United States v. Daniela Gozes-Wagner ( 2020 )


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  •      Case: 19-20157   Document: 00515580734     Page: 1   Date Filed: 09/28/2020
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE FIFTH CIRCUIT
    United States Court of Appeals
    Fifth Circuit
    FILED
    No. 19-20157                 September 28, 2020
    Lyle W. Cayce
    UNITED STATES OF AMERICA,                                                 Clerk
    Plaintiff - Appellee
    v.
    DANIELA GOZES-WAGNER, also known as Daniela Wagner, also known as
    Daniela Mayer Gozes, also known as Daniela Gozes,
    Defendant - Appellant
    Appeal from the United States District Court
    for the Southern District of Texas
    Before STEWART, DENNIS, and HAYNES, Circuit Judges.
    CARL E. STEWART, Circuit Judge:
    A jury convicted Daniela Gozes-Wagner of conspiracy to commit health
    care fraud and conspiracy to commit money laundering. The district court
    sentenced her to 120 months (10 years) imprisonment on each count, with the
    sentences running consecutively, for a total of 240 months (20 years). The court
    also ordered her to pay more than $15 million in restitution.
    On appeal, Gozes-Wagner argues that her sentence should be vacated
    because it was the result of an unconstitutional “trial penalty”—a punishment
    for choosing to exercise her right to stand trial instead of pleading guilty. She
    also argues that her sentence should be vacated because it was both
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    No. 19-20157
    procedurally and substantively unreasonable. Finally, she seeks vacatur of the
    restitution award on several grounds. Finding no reversible error, we affirm.
    I. Background
    A. The Conspiracy
    Daniela Gozes-Wagner worked as a mid-level manager for a Russian-led
    conglomerate that stole millions from Medicare and Medicaid. Her role in the
    conspiracy included, among other things: recruiting doctors to approve
    unnecessary medical tests, hiring “seat warmers” to sit in empty offices
    designated as fronts for shell companies that she helped manage to cover up
    the scheme, and overseeing payroll operations for “testing facilities” in the
    Houston area. Other members of the conspiracy relevant to this appeal include:
    Aliksander Beketav, Mikhail Shiforenko, Alexsandr Voronov, and Boris Robert
    Brodsky.
    In 2014, a grand jury returned a two-count indictment against Beketav,
    Shiforenko, Voronov, and Gozes-Wagner. All four were charged with one count
    of conspiracy to commit health care fraud. The Russians—but not Gozes-
    Wagner—also were charged with one count of conspiracy to commit money
    laundering. Later on, Brodsky was charged in a single-count superseding
    information with conspiracy to commit health care fraud. Initially, then,
    Gozes-Wagner and Brodsky each faced only a conspiracy to commit health care
    fraud charge, while Beketav, Shiforenko, and Voronov each faced both a
    conspiracy to commit health care fraud charge and a conspiracy to commit
    money laundering charge.
    Slowly but surely, circumstances changed. Soon after being arrested in
    2015, Beketav attempted to hang himself and became incapacitated. In July
    2016, Voronov pleaded guilty without a plea agreement to a superseding
    information charging him with a single count of conspiracy to commit health
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    care fraud. The conviction carried a maximum sentence of 60 months in prison.
    Meanwhile, Shiforenko had been cooperating with the Government. In
    December 2016, he agreed to plead guilty to the conspiracy to commit health
    care fraud charge in exchange for the Government agreeing to dismiss the
    conspiracy to commit money laundering charge. This meant that he now faced
    a statutory maximum sentence of 120 months. At this point, of the originally
    indicted conspirators, Gozes-Wagner was the only one who might go to trial.
    In March 2017, a grand jury returned a superseding two-count
    indictment against Gozes-Wagner. This time, she was charged with two
    counts: conspiracy to commit health care fraud charge and conspiracy to
    commit money laundering. Shortly thereafter, the district court granted the
    Government’s request to dismiss the charges against Beketav because of his
    incapacitation. And in August 2017, Brodsky pleaded guilty to the single count
    of conspiracy to commit health care fraud that he faced. Brodsky’s conviction
    carried a statutory maximum sentence of 60 months.
    It was then the case that none of Gozes-Wagner’s co-conspirators would
    be sentenced to more than 120 months in prison. Gozes-Wagner, meanwhile,
    faced a combined statutory maximum of 360 months imprisonment: 120
    months for a conviction of conspiracy to commit health fraud under 18 U.S.C.
    § 1347, and 240 months for a conviction of conspiracy to commit money
    laundering under 18 U.S.C. § 1956(a)(1). This 360-month maximum sentence
    was three times Shiforenko’s 120-month maximum sentence and six times
    Voronov and Brodsky’s 60-month maximum sentences.
    It bears mentioning here that Judge Melissa Harmon had presided over
    the conspirators’ cases until this point and had taken the guilty pleas of
    Brodsky, Voronov, and Shiforenko. But just days before Gozes-Wagner’s trial
    was set to begin, her case was transferred to Judge David Hittner. Trial began
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    before Judge Hittner on September 25, 2017. It ended several days later when
    the jury convicted Gozes-Wagner on both counts she faced.
    In July 2018, before anyone in the conspiracy had been sentenced, the
    conspirators’ cases were reassigned to Judge Andrew Hanen. A few months
    later, in October 2018, Gozes-Wagner’s case was transferred back to Judge
    Hittner for sentencing. Shiforenko’s, Voronov’s, and Brodsky’s cases remained
    before Judge Hanen. Our references to “the district court” throughout this
    opinion are to Judge Hittner.
    Gozes-Wagner was the first conspirator to be sentenced. Her sentencing
    hearing was held on March 6, 2019. The table below illustrates the relative
    positions of the co-conspirators at the time Gozes-Wagner was sentenced.
    Disposition of           Max
    Conspirator            Role           Counts
    charges           Sentence
    Beketav            Leader       HCF 1 & ML 2         Dismissed              N/A
    Chief
    Shiforenko                           HCF 3             Plea agmt           10 yrs
    assistant
    Voronov           Manager           HCF            Plea (no agmt)          5 yrs
    1  “HCF” is short for conspiracy to commit health care fraud. Even though Voronov
    initially was charged under 18 U.S.C. § 1347, which carries a 10-year statutory maximum
    sentence, the charge he pleaded to in the superseding information was under 18 U.S.C. § 371,
    which carries a 5-year statutory maximum sentence. Brodsky was initially charged under
    § 371, and he pleaded guilty under that statute. Shiforenko, meanwhile, pleaded to the more
    serious charge in the initial indictment under § 1347, and Gozes-Wagner was convicted under
    § 1347, too. This explains why Voronov and Brodsky faced 5-year statutory maximum
    sentences for conspiracy to commit health care fraud while Shiforenko and Gozes-Wagner
    faced 10-year statutory maximum sentences for similar, but distinct, convictions.
    2   “ML” is short for conspiracy to commit money laundering.
    3 Although Shiforenko was initially charged with conspiracy to commit health care
    fraud and conspiracy to commit money laundering, the table only includes the conspiracy to
    commit health care fraud charge because that’s the only one upon which he was convicted.
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    Brodsky         Manager           HCF              Plea agmt            5 yrs
    Gozes-Wagner       Manager       HCF & ML         Convicted by jury        30 yrs
    The PSR calculated Gozes-Wagner’s Guidelines range as 324 to 360
    months (27 to 30 years). 4 Probation recommended a sentence of 324 months,
    the low end of the Guidelines. Gozes-Wagner sought a significant downward
    variance. The Government’s position was unclear. The prosecutor first
    requested that she be sentenced at “the low end of the guidelines.” When
    reminded by Judge Hittner that such a sentence would amount to at least 27
    years, the prosecutor said, apparently in error, that such a sentence “would be
    above the sentencing max.” As such, he asked “for 240 months [20 years],”
    which he said amounted to “the sentencing max . . . under the guidelines.”
    Gozes-Wagner emphasized that she faced a much lengthier sentence
    than her pleading co-conspirators. She argued that because Shiforenko faced
    only a 120-month maximum sentence and Voronov and Brodsky faced only 60-
    month maximum sentences, it would be unfair and illegal to sentence her, as
    she is arguably not as culpable as them, to anything close to the Guidelines
    range of 324 to 360 months.
    The district court listened to Gozes-Wagner’s arguments and then
    pronounced its sentence. Consistent with the Government’s final request, it
    sentenced her to 240 total months imprisonment: 120 months on each count of
    conviction, to run consecutively. The 20-year sentence amounted to a 7-year
    downward variance from the low end of her Guidelines range. Gozes-Wagner
    also was ordered to pay $15,283,985 in restitution.
    But it is how the court reached its sentence that is primarily at issue in
    this appeal. To more fully appreciate the context in which the sentencing
    4   Although Gozes-Wagner challenged the calculation of the Guidelines range in the
    district court, she does not do so on appeal.
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    occurred, we will begin by examining what transpired during trial. We will
    then closely inspect the sentencing hearing itself.
    B. The Trial
    The Government presented its case-in-chief through the testimony of
    fourteen witnesses over three days. Its first witness was Agent William
    Marlowe, a task force officer with the FBI in Houston. Agent Marlowe testified
    that the investigation into the Beketav Group began in 2009 with “notice that
    patients were receiving monies in return for medical services.” Suspicious
    findings appeared almost immediately. Although billing records described
    patients as being seen at specific offices, follow-up interviews with those same
    patients confirmed that they had in fact been seen at their houses. Then there
    was the “cyclical billing,” where a patient would receive “a battery of diagnostic
    tests” one month followed by the same tests several months later. The
    investigative trail led agents to the Beketav Group, Agent Marlowe testified.
    Agent Marlowe explained that Gozes-Wagner’s initial role in the
    conspiracy was as “a marketer or recruiter,” but her duties grew. On more than
    one occasion, when he visited locations believed to be operated by the group,
    she was the person who appeared to be in charge.
    The Government then called Sandra Garcia as its second witness. She
    told the jury that Gozes-Wagner hired her as a medical assistant in 2014.
    Garcia testified that Gozes-Wagner instructed her to review medical files and
    find patients who complained of neuropathy, or numbness, and then contact
    them after 30 or 60 days to see if they needed more tests. The practice made
    Garcia uncomfortable because it seemed to be designed to evade Medicare
    scrutiny, she testified. Garcia soon discovered what appeared to her to be
    outright fraud: reimbursements for MRI tests that could not have possibly been
    done because her employer did not have an MRI machine. When she confronted
    Gozes-Wagner about the issue, Gozes-Wagner told her it must have been an
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    accident. When Garcia raised the issue a second time, she was told she was
    being fired.
    Then, to her surprise, she wasn’t fired. Instead, Gozes-Wagner told her
    that for $10 an hour all she had to do was sit in an empty office and, in Garcia’s
    words, “watch Netflix all day long.” Garcia’s primary duty was to wait for the
    phone to ring. If it was Medicare calling, she was instructed by Gozes-Wagner
    to say that “the doctor is not in the office at the moment” and that she’d call
    them back. In sum, Garcia testified that she took direction from Gozes-Wagner
    to help perpetuate what she believed to be a Medicare fraud scheme. A handful
    of other witnesses told stories similar to Garcia’s.
    Three FBI special agents testified. Special Agent Kevin Lammons
    testified, among other things, that he found medical forms in some of the offices
    operated by the Beketav Group that had been signed by a doctor and had
    requested a specific test for a patient even though there were blank spaces on
    the forms where the patient’s name and information were supposed to appear.
    In other words, the forms were “pre-signed” before a patient had ever been
    seen. Special Agent Paul Nixon, who oversaw the execution of the search
    warrant in February 2015 at the office where Gozes-Wagner worked, also
    described finding pre-signed forms by at least half a dozen doctors. One
    particular document suggested it was Gozes-Wagner’s idea to defraud
    Medicare by over-billing for allergy tests, Nixon testified. Finally, Special
    Agent Tiffany Smith testified that she found keys to various offices while
    searching Gozes-Wagner’s desk, suggesting she had an important role in the
    Beketav Group.
    Also testifying for the Government were Monica Roberts and Kathleen
    Anderson. Roberts, a Special Agent with the Department of Health and Human
    Service’s Office of Inspector General, described documents seized from Gozes-
    Wagner’s desk that implicated her in the fraud. Anderson, a forensic
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    accountant with the FBI, traced the illicit profits from the conspiracy to the
    bank accounts of the conspiracy’s main players, including Gozes-Wagner. In
    particular, Anderson’s testimony showed that Gozes-Wagner’s haul increased
    every year from 2010 through 2014, suggesting her value to the conspiracy
    grew with it.
    The Government’s final two witnesses were Dr. Jack McCoy and Donna
    Large. Dr. McCoy, a certified fraud examiner, served as an FBI source in the
    agency’s investigation into the Beketav Group. Dr. McCoy testified that based
    on his experience at one clinic, it was evident that fraud was occurring. Large,
    a registered nurse who investigated the fraud for Medicare, agreed. She
    highlighted all of the red flags apparent from the billing practices employed by
    the Beketav Group. There were many.
    When the Government rested, Gozes-Wagner moved for acquittal. The
    district court denied her request. Gozes-Wagner then put on six witnesses of
    her own: her mother, her roommate, her rabbi, and several other friends of
    hers. Their testimony was materially indistinguishable: Gozes-Wagner had a
    reputation in the community for being honest, trustworthy, and a law-abiding
    citizen. When she rested her case, she again moved for acquittal, and the court
    again denied her request.
    The jury deliberated for about three hours. It found her guilty of both
    conspiracy to commit healthcare fraud and conspiracy to commit money
    laundering.
    C. The Sentencing Hearing
    About a year-and-a-half passed between Gozes-Wagner’s conviction and
    her sentencing hearing. On March 6, 2019, the court began the hearing by
    stating, “All right. We’re here for sentencing in this case. The defendant, she
    was the only defendant to plead not guilty, I believe; is that correct, Counsel?”
    This was the first of several instances in which the district court noted Gozes-
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    Wagner’s decision to go to trial during the hearing. These references lie at the
    core of the constitutional, procedural, and substantive challenges to Gozes-
    Wagner’s sentence.
    The district court then began to discuss Gozes-Wagner’s numerous
    objections to the PSR. After addressing the first three, the following exchange
    occurred between the court and the prosecutor:
    [THE COURT:] Now, my understanding is the other
    defendants pled guilty; is that correct, Counsel?
    MR. CHU [the prosecutor]: Yes, