First, the Court rejected the defendants' double jeopardy argument based on their acquittal at a first trial of making false statements. The Court concluded that, because the false statement charges were limited to six particular therapy notes, the jury's acquittal on those charges did not necessarily include a finding that the defendants were not part of the broader conspiracy. Double jeopardy therefore did not preclude the government from re-trying the defendants on the health care conspiracy charge (which resulted in a mistrial at the first trial).
Second, the Court found that overwhelming evidence existed to show that the defendants knew of object of the conspiracy and voluntarily joined it, given their numerous continuous acts in furtherance of the conspiracy over a number of years.
Third, the Court found no abuse of discretion in permitting the admission of testimony regarding Medicare coverage determinations, since it was relevant to the government's theory of motive, and the court issued a limiting instruction. The Court no found abuse of discretion in permitting trial testimony about illegal kickbacks, since it was relevant one of the defendant's knowledge and involvement in the conspiracy. And the Court found that, while it may have been error to have permitted expert testimony that one of the defendants may have violated a different law, any error was harmless given a limiting instruction and overwhelming evidence against the defendant.
Fourth, the Court found no abuse of discretion in the district court's dismissal and replacement of a juror who was repeatedly tardy.
Fifth, as to jury instructions, the Court found that any error giving the deliberate ignorance instruction was harmless because the court also instructed the jury on actual knowledge, and the jury could have convicted on such a theory. The Court also rejected a defendant's challenge to an aiding and abetting instruction, as that instruction was not given in connection with the conspiracy charge.
Finally, the Court upheld two sentencing enhancements as to one of the defendants. The Court found that a four-level enhancement for being an organizer/leader was warranted because he was the manager of the business, directed certain actions by his subordinates, authorized them to use his signature, and profited greatly from the conspiracy. The Court also found that the vulnerable-victim enhancement was appropriate because the company served elderly patients with acute mental illness, and the defendant failed to properly treat them by signing whatever documents were put in front of him without regard to their medical needs.
