Court Opinion

ID: 9352580
Source: CourtListenerOpinion
Date Created: 2023-01-06 22:00:33.65124+00
Date Added: 2024-06-11T16:57:49.973566
License: Public Domain

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                                                             [PUBLISH]
                                    In the
                 United States Court of Appeals
                         For the Eleventh Circuit

                           ____________________

                                 No. 19-13838
                           ____________________

        UNITED STATES OF AMERICA,
                                                       Plaintiff-Appellee,
        versus
        PHILIP ESFORMES,

                                                   Defendant-Appellant.

                           ____________________

                  Appeal from the United States District Court
                      for the Southern District of Florida
                    D.C. Docket No. 1:16-cr-20549-RNS-1
                           ____________________
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        2                     Opinion of the Court                19-13838

                            ____________________

                                  No. 19-14874
                            ____________________

        UNITED STATES OF AMERICA,
                                                        Plaintiff-Appellee,
        versus
        PHILIP ESFORMES,

                                                     Defendant-Appellant.

                            ____________________

                  Appeal from the United States District Court
                      for the Southern District of Florida
                    D.C. Docket No. 1:16-cr-20549-RNS-1
                           ____________________

        Before WILLIAM PRYOR, Chief Judge, JILL PRYOR, and GRANT, Cir-
        cuit Judges.
        WILLIAM PRYOR, Chief Judge:
               Philip Esformes challenges his convictions of healthcare
        fraud, illegal kickbacks, and money laundering and the related res-
        titution award and forfeiture judgment. After Esformes filed this
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        19-13838               Opinion of the Court                         3

        appeal, President Trump commuted his sentence of imprisonment
        and rendered any challenge to it moot. In his remaining challenges,
        Esformes argues that his indictment should have been dismissed
        because of prosecutorial misconduct, that the district court errone-
        ously admitted expert opinion testimony against him, that the ad-
        missible evidence against him was insufficient to sustain his convic-
        tions, and that the restitution award and forfeiture judgment
        should be vacated. We affirm.
                                I. BACKGROUND
                Philip Esformes owned and operated the “Esformes Net-
        work”—several medical facilities in Miami-Dade County, Florida.
        The Network included “skilled nursing facilities,” residential med-
        ical facilities that provided services performed by nurses, such as
        physical therapy or the operation of sensitive medical devices.
        Medicare or Medicaid will pay for a stay at a skilled nursing facility
        only if the patient receives medical certification that the admission
        is necessary and if the patient spent at least three days in an acute-
        care hospital immediately before admission.
               After a grand jury indicted two of his associates, Gabriel and
        Guillermo Delgado, Esformes entered into a joint-defense agree-
        ment with the Delgados. The government later added a drug
        charge to Guillermo Delgado’s indictment that threatened a signif-
        icantly higher term of imprisonment. Esformes then “offered to
        pay a significant sum of money to [Guillermo] Delgado so that he
        could flee the United States and avoid prosecution in the United
        States.” The Delgados signed a sealed plea agreement, began
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        4                       Opinion of the Court                 19-13838

        recording their conversations with Esformes, and passed along to
        the government multiple recordings, including some that involved
        conversations between Esformes and his attorneys.

                The following year, an indictment charged that Esformes
        and others conspired to use the Network to defraud Medicare and
        Medicaid of millions of dollars. The indictment alleged that Es-
        formes bribed doctors at local hospitals to refer patients to his
        skilled nursing facilities who did not need that care and that his
        Network provided unnecessary and expensive medical services to
        those patients and fraudulently inflated bills with services that the
        facilities did not provide. It further alleged that the conspirators
        split their ill-gotten gains with referring doctors and bribed state
        officials to gain advance notice of otherwise random inspections.
        And it alleged that they laundered the proceeds of their crimes by
        various means, including paying “[f]emale [c]ompanion[s,]”
        providing “limousine services” to Esformes, and bribing a Univer-
        sity of Pennsylvania basketball coach to aid the admission of Es-
        formes’s son.
               The Federal Bureau of Investigation promptly executed a
        search warrant for Esformes’s Eden Gardens medical facility to
        “seiz[e] . . . business records related to the health-care fraud inves-
        tigation of Esformes.” The government knew beforehand that
        Norman Ginsparg, an Illinois-licensed attorney who worked with
        Esformes, had an office at Eden Gardens. And a member of Es-
        formes’s defense team warned the agents that there were privi-
        leged materials at Eden Gardens.
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        19-13838              Opinion of the Court                       5

               The government established a “taint protocol” to identify
        privileged documents found in the search and to keep the prosecu-
        tion team from seeing them. It chose agents who were not other-
        wise involved in the investigation to conduct the search. But these
        measures failed.
               As the government now admits, “the agents conducting the
        search did not receive sufficient instructions on how to treat or
        identify potentially privileged materials[,]” and they passed on to
        the prosecution team a substantial portion—at least a hundred—of
        the privileged documents.
               The prosecution team started to review the Eden Gardens
        materials before prosecutors confirmed that the materials were not
        privileged and before Esformes received copies of the seized docu-
        ments. No prosecutor raised any privilege concerns until over four
        months after the Eden Gardens search, when Assistant United
        States Attorney Elizabeth Young received the scanned version of
        the documents and encountered a memorandum with a law firm’s
        header at the top. But at that point because of other disputes with
        Esformes’s counsel, Young had known about potential privilege is-
        sues for more than a month. And as the district court pointed out,
        when she encountered the obviously privileged document in De-
        cember, she did not consult with either Esformes’s defense team or
        the district court.
               The prosecutors not only reviewed privileged documents
        but also tried to use them against Esformes before trial on two oc-
        casions. First, the government presented privileged documents to
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        6                      Opinion of the Court                19-13838

