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U.S. v Borrasi

Case No. 09-4088 (C.A. 7, May. 4, 2011)

Roland Borrasi, a medical doctor, was convicted of Medicare fraud after he accepted a salary from a hospital in exchange for continually referring patients to the facility, a violation of 42 U.S.C. § 1320a-7b. In this appeal, Borrasi attacks both his conviction and his sentence. We find that the district court did not err by admitting minutes from hospital committee meetings to prove attendance records while excluding discussion of reports to which the minutes refer, as the latter constituted inadmissible hearsay. Because the Medicare fraud statute criminalizes payments when induction of referrals is among the purposes for the payments, we also find that the district court did not err in instructing the jury. Accordingly, we affirm his conviction. In addition, we find that the district court did not err in sentencing Borrasi. It reasonably estimated the loss amount in determining his offense level, it properly assessed a leadership enhancement to his offense level, and it expressed adequate reasons to sentence Borrasi to a longer term than his co-defendant. Accordingly, we affirm his sentence as well.


Dr. Borrasi owned Integrated Health Centers, S.C. (“Integrated”), a corporate group of healthcare providers in Romeoville, Illinois. He worked primarily at nursing homes and hospitals. Through this work, he became acquainted with Chief Executive Officer Wendy Mamoon, Director of Operations Mahmood Baig, and other officers and directors of Rock Creek Center, L.P., a licensed inpatient psychiatric hospital in Lemont, Illinois. Reimbursements from the Medicare federal health care program constituted the vast majority of payments received by Rock Creek.

At some time between 1999 and 2002, Borrasi, Mamoon, Baig, and others conspired to pay bribes to Borrasi and other individuals at Integrated in exchange for an increasing stream of Medicare patient referrals. Doctors Zafer Jawich, Bruce Roper, and Abhin Singla, as well as psychologist Agnes Jonas, were among those employed at Integrated at that time. Over that period, a sum of $647,204 in potential bribes was paid to Borrasi and Integrated physicians by Rock Creek. In 2001 alone, Borrasi referred approximately 484 Medicare patients to Rock Creek.

In order to conceal these bribes, Borrasi and other Integrated employees were placed on the Rock Creek payroll, given false titles and faux job descriptions, and asked to submit false time sheets. Borrasi, for example, was named “Service Medical Director” and was allegedly required to be available at all times; Baig later testified that Borrasi was not expected to perform any of the duties listed in his job description. According to minutes of Rock Creek’s various committee meetings, Borrasi and some Integrated physicians occasionally attended meetings and submitted reports of their work. But they attended only a very small percentage of the actual meetings, and multiple witnesses testified to rarely seeing them in the Rock Creek facility for meetings or other duties. Jonas, Jawich, and Roper each testified that the Integrated physicians did not perform their assigned administrative duties, their reports and time sheets notwithstanding. Baig testified that he, Borrasi, and Mamoon did not expect the Integrated physicians to perform any actual administrative duties.


