (5th Cir.2002). As we have recognized, [f]ace-to-face marketing [] intended to reach a large number of persons for the purpose of facilitating health care fraud can constitute mass-marketing. United States v. Jackson, 220 Fed.Appx. 317, 332 (5th Cir. Mar. 2, 2007). The district court, on the recommendation of the presentence investigation report, found section 2B1.1(b)(2)(A)(ii) applicable over Mauskar's objection that while he may have known about the mass-marketing, the record contained no evidence he actually participated in that or encouraged it or developed it or planned it. Mauskar renewed his objection to the mass-marketing enhancement in a motion filed shortly after sentencing, arguing that precedent did not support the enhancement absent evidence that Mauskar was personally involved in the mass-marketing. The district court again rejected Mauskar's argument, finding that he was inextricably involved in the mass marketing aspect of the offense. In support of this finding, the district court noted that well over a thousand elderly, ambulatory Medicare beneficiaries were escorted to Defendant Mauskar's medical clinic to acquire free motorized wheelchairs and that Mauskar's staff used a separate sign-in sheet for the Medicare wheelchair applicants... [to] reduce the number of arguments... about who was entitled to be paid the recruiting fee for having brought in the wheelchair applicants. The plain language of the Guidelines forecloses Mauskar's argument that the mass-marketing enhancement does not apply to his conduct. The mass-marketing enhancement is applicable if an offense... was committed through mass-marketing. U.S.S.G. § 2B1.1(b)(2)(A)(ii). `Offense' means the offense of conviction and all relevant conduct under § 1B1.3 (Relevant Conduct) unless a different meaning is specified or is otherwise clear from the context. U.S.S.G. § 1B1.1 cmt. n.1(H). And in the case of a jointly undertaken criminal activity, relevant conduct includes all reasonably foreseeable acts and omissions of others in furtherance of the jointly undertaken criminal activity. U.S.S.G. § 1B1.3(a)(1)(B). Given this standard, the district court did not err in finding Mauskar eligible for the mass-marketing enhancement.
U.S.S.G. § 2B1.1(b)(1) provides for a twenty-level enhancement if a defendant's offense, including all reasonably foreseeable acts and omissions of others in furtherance of the jointly undertaken criminal activity, id. § 1B1.3(a)(1)(B), resulted in a loss between $7,000,000 and $20,000,000. Loss is the greater of actual loss or intended loss. Id. § 2B1.1 cmt. n.3(A). `Intended loss' (I) means the pecuniary harm that was intended to result from the offense; and (II) includes intended pecuniary harm that would have been impossible or unlikely to occur. Id. § 2B1.1 cmt. n.3(A)(ii). The [district] court need make only a reasonable estimate of the loss based on available information. Id. § 2B1.1 cmt. n.3(C). Here, the district court estimated $15,311,867 as the total loss attributable to Mauskar and accordingly applied a twenty-level enhancement. In his opening brief, Mauskar raises three objections to the district court's loss estimate, all of which relate to his responsibility for $13,480,000 the DME companies billed Medicare for medically unnecessary motorized wheelchairs. First, Mauskar argues that he is not responsible for an unspecified portion of that amount because the DME companies altered some certificates of medical necessity, after Mauskar signed them, to ensure that the government would accept the certificates and pay for the wheelchairs. This argument fails because the district court did not include the allegedly altered certificates in its loss calculation: [I]n view of the questionable CMNs, which the defendant has estimated at 600 off of 2400, I'm going to be somewhat even more conservative and base my loss finding here upon the 1685 CMNs that the government was able to document out of Dr. Mauskar's own files. Even had the district court decided to include the allegedly altered certificates in its loss calculation, it would not have clearly erred. By signing the certificates of medical necessity, Mauskar verified ineligible patients' eligibility for power wheelchairs; it was entirely foreseeable from his perspective that the DME companies would use those CMNs to defraud Medicare and Medicaid. Second, Mauskar suggests that he should not be held responsible for the $13,480,000 because he was unaware that the DME companies billed Medicare and Medicaid for power wheelchairs