        Norman Ginsparg, one of Esformes’s alleged co-conspirators, in an
        unsuccessful attempt to convince him to cooperate with the gov-
        ernment. And second, prosecutors interviewed one of Ginsparg’s
        assistants about the same privileged documents at length to deter-
        mine whether they incriminated Esformes. As the district court
        found, the prosecutors’ “myopic view of Ginsparg as a criminal and
        not an attorney skewed their reaction to, and blurred their ability
        to see, the potential for privilege” in these documents.
                Esformes moved to dismiss the indictment and to disqualify
        Young and other prosecutors due to their violations of his attorney-
        client and attorney work-product privileges. A magistrate judge
        found prosecutorial misconduct and even a bad-faith “attempt[] to
        obfuscate the record” of that misconduct. The magistrate judge ac-
        cordingly recommended suppressing the fruits of these intrusions
        on privilege. But the magistrate judge recommended that the dis-
        trict court reject Esformes’s request to dismiss the indictment or to
        disqualify members of the prosecution team. The magistrate judge
        reasoned that after the privileged materials were suppressed, Es-
        formes would not be further prejudiced: the recordings of privi-
        leged communications were evidence primarily for a count of the
        indictment that had been dismissed; no charges resulted from the
        privileged documents seized at Eden Gardens; and no privileged
        materials would be introduced at trial to prejudice Esformes. The
        district court found that the conversations between the Delgados
        and Esformes were not privileged and modified the suppression or-
        der to cover only the conversations between Esformes and his
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        19-13838                Opinion of the Court                          7

        attorneys, but the district court otherwise adopted the magistrate
        judge’s proposed remedies and rationale.
                Although the district court agreed with the magistrate judge
        that the prosecutors committed misconduct, it rejected the magis-
        trate judge’s finding of bad faith and dishonesty. During a hearing
        on the magistrate judge’s report and recommendation, the district
        court granted three prosecutors leave to be represented by private
        counsel to urge the district court to reverse those findings. The dis-
        trict court “f[ound] that it [was] unnecessary to adopt the Magis-
        trate Judge’s credibility determinations” and criticisms of the pros-
        ecution team’s “‘attempts to obfuscate the record,’ . . . particularly
        given the adverse consequences of such findings to the careers of
        the prosecutors.” Those credibility assessments played no role in
        the magistrate judge’s determination of the proper remedy; only
        the prejudice to Esformes mattered. But the district court still af-
        firmatively rejected the magistrate judge’s findings. The district
        court accepted the prosecutors’ explanation that they were con-
        fused, not mendacious, about the scope of Esformes’s invocations
        of privilege. It found it implausible that a prosecution team that
        tried, however incompetently, to maintain privilege protections
        would take the risk of fabricating a justification for its actions after
        the fact.
               At Esformes’s two-month trial, prosecutors presented three
        types of evidence material to this appeal. First, Esformes’s co-con-
        spirators, including Gabriel Delgado, testified about the conspir-
        acy, its means, and their roles in it. Second, the prosecutors
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        8                       Opinion of the Court                   19-13838

        presented summary testimony from Michael Petron, who identi-
        fied various transactions in Esformes’s financial records as bribes,
        kickbacks, and efforts to conceal illegal proceeds. Third, Dr. David
        Cifu testified as an expert witness to explain how skilled nursing
        facilities work; what type of patients are suitable for stays in them;
        and how Medicare and Medicaid treat stays in skilled nursing facil-
        ities.
               Dr. Cifu serves as the Chairman of the Department of Phys-
        ical Medicine and Rehabilitation and as the Executive Director of
        the Center for Rehabilitation Sciences and Engineering at Virginia
        Commonwealth University. He has decades of experience with
        skilled nursing facilities. Dr. Cifu explained the “continuum of ser-
        vices” between acute-care hospitalization and less intense forms of
        care, such as skilled nursing facilities, and he reviewed hypothetical
        case studies of skilled-nursing-facility patients.
                Dr. Cifu testified that ordinarily, young, able-bodied psychi-
        atric patients are poor fits for skilled nursing facilities. He testified
        that, in his thirty years of experience, he did not remember a single
        patient “who just had behavioral issues who was in a [skilled nurs-
        ing facility].” He similarly could not recall a single patient at the
        five skilled nursing facilities at which he had worked who was ad-
        mitted from a psychiatric hospital. Prosecutors used this testimony
        to support their argument that Esformes’s patients who were ad-
        mitted to skilled nursing facilities for psychiatric reasons had been
        admitted for illegitimate reasons in violation of Medicare and Med-
        icaid guidelines.
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        19-13838                Opinion of the Court                          9

                After it allowed Dr. Cifu to testify, the district court admit-
        ted his expert opinions over Esformes’s objection under Daubert v.
        Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993). The dis-
        trict court evaluated Dr. Cifu’s qualifications, methodology, and
        helpfulness to the jury, see FED. R. EVID. 702, and found him qual-
        ified to inform the jury about care in skilled nursing facilities and
        the criteria for entering them “based upon his education, training,
        and experience.” It acknowledged that Dr. Cifu “didn’t do any test-
        ing” to support his conclusions but still found his testimony reliable
        because “some people by education and training can give testi-
        mony in an area” despite not relying on precise scientific methods.
        And it found that “his testimony was helpful to the jury in under-
        standing the relationship between how [skilled nursing facilities]
        work, how patients come in and out of [skilled nursing facilities],
        [and] what types of treatment are generally required in a [skilled
        nursing facility]” and that it “help[ed] them understand the rela-
        tionship between the Medicare rules and regulations and guide-
        lines as they pertain to [skilled nursing facilities] and other rehabil-
        itation facilities.” The district court also overruled Esformes’s ob-
        jection that the pretrial disclosures about Dr. Cifu were insufficient
        or misleading. It remarked that “there might be a case somewhere
        where defense has received more information about [an expert wit-
        ness] before a trial, but I haven’t seen one in my career.”
              Esformes contended that Dr. Cifu was not qualified to testify
        about whether psychiatric patients are commonly or properly ad-
        mitted to skilled nursing facilities. Dr. Cifu admitted on cross-
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         10                     Opinion of the Court                19-13838

         examination that he was not familiar with the procedures required
         by Florida law that were supposed to guarantee that no one enter
         a skilled nursing facility without medical necessity. See Fla. Admin.
         Code Ann. r. 59G-1.040. The district court rejected Esformes’s ar-
         guments, but it instructed the jury that “under appropriate circum-
         stances psychiatric patients are eligible for coverage for skilled
         nursing facility services under both Medicare and Medicaid.”
                The jury convicted Esformes on 20 counts. Esformes was
         convicted of one count of conspiracy to defraud the United States
         and to pay and receive healthcare kickbacks, two counts of receiv-
         ing kickbacks, four counts of paying kickbacks, one count of con-
         spiracy to commit money laundering, nine counts of money laun-
         dering, one count of conspiracy to commit federal program brib-
         ery, one count of conspiracy to commit federal program bribery
         and honest services wire fraud, and one count of obstruction of jus-
         tice. The jury failed to reach a verdict with respect to the six re-
         maining counts, and the government has stated that it intends to
         retry Esformes on those counts.
               The district court sentenced Esformes to 240 months of im-
         prisonment and three years of supervised release. It also awarded
         approximately $5.5 million in restitution payments based on its
         “highly conservative estimate” of the federal government’s loss
         owing to Esformes’s crimes and the estimated costs of his impris-
         onment and supervised release. The district court derived the loss
         figure—the same figure it used for the purpose of calculating Es-
         formes’s prison sentence—from defense counsel’s suggestion that
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         19-13838               Opinion of the Court                       11

