United States v. Cathedral Henderson , 893 F.3d 1338 ( 2018 )

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[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 16-16984
________________________
D.C. Docket No. 1:15-cr-00072-JRH-BKE-1
UNITED STATES OF AMERICA,
Plaintiff - Appellee,
versus
CATHEDRAL HENDERSON,
Defendant - Appellant.
________________________
Appeal from the United States District Court
for the Southern District of Georgia
________________________
(June 27, 2018)
Before ROSENBAUM, JILL PRYOR and RIPPLE,∗ Circuit Judges.
RIPPLE, Circuit Judge:
∗
Honorable Kenneth F. Ripple, United States Circuit Judge for the Seventh Circuit,
sitting by designation.
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After a federal investigation into recordkeeping practices at a Department of
Veterans Affairs (“VA”) hospital, Cathedral Henderson was charged with fifty
counts of making false statements in connection with the delivery of, or payment
for, healthcare services, in violation of 18 U.S.C. § 1035; and with one count of
knowingly and willfully making a materially false statement to a federal agent, in
violation of 18 U.S.C. § 1001. A jury convicted Mr. Henderson on all counts, and
the district court sentenced him to twenty-seven months’ imprisonment for each of
the fifty-one counts, to be served concurrently. The district court also denied
Mr. Henderson’s motions for judgment of acquittal and for a sentence reduction.
Mr. Henderson now challenges the sufficiency of the evidence supporting his
convictions and separately challenges his sentence. Because his convictions are
supported by legally sufficient evidence and because the district court did not err in
applying the Sentencing Guidelines, we affirm his convictions and his sentence.
I
BACKGROUND
A.
At all relevant times, Mr. Henderson was the Chief of the Fee Division at
Charlie Norwood VA Medical Center, which is a VA hospital in Augusta, Georgia.
For various reasons, a VA patient sometimes needs healthcare that the VA cannot
2
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provide through its own facilities. When a VA healthcare provider determines that
a patient needs treatment outside of the VA system, that provider enters a “consult”
in the Computerized Patient Record System (“CPRS”). CPRS forwards all
consults to the Fee Division, which reviews the consults to verify that they are
appropriate for outside care and that the VA will pay the non-VA healthcare
provider for the services. After providing an “authorization for care,” an employee
in the Fee Division schedules the patient’s appointment with the non-VA
provider. 1
The Fee Division also is responsible for paying the non-VA provider after
the outside services are performed. Before paying for the services, an employee in
the Fee Division must verify that the VA patient actually received the scheduled
services. A Fee Division employee can verify that the services were performed by
reviewing the patient’s medical records for evidence of the services (such as test
results, physician reports, or a signed consent form) or by speaking personally to
the patient. The Fee Division employee “completes” the consult by paying the
outside provider’s bill and by adding an explanatory note to the patient’s file in
CPRS (such as the date that the outside services were rendered). Marking a
consult as complete in CPRS triggers a notification to the VA provider who
1
R.109 at 206 (Trial Tr.) (testimony of Maribeth Bredehoft-Veidt).
3
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originally ordered the consult, allowing that provider to review the results and to
make further decisions about patient care.
In 2012, it became clear that the consult system had not been operating as it
should; there were 2.1 million open consults in CPRS. This backlog made it
difficult for VA physicians to know the status of a consult and to determine how
they should proceed with patient care. The VA therefore instructed its facilities to
engage in a CPRS clean-up project to resolve as many of the open consults as
possible. The clean-up project proceeded in multiple steps. First, the VA
automatically closed all consults that had been open for five or more years and
deleted all duplicate consults. Then, for consults that had been open between
ninety days and five years, the VA engaged in a more thorough review process.
First, it examined each record. For patients who had died or had missed several
appointments, the VA discontinued the consults. For all others, the VA directed all
facilities to review the patient records to determine whether the patient had
received the consult services.
VA examiners employed several techniques to determine whether a patient
had received the consult services. For instance, an examiner might find in the
patient’s medical records a progress report from the outside healthcare provider.
VA employees working on the clean-up project also could call a patient to
determine whether the patient had received the outside services. Once the VA had
4
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verified that the patient had received the services, the examiner closed the consult
in CPRS with an explanatory comment. If the VA could not verify completion of
the services, the examiner would send the consult to the VA provider who initially
ordered the consult for further follow-up.