and delivered less expensive scooters. This argument, which Mauskar did not make before the district court, is without merit. The fact that the DME companies billed the government for power wheelchairs and delivered scooters does not absolve Mauskar from responsibility for issuing certificates of eligibility for power wheelchairs to ineligible patients, regardless of whether he knew of this additional dimension of the conspiracy. In any event, Mauskar's failure to make this argument before the district court forecloses our review. See United States v. Guerrero, 5 F.3d 868, 871 (5th Cir.1993) (holding that fact questions that could have been resolved by the district court upon proper objection can never constitute plain error). Third, Mauskar asserts without explanation that if [he] is responsible for any of the loss in this regard it should be limited to the amount paid [to] the DMEs for the specific patients whose information was presented at trial, an amount totaling $86,226[,] ... with a reduction for the amount secured through alterations to Mauskar's prescriptions without his knowledge. To the extent Mauskar means to argue that the district court could consider only evidence presented at trial in sentencing Mauskar, his argument is without merit, as [t]he sentencing judge is entitled to find by a preponderance of the evidence all the facts relevant to the determination of a Guideline sentencing range. United States v. Mares, 402 F.3d 511, 519 (5th Cir.2005). Further, as discussed above, the record reflects that the district court did not consider the altered CMNs in calculating the loss that resulted from Mauskar's conduct. Mauskar's argument on this point thus fails. In his reply brief, Mauskar asserts that because the DME companies billed approximately $10,000 per patient but the government paid approximately $5,000 per patient, the district court erred in finding Mauskar responsible for eighty percent of the amount billed, rather than fifty percent. As above, Mauskar's failure to raise this argument before the district court forecloses appellate review. See Guerrero, 5 F.3d at 871. Moreover, even assuming arguendo that the district court did err on this point, the error would be harmless, as even the application of Mauskar's proposed fifty percent discount rate would not reduce the loss estimate below $7,000,000, the threshold for a twenty-level enhancement under section 2B1.1(b)(1). See United States v. Watson, 966 F.2d 161, 164 (5th Cir.1992) (Watson has not demonstrated that the evidence is sufficient to reduce the value of the stolen property by ... the amount necessary to decrease his offense level.... Accordingly, any error by the district court would be harmless. (citations omitted)).
U.S.S.G. § 3B1.1(b) provides for a three-level enhancement [i]f the defendant was a manager or supervisor (but not an organizer or leader) and the criminal activity involved five or more participants or was otherwise extensive. To qualify for an adjustment under this section, the defendant must have been the organizer, leader, manager, or supervisor of one or more other participants. Id. § 3B1.1 n.2. A `participant' is a person who is criminally responsible for the commission of the offense, but need not have been convicted. Id. § 3B1.1 n.1. The district court applied the enhancement to Mauskar, finding by a preponderance of the evidence that he had supervised at least one criminally responsible participant, Nadine Norman, and that the criminal activity at issue was otherwise extensive. Mauskar raises three objections to the district court's analysis. First, he criticizes the district court's finding that Nadine Norman, Mauskar's former office manager, was a criminally responsible participant, noting that she was acquitted of all charges. To the extent this criticism constitutes an argument that Norman's acquittal precluded the district court's finding that she was a criminally responsible participant, the argument fails. See United States v. Davis, 19 F.3d 166, 172 (5th Cir.1994) (The district court could have enhanced Davis' sentence based on his leadership of Facey and Coulton despite their acquittals.). Second, Mauskar asserts that [t]he employees used to support this enhancement were not `criminal participants' as required for application of this enhancement. This argument also fails. The court reviews the district court's preponderance-of-the-evidence factual determination that Nadine Norman was a criminally responsible participant for clear error, and that determination is