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United States v. Willner

United States Court of Appeals, Eleventh Circuit

November 5, 2013

United States of America, Appellee,
v.
Mark Willner, Alberto Ayala, Vanja Abreu, and Hilario Morris, Appellants.

         ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF FLORIDA

         BRIEF FOR THE UNITED STATES

          Wifredo A. Ferrer United States Attorney Attorney for Appellee

          Emily Smachetti Deputy Chief, Appellate Division

          Jonathan D. Colan Assistant United States Attorney

          Sally M. Richardson Assistant United States Attorney Of Counsel

         Certificate of Interested Persons

         Undersigned counsel for the United States of America hereby certifies that the following is a complete list of persons and entities who have an interest in the outcome of this case who were not included in the Certificate of Interested Persons set forth in appellant's brief:

         Colan, Jonathan D.

         Richardson, Sally M.

         Sally M. Richardson Assistant United States Attorney

          Statement Regarding Oral Argument

         The United States of America respectfully suggests that the facts and legal arguments are adequately presented in the briefs and record before this Court and that the decisional process would not be significantly aided by oral argument.

          Table of Contents

         Page:

         Certificate of Interested Persons . . ................................. c-1

         Statement Regarding Oral Argument .. ................................ i

         Table of Contents ................................................. ii

         Table of Citations ................................................. v

         Statement of Jurisdiction . . ........................................ ix

         Statement of the Issues . . .......................................... 1

         Statement of the Case:

         1. Course of Proceedings and Disposition in the Court Below .. . . . . 1

         2. Statement of the Facts ................................... 3

         a. Offense Conduct.. ................................. 3

         Introduction. . .................................... 3

         Partial Hospitalization Program (PHP). . ............... 4

         Quindoza Testimony.. .............................. 7

         American Therapeutic Corporation (ATC). . . .......... 10

         American Sleep Institute (ASI). . .................... 24

         Alberto Ayala .................................... 26

         Mark Willner. . .................................. 38

         Vanja Abreu ..................................... 45

         Hilario Morris.. .................................. 54

         Medicare Billings ................................. 57

         b. Defense Conduct. . ............................... 60

         3. Standards of Review . . ................................. 61

         Summary of the Argument ......................................... 62

         Argument and Citations of Authority:

         I. There Is More than Sufficient Evidence to Support the Jury's Guilty Verdict Against Abreu. . ..................... 64

         II. The District Court Did Not Abuse its Discretion in its Evidentiary Rulings.. ................................... 67

         A. Admission of Quindoza testimony.. .................. 67

         B. Limitation on Cross-Examination of Quindoza.. ........ 73

         C. Evidence Regarding Use Of Medical Extenders ......... 74

         D. Exclusion of Panzer's Expert Testimony.. ............. 76

         E. Exclusion of Evidence of Abreu's Non-PHP Duties.. . . . . 79

         F. Admission of GEX 290. . .......................... 81

         G. Admission of Jimenez's Testimony about Morris's Response.. ...................................... 83

         III. The District Court Did Not Abuse its Discretion in Instructing the Jury . . ............................................. 84

         A. Refusal to Give Instruction on Florida Law on Medical Extenders. . ..................................... 85

         B. Refusal to Instruct Jury on Uncertainty of Law.. ........ 87

         C. Giving Deliberate Ignorance Instruction ............... 88

         IV. There Was No Cumulative Error. . ........................ 89

         V. Abreu's Sentence Is Not Unreasonable. . ................... 90

         A. Procedural Reasonableness. . ....................... 94

         B. Substantive Reasonableness.. ....................... 95

         Conclusion .. ................................................... 98

         Certificate of Compliance .......................................... 99

         Certificate of Service ................ ............................. 99

          Table of Citations

         Cases: Page:

         Gall v. United States, 552 U.S. 38, 128 S.Ct. 586 (2007).. .................................. 95

         Rita v. United States, 551 U.S. 338, 127 S.Ct. 2456 (2007).. ................................ 96

         United States v. Baker, 432 F.3d 1189 (11th Cir. 2005).. ..................................... 90

         United States v. Booker, 543 U.S. 220, 125 S.Ct. 738 (2005).. ................................. 93

         United States v. Caro, 454 F.App'x 817 (11th Cir. 2012) .................................... 86

         United States v. Dabbs, 134 F.3d 1071 (11th Cir. 1998).. ..................................... 94

         United States v. Duran, No. 11-14507 (11th Cir.), cert. denied, No. 13-284 (Oct. 15, 2013) ..................... 3, 96

         United States v. Ellisor, 522 F.3d 1255 (11th Cir. 2008).. ..................................... 80

         United States v. Hill, 643 F.3d 807 (11th Cir. 2011).. ...................................... 70

         Cases: Page:

         United States v. McDowell, 250 F.3d 1354 (11th Cir. 2001).. ..................................... 65

         United States v. Medina, 485 F.3d 1291 (11th Cir. 2007).. ..................................... 61

         United States v. Menendez, 315 F.App'x 103 (11th Cir. 2008) .................................... 89

         United States v. Menichino, 989 F.2d 438 (11th Cir. 1993).. ...................................... 94

         United States v. Negron, No. 11-16125 (11th Cir. April 18, 2013). . ............................ 3

         United States v. Olano, 507 U.S. 725, 113 S.Ct. 1770 (1993).. ................................ 83

         United States v. Pendergraft, 297 F.3d 1198 (11th Cir. 2002).. ..................................... 64

         United States v. Pielago, 135 F.3d 703 (11th Cir. 1998).. ...................................... 83

         United States v. Prather, 205 F.3d 1265 (11th Cir. 2000).. ..................................... 88

         United States v. Range, 94 F.3d 614 (11th Cir. 1996).. ....................................... 62

          Table of Citations

         Cases:

         Page: United States v. Schlei, 122 F.3d 944 (11th Cir. 1997).. ................................ 62, 88, 89

         United States v. Shaw, 560 F.3d 1230 (11th Cir. 2009).. ..................................... 94

         United States v. Simpson, 228 F.3d 1294 (11th Cir. 2000).. ..................................... 64

         United States v. Starke, 62 F.3d 1374 (11th Cir. 1995).. ................................... 62, 88

         United States v. Sterlin, 466 F.App'x 792 (11th Cir. 2012) .................................... 85

         United States v. Talley, 431 F.3d 784 (11th Cir. 2005).. ................................ 62, 96, 97

         United States v. Trujillo, 146 F.3d 838 (11th Cir. 1998).. ...................................... 61

         United States v. Valnor, 451 F.3d 744 (11th Cir. 2006).. ...................................... 97

         United States v. Waldon, 363 F.3d 1103 (11th Cir. 2004).. ..................................... 90

          Table of Citations

         Cases: Page: United States v. White, 335 F.3d 1314 (11th Cir. 2003).. ..................................... 62

         United States v. White, 492 F.3d 380 (6th Cir. 2007).. ....................................... 70

         United States v. Williams, 435 F.3d 1350 (11th Cir. 2006).. ..................................... 96

         United States v. Woodard, 531 F.3d 1352 (11th Cir. 2008).. ................................... 85

         Statutes & Other Authorities: Page:

         18 U.S.C. § 2 ....................................................... 1

          18 U.S.C. § 371 ..................................................... 1

         18 U.S.C. § 1347 ................................................. 1, 91

         18 U.S.C. § 1349 .................................................... 1

         18 U.S.C. § 3231 .................................................... 9

          18 U.S.C. § 3742 ................................................... ix

         28 U.S.C. § 1291 ................................................... ix

         42 U.S.C. § 1320a-7b(b)(1).. ....................................... 1, 67

          Fed. R. App. P. 32 .................................................. 99

          Statutes & Other Authorities Page:

         Fed. R. App. P. 4 .................................................... 9

         Fed. R. Crim. P. 29. . ................................................ 2

         Fed. R. Evid. 701.. ................................................. 70

         Fed. R. Evid. 801.. .............................................. 81, 84

         United States Sentencing Guidelines: Page:

          § 1B1.3.. ......................................................... 94

         § 2B1.1.. ...................................................... 91, 94

         Statement of Jurisdiction

         This is an appeal from final judgments of the United States District Court for the Southern District of Florida in a criminal case. The district court entered judgment against: Mark Willner and Alberto Ayala on October 1, 2012; Vanja Abreu on October 10, 2012 (DE1264); and Hilario Morris on January 25, 2013 (DE1528). The district court had jurisdiction to enter the judgments pursuant to 18 U.S.C. § 3231. Mark Willner and Alberto Ayala filed timely notices of appeal on October 10, 2012 (DE1252, 1255); Vanja Abreu filed a timely notice of appeal on October 24, 2012 (DE1291); and Hilario Morris filed a timely notice of appeal on January 29, 2013 (DE1538). See Fed. R. App. P. 4(b). This Court has jurisdiction over this appeal pursuant to 28 U.S.C. § 1291, and authority to examine Vanja Abreu's challenge to her sentence pursuant to 18 U.S.C. § 3742(a).

          Statement of the Issues

         1. Whether sufficient evidence supports the jury's guilty verdict against Abreu.

         2. Whether the district court abused its discretion in its evidentiary rulings.

         3. Whether the district court abused its discretion in instructing the jury.

         4. Whether there was cumulative error requiring reversal. 5. Whether Abreu's sentence, a year below her sentencing guideline, is unreasonable.

         Statement of the Case

         1. Course of Proceedings and Disposition in the Court Below

         A federal grand jury returned a 38-count indictment charging appellants, Mark Willner, Alberto Ayala, Vanja Abreu, and Hilario Morris, and 15 co-defendants, with Medicare fraud offenses (DE26). All four appellants and 12 co-defendants were charged with conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349 (Count I). Willner was charged with five counts of health care fraud, in violation of 18 U.S.C. § 2, 1347 (Counts VII, IX - XII) and Ayala with two counts (Counts II, IV). Morris and eight co-defendants were charged with conspiring to defraud the United States and to receive and pay kickbacks, in violation of 18 U.S.C. § 371 and 42 U.S.C. § 1320a-7b(b)(1) and (b)(2) (Count XIII) (DE26).

          Appellants and three co-defendants went to trial (DE1365). At the close of the government's case, appellants moved for judgments of acquittal under Fed. R. Crim. P. 29 (DE950, 952; DE1423:4-11, 24-31, 48-58; DE1425:193-96); the motions were denied after argument, except for Abreu's, which was taken under advisement (DE1423:22, 46, 69; DE1425:201). At the conclusion of all the evidence, appellants renewed their motions for Rule 29 acquittal (DE1428:126-29), which were denied, except for Abreu's, which was taken under advisement (DE1428:132).

         After an eight-week trial, the jury returned verdicts finding Willner, Ayala, and Abreu guilty of Count I, and Morris guilty of Count XIII (DE1416:15-25; DE1031-33, 1035). Willner was found not guilty of Counts VII, IX - XII; Ayala was found not guilty of Counts II, IV (DE1031-32). The jury did not reach a verdict on Count I as to Morris, but on Count XIII, found that Morris conspired to knowingly or willfully offer or pay kickbacks and bribes in return for referring individuals for PHP services (DE1416:21-22).

         Willner and Ayala filed a joint motion for new trial, which Abreu and Morris adopted (DE1102, 1110, 1113); Abreu filed a motion for judgment notwithstanding verdict and/or for new trial (DE1159). The government filed an omnibus response (DE1172), Abreu replied (DE1182), and the court denied the motions (DE1224, 1258).

          Willner was sentenced to 120 months' imprisonment (DE1227); Ayala to 120 months' imprisonment (DE1226); Abreu to 108 months' imprisonment; and Morris to 60 months' imprisonment (DE1528).

         2. Statement of the Facts

          a. Offense Conduct

         Introduction

         Medlink was the management company for American Therapeutic Corporation (ATC), a community mental health center (CMHC) with a partial hospitalization program (PHP), and for American Sleep Institute (ASI), a sleep study center (DE1366:58). Larry Duran, Judith Negron, and Marianella Valera controlled all three companies with overlapping ownership (DE1366:58; DE1368:200-03).[1] Appellants Ayala and Willner were psychiatrists employed as medical directors for ATC's PHP. Appellant Abreu was a therapist employed as a program director, and later as a corporate director, for ATC, with responsibilities over all aspects of ATC's PHP. Appellant Morris was employed as a ...


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