Charlie Norwood VA Medical Center had 30,000 open consults to address in
the mandated consult clean-up process. Maribeth Bredehoft, its Chief of Health
Administration Services, supervised the process. She instructed employees at all
levels of the VA to participate, including non-clinical personnel (such as billers or
schedulers). Bredehoft prepared detailed training and instructions for employees
working on the clean-up project. Specifically, she instructed all employees on the
project to examine each patient’s medical records for documentary evidence that
the services had been provided and to close each consult that had such
documentation with an explanatory comment in CPRS. If the employee could not
find such documentation or if it was not clear from the file whether the service had
been provided, Bredehoft instructed that the employee should leave the consult
open for further review.
Eventually, Bredehoft instructed Mr. Henderson to supervise his own
subordinates in the clean-up project. Bredehoft did not include Mr. Henderson in
the detailed training process that she provided for other employees participating in
the clean-up. The Government presented evidence that, as Chief of the Fee
5
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Division, Mr. Henderson was familiar with the routine consult completion process
and had supervised regularly Fee Division employees in the closing of consults
after the outside bills were paid.
Bredehoft emailed Mr. Henderson and instructed him that there were
“thousands of consults” in CPRS that “need action.”2 She said that the consults
“from the very beginning … [were] to be completed when the claim was processed
and doc[umentation] received and that was not done.”3 Mr. Henderson responded
that consults were “clinical” and that he did not believe his staff should be
responsible for closing them. 4 Bredehoft responded that the consults were “past
consults … that were to be closed when the claim was processed for payment.
That meant that the services were rendered, documentation along with claim
received, bill processed … that is the bottom line.”5 Despite his protests to
Bredehoft, Mr. Henderson eventually acquiesced in her request that he join the
clean-up process.
As Chief of the Fee Division, Mr. Henderson oversaw two groups of
employees: Fee Clerks and Revenue Clerks. Fee Clerks regularly closed consults
as part of their job duties and were involved in the process of paying the bills from
2
R.136 at 10.
3
Id.
4
Id. at 8.
5
Id.
6
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outside service providers. Revenue Clerks had different responsibilities related to
the VA’s provision of medical services to employees of other federal agencies.
Specifically, the Revenue Division managed the process of billing those federal
agencies for that medical care. The Revenue employees therefore had no
experience with the VA consult process because they did not close consults as part
of their regular job duties and, prior to working on the clean-up project, had no
access to CPRS. Mr. Henderson nevertheless delegated the consult clean-up
project to four Revenue employees.
Mr. Henderson directed the Revenue employees to close consults opened
from October 1, 2012, through September 30, 2013. He instructed them to close
all of those consults with a comment in CPRS along the lines of “[s]ervices
rendered or patient refused services.”6 He did not instruct them to examine each
patient’s medical records for evidence that the patient actually had received the
services, an important step in the consult-closing process. Following
Mr. Henderson’s instructions, the Revenue employees closed 2,725 open consults
with the comment “services rendered or patient refused services.”
During the clean-up process, Bredehoft performed random checks of the
closed consults to ensure that the closed consults indeed were accompanied by
6
R.109 at 188 (Trial Tr.) (testimony of Denise Gray).
7
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appropriate documentary evidence. During one of these checks, she discovered
some of the consults closed by the Revenue employees. She confronted
Mr. Henderson, because she suspected that the employees were closing consults
without following the appropriate procedure to verify that the services had been
rendered. She informed Mr. Henderson that the comments on the closed consults
were incorrect and ordered him to fix them. Mr. Henderson did not follow this
directive and did not instruct the Revenue employees to correct the improperly
closed consults.
The Government does not dispute that Mr. Henderson did not receive the
full training that Bredehoft provided to other employees involved in the clean-up
mandate. It emphasizes that, as Chief of the Fee Division, “Henderson was an
expert in the responsibilities of the Fee Division and knew its regulations” and
“knew the proper way to confirm that the patient had received the services before
closing a consult.”7 However, the Revenue employees also did not receive
Bredehoft’s special training; they were limited to the instructions given to them by
Mr. Henderson.
At some point, the Office of the Inspector General received an anonymous
tip that consults were being closed improperly at Charlie Norwood and sent
7
Government’s Br. 12.
