Opinion ID: 2779689
Heading Depth: 2
Heading Rank: 3

Heading: Mass-Marketing Increase

Text: Defendants Antonio Macli, Jorge Macli, and Huarte challenge the district court’s imposition of a two-level increase for mass-marketing under § 2B1.1(b)(2)(A)(ii). 18 They argue the mass-marketing targeting Medicare beneficiaries was incidental to the fraud in this case and that the increase does not apply when the true victim of the offense is the United States. 18 We note that, though his PSI included a two-level increase for mass-marketing, the district court declined to apply the increase to defendant Dr. Kushner. At the sentencing of defendants Antonio Macli, Jorge Macli, and Huarte, the district court stated (1) that Dr. Kushner was further removed from the mass marketing aspect of the scheme and (2) that the enhancement as to Dr. Kushner would not have affected Dr. Kushner’s sentence, so the district court did not apply it. 60 Case: 12-16056 Date Filed: 02/17/2015 Page: 61 of 85 The guidelines provide for a two-level increase to the offense level if the offense was committed through mass-marketing. U.S.S.G. § 2B1.1(b)(2)(A)(ii). The term “mass-marketing” means 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.” Id. § 2B1.1 cmt. n.4(A) (emphasis added). Generally, “offense” means the offense of conviction and all relevant conduct under § 1B1.3. Id. § 1B1.1 cmt. n.1(H). In the case of “jointly undertaken criminal activity,” such as a conspiracy, relevant conduct includes “all reasonably foreseeable acts and omissions of others in furtherance of the jointly undertaken criminal activity.” Id. § 1B1.3(a)(1)(B); see also id. § 1B1.3 cmt. n.2. Looking to the plain language of the guidelines, the mass-marketing increase applies to Antonio Macli, Jorge Macli, and Huarte. Patient recruiters engaged in mass-marketing in this case by targeting Medicare beneficiaries and bringing them to Biscayne Milieu for treatment. See U.S.S.G. § 2B1.1 cmt. n.4(A) (defining mass-marketing and including “other means”). Although these three defendants did not personally recruit patients for the clinic, they were substantially involved in the recruitment efforts. Huarte maintained the money sheets and settled disputes among patient recruiters as to which patients were associated with which 61 Case: 12-16056 Date Filed: 02/17/2015 Page: 62 of 85 recruiters. Antonio Macli and Jorge Macli hired recruiters, authorized the payment of kickbacks, and instructed recruiters to submit fraudulent invoices for case management. Further, upon learning of Detroit’s underserved population of Medicare-eligible substance abusers, Jorge Macli directed (and funded) Rufus Cargile to “market[]” Biscayne Milieu’s services on out-of-state trips to Michigan. As above, because this case involved jointly undertaken criminal activity, the appellants’ relevant conduct includes all reasonably foreseeable acts and omissions of others in furtherance of the conspiracies. See U.S.S.G. § 1B1.3(a)(1)(B). Here, the mass-marketing efforts by the recruiters were reasonably foreseeable to Antonio Macli, Jorge Macli, and Huarte. While this Court has not applied the mass-marketing increase in the health care fraud context, the Fifth Circuit has. See United States v. Mauskar, 557 F.3d 219, 233 (5th Cir. 2009) (holding that face-to-face marketing, intended to reach a large number of persons for the purpose of facilitating health care fraud, can constitute mass-marketing under the guidelines); see also United States v. Isiwele, 635 F.3d 196, 198 (5th Cir. 2011) (applying Mauskar where defendant targeted elderly and low-income Medicare beneficiaries in order to submit fraudulent claims). In Mauskar, the defendant conspired to defraud Medicare and Medicaid by, among other things, falsely certifying that ambulatory patients needed motorized 62 Case: 12-16056 Date Filed: 02/17/2015 Page: 63 of 85 wheelchairs. Mauskar, 557 F.3d at 224. Recruiters facilitated the fraud by targeting and escorting beneficiaries to the defendant’s clinic for evaluations. Id. The defendant objected to the mass-marketing increase on the grounds that he did not personally participate in the mass-marketing of patients. Id. at 233. The Fifth Circuit rejected that argument, noting the offense included all relevant conduct. Id. Because the case involved jointly undertaken criminal activity (conspiracy to commit health care fraud), the relevant conduct included all reasonably foreseeable acts and omissions of others in furtherance of the criminal activity, which included mass-marketing by recruiters. See id. Similarly here, the recruiters’ conduct was not just foreseeable, but orchestrated and facilitated by defendants Antonio Macli, Jorge Macli, Huarte, and Biscayne Milieu’s payments to the recruiters. We need not decide the applicability of the mass-marketing increase to every possible health care fraud scheme. The facts of this case center on the defendants’ repeated attempts to target and profit from new patient populations. For all these reasons, defendants Antonio Macli, Jorge Macli, and Huarte have shown no error as to the two-level increase for massmarketing.