plausible in light of the record as a whole. See United States v. Holmes, 406 F.3d 337, 363 (5th Cir.2005). During Mauskar's first trial, for example, one witness testified that Norman (1) paid recruiters for referring patients to Mauskar's practice; (2) requested kickbacks from the medical equipment companies; and (3) controlled which recruiters could bring patients to Mauskar's office. Another witness testified that Norman received a cash payment of between seven and eight thousand dollars from a medical equipment company representative in the parking lot of Mauskar's office. Supported by this evidence, the district court's determination easily withstands clear error review. Third, Mauskar asserts that any supervision provided by [him] over [criminally responsible participants] was during the course and scope of their employment and implies that this fact precludes an aggravating role enhancement. Neither the text of section 3B1.1(b) nor case law supports Mauskar's argument on this point; to the contrary, numerous courts have upheld aggravating role enhancements based on supervision of employees. See, e.g., United States v. Chau, 293 F.3d 96, 103 (3d Cir. 2002) (Chau argues that this enhancement is improper because he merely directed his handyman, Fantom, to clean up the building.... However, this is sufficient for a district court to impose this enhancement.); United States v. Austin, 103 F.3d 606, 611 (7th Cir.1997) (holding that district court's finding that a defendant's employee was a criminally responsible participant within the meaning of section 3B1.1 was not clearly erroneous).
U.S.S.G. § 3B1.3 provides for a two-level enhancement if the defendant abused a position of public or private trust... in a manner that significantly facilitated the commission or concealment of the offense. The district court found section 3B1.3 applicable to Mauskar, noting that Medicare and Medicaid relied on him to give honest and accurate assessments of his patients' need for power wheelchairs and physical therapy services. Mauskar argues before this court that Medicare placed its trust in the physical therapy clinics and the DME companies, not in Mauskar. As the district court recognized, however, Medicare and Medicaid do rely on physicians such as Mauskar to provide honest assessments of their patients' needs for the medical services and products the government provides. Consistent with this fact, we have previously held that medical providers maintain a position of trust with the insurers they bill and have approved sentence enhancements for violations of that trust. See, e.g., United States v. Gieger, 190 F.3d 661, 665 (5th Cir.1999); United States v. Iloani, 143 F.3d 921, 922-23 (5th Cir.1998). The district court's application of section 3B1.3 is thus consistent with our precedent.
After United States v. Booker, 543 U.S. 220, 125 S.Ct. 738, 160 L.Ed.2d 621 (2005), a criminal defendant's argument for a sentence below that prescribed by the Sentencing Guidelines can take one of two forms: First, [a defendant] might argue within the Guidelines' framework, for a departure from the applicable Guidelines range on the ground that his circumstances present an atypical case that falls outside the heartland to which the United States Sentencing Commission intends each individual Guideline to apply. Second, [a defendant] might argue that, independent of the Guidelines, application of the sentencing factors set forth in 18 U.S.C. § 3553(a) (2000 ed. and Supp IV) warrants a lower sentence. Rita v. United States, 551 U.S. 338, 127 S.Ct. 2456, 2461, 168 L.Ed.2d 203 (2007) (citing Booker, 543 U.S. at 259-60, 125 S.Ct. 738). Mauskar argues that we should vacate his sentence because the district court erroneously believed that [it] was confined to a `heartland' analysisin other words, that the district court failed to recognize that application of the sentencing factors set forth in section 3553(a) might warrant a lower sentence independent of the Guidelines. To the contrary, the district court recognized the advisory nature of the Guidelines and explicitly declined to impose a below-Guidelines sentence in reliance on the factors set forth in section 3553(a): The Court has considered the advisory guidelines and finds that a sentence within the recommended range suggested by the advisory guidelines is appropriate to the circumstances of this case and serves the purpose of fulfilling the function of [Title] 18, United States Code, Section 3553(a). Mauskar's argument on this point is thus without merit.