8
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Tracy Brumfield to investigate. Investigator Brumfield conducted some interviews
but, due to the limited nature of the anonymous tip, was unable to uncover any
wrongdoing in his initial investigation. Later, however, the Office of the Inspector
General received a more detailed report from a VA employee. Specifically, the
employee alerted the Inspector General that there were “four employees” who
“were not familiar with the process of completing consults.”8 The employee also
reported that she was concerned with the “verbiage” the group had used to close
consults: “[s]ervices have been completed or patients refused services.”9
Investigator Brumfield conducted several more interviews. Notably, he
interviewed the Revenue employees involved in the clean-up mandate. 10 During
one of these interviews, he learned that one of the Revenue employees had written
down Mr. Henderson’s exact instructions at the time he had given them. Those
instructions included a directive to include the comment “services have been
completed or patient refused service” on each of the closed consults.11
8
R.109 at 459 (Trial Tr.) (testimony of Tracy Brumfield).
9
Id.
10
Investigator Brumfield testified that he interviewed only three of the four Revenue
employees, as one had passed away before his investigation.
11
R.135 at 28.
9
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After Investigator Brumfield had conducted about thirty interviews, he
interviewed Mr. Henderson. They had a discussion about what instructions
Mr. Henderson had given the Revenue employees.
SPECIAL AGENT BRUMFIELD: So as I understand what you’ve
just said is that they went into the system and they did not contact any
of the patients, however it was noted.
Now, the directions that you specifically gave them, do you
recall what those directions were?
MR. HENDERSON: To administratively close the consult by Chief
of H.A.S. That’s the statement. That’s all.
SPECIAL AGENT BRUMFIELD: Was there any other comments
that they were to put into the system?
MR. HENDERSON: Not that I remember, no.[12]
Later, Investigator Brumfield confronted Mr. Henderson with the
instructions one of the Revenue employees had written down and given to
Investigator Brumfield, which matched the statement the Revenue employees had
entered on the closed consults. Mr. Henderson confirmed that the directions
“sound[ed] familiar to what [he] shared with them [for] how to process” the
consults. 13 Mr. Henderson’s explanation for giving the instructions that he did was
that the Revenue employees “shouldn’t have been [handling consults] in the first
12
Id. at 25–26.
13
Id. at 28.
10
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place,” that they “wouldn’t know how to find” documentary evidence in CPRS that
the consult had been completed, and that he did not want to “explain to them
something clinically that they would never be able to find.”14
B.
A grand jury indicted Mr. Henderson on fifty counts of making false
statements in connection with the delivery of or payment for healthcare services, in
violation of 18 U.S.C. § 1035, based on the statement entered on each of the closed
consults. It also indicted him on one count of making a false statement to a federal
agent, in violation of 18 U.S.C. § 1001, based on his statement to Investigator
Brumfield. After the Government presented its evidence at trial, Mr. Henderson
moved for a judgment of acquittal on all counts, which the district court denied. A
jury convicted Mr. Henderson on all counts. After the conviction, Mr. Henderson
filed a written renewed motion for judgment of acquittal or, in the alternative, for a
new trial. The district court denied that motion.
At sentencing, the Government asked the district court to apply U.S.S.G.
§ 2B1.1(b)(15)(A), for a theft offense involving “the conscious or reckless risk of
death or serious bodily injury.” Mr. Henderson’s probation officer had not
included this guideline in Mr. Henderson’s sentencing recommendation.
14
Id. at 34.
11
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Mr. Henderson objected to the application of § 2B1.1(b)(15)(A), contending that
he did not consciously or recklessly disregard any risk. The district court noted
that Mr. Henderson had expressed concern to Bredehoft about the consult clean-up
project, specifically “about the lack of his medical training and that of his
employees who were being tasked with the job of reviewing and closing the old
consultations.”15 Mr. Henderson also “initially refused to comply with the orders
to close” the consults. 16 The fact that Mr. Henderson carried out Bredehoft’s
commands anyway led the district court to conclude that Mr. Henderson was
“aware of the risk and that notwithstanding that risk, he disregarded it and gave the
instructions to his employees to summarily close the consultations.”17 The district
court calculated the guidelines range as twenty-seven to thirty-three months’
imprisonment and ultimately sentenced Mr. Henderson to twenty-seven months for
each of the fifty-one counts, all to be served concurrently.
The district court entered the judgment of conviction on October 21, 2016. 18
On November 2, 2016, Mr. Henderson filed a motion under Federal Rule of
Criminal Procedure 35 to reduce his sentence. 19 On November 4, 2016,
15
R.134 at 23 (Sentencing Tr.).
16
Id.
17
Id. at 24.
18
R.120.
19
R.121.
12
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Mr. Henderson timely filed a notice of appeal specifically as to the district court’s
October 21 judgment. 20 The district court denied Mr. Henderson’s motion to
reduce his sentence on November 14, 2016. Mr. Henderson did not appeal
separately the November 14 denial or amend his original notice of appeal to
incorporate the district court’s November 14 denial.