Judge(s): Michael Kanne
Jurisdiction: U.S. Court of Appeals, Seventh Circuit
Related Categories: Criminal Justice
Circuit Court Judge(s)
David Hamilton
Michael Kanne
John Tinder

Trial Court Judge(s)
William Hibbler

Appellant Lawyer(s) Appellant Law Firm(s)
Edward Genson Genson & Gillespie
Marc Martin Law Office

Appellee Lawyer(s) Appellee Law Firm(s)
Christopher Grohman U.S. Department of Justice



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1320a-7b. in this appeal, borrasi attacks both his con- admissible as to another party or for another purpose is ad- text refers to `any remuneration.' that includes not only ambiguity. the government's argument to the jury nullified his 110 f.3d 1281, 1284 (7th cir. 1997) (affirming organizer by crediting his alleged services in any amount, and it is rock creek's payments to him or other integrated phy- nevertheless have found it to constitute harmless error 42 u.s.c. 1320a-7b et seq. baig pled guilty to all seven in rock creek committees, and various administrative ment did not question the reliability of the documents. tiary ruling, and the second focuses on the government's 816, 822 (7th cir. 2006) (quoting united states v. lopez, payments--in the guise of salaries--from rock creek service to under-served groups; it ultimately sentenced the facts of the case and the individual defendants' char- baig, and others conspired to pay bribes to borrasi and argue that certain reports were made and then tendered no. 09-4088 15 where he had substantial decision-making authority). made individual, particularized sentencing determina- because they were "record[s] . . . of acts, events, conditions, $150,000" because the services he allegedly rendered has a bona fide employment relationship with such in criminal history category i. after considering the no. 09-4088 5 duties listed in his job description. according to minutes when it determined the loss value attributed to borrasi's back, bribe, or rebate) . . . in return for referring integrated employees were placed on the rock creek other integrated employees did not have to perform tion at least "comport[ed] with congressional intent." id. administrative services were nonextant or de minimis. f.3d at 709. borrasi argues that he was prejudiced in his the government to prove loss, the defendants' wholly garding the substance of those reports. those reports court was overly generous in crediting borrasi with alleges the district court did not make adequate findings of guilty on each count against borrasi and mamoon. viction. in addition, we find that the district court it if the jury's ultimate decision was not influenced by in the hearsay. it did allow borrasi to examine rock creek salary from a hospital in exchange for continually required to be available at all times; baig later testified 8 no. 09-4088 no. 06 cr 916-2--william j. hibbler, judge. an adequate curative instruction. for which payment may be made in whole or in the particularity required for sentencing determinations. common connection between the criminals, where he v. quintero, 618 f.3d 746, 753 (7th cir. 2010). ings, and multiple witnesses testified to rarely seeing and there was much evidence showing that the alleged payments, we also find that the district court did not err an individual to a person for the furnishing or object to that amount, and he bore the burden of pro- borrasi's second challenge to his conviction turns on have borne the brunt of any leadership enhancement. for the admission of these reports or the minutes' substan- erly assessed a leadership enhancement to his offense federal rules of evidence, but borrasi's attorney would tenced her to 6 months' incarceration. in denying ments from the medicare federal health care program corresponded to a 14-level increase. it then found that in their assigned committees to justify receiving salaries the loss amount--based on the fair market value of the were made primarily as [referral] inducements." id. at 30. borrasi challenges both his conviction and his sen- doctrine, under which the trier of fact would determine federal rule of evidence 803(6) excepts certain "records minutes of business meetings. fed. r. evid. 803(6). the trial or, in the alternative, a judgment of acquittal, (7th cir. 2010). we will uphold the district court's loss rock creek paid for borrasi, and a portion of baig's salary. able."). accordingly, the district court did not err in he asserts that the district court did not identify the 16 no. 09-4088 minutes lists attendees at the meetings. the govern- the district court's lack of specificity in doing so that he the offense level, see u.s.s.g. 2b1.1, but did reduce offense level, properly enhanced the offense level due ous. we will consider each of borrasi's five issues in theory of defense and that the district court did not cure signed to help combat health care fraud: assessing borrasi's conduct. we join our sister circuits in interpreted and applied the federal rules of evidence 6 no. 09-4088 we disagree with borrasi's contention. the govern- district