         only one percent of the services for which Esformes billed Medi-
         care and Medicaid were skilled nursing facility services to non-el-
         derly psychiatric patients. The district court also ordered that Es-
         formes forfeit $38.7 million because it calculated that sum of
         money was “equal in value to the property traceable to the prop-
         erty involved in [Esformes’s] money laundering offenses.” See 18
         U.S.C. § 982(a)(1). That figure came from the summary witness,
         Petron, who estimated that Esformes personally profited that
         much from the Esformes Network. In a special verdict, the jury had
         previously found some of Esformes’s specific pieces of property—
         worth much less than $38.7 million—to be forfeitable. See FED. R.
         CRIM. P. 32.2(b)(5).
                  After Esformes filed his appeal, then-President Donald
         Trump commuted Esformes’s term of imprisonment to time
         served but “le[ft] intact and in effect the remaining three-year term
         of supervised release with all its conditions, the unpaid balance of
         his . . . restitution obligation, if any, and all other components of
         the sentence.” The Bureau of Prisons released Esformes from cus-
         tody, and we allowed the parties to file supplemental briefs to “dis-
         cuss[] the impact, if any, of the presidential commutation of [Es-
         formes’s] sentence on this appeal.”
                           II. STANDARDS OF REVIEW
                We decide jurisdictional issues de novo. United States v.
         Lopez, 562 F.3d 1309, 1311 (11th Cir. 2009). We review decisions
         not to dismiss an indictment and to admit expert opinion testimony
         for abuse of discretion. United States v. Davis, 708 F.3d 1216, 1221
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         12                     Opinion of the Court                19-13838

         (11th Cir. 2013); United States v. Frazier, 387 F.3d 1244, 1258 (11th
         Cir. 2004) (en banc). “A district court abuses its discretion when it
         applies an incorrect legal standard, relies on clearly erroneous fac-
         tual findings, or commits a clear error of judgment.” United States
         v. $70,670.00 in U.S. Currency, 929 F.3d 1293, 1300 (11th Cir. 2019).
         We review a denial of a motion for acquittal for insufficient evi-
         dence de novo, “view[ing] the evidence in the light most favorable
         to the government.” United States v. Almanzar, 634 F.3d 1214,
         1221 (11th Cir. 2011). Finally, when reviewing the restitution
         award and forfeiture judgment, we review factual findings for clear
         error and questions of law de novo. United States v. Edwards, 728
         F.3d 1286, 1291 (11th Cir. 2013); United States v. Kennedy, 201 F.3d
         1324, 1329 (11th Cir. 2000).
                                 III. DISCUSSION
                 We divide our discussion into five parts. First, we explain
         that the presidential commutation renders Esformes’s appeal of his
         prison sentence moot but does not otherwise affect his appeal. Sec-
         ond, we explain that the district court did not abuse its discretion
         when it declined to dismiss the indictment or to disqualify the pros-
         ecutors due to misconduct. Third, we affirm the admission of Dr.
         Cifu’s expert-opinion testimony. Fourth, we affirm the restitution
         amount as not clearly erroneous. And fifth, we hold that there was
         sufficient evidence for the jury to convict Esformes of money laun-
         dering and that the forfeiture judgment based on money launder-
         ing was lawfully calculated.
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         19-13838               Opinion of the Court                      13

         A. The Commutation of Esformes’s Prison Sentence Renders His
                       Appeal of that Sentence Moot.
                Esformes contends that the commutation of his prison sen-
         tence renders his appeal of that sentence moot, bars retrial if this
         Court vacates any of his convictions, and “bars any attempt to fur-
         ther prosecute [him] on [c]ount [o]ne, the hung count” of conspir-
         acy to commit healthcare fraud and wire fraud. We agree—as does
         the government—with his first contention, and we need not ad-
         dress the second because we are not vacating any of his convic-
         tions. So, we need only address his last argument.
                Esformes argues that the President’s grant of clemency bars
         further prosecution on at least count one, on which the jury failed
         to reach a verdict. Esformes interprets the clemency warrant as “in-
         tended to end [his] incarceration, precluding any further prosecu-
         tion for the conduct at issue in this case.” Because count one is an
         indictment for the same conduct as the counts of conviction, he
         argues that a new trial on that count would violate the terms of the
         clemency warrant, the Double Jeopardy Clause, and his due pro-
         cess right to be free from vindictive prosecution.
                We cannot reach the merits of this argument because the
         hung counts were not the basis of a final judgment. With limited
         exceptions not relevant here, we review only final judgments. 28
         U.S.C. § 1291. “Final judgment in a criminal case means sentence.
         The sentence is the judgment.” Berman v. United States, 302 U.S.
         211, 212 (1937); see also United States v. Tovar-Rico, 61 F.3d 1529,
         1536 (11th Cir. 1995); United States v. Kaufmann, 951 F.2d 793, 794
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         14                     Opinion of the Court                 19-13838

         (7th Cir. 1992) (“The judgment is obviously not final as to counts
         of the indictment which remain outstanding.”). The hung counts
         against Esformes were not part of the basis of his sentence, so they
         are not part of any judgment we have jurisdiction to review.
           B. The District Court Properly Declined to Dismiss the Indict-
                    ment or Disqualify the Prosecution Team.
                The parties agree that prosecutors engaged in misconduct,
         but Esformes argues that the district court should have either dis-
         missed the indictment or disqualified the prosecutors instead of
         only suppressing the improperly obtained evidence. The govern-
         ment contends that Esformes failed to prove “demonstrable preju-
         dice” from the intrusion on his privilege when the suppression or-
         ders are considered, so dismissal of the indictment or disqualifica-
         tion of the prosecution team would have been improper. We agree
         with the government.
                “Federal courts possess the power and duty to dismiss fed-
         eral indictments obtained in violation of the Constitution or laws
         of the United States[,]” United States v. Pabian, 704 F.2d 1533, 1536
         (11th Cir. 1983), but “absent demonstrable prejudice, dismissal [is]
         plainly inappropriate as a remedy” for the violation of attorney-cli-
         ent privilege. United States v. Ofshe, 817 F.2d 1508, 1515 (11th Cir.
         1987). Without demonstrable prejudice, dismissal of an indictment
         is inappropriate “in the case of even the most egregious prosecuto-
         rial misconduct . . . .” United States v. Merlino, 595 F.2d 1016, 1018
         (5th Cir. 1979) (discussing a violation of Brady v. Maryland, 373
         U.S. 83 (1963)). Instead, the remedy should ordinarily be limited to
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         19-13838                Opinion of the Court                        15

         preventing the prosecution from using illegally obtained evidence
         against the defendant. Cf. United States v. Morrison, 449 U.S. 361,
         364–65 (1981).
                Esformes and his supporting amici curiae suggest that we
         should presume prejudice here. Esformes invokes our sister cir-
         cuit’s burden-shifting approach to assess prejudice: the Ninth Cir-
         cuit requires that the government make an affirmative showing of
         harmlessness if the prosecutors deliberately violated a defendant’s
         privilege and obtained information about the defendant’s trial strat-
         egy. See United States v. Danielson, 325 F.3d 1054, 1072 (9th Cir.
         2003). But Esformes did not explain why we should adopt this
         novel approach in his opening brief, and even if we considered his
         arguments or those of his amici, his suggested approach would be
         foreclosed by precedent.
                 Our Court has explained that the prejudice that can warrant
         a dismissal of indictment must be “demonstrable,” not presumed
         based on a constitutional violation. Ofshe, 817 F.2d at 1515. As our
         predecessor circuit stated, “there is no per se rule requiring dismis-
         sal of the indictment as the sanction for the intrusion into the attor-
         ney-client relationship by government agents.” United States v.
         Melvin, 650 F.2d 641, 643 (5th Cir. Unit B Jul. 1981).
                Esformes has not even attempted to satisfy his burden of
         proving prejudice. The district court applied the correct legal stand-
         ard and found that the privilege violations did not prejudice Es-
         formes because the privileged materials did not serve as either the
         basis for the charges against him or the evidence admitted at trial.
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         16                     Opinion of the Court                19-13838

         Nor did the privilege violations provide the government with any
         strategic advantage. Esformes has not sought to establish that this
         finding is clearly erroneous. Esformes also argues that the admitted
         recordings of his conversations with the Delgados were privileged,
         but we agree with the district court that these conversations were
         not privileged because they were not between an attorney and his
         client.
                 Esformes also challenges the decision to reject the magis-
         trate judge’s finding that the prosecutors acted in bad faith, but we
         decline to address this issue because it does not affect the outcome
         of this appeal. The district court explained that, even if it had ac-
         cepted the magistrate judge’s finding of bad faith, that finding
         would not have affected its choice of remedy. Because we affirm
         the finding of no prejudice, the issue of bad faith likewise cannot
         affect our disposition of this appeal.
         C. Assistant United States Attorney Young Did Not Have a Con-
                                  flict of Interest.
                Esformes also argues that prosecutor Elizabeth Young “had
         multiple conflicts of interest that should have disqualified her as a
         matter of law . . . .” He argues that she should have been disquali-
         fied because she “inject[ed] her personal interest in opposition to
         Esformes’[s] motions to dismiss or disqualify” and impermissibly
         served as both a witness and an advocate in the disqualification pro-
         ceedings. We reject these arguments.
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         19-13838               Opinion of the Court                        17

                    1. Young Was Not an “Interested Prosecutor.”
                “[F]ederal prosecutors are prohibited from representing the
         [g]overnment in any matter in which they, their family, or their
         business associates have any interest.” Young v. United States ex
         rel. Vuitton et Fils S.A., 481 U.S. 787, 803 (1987) (citing 18 U.S.C.
         § 208(a)). The decision in Young “establish[ed] a categorical rule
         against the appointment of an interested prosecutor”: such an ap-
         pointment is treated as a structural error not subject to harmless-
         error analysis. Id. at 814 (plurality opinion); see also United States
         v. Siegelman, 786 F.3d 1322, 1329 (11th Cir. 2015).
                 Esformes argues that Young was “interested” because she
         had a personal, professional interest in having the magistrate
         judge’s finding of bad faith reversed. Young was represented by
         outside counsel at the disqualification hearing, and her counsel em-
         phasized that “the findings as recommended by the magistrate
         [would] have serious ramifications to Ms. Young professionally.”
         According to Esformes, Young “put her self-interest at the center
         of this controversy[,]” and the district court wrongly took that per-
         sonal interest into account when it specifically cited “the adverse
         consequences of [the magistrate judge’s credibility] findings to the
         careers of the prosecutors.” Because Young had a “dominant role
         in Esformes’[s] prosecution[,]” Esformes maintains that her conflict
         of interest is enough to require vacatur of his convictions. We dis-
         agree.
                 Young’s professional interest in avoiding sanctions from the
         district court did not disqualify her as an “interested prosecutor.”
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         18                     Opinion of the Court                 19-13838

         Every advocate has a personal, professional interest in the success
         of his matters. And every attorney has a strong personal interest in
         avoiding sanctions by a court, formal or not, because of their po-
         tential impact on an attorney’s career. We recognized the magni-
         tude of this interest in United States v. Shaygan, in which we held
         that it was a violation of prosecutors’ due process rights for a court
         to publicly reprimand them without notice and an opportunity to
         be heard, including the benefit of personal legal representation. 652
         F.3d 1297, 1317–18 (11th Cir. 2011). Young exercised the rights we
         recognized in Shaygan to challenge a sanction against her. A pros-
         ecutor who exercises her constitutional right to protect her profes-
         sional reputation does not disqualify herself from further proceed-
         ings by that same act. If self-defense of that sort were enough to
         require recusal, any accused could disqualify his prosecutors by ac-
         cusing them of misconduct.
               2. Young Did Not Violate the Advocate-Witness Rule.
                Esformes also argues that Young violated the rule that advo-
         cates may not testify in a case when she participated in the hearing
         on the motion to disqualify her, see United States v. Hosford, 782
         F.2d 936, 938 (11th Cir. 1986), but this challenge also fails. Even if
         it were error for Young to have testified at the hearing before the
         magistrate judge, Esformes invited that error when he called her to
         the stand, and he cannot complain about it now. See United States
         v. Ross, 131 F.3d 970, 988 (11th Cir. 1997). But apart from the in-
         vited-error bar, we would reject Esformes’s argument because
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         19-13838               Opinion of the Court                        19

         Young was not a “witness” in the sense governed by the advocate-
         witness rule.
                 Esformes’s objection misunderstands the advocate-witness
         rule. That rule responds to the concern that “the prestige or prom-
         inence of a government prosecutor’s office will artificially enhance
         his credibility as a witness” or that “the performance of dual roles
         by a prosecutor might create confusion on the part of the trier of
         fact as to whether the prosecutor is speaking in the capacity of an
         advocate or of a witness . . . .” Hosford, 782 F.2d at 938–39 (quoting
         United States v. Johnston, 690 F.2d 638, 643 (7th Cir. 1982)). The
         classic case involves an advocate testifying against the defendant at
         trial. See, e.g., Walker v. Davis, 840 F.2d 834, 836 (11th Cir. 1988)
         (“[The prosecutor and the defendant] were the only two witnesses
         to give testimony concerning [the defendant’s] alleged confes-
         sion.”) Young was not testifying to the jury about the charges in
         the case but was instead testifying to a magistrate judge about her
         own investigatory work. She was not serving as both an advocate
         and a witness in the way that the traditional rule envisions, and so
         her actions were consistent with the rule’s requirements.
         D. The District Court Properly Admitted Dr. Cifu and Denied Es-
                          formes’s Motion for Acquittal.
                Esformes argues that the district court abused its discretion
         when it admitted Dr. Cifu’s expert testimony and that this error
         entitles him to acquittal or vacatur “on the counts involving
         healthcare services, including [c]ount [o]ne which resulted in a
         hung-jury.” As we explained above, we lack jurisdiction to consider
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         20                      Opinion of the Court                 19-13838

         his arguments with respect to count one. We reject his other argu-
         ments because the district court did not abuse its discretion when
         it admitted Dr. Cifu’s testimony.
                Esformes challenges the admission of Dr. Cifu’s testimony
         on three grounds. First, he argues that Dr. Cifu’s testimony differed
         so greatly from the government’s pretrial disclosures that it should
         not have been allowed. Second, he argues that the district court
         erred by deferring its Daubert ruling until after Dr. Cifu testified.
         And third, he argues that the district court did not properly apply
         the Daubert factors when it admitted Dr. Cifu’s testimony.
                 Esformes offers a skeletal argument, similar to his two ob-
         jections before the district court, that “the substance of [Dr.] Cifu’s
         trial testimony differed materially from the government’s pretrial
         disclosures.” But aside from a bare citation to the disclosures, Es-
         formes does not support his assertion. “We have long held that an
         appellant abandons a claim when he either makes only passing ref-
         erences to it or raises it in a perfunctory manner without support-
         ing arguments and authority.” Sapuppo v. Allstate Floridian Ins.
         Co., 739 F.3d 678, 681 (11th Cir. 2014). So we decline to address the
         merits of this contention.
                Esformes’s next argument is that “the district court failed to
         perform the gatekeeping function required by Daubert” when it
         deferred ruling on the government’s Daubert motion until after
         Dr. Cifu testified. This argument relies on a supposed categorical
         rule that the district court must never allow the jury to hear an
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         19-13838               Opinion of the Court                        21

         expert’s testimony before ruling on it. But there is no categorical
         rule that constrains the district court’s discretion.
                 To protect the jury from confusion by unreliable experts,
         the district court must “evaluate the reliability of the testimony be-
         fore allowing its admission at trial.” Frazier, 387 F.3d at 1262. The
         district court has broad discretion to formulate the procedures to
         make that admissibility determination and is not required, for ex-
         ample, to conduct a separate Daubert hearing. See United States v.
         Hansen, 262 F.3d 1217, 1234 (11th Cir. 2001). Likewise, neither the
         Federal Rules of Evidence nor our caselaw categorically require the
         district court to prevent the jury from hearing evidence that has
         not yet been admitted. Instead, with the exception of hearings on
         the admissibility of confessions, “[a] great deal must be left to the
         discretion of the judge who will act as the interests of justice re-
         quire.” See FED. R. EVID. 104 advisory committee’s note to 1972
         proposed rule.
                 Esformes has not established that the district court abused
         its discretion. The district court completed its Daubert evaluation,
         as required, before it admitted Dr. Cifu’s testimony. Esformes ar-
         gues that the decision to defer the ruling until after the jury heard
         Dr. Cifu’s testimony is a per se abuse of discretion, but there is no
         authority for that categorical rule of law. And Esformes fails to ex-
         plain what about his trial rendered the procedure the district court
         employed an unreasonable exercise of discretion. And even if the
         district court had erred by allowing Dr. Cifu to testify before his
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         22                       Opinion of the Court                    19-13838

         admission, that error would be harmless because Dr. Cifu’s testi-
         mony was properly admitted. See FED. R. CRIM. P. 52(a).
                 Finally, the district court did not abuse its discretion when it
         admitted Dr. Cifu’s expert opinion testimony. When it decides
         whether to admit an expert witness, the district court must deter-
         mine whether “(1) the expert is qualified to testify competently re-
         garding the matters he intends to address; (2) the methodology by
         which the expert reaches his conclusions is sufficiently reliable . . . ;
         and (3) the testimony assists the trier of fact . . . to understand the
         evidence or to determine a fact in issue.” Frazier, 387 F.3d at 1260
         (quoting City of Tuscaloosa v. Harcros Chems., Inc., 158 F.3d 548,
         562 (11th Cir. 1998)); see also FED. R. EVID. 702; Daubert, 509 U.S.
         at 592–93. The district court reasonably applied this standard when
         it relied on Dr. Cifu’s background in skilled nursing care to qualify
         him, did not “skip[] the methodology requirement” (as Esformes
         argues) when it did not require specific scientific methods for his
         testimony, and reasonably found the testimony helpful to the jury.
                  As to the first factor, the district court found that Dr. Cifu
         was qualified to speak about skilled nursing facility practices based
         on his education and experience. The district court found that he
         had “been a physiatrist and medical director at [skilled nursing fa-
         cilities] for the last 30 years[,] . . . a professor at a medical school[,]
         . . . [and author of] 230 scholarly articles . . . and 30 book chapters
         or books on a wide range of topics.” Because of that professional
         experience, he was “familiar with the rules, regulations, and man-
         uals of Medicare.”
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         19-13838                 Opinion of the Court                           23