II
DISCUSSION
Mr. Henderson now challenges the sufficiency of the evidence supporting
each of his convictions. He also contends that the district court improperly applied
U.S.S.G. § 2B1.1(b)(15)(A) to increase his offense level to fourteen. For the
reasons stated below, we cannot accept Mr. Henderson’s arguments and
accordingly affirm the judgment of the district court.
A.
Mr. Henderson was convicted of fifty counts of violating 18 U.S.C. § 1035,
which prohibits the making of any “materially false, fictitious, or fraudulent
statements or representations … in connection with the delivery of or payment for
health care benefits, items, or services.”21 He now contends that the Government
20
R.122.
21
The full statute reads:
(continued … )
13
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failed to prove that the false statements entered into CPRS were material and that
he had the requisite criminal intent.
1. Materiality
In his motion for judgment of acquittal, Mr. Henderson raised challenges
only as to his criminal intent. Therefore, our review of Mr. Henderson’s
challenges to the sufficiency of the evidence regarding the materiality of the false
entries in CPRS is limited to review for plain error. See United States v. Joseph,
709 F.3d 1082, 1093 (11th Cir. 2013) (“We review unpreserved objections for
plain error, including unpreserved objections to … the sufficiency of the
evidence.” (citations omitted)). 22
(a) Whoever, in any matter involving a health care benefit program,
knowingly and willfully——
(1) falsifies, conceals, or covers up by any trick, scheme, or device a
material fact; or
(2) makes any materially false, fictitious, or fraudulent statements or
representations, or makes or uses any materially false writing or
document knowing the same to contain any materially false,
fictitious, or fraudulent statement or entry,
in connection with the delivery of or payment for health care benefits,
items, or services, shall be fined under this title or imprisoned not more
than 5 years, or both.
18 U.S.C. § 1035.
22
The Government contends that the parties had agreed that mens rea was the only
disputed element at trial. The parties did not formally enter into a stipulation that the materiality
of the statements was not in dispute. Because we find that Mr. Henderson failed to preserve his
arguments on materiality by not including them in his motion for judgment of acquittal, we need
not decide whether, in the absence of a formal stipulation, Mr. Henderson can be said to have
“agreed” that materiality was not in dispute.
14
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To prevail under the plain error standard, Mr. Henderson must show “(1)
error, (2) that is plain, and (3) that has affected the defendant’s substantial rights.”
United States v. Hesser, 800 F.3d 1310, 1324 (11th Cir. 2015) (quoting United
States v. Khan, 794 F.3d 1288, 1300 (11th Cir. 2015)). Moreover, even if we
determine that Mr. Henderson has satisfied these threshold criteria, we only “may
exercise our discretion to recognize” the error if it “seriously affect[s] the fairness,
integrity or public reputation of judicial proceedings.” Id. (alteration in original)
(quoting United States v. Moriarty, 429 F.3d 1012, 1019 (11th Cir. 2005) (per
curiam)).
A false statement is material if it “‘has a natural tendency to influence, or
[is] capable of influencing, the decision of” the decisionmaking body to which it
was addressed.” Kungys v. United States, 485 U.S. 759, 770 (1988); see also
United States v. Clay, 832 F.3d 1259, 1309 (11th Cir. 2016). 23 The Government
does not need to show that the decisionmaker actually relied on the false statement.
Clay, 832 F.3d at 1309. Moreover, a false statement can be material even “if the
23
The discussions of materiality in Kungys v. United States, 485 U.S. 759 (1988), and
United States v. Clay, 832 F.3d 1259 (11th Cir. 2016), related to criminal false statements under
different statutes. As the Supreme Court has noted, though, “material” has a longstanding and
commonly understood meaning “in the context of false statements.” Kungys, 485 U.S. at 769.
We see no reason not to apply a consistent definition across statutes criminalizing material false
statements. See United States v. Natale, 719 F.3d 719, 737 n.9 (7th Cir. 2013) (applying Kungys
definition of “material” to materiality analysis under 18 U.S.C. § 1035).
15
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decision maker actually knew or should have known that the statement was false.”
Id. (quoting United States v. Neder, 197 F.3d 1122, 1128 (11th Cir. 1999)).