court's instructions de novo. united states v. records exception those records whose "source of infor- significant part for their referrals instead of their ser- creek committee meetings. the face sheet of each set of sentences. pulley, 601 f.3d at 668. here, the district court motivation of remuneration is to be considered in borrasi had performed some valuable services for rock but rather statements of reports by integrated physicians perform any actual administrative duties. a reversal is not warranted." id. at 710. (continued...) the district court noted that the $647,204 loss amount tends that the district court should have given him integrated physicians did not perform their assigned viding "substantiated evidence . . . to counter the govern- on appeal, he wisely limits his attack on his conviction enhancement to mamoon, rock creek's ceo, her actual would refute the government's assertion that he and the avoidance of disparity in arriving at its sentences. but the court did not abuse its discretion in refusing to tion of 1320a-7b(b). the first circuit did not decide in an outpatient clinic at borrasi's building and certainly inadmissible because the statements would constitute federal rule of evidence 105 provides: "when evidence1 holding that if part of the payment compensated past findings as to the loss amount sufficient to determine guidelines sentence it imposed is reasonable. see id. at 668 requisite specificity to deny him a greater discount whenever the benefits extended were partially to induce counts each of medicare-related bribery, in violation of the enhancement in this case. of particular note, borrasi applied those procedures, we review the sentence's sentence is appropriate, and it is within the guidelines united states v. greber, 760 f.2d 68, 71 (3d cir. 1985) ("the tions based on the 3553(a) factors as to borrasi and during its closing arguments did not entitle borrasi to a in instructing the jury. accordingly, we affirm his con- borrasi next argues that the district court was not some of the minutes contained comments about com- actively recruited physicians into his scheme, controlled that he and other integrated physicians earned their ment proved the loss value to be $647,204. borrasi did not because it could not have had a substantial and prising time sheets, attendance records from meeting of the rules. based on borrasi's criminal conduct, the district court at the conclusion of his trial, borrasi moved for a new homes and hospitals. through this work, he became ac- and warrants reversal of his conviction. we review the 3553(a)(6) mandates vacature of his sentence in light of when determining the appropriate sentence for a that hospital committee meeting minutes plainly fall administrative duties, their reports and time sheets did not err in sentencing borrasi. it reasonably estimated 1. exclusion of hearsay his team rendered, their membership and participation a sum that included the administrative salaries of creek, but noted that it was difficult to measure the payments were made primarily or solely with a corrupt estimated the amount of loss in determining borrasi's exact value of that benefit. the district court reduced the when it prevented him from using comments in unsubstantiated statements are not enough to under- proposal. he relies on united states v. bay state am- borrasi urges us to adopt a "primary motivation" no. 09-4088 9 guilty of similar conduct." 18 u.s.c. 3553(a)(6). the witnesses about whether they received the reports, based upon his objections to the psr. the government borrasi's motion to reconsider his sentence based on base offense level according to 2b1.1, considering the some amount was paid not pursuant to a bona fide em- bility, and borrasi now argues that the scope of the stip- because borrasi's challenge to the district court's jury need to avoid unwarranted sentence disparities among role in the fraudulent scheme was less extensive and ment, one year of home confinement, and five years' and leader enhancement where the appellant was the creek]." (sent. tr. 52.) this reduction did not change supervised release. each defendant was required to pay borrasi argues that he must be resentenced because referrals to rock creek and also to ensure the referred reasonable to determine the loss amount for sentencing, each circuit to actually reach the issue has rejected meetings to prove attendance records while excluding remand for resentencing because of three errors during waiver."). his first allegation of error involves an eviden- specifically, "statements made by third parties in an and human servs., 969 f.2d 534, 537 n.2 (7th cir. 1992) tive discussion of them. that alone justifies the district and value of any legitimately rendered services, we appeal from the united states district court against that amount based on the 24-hour on-call services fute--that borrasi never laid any additional foundation her profoundly disabled son, and found the guidelines and some integrated physicians occasionally attended would have offset the overwhelming evidence that regarding increasing the offense level to reflect the patients at [rock creek], and some adjustment for the instructing the jury, and the government's comments "any amount paid by an employer to an employee (who within the scope of the business records exception cussions of the reports purporting to show the integrated the primary motivation theory borrasi advocates. see more than the $150,000 credit it gave him for the value no. 09-4088 13 any other exception. accordingly, the statements con- a group, to further the business of the conspiracies," and f.3d 427, 432 (7th cir. 2007). he needed to convincingly justified in assessing a four-level leadership enhance- 20 no. 09-4088 mamoon did not expect the integrated physicians to borrasi and the other physicians were being paid in into evidence and use them for a different purpose. at 907. the court explicitly adopted the psr's assessment the district court gave borrasi the benefit of the doubt u.s.c. 3553(a) factors, de novo. united states v. pulley, of rock creek's various committee meetings, borrasi deference will not excuse an absence of findings al- the meeting minutes almost certainly fell within rule then argues that, even if his conviction stands, we must the existence and value of medical services abounded. see commentary during closing arguments regarding the this disparity, the district court explained that the dis- tained within hearsay unless each layer is properly admit- common-sense holding. the instruction tracked the for the seventh circuit (...continued)1 loss amount and enhancing the offense level due to their tion was not accurate; and the jury heard recorded con- range to be considerably longer than necessary to at some time between 1999 and 2002, borrasi, mamoon, the meeting minutes at issue were taken during rock from rock creek for their respective activities. the gov- to his leadership role, and correctly considered and his sentence and that of his co-defendant warrants had we found the exclusion erroneous, we would leadership roles, the court calculated borrasi's offense enced reports, including the descriptions of medical its proper scope and instruct the jury accordingly." the district court did not erroneously interpret and because it was rock creek's regular practice to take finding that he was an organizer or leader of integrated receives any remuneration (including any kick- also those amounts for which some professional time was on the government's objection, the district court ruled rules 802 and 803(6). it properly allowed borrasi to defense because he was barred from showing the jury argument persuasive. see united states v. sensmeier, 361 f.3d 982, 989 (7th cir. 904 (7th cir. 2010). we will affirm borrasi's conviction before kanne, tinder, and hamilton, circuit judges. decision to allow the government to introduce the minutes "brought . . . people together, both individually and as the restitution required of borrasi to $497,204. the district court erred in neither its evidentiary rulings fundamental than borrasi's. we conclude that the given defendant, the district court should consider "the release. mamoon was sentenced to six months' imprison- were subject to certain statutory restrictions. borrasi was nor its jury instructions, so we affirm the district court's see fed. r. evid. 803(6) (excluding from the business minutes are not "double hearsay" because the minutes mation or . . . method or circumstances of preparation to his purported leadership role in the criminal scheme. against borrasi, mamoon, and baig, charging them with employer) for employment in the provision of covered plated uses of the evidence. the district court then held a joint, two-day sentencing borrasi now contends that, because the government language of 1320a-7b(b)(1), combining it with a defini- calculation unless we are left with a definite and firm services he and his employees allegedly performed for disantis, 565 f.3d 354, 359 (7th cir. 2009). we also review tions and will affirm his sentence. de novo whether a particular instruction was appropriate creasing stream of medicare patient referrals. doctors zafer both inaccurate as to the law and inadequate to cure district court accepted the parties' stipulation that the manded by their respective actions and circumstances. mine, nor even question, the court's acceptance of the chief, and his closing arguments. even if the court provided. under the primary motivation doctrine, the on the matter, the district court denied his motion, con- opinions, or diagnoses, made at or near the time . . . kept notably in a fraud case in which factual complexities about any prejudice from the government's statements during admit any substantive descriptions of the reports in defendants could only be found guilty if the payments loss amount by $150,000 to "compensate for the efforts truth of the matters asserted. see fed. r. evid. 801(c). argues that any credit was inappropriate and that the v. mcclatchey, 217 f.3d 823, 835 (10th cir. 2000) ("[a] united states court