Opinion ID: 69278
Heading Depth: 4
Heading Rank: 1

Heading: Upward Adjustment for Role in Offense

Text: Ekiko and Brown assert that the district court erred by adjusting their offense levels upward three levels based upon their roles in the conspiracy. The district court determined that Brown and Ekiko were managers or supervisors in the criminal activity and that the criminal enterprise was extensive. Accordingly, the district court raised Brown’s and Ekiko’s offense level by three. See U.S. S ENTENCING G UIDELINES M ANUAL § 3B1.1(b) (2008). Brown and Ekiko challenge this determination on appeal.
Brown did not file any written objections to the presentence report (PSR), and he did not object to the imposition of the three-level enhancement at sentencing. As a result, this court reviews his objection on appeal for plain error. United States v. Ronquillo, 508 F.3d 744, 748 (5th Cir. 2007), cert. denied, 128 S. Ct. 2458 (2008). 11 Patel also argues that the district court’s instruction diluted the mens rea requirement and gave the jury the ability to find her guilty if she “should have known” that criminal wrongdoing was occurring. But the court’s instructions explicitly warned the jury that “demonstrating that the defendant was negligent, careless or foolish” was insufficient. Thus, the court did not abuse its discretion by instructing the jury on deliberate ignorance. Ogba, 526 F.3d at 232. 12 No. 07-20471 On appeal, Brown argues that he was not a manager or supervisor. Specifically, Brown asserts that, at best, he “employed other people who in turn may have paid individuals brought to Houston as an incentive to take the trip.” This concession alone is sufficient to support a finding that Brown was a manager. Mauskar, 557 F.3d at 235 (affirming district court’s application of the enhancement because the defendant supervised at least one criminally responsible participant and the criminal activity charged was otherwise extensive). The evidence introduced at trial demonstrated that Brown brought in over 521 patients from the state of Louisiana during the August 22, 2002 to March 6, 2003 time period. Brown also offered to pay the Medicare beneficiaries extra money if they brought in patients on their own. In sum, Brown’s actions demonstrate that he occupied a manager or supervisor role in the conspiracy. The district court did not plainly err by increasing his offense level by three for the role he played in the offense.
Ekiko argues that he did not have an manager or supervisor role in the offense because the Government never established that the persons Ekiko supervised or managed participated in the fraud. Ekiko objected to the application of the three-level enhancement at sentencing. As a result, we review the district court’s factual findings for clear error and the application of the sentencing guidelines de novo. United States v. Gould, 529 F.3d 274, 276 (5th Cir. 2008) We review the district court’s determination that an individual was a criminally responsible participant for clear error, and ask whether the determination is “plausible in light of the record as a whole.” See United States v. Holmes, 406 F.3d 337, 363 (5th Cir. 2005). The commentary to U.S. Sentencing Guidelines § 3B1.1 states that a participant is “a person who is criminally responsible for the commission of the offense, but need not have been convicted.” At sentencing, the Government 13 No. 07-20471 argued that Allen Driver, King Robinson, Shenike Harrison and Michelle Morris were participants subject to Ekiko’s control. Harrison testified that Robinson was hired to drive patients to the clinic and deliver scooters for Ekiko. Driver testified that he was hired to do the same. Ekiko asserts that these individuals were independent contractors, not employees. But the testimony established that Ekiko told the individuals where to go and what to do with the patients. The fact that Ekiko did not control every aspect of their employment does not preclude a finding that he supervised their actions.12 Mauskar, 557 F.3d at 235 (affirming application of three-level enhancement where testimony established that the appellant paid recruiters for referring patients, requested kickbacks and controlled which recruiters could bring patients in). Thus, the district court did not commit clear error in concluding that Ekiko occupied an aggravating role in the offense. 2. Upward Adjustment Based on Intended Loss Computation Patel raised two objections to the calculation of her total offense level at sentencing. She renews both objections on appeal. First, she argues that her total offense level is not supported by the record because the jury acquitted her on the conspiracy charges. As a result, Patel asserts that she cannot be held responsible for amounts lost because of the conspiracy. Second, Patel claims 12 Ekiko asserts in his reply brief that the offense was not extensive within the meaning of § 3B1.1 because he was not responsible for the bulk of the Medicare fraud. But the third comment to § 3B1.1 states that “[i]n assessing whether an organization is ‘otherwise extensive,’ all persons involved during the course of the entire offense are to be considered. Thus, a fraud that involved only three participants but used the unknowing services of many outsiders could be considered extensive.” U.S. SENTENCING GUIDELINES § 3B1.1 cmt. n.3. In this case, the Government introduced substantial evidence that Ekiko utilized the services of Gottlieb, Patel, Skripka, and Rodriguez to defraud Medicare. In addition, the evidence demonstrated that Ekiko used recruiters to drum up business at Gottlieb’s clinic and increase his profits. Thus, the evidence demonstrates that the offense was extensive. 14 No. 07-20471 that the PSR inappropriately relied on information that was beyond the scope of the trial witnesses’ testimony. The district court’s determination of the intended amount of loss is a factual finding that we review for clear error. United States v. Klein, 543 F.3d 206, 214 (5th Cir. 2006). The district court’s method of calculation, however, is reviewed de novo. Id. Patel asserts that the amount of loss calculated is unfairly based on the conspiracy charge of which she was acquitted. The fact that Patel was acquitted of the conspiracy charge does not preclude the court from taking into account her participation in the scheme. This court has repeatedly held that “a jury’s verdict of acquittal on some . . . counts does not prevent the sentencing court from considering conduct underlying the acquitted count as long as that ‘related’ conduct has been proved by a preponderance of the evidence.” United States v. Pineiro, 470 F.3d 200, 206 (5th Cir. 2006). Patel has not shown that the district court’s enhancement of her sentence based on acquitted conduct was in error. She asserts only that the evidence suggests that her Medicare account was being used without her knowledge and that the testimony given in support of the district court’s finding was based on speculation. She also asserts that she was not given a forum to confront witnesses. There is no basis for these assertions. Agent Judy Sly of the Department of Health and Human Services testified that approximately $14 million was billed to Patel’s unique physician identification number. Patel asserts that Agent Sly’s testimony supports an inference that Patel’s account was being used without her knowledge because each billing code was not supported by an accompanying signed CMN. But Patel does not deny that she pre-signed CMN forms and approved over ninety-five percent of her patients. Agent Sly’s testimony established that the CMNs signed by Patel were then sold to DME suppliers who used the prescriptions to generate 15 No. 07-20471 over $9 million in reimbursement fees from Medicare. Patel does not suggest that the district court’s mathematical calculations were in error; rather she questions the credibility of the testimony relied on by the district court.13 This is insufficient to warrant reversal of the district court’s findings.