Mr. Henderson contends that the Government failed to prove the materiality
of the false statements entered into CPRS because, at best, the ambiguous
statements would have confused medical professionals and would not have
influenced their substantive decisionmaking. 24 At trial, however, the Government
presented evidence that the false statement could have misled a medical
professional into thinking that the services actually had been rendered. 25
The Government also presented witnesses who testified that the comment
entered into CPRS (that services were rendered or the patient had refused services)
24
Section 1035 applies only to statements made “in any matter involving a health care
benefit program” and “in connection with the delivery of or payment for health care benefits,
items, or services.” 18 U.S.C. § 1035. We recognize that one of our sister circuits has held that
§ 1035 applies only to statements that are material to the health care benefit program, as
opposed to being material to future health care decisions made by health care providers. Natale,
719 F.3d 719. Mr. Henderson has not relied on the Seventh Circuit’s holding in Natale, nor has
he demonstrated that the Government’s evidence did not satisfy the Natale standard. We
therefore decline to comment on whether we would apply the Natale standard in our circuit to
convictions under § 1035. Moreover, “[i]t is the law of this circuit that, at least where the
explicit language of a statute or rule does not specifically resolve an issue, there can be no plain
error where there is no precedent from the Supreme Court or this Court directly resolving it.”
United States v. Lejarde-Rada, 319 F.3d 1288, 1291 (11th Cir. 2003) (per curiam). Therefore,
even if we were to adopt the Natale standard, it would not require reversal here, because there
can be no plain error when the error is not “clearly established and obvious.” United States v.
Hesser, 800 F.3d 1310, 1325 (11th Cir. 2015).
25
R.109 at 326 (Trial Tr.) (testimony of Victoria Coates). Coates testified that the
language used to close the consults risked patient health because medical providers could read it
and “believe that they understand what’s going on, but that’s not really true.” Id.
16
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was “internally inconsistent.”26 Because a patient cannot both receive and refuse
services, a medical provider would have had to take the time to figure out what
actually had happened before proceeding with patient care. 27 Mr. Henderson
counters that the fact that a professional would have had to inquire further
demonstrates that the statements were not material. We cannot accept this view.
First, he ignores the fact that despite the ambiguity in the statements, a medical
professional might have misunderstood the comment as indicating that the patient
did actually receive services. In any event, causing confusion through ambiguous
statements endangered patient care, even if the only effect on the operations of the
VA was to delay treatment while the medical professional sorted out the confusion.
Mr. Henderson also contends that the false statements used to close the
consults cannot be material because all of the consults were from previous fiscal
years and therefore could not have been used as authorization to retain and later
compensate the outside healthcare provider. It might be true that the outside bills
could not have been paid without more up-to-date consults, but the Government
presented testimony at trial that the older consults still were relevant to the
operation of the VA healthcare system. Investigator Brumfield testified that the
26
Id. at 325; see also id. at 573 (testimony of Michael Davies).
27
Id. at 573. Davies testified that the language used to close the consults would have
required him to follow up with the outside provider and the patient, either to get the consult
results (if the services had been rendered) or to discuss the patient’s refusal (if the patient had
refused services). Id.
17
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fiscal year in which a consult was entered “did not matter” and that “the consult
matters” and stays “open until [the] veteran … properly receiv[es] the care.”28
Another VA employee testified that a consult could be “ordered in one fiscal year,
but then completed in maybe one or two fiscal years afterwards.”29 Moreover, the
VA focused its efforts on reviewing all consults that were between ninety days and
five years old, indicating that consults older than the current fiscal year were
important to the VA’s operations.
Therefore, we see no error, let alone plain error, in the sufficiency of the
Government’s evidence as to the materiality of the false statements in CPRS.
2. Mens Rea
Next, Mr. Henderson challenges his § 1035 convictions on the ground that
the Government did not prove the requisite criminal intent. Because
Mr. Henderson properly preserved this argument in his motion for judgment of
acquittal, we review it under the usual standard. We review de novo the district
court’s denial of a motion for judgment of acquittal, but “our evaluation is
comparable to the standard used in reviewing the sufficiency of the evidence to
sustain a conviction.” United States v. Bergman, 852 F.3d 1046, 1060 (11th Cir.
2017) (quoting United States v. Ellington, 348 F.3d 984, 989 (11th Cir. 2003) (per
28
Id. at 521 (testimony of Tracy Brumfield).
29
Id. at 552 (testimony of Shayla Desir).
18
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curiam)). “Under that standard, we review the evidence presented at trial in the
light most favorable to the government, and we draw all reasonable factual
inferences in favor of the jury’s verdict.” Id. “[W]e will not overturn a jury’s
verdict ‘if any reasonable construction of the evidence would have allowed the jury
to find the defendant guilty beyond a reasonable doubt.’” United States v.