of appeals sonable and fair for borrasi, but gave him a minimal refute the government's proof with his own, but there otherwise admissible business record cannot properly be we review the district court's factual finding regarding attended only a very small percentage of the actual meet- mitted, the court, upon request, shall restrict the evidence to be a circuit split regarding the appropriate interpreta- side the realm of permissible computations. id. ment) and mamoon's offense level at 26 (yielding a range the minutes and any comments in the minutes re- ment's explicit proof of loss." united states v. gordon, 495 three-week trial included testimony from integrated resentencing. we are unpersuaded by his three conten- evidentiary decision was erroneous, we will not reverse the four-level enhancement for clear error, and borrasi's patient referrals); united states v. kats, 871 f.2d 105, 108 the payments was for patient referrals. he contends that vices. baig testified that he paid kickbacks to borrasi; any work to receive a salary from rock creek. the district court's instructions comported with this [w]hoever knowingly and willfully solicits or ical services for the patients borrasi referred to rock creek 1989), where the first circuit affirmed the appellants' ships because the statute was violated if any portion of allowed borrasi to introduce the minutes' specific dis- prevent mamoon from re-offending; it ultimately sen- although the district court assessed only a two-level inadmissible hearsay. 586 f.3d 532, 537 (7th cir. 2009). borrasi's burden of for professional services." greber, 760 f.2d at 72. proven by the government. ultimately, borrasi has not physicians' work, it is highly unlikely that the evidence determined that borrasi accepted bribes totaling $647,204, in romeoville, illinois. he worked primarily at nursing no. 09-4088 11 we find that the district court properly calculated the tence in this appeal. he first argues that two errors bribery in procurement of bank loan and other com- if `one purpose of the payment was to induce future did not err by admitting minutes from hospital committee the law, and we will reverse only if the instructions 14 no. 09-4088 them in the rock creek facility for meetings or other computations." united states v. peterson-knox, 471 f.3d 2. application of leadership enhancement convictions after "the district court instructed that the later limit the evidentiary uses to which he could apply level at 28 (yielding a range of 78-97 months' imprison- district court found that the guidelines range was rea- the district court's determination of how much to reduce iii. conclusion ported to show that they did not participate sufficiently 25 (7th cir. 2010), and concluded that each supported finally, he asserts that the great disparity between remuneration was to compensate for bona fide services and rock creek's criminal activities. borrasi argues that defendant-appellant. 5-4-11 the minutes or the reports themselves. ployment relationship. the trial court did not err in misled the jury and prejudiced his defense. united states with violating and conspiring to violate. because med- was convicted of medicare fraud after he accepted a heard the defendants' mitigation evidence, including well as the lack of evidence to establish the existence the minutes. to support this broad premise, he cites persuasive authority weighs heavily against borrasi's borrasi then moved the district court to reconsider alleging twelve separate grounds for relief that included borrasi first argues that the district court erroneously sentencing is a factual determination, one which we but contrary to his allegation, there does not appear to compared to his own. we disagree because 3553(a)(6) referrals or induced future referrals, that portion of the for their referrals of medicare patients. ingly, we affirm his sentence as well. intent." id. rather, it held that the district court's instruc- sentencing borrasi. are inclined to agree--that "if anything, the district items or services." 42 u.s.c. 1320a-7b(b)(3). seizing errors require us to remand for resentencing. first, he sonable because it was much longer than that imposed enabled rock creek and borrasi to maximize their of defense throughout his cross-examinations, his case-in- could not--argue that the reports were themselves trust- sole caregiver. the court sentenced borrasi to seventy- secretary, as well as lease payments for one of integrated's expended."); united states v. davis, 132 f.3d 1092, 1094 no. 09-4088 7 borrasi's offense level under u.s.s.g. 3b1.1(a) after conviction that an error has been made." tanner, 628 f.3d was named "service medical director" and was allegedly that borrasi could access and control. these methods bulance and hosp. rental serv., inc., 874 f.2d 20 (1st cir. of the leadership enhancement. the psr examined seven mamoon's, which he complains was markedly lenient borrasi and his integrated group, the value of the lease put upon their admission, it waived any opportunity to established baig's role in rock creek's admissions depart- in december 2006, a grand jury returned an indictment cluding that the disparate sentences were justified by 2004) ("[w]hile we acknowledge that the burden is on patients were returned to nursing homes and facilities court found mamoon's case to be outside the heartland 2 no. 09-4088 no. 09-4088 17 to be at the beck and call for the residents of [rock of the statute, found her to be the critical caregiver for (9th cir. 1989) ("[t]he medicare fraud statute is violated (7th cir. 2000)). borrasi broadly concludes that the worthy business records falling within rule 803(6) or 18 no. 09-4088 that borrasi was not expected to perform any of the patient referrals."). turn it into a trap--set upon admission of evidence and for the northern district of illinois, eastern division. borrasi also attacks his sentence, arguing that three of 63-78 months' imprisonment). the district court then the reports--partially incorporated by the minutes-- two months' imprisonment and two years' supervised 1. sufficiency of loss calculation udicially misstated the law in its closing argument b. challenges to sentencing scope of 1320a-7b(b)(3)'s exemption--we review the jawich, bruce roper, and abhin singla, as well as psychol- pendently to fall within a recognized hearsay excep- ments to borrasi was "intended to induce" him to refer no. 09-4088 guidelines range in borrasi's case and that the below- discussion of reports to which the minutes refer, as the plaintiff-appellee, ii. analysis according to borrasi, this ruling prejudiced his case the loss amount calculated by the district court for did not limit the uses to which the minutes could be during the meetings, and it allowed him to use the admit- factors on the record. he also argues that he was only the interpretation of the criminal statute he was charged tion." united states v. christ, 513 f.3d 762, 769 (7th cir. government's proof of loss."). were we to give effect to district court erred by increasing his offense level due that borrasi and the other integrated physicians received physicians at rock creek meetings. this summary pur- in order to conceal these bribes, borrasi and other latter constituted inadmissible hearsay. because the relationship between integrated and rock creek, and borrasi argues that the district court did not make sion. indeed, this argument inverts the very spirit of the the government argues--and borrasi does not re- admitted for their truth unless they can be shown inde- defendants with similar records who have been found were either illusory or valueless. (appellee's br. at 36-37.) met his heavy burden of proving that the district court's judgment of conviction. the district court reasonably the loss amount in determining his offense level, it prop- ogist agnes jonas, were among those employed at inte- of the various individuals which did in fact benefit the shall be fined not more than $25,000 or imprisoned curative instruction. because at least part of the pay- crepancy in sentencing was not only justified but de- ted minutes in an attempt to prove those arguments. instructions necessarily implicates a question of law--the services they provided to rock creek. integrated received for their referrals. accordingly, "any sicians recorded by singla, including one in which sicians was pursuant to legitimate employment relation- downward adjustment accounting for his medical payment violates 42 u.s.c. 1320a-7b(b)(1). cordings of borrasi's conversations with integrated phy- tion is necessary both to avoid the possibility of convic- 10 no. 09-4088 ment sought to introduce them to support its expert's 42 u.s.c. 1320a-7b(b)(1). the government theorized assessed his base offense level at 8 under u.s.s.g. 2b4.1, value of benefits received through the crime. u.s.s.g. argued that he should have received a significant credit charged, for example, with violating one statute de- the rock creek hierarchy--a hierarchy that included meetings and submitted reports of their work. but they together, id. at 886, but a court's findings need only be a referrals.' " (quoting greber, 760 f.2d at 69)); united states supplemented borrasi's rent. further, baig was paid be guilty of a felony and upon conviction thereof, or specific references to them in the minutes, constituted criminal scheme, see united states v. curb, 626 f.3d 921, 924- turn, beginning with the alleged infirmities in his convic- payroll, given false titles and faux job descriptions, and reports met the business-records exception to the against the loss amount generated by borrasi's criminal the court did not consider the appropriate enhancement borrasi reasonable. the district court did not clearly err as to his offense level based upon the value he received did not contain statements of outsiders to rock creek, the psr. error the district court committed was harmless and acteristics. borrasi then timely appealed. ted under an exception to rule 802. fed. r. evid. 805. united states v. vivit, 214 f.3d 908, 914-16 (7th cir. 2000). 2009). bay state "whether the government must show that such other individuals at integrated in exchange for an in- minutes themselves would fall within this exception. tion based on innocent or de minimis conduct and also to the integrated physicians, solidified and expanded the followed the appropriate procedures and considered the borrasi points out, however, that the statute exempts its use for an abuse of discretion, but we review its inter- if the payments were also intended to compensate united states of america, from both borrasi and the government, the district court and directors of rock creek center, l.p., a licensed inpa- the sentencing phase. the government argues that the the error. united states v. oros, 578 f.3d 703, 707 (7th cir. which is admissible as to one party or for one purpose but not states v. salem, 597 f.3d 877, 884 (7th cir. 2010). our summary of the attendance of borrasi and his integrated more specific in discussing how it calculated the credit 2b4.1(b)(1). after considering the psr and arguments tion. 4 no. 09-4088 injurious effect on the outcome of the trial. see oros, 578 government, in violation of 18 u.s.c. 371, and six decisions about which borrasi complains were not errone- issues for review, preferably those not forfeited by contends that the exclusion was erroneous because the rule has such a preclusive effect at the moment of admis- ("[i]f the district court provides an adequate statement of 222 f.3d 428, 437 (7th cir. 2000)). rock creek. the appropriate level of his offense. specifically, he con- referring patients to the facility, a violation of 42 u.s.c. patients to rock creek, "the statute was violated, even mamoon during both the sentencing hearing and the constituted the vast majority of payments received by cording to borrasi, the district court's findings lacked the and any statements therefrom are hearsay, as each com- 22 no. 09-4088 rock creek. he believed the substantive information in medicare fraud statute implies that only the primary each of borrasi's vague valuations, in fact, the credits for 2. interpretation of 42 u.s.c. 1320a-7b by suggesting that it did not matter if any portion of tenth circuits convincing, and we decline borrasi's constitute a reasonable estimate based on the evidence. tencing procedures, including its consideration of the 18 with privileges at rock creek. but he does not--and director of operations mahmood baig, and other officers kanne, circuit judge. roland borrasi, a medical doctor, ulation agreement was not limited to specific contem- no. 09-4088 3 mercial bribery. that section requires augmenting the ("[i]t behooves litigants to choose with care a few select (5th cir. 1998) (holding that 1320a-7b(b)(2) is violated crime. and borrasi questioned mamoon about the reports and range, we presume the sentence is substantively reason- the minutes' substantive descriptions of the reports v. a middleman between the integrated physicians and his sentence, arguing that it should be significantly from his rock creek activities. second, he contends the allows for warranted disparities among co-defendants' formula or methodology it used and thus did not provide work for rock creek and that his contract's job descrip- hearsay prohibition. tained in the reports, as well as any quotations from the defendants' intent in any given case and find was no testimony as to the value of the on-call services, invitation to create a circuit split. nothing in the find the district court's estimate of the amount to credit reasonable estimate of the loss, united states v. christianson, some behavior from its coverage. it does not criminalize 803(6), especially given that--despite the involvement of factors relevant in determining borrasi's role in this conviction that the district court made a mistake. united presentence report (psr) and the parties' arguments rejected his disparate sentencing argument. accordingly, the government argues--and from the cold record we in addition, rock creek paid the salary for integrated's we affirm the sentence imposed. ernment and borrasi stipulated to the minutes' admissi- given the complexities of this medicare fraud case, as no. 09-4088 21 tient psychiatric hospital in lemont, illinois. reimburse- 601 f.3d 660, 664 (7th cir. 2010). if the court properly of regularly conducted activity" from rule 802's general ment to facilitate the scheme. see united states v. house, offices. this arrangement purportedly gave rock creek "free money" from rock creek. the jury returned verdicts tion of remuneration. to convict borrasi, the instruction statute he was charged with violating. we find neither mamoon, who borrasi venomously asserts should versations in which borrasi described the "free money" challenges the exclusion of the reports referenced in proof on appeal requires him to demonstrate that the rock creek officers in the fraudulent scheme--the govern- required the jury to find--beyond a reasonable doubt--that jawich testified that he did minimal administrative medicare fraud statute criminalizes payments when both to oversee the admission and stays of integrated's sums for which no actual service was performed but district court's instructions in this case would have been substantive reasonableness for an abuse of discretion. id. a. challenges to conviction approximately 484 medicare patients to rock creek. determination was "outside the realm of permissible level, and it expressed adequate reasons to sentence asked to submit false time sheets. borrasi, for example, its closing arguments. he contends that such a construc- dr. borrasi owned integrated health centers, s.c. borrasi admitted to referring patients in exchange for to two allegations of error. see ehrhart v. sec'y of health give effect to the rule of lenity in the face of statutory salaries. yet borrasi was able to expound on this theory grated at that time. over that period, a sum of $647,204 on his co-defendant. we review the district court's sen- mamoon's son had suffered that left mamoon as his during the guilt phase of his trial require a new trial. he services he rendered--was not sufficiently detailed to activities. but we have previously found such estimation $497,204 in restitution. review for clear error. united states v. ali, 619 f.3d 713, 720 ban on the admission of hearsay evidence. borrasi argues duties. jonas, jawich, and roper each testified that the we find the reasoning of the third, fifth, ninth, and committee meetings at length. nevertheless, borrasi hearing on borrasi's motion for reconsideration. it as a matter of law. united states v. tanner, 628 f.3d 890, district court's determination was inaccurate and out- rule. rule 105 is a vehicle for the enforcement of the court's decision to bar the jury's receipt of the reports, as 2008) (quoting woods v. city of chicago, 234 f.3d 979, 986 for not more than five years, or both. borrasi did not object to that calculation, but rather testimony regarding a severely debilitating accident enhancement to borrasi based on his role in the offense. f.3d 816, 819 (7th cir. 2009). even if we determine the reasons, consistent with 3553(a), for believing that the hancement against mamoon. the district court increased sprung later in trial--to effectively prevent enforcement prises statements written by physicians not testifying person who offers or pays remuneration to another minutes, and medicare reimbursement claims; and re- in the course of a regularly conducted business activity" tors. borrasi sought to introduce the minutes as exhibits no. 09-4088 19 courts may not permit the introduction of hearsay con- district court's decision to exclude the evidence or limit argued october 22, 2010--decided may 4, 2011 viction and his sentence. we find that the district court borrasi now argues that a plain application of in potential bribes was paid to borrasi and integrated medicare reimbursement claims. roland borrasi, loss amount should have been the full amount listed in physicians by rock creek. in 2001 alone, borrasi referred were paid for by medicare, his referrals and conduct him to 72 months' incarceration. by contrast, the district hearing for borrasi and mamoon. both defendants were indicate lack of trustworthiness"). borrasi, however, services rendered would have exceeded the total loss person violates the act so long as one purpose of the meeting minutes during his defense, despite its earlier the misconduct by striking the argument and by giving 12 no. 09-4088 lower to comport with mamoon's. after holding a hearing quainted with chief executive officer wendy mamoon, ment against him while assessing only a two-level en- them not guilty if the primary motivation behind the pretation of the rules de novo. united states v. rogers, 587 alleged evidentiary, procedural, and instructional errors. i. background no. 09-4088 23 so the jury could consider the information in those refer- district court did not clearly err in assessing a four-level induction of referrals is among the purposes for the now attacks. granted, the district court could have been before the court that borrasi wished to introduce for the of the actual services he performed for rock creek. ac- borrasi finally argues that his sentence was unrea- arguments do not leave us with a "firm and definite if the jury instructions fairly and accurately summarized rule 105, yet he cites no case for his proposition that the1 borrasi to a longer term than his co-defendant. accord- part under a federal health care program . . . shall availability 24 hours a day of certain medical personnel 3. sentencing discrepancy notwithstanding. baig testified that he, borrasi, and and rock creek employees; documentary evidence com- this language, borrasi argues that the prosecution prej- one count of conspiracy to defraud the united states mittee reports submitted to rock creek's board of direc- counts, but mamoon and borrasi proceeded to trial. the ("integrated"), a corporate group of healthcare providers arranging for the furnishing of any item or service offer or payment is to induce medicare or medicaid

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