                 Esformes complains that Dr. Cifu “had no experience with
         primary psychiatric admissions” and was unfamiliar with Florida’s
         regulations requiring medical certification for admission to a skilled
         nursing facility. Those regulations, Esformes argues, undermine
         Dr. Cifu’s testimony because Florida already has measures to pre-
         vent patients from unnecessarily entering skilled nursing facilities.
         See Fla. Admin. Code Ann. r. 59G-1.040. He also argues that Dr.
         Cifu misunderstood the role of Medicare regulations in governing
         skilled nursing facilities’ operations. Esformes’s arguments are mis-
         placed.
                 Dr. Cifu was not offered as an expert psychiatrist or an ex-
         pert in Florida state regulations. What Esformes describes as a lack
         of experience with psychiatric admissions was part of Dr. Cifu’s tes-
         timony: in his experience, there were few to no psychiatric admis-
         sions to the kind of facilities where he worked. The government as
         “proponent of the testimony does not have the burden of proving
         that it is scientifically correct, but that by a preponderance of the
         evidence, it is reliable.” Allison v. McGhan Med. Corp., 184 F.3d
         1300, 1312 (11th Cir. 1999). Esformes’s arguments were permissible
         to undermine the inferences the jury might have drawn from Dr.
         Cifu’s testimony, but those arguments do not establish that Dr.
         Cifu was not an expert in his field.
                Second, the district court properly found that Dr. Cifu’s tes-
         timony was reliable even though he “didn’t do any testing” or use
         “scientific methods.” “The trial court must have the same kind of
         latitude in deciding how to test an expert’s reliability . . . as it enjoys
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         24                     Opinion of the Court                  19-13838

         when it decides whether that expert’s relevant testimony is relia-
         ble.” Kumho Tire Co. v. Carmichael, 526 U.S. 137, 152 (1999). In
         some cases, an admissible expert will need rigorous scientific or sta-
         tistical analysis, but Daubert also allows for admitting experts
         whose methods are less formal, such as when an expert testifies
         primarily based on experience. See id. at 151. The proponent of the
         testimony in such a case must “explain how that experience led to
         the conclusion he reached, why that experience was a sufficient ba-
         sis for the opinion, and just how that experience was reliably ap-
         plied to the facts of the case.” Frazier, 387 F.3d at 1265. Dr. Cifu’s
         experience with skilled nursing facilities as a practitioner, adminis-
         trator, and educator was both extensive and directly on point, and
         he painstakingly explained the basis of his bottom-line opinions
         with reference to hypothetical examples, his own personal experi-
         ence with patients, and federal regulations. No more “scientific”
         methodology was necessary.
                Third, we affirm the ruling that Dr. Cifu’s testimony was
         helpful to the jury. Although Esformes asserts that the district court
         “never even mentioned” this requirement, the district court, in
         fact, made a specific finding on the record that the testimony was
         helpful:
               I . . . think his testimony was helpful to the jury in un-
               derstanding the relationship between how [skilled
               nursing facilities] work, how patients come in and out
               of [skilled nursing facilities], what types of treatment
               are generally required in a [skilled nursing facility],
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         19-13838                Opinion of the Court                         25

                and to also help them understand the relationship be-
                tween the Medicare rules and regulations and guide-
                lines as they pertain to [skilled nursing facilities] and
                other rehabilitation facilities.
         Esformes has given us no reason to reject this finding.
                Esformes’s argument that he is entitled to a judgment of ac-
         quittal for his “counts involving healthcare services” fails along
         with his objections to Dr. Cifu’s testimony. Esformes argues that,
         without Dr. Cifu’s allegedly inadmissible testimony and its conclu-
         sion that psychiatric patients are always unsuitable for skilled-nurs-
         ing-facility care, there was no reasonable basis for the jury’s verdict.
         But the district court did not err in admitting Dr. Cifu’s testimony.
         And we must presume that the jury followed the district court’s
         instruction that psychiatric patients may sometimes belong in
         skilled nursing facilities. See Almanzar, 634 F.3d at 1222. Esformes
         also fails to engage with the other evidence presented in his two-
         month trial and falls well short of establishing that no rational jury
         could have found him guilty of healthcare fraud beyond a reasona-
         ble doubt. Cf. id. at 1221.
          E. The District Court’s Restitution Order Was Not Clearly Erro-
                                        neous.
               Esformes argues that the restitution order was clearly erro-
         neous. He contends that the restitution order was not based on
         “the amount of loss actually caused by [his] conduct” because there
         was no evidence of any loss to the government at all. United States
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         26                      Opinion of the Court                  19-13838

         v. Huff, 609 F.3d 1240, 1247 (11th Cir. 2010) (internal quotation
         marks and emphasis omitted). And he argues that even if there was
         loss, the district court calculated it unreasonably and with reference
         to unreliable evidence. We disagree.
                 There was plenty of evidence of actual loss to the govern-
         ment; indeed, defrauding the government was the core of the Es-
         formes Network conspiracy. Esformes’s only argument to the con-
         trary is that the evidence of loss came from Dr. Cifu’s testimony,
         which was unreliable and should not have been admitted. We have
         already rejected that argument. Because it was reasonable for the
         jury to find Esformes had defrauded the government beyond a rea-
         sonable doubt, it was not clearly erroneous for the district court to
         find a loss to the government by a preponderance of the evidence.
         See Anderson v. City of Bessemer City, 470 U.S. 564, 573–74 (1985)
         (“If the district court’s account of the evidence is plausible in light
         of the record viewed in its entirety, the court of appeals may not
         reverse it . . . .”); see also United States v. Bradley, 644 F.3d 1213,
         1298 (11th Cir. 2011).
                Nor did the district court make an “arbitrary” calculation
         based on an unqualified witness’s testimony. Esformes criticizes
         the district court for relying on an unreliable former Esformes Net-
         work nurse, Ada Maxine Ginarte, to calculate the extent of the gov-
         ernment’s loss. Esformes misinterprets the record: the district
         court did not rely on Ginarte’s testimony. Ginarte testified that ten
         percent of her patients did not belong in her facility, but the district
         court assumed that only one percent of Esformes Network patients
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         19-13838               Opinion of the Court                       27

         were improperly placed in a skilled nursing facility. The district
         court relied on the government’s summary witness, who estimated
         that $4.45 million of the payments received by the Esformes Net-
         work were based on young psychiatric patients housed at skilled
         nursing facilities, along with Esformes’s counsel’s estimation that
         one percent of patient payments fit that description. “[A] district
         court may accept a reasonable estimate of the loss based on the
         evidence presented[,]” United States v. Cobb, 842 F.3d 1213, 1220
         (11th Cir. 2016) (internal quotation marks omitted), and Esformes
         has not established that the district court’s estimate based on this
         evidence was unreasonable.
               F. The District Court’s Forfeiture Order Was Lawful.
                Finally, Esformes challenges the judgment of forfeiture
         against him. He argues that the convictions underlying the forfei-
         ture fail as a matter of law and that the district court unconstitu-
         tionally overrode the jury’s forfeiture verdict. These arguments
         fail.
                 It is a federal crime to engage in a transaction knowing that
         it “is designed in whole or in part . . . to conceal or disguise the
         nature, the location, the source, the ownership, or the control of
         the proceeds of specified unlawful activity . . . .” 18 U.S.C.
         § 1956(a)(1)(B)(i). And although “transactions [that] are engaged in
         for present personal benefit, and not to create the appearance of
         legitimate wealth” do not constitute money laundering, United
         States v. Blankenship, 382 F.3d 1110, 1130 (11th Cir. 2004) (quoting
         United States v. Garcia-Emanuel, 14 F.3d 1469, 1474 (10th Cir.
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         28                     Opinion of the Court                 19-13838

         1994)), those transactions can constitute money laundering if they
         are unusually structured to disguise the source of the funds, see id.
         at 1129. When a defendant is found guilty of federal money laun-
         dering, the district court “shall order that the person forfeit to the
         United States any property, real or personal, involved in such of-
         fense, or any property traceable to such property.” 18 U.S.C.
         § 982(a)(1).
         1. Legally Sufficient Evidence Supported Esformes’s Money-Laun-
                                 dering Convictions.
                 The government presented “substantial evidence of pur-
         poseful concealment” of the proceeds of Esformes’s crimes. See
         United States v. Naranjo, 634 F.3d 1198, 1208 (11th Cir. 2011). The
         Delgados testified that they financed kickbacks and bribes by artifi-
         cially inflating medical invoices for medical equipment that they
         sent to Esformes Network facilities. When the Esformes Network
         paid these invoices, it reimbursed the Delgados for paying kick-
         backs and bribes to doctors. Esformes and the Delgados “struc-
         tur[ed] the transaction in a way to avoid attention” and to share the
         proceeds of the illegal Medicare and Medicaid payments without
         being detected. See id. (quoting United States v. Majors, 196 F.3d
         1206, 1213 n.18 (11th Cir. 1999)). Moreover, the Delgados testified
         that they were the intermediaries for payments for limousines and
         female “companions” for Esformes and used shell accounts to fa-
         cilitate Esformes’s scheme to bribe the University of Pennsylvania
         basketball coach. The jury was entitled to rely on this evidence to
         find that Esformes committed money laundering.
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         19-13838                Opinion of the Court                        29

             2. Esformes’s Sentence Did Not Violate the Constitution.
                Esformes separately argues that the forfeiture judgment is
         unlawful because the district court made its own calculation of the
         amount of forfeiture that was different from the jury’s special ver-
         dict about the forfeiture of some of Esformes’s property. This ar-
         gument is foreclosed by Supreme Court precedent.
                 When district courts assess statutorily required criminal for-
         feiture, they follow Rule 32.2 of the Federal Rules of Criminal Pro-
         cedure. The rule contemplates two types of forfeiture determina-
         tions: a court can order forfeiture of an amount of money, or it can
         order the forfeiture of specific pieces of property. “If the govern-
         ment seeks a personal money judgment, the court must determine
         the amount of money that the defendant will be ordered to pay.”
         FED. R. CRIM. P. 32.2(b)(1)(A). Likewise, by default “the court must
         determine what property is subject to forfeiture under the applica-
         ble statute.” Id. But in a jury case, either party can “request[] that
         the jury be retained to determine the forfeitability of specific prop-
         erty if it returns a guilty verdict.” FED. R. CRIM. P. 32.2(b)(5)(A).
         The jury then “determine[s] forfeiture” via a special verdict. FED.
         R. CRIM. P. 32.2(b)(5)(B). But even then, the jury only determines
         “the forfeitability of specific property,” and “a party is not entitled
         to a jury finding regarding a money judgment.” United States v.
         Curbelo, 726 F.3d 1260, 1277 (11th Cir. 2013).
                The district court followed Rule 32.2 to the letter. The jury
         returned a special verdict finding certain properties forfeitable, and
         the district court calculated a money judgment afterward.
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         30                      Opinion of the Court                  19-13838

                 The Supreme Court has already rejected the argument that
         this procedure violates a defendant’s right to a jury trial. The Court
         explained in Libretti v. United States that “the right to a jury verdict
         on forfeitability does not fall within the Sixth Amendment’s consti-
         tutional protection.” 516 U.S. 29, 49 (1995). Esformes insists that
         this statement was dictum that more recent decisions have under-
         mined. But we rejected this exact argument in United States v.
         Elbeblawy and explained that “we must follow the case which di-
         rectly controls, leaving to the Supreme Court the prerogative of
         overruling its own decisions.” 899 F.3d 925, 941 (11th Cir. 2018)
         (internal quotation marks omitted) (alterations adopted).
                Esformes also argues that, even if judicial determination of
         forfeiture is not per se unconstitutional, it is unconstitutional if it
         conflicts with a previous jury verdict. See Brown v. Ala. Dep’t of
         Transp., 597 F.3d 1160, 1184 (11th Cir. 2010) (explaining that the
         Seventh Amendment requires that courts defer to jury findings
         when they sit in equity). This argument is misplaced because the
         jury and judge answered different questions. The jury calculated
         the “forfeitability of specific property[,]” FED. R. CRIM. P.
         32.2(b)(5)(A), but the judge calculated a lump-sum money judg-
         ment. The judge did not override the jury’s verdict by providing a
         different answer from that provided by the jury when it was an-
         swering a different question. Cf. United States v. Watts, 519 U.S.
         148, 155–56 (1997) (explaining that a jury’s acquittal of conduct
         does not require that the district court at sentencing find by a pre-
         ponderance of the evidence that the conduct did not occur).
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         19-13838                 Opinion of the Court                          31

                 Esformes’s other constitutional challenges are even weaker.
         Esformes contends that the application of Rule 32.2 violated the
         Double Jeopardy Clause and the Eighth Amendment’s prohibition
         of “excessive fines.” U.S. CONST. amends. V, VIII. Because Es-
         formes’s Double Jeopardy argument is presented in a single sen-
         tence with a citation to a case not involving forfeiture, it is forfeited.
         Sapuppo, 739 F.3d at 681. And Esformes’s excessive-fines argument
         fails on the merits.
                The Constitution prohibits “excessive fines,” including ex-
         cessive forfeitures. U.S. CONST. amend. VIII; see United States v.
         Bajakajian, 524 U.S. 321, 327–28 (1998). But “[i]f the value of the
         forfeited property is within the permissible range of fines under the
         relevant statute or sentencing guideline, the forfeiture is presump-
         tively constitutional.” United States v. Waked Hatum, 969 F.3d
         1156, 1168 (11th Cir. 2020). The maximum fine for Esformes’s
         money-laundering crimes is “twice the value of the property in-
         volved in the transaction.” 18 U.S.C. § 1956(a)(1). And the district
         court found that the $38.7 million Esformes derived from the Es-
         formes Network was “equal in value to the property traceable to
         the property involved in” Esformes’s crimes, so Esformes could
         have been fined up to $77.4 million under the statute.
                Esformes does not contest the $38.7 million calculation of
         the value of the property “involved in” his crimes, so any forfeiture
         under $77.4 million was presumptively constitutional. And Es-
         formes offers no basis to rebut that presumption.
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         32                   Opinion of the Court             19-13838

                               IV. CONCLUSION
                We AFFIRM Esformes’s convictions, restitution award, and
         forfeiture judgment.
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         19-13838               GRANT, J., Concurring                         1

         GRANT, Circuit Judge, concurring:
                 I write separately to offer a cautionary word about
         Esformes’s second Daubert argument. Because the ultimate
         decision to admit Dr. Cifu’s expert testimony was proper, the
         district court did not reversibly err by deferring its admissibility
         ruling until after the jury had heard his testimony. But that is all
         the majority opinion (which I join in full) stands for on this
         question. As a general matter, a wait-and-see approach to
         admissibility for expert testimony is fraught with risk.
                Expert evidence is unique in its capacity to be “both
         powerful and quite misleading because of the difficulty in
         evaluating it.” Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579,
         595 (1993) (quotation omitted). Because an “expert’s testimony
         often will rest upon an experience confessedly foreign in kind to
         the jury’s own,” the trial judge must separately work “to assure
         that the specialized testimony is reliable and relevant” and to “help
         the jury evaluate that foreign experience.” Kumho Tire Co. v.
         Carmichael, 526 U.S. 137, 149 (1999) (quotation omitted and
         alteration adopted). Consequently, a trial court “abuses its
         discretion by failing to act as a gatekeeper” regarding the reliability
         of expert testimony. McClain v. Metabolife Int’l, Inc., 401 F.3d
         1233, 1238 (11th Cir. 2005). “The importance of Daubert’s
         gatekeeping requirement cannot be overstated.” United States v.
         Frazier, 387 F.3d 1244, 1260 (11th Cir. 2004) (en banc).
               Esformes argues that the district court’s approach to
         gatekeeping here was a “per se abuse of discretion.” See Maj. Op.
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         2                      GRANT, J., Concurring                19-13838

         at 21. As the majority notes, “there is no authority for that
         categorical rule of law.” Id. True enough. But there is also no
         authority for the inverse point—that a district court can wait until
         the conclusion of an expert’s testimony to a jury before it rules on
         admissibility.
                 Instead, precedent suggests that waiting to qualify expert
         witnesses until after their testimony is usually misguided. The
         Daubert Court described the gatekeeping inquiry as a “preliminary
         assessment” made “at the outset” to determine what an expert is
         “proposing to testify” about. Daubert, 509 U.S. at 592. Our own
         caselaw also frames its analysis in the future tense. A gatekeeper’s
         role is to assess “the expert’s qualifications, the reliability of the
         testimony, and the extent to which the testimony will be helpful to
         the trier of fact.” United States v. Azmat, 805 F.3d 1018, 1041 (11th
         Cir. 2015) (emphasis added).
                It is true that the gatekeeping inquiry required under Rule
         702 is “a flexible one” and that “Daubert hearings are not required
         by law or by rules of procedure.” City of Tuscaloosa v. Harcros
         Chem., Inc., 158 F.3d 548, 562 n.16, 564 n.21 (11th Cir. 1998)
         (quotation omitted). But “discretion in choosing the manner of
         testing expert reliability” is not the same as “discretion to abandon
         the gatekeeping function” or to “perform the function
         inadequately.” McClain, 401 F.3d at 1238 n.4 (quoting Kumho Tire
         Co., 526 U.S. at 158–59 (Scalia, J. concurring)). A court cannot be
         an effective gatekeeper for witnesses who are already through the
         gate.
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         19-13838               GRANT, J., Concurring                        3

                The majority identifies a situation where admissibility
         hearings “must” be conducted outside the presence of a jury per
         Federal Rule of Evidence 104: if the hearing “involves the
         admissibility of a confession.” Maj. Op. at 21; Fed. R. Evid. 104(c).
         Rule 104(c) also applies where “justice so requires.” Fed. R. Evid.
         104(c)(3). But the danger here was not conducting Dr. Cifu’s
         admissibility hearing in front of the jury—it was holding that
         hearing after he had already testified.
                 To be sure, juries sometimes “inadvertently” hear
         inadmissible evidence, and we generally assume that they will
         follow an instruction to disregard it. United States v. Stone, 9 F.3d
         934, 938 (11th Cir. 1993). But expert witnesses deserve extra
         caution. “[N]o other kind of witness is free to opine about a
         complicated matter without any firsthand knowledge” based on
         “otherwise inadmissible hearsay.” Frazier, 387 F.3d at 1260. Here,
         because the expert testimony was admissible, any error about
         when it was admitted is harmless. I simply note that—more than
         in other evidentiary contexts—a district court’s decision to permit
         expert testimony without first assessing its admissibility risks
         creating a reversible error. After all, “abdication” of a gatekeeping
         role is “in itself an abuse of discretion.” McClain, 401 F.3d at 1238.
         In short, even if there is no “per se rule compelling such a
         procedure in every case,” treating an admissibility determination
         as a preliminary question to expert testimony “may often be
         advisable.” Watkins v. Sowders, 449 U.S. 341, 349 (1981).