Crabtree, 878 F.3d 1274, 1284 (11th Cir. 2018) (quoting United States v. Wilson,
788 F.3d 1298, 1308 (11th Cir. 2015)).
Section 1035 requires that the defendant act “knowingly and willfully.” “A
defendant acts willfully when he acts with ‘knowledge that his conduct was
unlawful’ and acts knowingly if he acts with ‘knowledge of the facts that constitute
the offense.’” Clay, 832 F.3d at 1301 (quoting United States v. Dominguez, 661
F.3d 1051, 1068 (11th Cir. 2011)). The Government is entitled to prove
knowledge or intent through circumstantial evidence. Id. at 1309.
First, Mr. Henderson submits that Bredehoft “gave him reassurances that
the medical services had been rendered in all of the cases and that they should have
been closed already.” 30 If Mr. Henderson truly believed that each patient on the
list had either refused or received services, he would not have been acting with
knowledge that the language used to close the consults was false. At trial,
30
Appellant’s Br. 25.
19
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however, the Government presented legally sufficient evidence to refute this claim.
For example, the Government placed in evidence a transcript of the conversation
between Investigator Brumfield and Mr. Henderson. Investigator Brumfield asked
Mr. Henderson why he gave his employees the instructions he did; specifically,
why he instructed the Revenue employees to close the consults with the comment
that the services were complete or that the patient had refused services.31
Mr. Henderson responded that the Revenue employees “wouldn’t know how to
find” the information necessary to complete the consults correctly, and he did not
want “to explain to them something clinically that they would never be able to
find, because they shouldn’t have be [sic] doing it in the first place.” 32
Mr. Henderson also ignored Bredehoft’s instruction to remedy the improperly
closed consults after she discovered the problem. Finally, Mr. Henderson was
familiar with the usual consult-closing process, had closed numerous consults
properly before the clean-up project began, and was aware of how much time it
would take to review each consult. The jury was entitled to believe that, to the
extent that Mr. Henderson relied on Bredehoft’s statements as evidence that the
thousands of consults warranted summary closure, such reliance was unreasonable.
31
R.135 at 31–32. Various witnesses described the comment with slightly different
phrasing; the slight differences are not relevant to this appeal. See, e.g., text accompanying note
37.
32
Id. at 34.
20
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From this evidence, the jury was entitled to infer that Mr. Henderson gave the
instructions not because he actually believed that the services were complete or
that the patients had refused services, but because he wanted to close the consults
quickly per Bredehoft’s insistence.
Second, Mr. Henderson contends that the Government did not prove his
criminal intent with sufficient evidence because he intentionally instructed the
Revenue employees to close consults only from prior fiscal years, and he knew that
the consults would have to be re-issued before the VA could pay the bills from
outside providers. The Government presented evidence, however, that
Mr. Henderson knew the statements were false and important to the operation of
the VA healthcare system. First of all, the Government’s evidence showed that the
entire review process focused on consults that were between ninety days and five
years old. If consults older than the current fiscal year were irrelevant, there would
have been no reason to instruct the employees to review consults as old as five
years. Second, the Government presented evidence that prior to the events of this
case, Mr. Henderson personally and correctly had closed consults that had been
ordered in prior fiscal years. 33 The jury was entitled to infer from this evidence
33
E.g., R.109 at 550–52 (Trial Tr.) (testimony of Shayla Desir).
21
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that Mr. Henderson knew that consults from previous fiscal years were still
relevant to the VA’s operations and, therefore, that the false language was material.
The Government presented sufficient evidence for a jury to find that
Mr. Henderson acted willfully34 and knowingly. Therefore, the district court did
not err in denying Mr. Henderson’s motion for judgment of acquittal.
B.
Mr. Henderson next challenges the sufficiency of the Government’s
evidence supporting his conviction under 18 U.S.C. § 1001(a)(2), which prohibits
making false statements to federal investigators.35 This conviction arose out of an
interview between Investigator Brumfield and Mr. Henderson during the federal
34
Mr. Henderson does not challenge the sufficiency of the Government’s evidence that
he acted willfully, meaning with the knowledge that his conduct was unlawful. The Government
presented ample evidence from which the jury could infer that Mr. Henderson knew his conduct
was unlawful. For example, CPRS notified Mr. Henderson with several warnings about criminal
liability for misuse of the system each time he logged on.
35
The statute provides:
(a) Except as otherwise provided in this section, whoever, in any matter within the
jurisdiction of the executive, legislative, or judicial branch of the Government of
the United States, knowingly and willfully—
(1) falsifies, conceals, or covers up by any trick, scheme, or device a material
fact;
(2) makes any materially false, fictitious, or fraudulent statement or
representation; or
(3) makes or uses any false writing or document knowing the same to contain
any materially false, fictitious, or fraudulent statement or entry;
shall be fined under this title [or] imprisoned not more than 5 years … .
18 U.S.C. § 1001.
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investigation into the consult clean-up process at Charlie Norwood. When
Investigator Brumfield first asked Mr. Henderson what instructions he gave the
Revenue employees, Mr. Henderson responded that they “put in there … ‘consult
administratively closed by Chief of H.A.S.,’ or whatever—that’s the statement
they used.”36 He said he did not remember if there were “any other comments that
they were to put into the system.” 37 However, in the course of the investigation,
Investigator Brumfield had spoken with several of the Revenue employees, at least
one of whom had written down detailed instructions from Mr. Henderson. These
detailed instructions included a statement that for “comments, you will type
‘services have been completed or patient refused service.’” 38 Later in the
interview, then, Investigator Brumfield confronted Mr. Henderson with the
instructions that Investigator Brumfield knew Mr. Henderson actually had given
his employees. Mr. Henderson acknowledged that he had, in fact, given those
instructions. 39
A conviction under § 1001(a)(2) requires the Government to prove “(1) that
a statement was made; (2) that it was false; (3) that it was material; (4) that it was
made with specific intent; and (5) that it was within the jurisdiction of an agency of
36
R.135 at 24.
37
Id. at 26.
38
Id. at 28.
39
Id.
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the United States.” Clay, 832 F.3d at 1305 (quoting United States v. House, 684
F.3d 1173, 1203 (11th Cir. 2012)). Mr. Henderson challenges the sufficiency of
the Government’s evidence of his criminal intent and the materiality of his false
statement to Investigator Brumfield. 40
First, Mr. Henderson submits that he did not knowingly make a false
statement because he told Investigator Brumfield that he did not remember any
other statement.41 He also submits that his instruction to “administratively close
the consult by Chief of H.A.S.” 42 was an explanation he gave to his staff and not
an instruction of what comment to enter. The transcript does not bear out his
claims. In the first place, we agree that if Mr. Henderson actually had told
Investigator Brumfield that he did not remember what comments he instructed his
staff to use, Mr. Henderson would not have made a false statement in his interview
with Investigator Brumfield. But the record is clear that Mr. Henderson stated to
Investigator Brumfield that he told the employees to “put in [CPRS]” that the
40
As with his challenge to the sufficiency of the Government’s evidence as to his
criminal intent under § 1035, Mr. Henderson properly preserved this challenge in his motion for
judgment of acquittal. Therefore, we apply the usual standard of review. Although we review
the district court’s denial of his motion for judgment of acquittal de novo, the district court did
not err in denying Mr. Henderson’s motion so long as “any reasonable construction of the
evidence would have allowed the jury to find the defendant guilty beyond a reasonable doubt.”
United States v. Crabtree, 878 F.3d 1274, 1284 (11th Cir. 2018) (quoting United States v.
Wilson, 788 F.3d 1298, 1308 (11th Cir. 2015)).
41
See R.135 at 26.
42
Id.
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consults were “administratively closed by Chief of H.A.S.” 43 That is inconsistent
with the notation actually used by the Revenue employees and with the evidence of
the instructions Mr. Henderson actually gave. The jury was entitled to find that
Mr. Henderson knew that his statement about the consult instructions was false.
Next, Mr. Henderson submits that his false statement to Investigator
Brumfield was not material because Investigator Brumfield already knew what
instructions Mr. Henderson actually had given to the Revenue employees.
However, a conviction under § 1001 requires only that the false statement must
have “a natural tendency to influence, or [be] capable of influencing, the decision
of the decisionmaking body to which it was addressed.” Clay, 832 F.3d at 1309
(quoting United States v. Boffil-Rivera, 607 F.3d 736, 741 (11th Cir. 2010)).
“[T]he test is not whether the agents were actually misled.” Id. “Indeed, a false
statement can be material even if the decision maker actually knew or should have
known that the statement was false.” Neder, 197 F.3d at 1128. Mr. Henderson’s
assertions about what instructions he gave certainly were material to the
Government’s investigation into the consult clean-up process at Charlie Norwood,
regardless of whether Investigator Brumfield knew from the start that the
statements were false.
43
Id. at 24.
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The Government presented sufficient evidence to convince a reasonable jury
both that Mr. Henderson knew his statements to Investigator Brumfield were false
and that the false statements were material under § 1001. Therefore, the district
court did not err in denying Mr. Henderson’s motion for judgment of acquittal.
C.
Mr. Henderson’s final challenge is to his sentence. His challenges all center
on the application of U.S.S.G. § 2B1.1(b)(15)(A). That provision provides for an
increase in offense level when a theft offense involves “the conscious or reckless
risk of death or serious bodily injury.” We have noted that the guideline “focuses
on the defendant’s disregard of risk, rather than on the result.” United States v.
Moran, 778 F.3d 942, 977 (11th Cir. 2015). The Government need not show
actual injury to any particular victim.
We review de novo the district court’s interpretation of § 2B1.1(b)(15)(A)
and its application of § 2B1.1(b)(15)(A) to the facts. Id. at 959. A finding of risk
of death or serious bodily injury under § 2B1.1(b)(15)(A) is a factual finding that
we review for clear error. See id. at 959, 978.
Mr. Henderson made, at two different points in the proceedings, different
arguments as to why this enhancement provision does not apply. At his
sentencing, he objected to the application of § 2B1.1(b)(15)(A) because he is not a
medical professional and because he was acting under protest, as evidenced by his
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email chain with Bredehoft about his hesitation to work on the project. Later, in a
Federal Rule of Criminal Procedure 35 motion for sentence reduction, he argued
that § 2B1.1(b)(15)(A) should not apply because the ambiguous language used to
close the consults meant that in all cases, medical professionals would require
follow-up clinical review, so there was no risk to patient health.
With respect to the arguments advanced at sentencing, Mr. Henderson has
two difficulties. First, he has not raised these specific arguments on appeal. See
United States v. Massey, 443 F.3d 814, 819 (11th Cir. 2006) (noting that specific
objections to an enhancement might not be preserved on appeal by different
objections to the same enhancement made below). Second, no matter what
standard of review we apply, his objections were without merit. As the district
court noted, Mr. Henderson’s initial refusal to participate in the project because he
thought the consults required clinical review, coupled with his eventual
acquiescence, demonstrated both that he was aware of the risks posed by closing
consults with inaccurate statements and that he consciously disregarded that risk.
With respect to the objection raised in the Rule 35 motion and now offered
on appeal, there are also two problems. First, under United States v. Cartwright,
413 F.3d 1295 (11th Cir. 2005), we lack jurisdiction to consider the district court’s
denial of Mr. Henderson’s Rule 35 motion. Mr. Henderson filed his notice of
appeal before he filed his Rule 35 motion and did not amend the original notice of
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appeal or file a new notice of appeal after the district court denied his Rule 35
motion. Therefore, as in Cartwright, we lack jurisdiction to consider an appeal of
the Rule 35 order. See Cartwright at 1299–1300.
Second, even if we had appellate jurisdiction over this contention, his
arguments on appeal lack merit under any standard of review. For the same reason
that the misrepresentations were material, they also risked serious bodily injury or
death. The Government presented myriad evidence that the false entries in CPRS
could have delayed and influenced patient care. Even a delay in order to follow up
on the ambiguous consult language could have caused death or serious bodily
injury. The Government did not need to show actual evidence of death or serious
bodily injury; the enhancement “focuses on the defendant’s disregard of risk,
rather than on the result.” Moran, 778 F.3d at 977. The district court did not
clearly err in finding that Mr. Henderson’s actions created a risk of death or serious
bodily injury in applying § 2B1.1(b)(15)(A). 44
44
Mr. Henderson makes much of the fact that the district court applied § 2B1.1(b)(15)(A)
contrary to the recommendation of the probation officer. He cites no authority for the novel
proposition that it is categorically improper for a district court to deviate from the
recommendations of probation officers in exercising its “broad discretion when imposing
sentences.” United States v. McQueen, 727 F.3d 1144, 1156 (11th Cir. 2013). The Government
asked the district court to apply § 2B1.1(b)(15)(A) in its presentencing submissions, and
Mr. Henderson was given the opportunity to, and did, respond with his own arguments. See Fed.
R. Crim. P. 32(h). As we have stated, the district court did not err in applying
§ 2B1.1(b)(15)(A). The fact that the probation officer disagreed is not an independent basis on
which Mr. Henderson can challenge his sentence.
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Conclusion
For the reasons set forth in the foregoing opinion, the judgment of the
district court is affirmed.
29