Federal Court Upholds Houston Doctor’s Sentence in Healthcare Fraud Conspiracy

December 23rd, 2019 by Tad Nelson in White Collar, White Collar Crime

White collar crimes such as fraud often involve multiple defendants accused of participating in a conspiracy. While prosecutors must prove that each defendant had “knowledge” of the conspiracy, that does not necessarily require proof of direct knowledge. In fact, the prosecution may prove its case by showing a defendant acted with “deliberate ignorance.” Put another way, a jury may consider as proof of a defendant’s guilt the fact they maintained a “charade of ignorance” about the underlying fraud.

5th Circuit: Trial Court Issued Proper “Deliberate Ignorance” Instruction

A recent decision from the U.S. Fifth Circuit Court of Appeals, United States v. Mazkouri illustrates how prosecutors can use proof of deliberate ignorance to convict a white collar defendant. This case involved what the Fifth Circuit described as a “massive conspiracy to commit healthcare fraud at Riverside General Hospital” here in Houston. Prosecutors charged the defendant in this case, formerly an attending physician at Riverside, with participating in the conspiracy.

Essentially, prosecutors alleged that the defendant signed paperwork admitting “large numbers of patients” to Riverside for participation in intensive psychiatric programs. In fact, many of these patients were not eligible or could not benefit from these programs, as they suffered from advanced conditions such as Alzheimer’s or dementia. Yet prosecutors said the defendant still signed-off on their admission, often after spending less than five minutes conducting an actual examination.

At trial, the prosecution argued that even if the defendant did not know he was admitting patients for medically unnecessary services–which were ultimately paid for by Medicare–he “at least acted with deliberate ignorance.” For example, a witness testified that another member of the alleged conspiracy told other staff members at Riverside they needed to keep the defendant happy “because we had to have [his] signatures” in admissions forms. More to the point, there was evidence that the defendant continued to sign admission forms even when it was brought to his attention that many of the patients “were not appropriate” for the treatment ordered.

The jury ultimately convicted the defendant on multiple charges. On appeal, he challenged the trial judge’s decision to issue “deliberate ignorance,” among other issues. The Fifth Circuit rejected this claim and affirmed the defendant’s convictions.

With respect to deliberate ignorance, the Fifth Circuit explained the instruction is appropriate when two conditions are met: (1) the evidence shows that there was a “subjective awareness of a high probability of the existence of illegal conduct,” and (2) the defendant engaged in “purposeful contrivance to avoid learning of the illegal conduct.” The government met both of those conditions here, the appeals court said, so the trial judge did not err in issuing the instruction.

Speak with a Houston White Collar Criminal Defense Attorney Today

Fraud and other white-collar criminal cases often involve highly complex questions of law. An experienced Houston criminal defense lawyer can help you understand the charges against you and assist you in preparing your case for trial. Contact the Law Offices of Tad Nelson & Associates in Houston, Galveston or League City to speak with an attorney today.

 

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