from the United States District Court for the Southern
District of Texas
SOUTHWICK, WILLETT, and OLDHAM, Circuit Judges.
S. OLDHAM, Circuit Judge
convicted Dr. Riaz Mazcuri for his role in a massive
conspiracy to commit healthcare fraud at Riverside General
Hospital. The jury also convicted him of fraudulently billing
Medicare by exploiting five nursing-home residents with
severe dementia. Mazcuri challenges his conviction and
sentence. We affirm.
2006 to 2012, Mazcuri was the attending physician at two
partial-hospitalization programs at Riverside General
Hospital ("Riverside")- Riverside Central
("Central") and Devotions Care Solutions
("Devotions"). Partial-hospitalization programs are
outpatient psychiatric services designed to provide
intensive, daily treatment to patients who have been
discharged from inpatient treatment or who suffer from an
acute exacerbation of a chronic mental disorder. Mazcuri
orchestrated a conspiracy at these facilities to bill
Medicare for unprovided or unnecessary services.
of the indictment charged Mazcuri with conspiracy to commit
healthcare fraud. At trial, Mazcuri's co-conspirator
Regina Askew testified that Mazcuri admitted large numbers of
patients to Central after speaking with them for only about
five minutes. When he was in a rush, Mazcuri sometimes
admitted patients after seeing them in a group or talking to
them briefly on the sidewalk.
Behn Courtney, who worked as a van driver and technician at
Central, testified that she picked up patients with
Alzheimer's disease or other forms of severe dementia
from a nursing home called Mission Care. She observed that
those patients often had to be coaxed into entering her van
because they didn't understand where they were going.
Courtney also prepared Central's patients for
"doctor days," when Mazcuri would visit the
facility to see his patients. On those days, Mazcuri spent
"maybe a minute, minute and a half," with each
patient. He visited groups of patients in wheelchairs and
never talked to them individually. Sometimes, Mazcuri left
the facility without having seen all of his patients. Robert
Crane, another co-conspirator, testified that similar
practices occurred at Devotions. Askew, Courtney, and Crane
were just a few of the many witnesses who testified about
Mazcuri's role in the conspiracy.
2-6 of the indictment charged Mazcuri with aiding and
abetting healthcare fraud involving five specific patients at
the Mission Care nursing home. Mazcuri admitted these five
patients to Central, but they all had severe dementia and
could not have benefited from treatment. For example, the
patient involved in Count 3 believed the year was 1938 when
it was 2009 and thought he lived in a casino. When the
Mission Care psychiatrist asked the patient involved in Count
4 where she was, she responded, "October, October."
Her dementia was so advanced that the psychiatrist
recommended her for hospice care one year before Mazcuri
authorized her treatment at Central. The patient involved in
Count 5 had Alzheimer's and could not understand why a
driver was picking her up from Mission Care each day. These
patients' illnesses were so severe that they were not
eligible for partial-hospitalization programs. But Mazcuri
admitted them anyway and sent the bill to Medicare.
were not the only patients with severe dementia that Mazcuri
exploited. Courtney testified that Government's Exhibit
67 contained a list of patients with post-admission
instructions such as, "Take off dementia" and
"Take off Alzheimer's." She explained:
"[I]f they had those diagnoses, they were not
appropriate for the [partial-hospitalization] program. So, we
had to take [them] off."
respect to the five patients involved in Counts 2-6, Mazcuri
personally billed Medicare for 382 visits, totaling $44, 500,
and Riverside billed Medicare for 2, 713 days of services,
totaling $1, 555, 100. Over the course of the conspiracy from
2006 to 2012, Mazcuri and Riverside together billed Medicare
for $69, 512, 730.25. Medicare paid $22, 922, 199.91 on those
found Mazcuri guilty on all six counts. The district court
calculated a final offense level of forty-three under the
Sentencing Guidelines. That typically results in a
recommendation of life in prison. But Mazcuri's counts
each carried a maximum penalty of ten years. Under the
Guidelines, that meant his recommended sentence was sixty
years. U.S.S.G. § 5G1.2(d). The district court varied
downward from the Guidelines recommendation and imposed a
sentence of 150 months. It also ordered restitution of $22,
922, 199.91 and forfeiture of $500, 000. Mazcuri timely
challenges his conviction based on three alleged errors by
the district court. He argues that these errors were so
prejudicial that we must grant him a new trial. We reject
each argument in turn.
argues that the district court violated Federal Rule of
Evidence 1006 when it admitted into evidence certain summary
charts, marked as Government's Exhibits 93-97. Those
exhibits summarize fraudulent activity found in two
voluminous spreadsheets, Government's Exhibits 3 and 5.
The summary charts show that Mazcuri sometimes billed more
than twenty-four hours of services in a single day. For
example, one chart shows that Mazcuri reported 58.9 hours of
service for 106 patients on July 22, 2008.
1006 permits the use of "a summary, chart, or
calculation to prove the content of voluminous writings"
that "cannot be conveniently examined in court."
The district court has broad discretion to admit these sorts
of summary charts. See Irons v. Aircraft Serv. Int'l,
Inc., 392 Fed.Appx. 305, 314 (5th Cir. 2010). The
parties dispute whether Mazcuri preserved his Rule 1006
arguments in the trial court and hence whether plain-error
review applies. See Puckett v. United States, 556
U.S. 129, 135 (2009); United States v.
Sanchez-Hernandez, 931 F.3d 408, 410-11 (5th Cir. 2019).
We need not resolve the disagreement, however, because
Mazcuri's arguments are meritless under any standard of
Mazcuri is wrong to claim that the Government should have
disclosed the summary charts earlier. Rule 1006 says that a
chart's "proponent must make the originals or
duplicates available . . . at a reasonable time and
place." But the rule says nothing about when the summary
chart itself must be disclosed to other parties. See,
e.g., Colón-Fontánez v. Municipality
of San Juan, 660 F.3d 17, 30 (1st Cir. 2011); United
States v. Bakker, 925 F.2d 728, 736 (4th Cir. 1991);
Coates v. Johnson & Johnson, 756 F.2d 524, 550
(7th Cir. 1985). Mazcuri's argument about the timing of
the charts' disclosure has no basis in Rule 1006, so we
Mazcuri cannot challenge the summary charts on the basis that
they included claims submitted by Cadwalder Behavioral
Clinics. We have held that for Rule 1006, the "essential
requirement is not that the charts be free from reliance on
any assumptions, but rather that these assumptions be
supported by evidence in the record." United States
v. Armstrong, 619 F.3d 380, 384 (5th Cir. 2010) (quoting
United States v. Buck, 324 F.3d 786, 791 (5th Cir.
2003)). Here, there is no dispute that the summary charts
accurately reflect the claims data in Exhibits 3 and 5. And
the Government proved at trial that Mazcuri was the medical
director for Cadwalder and had submitted bills using
Cadwalder's provider number. If ...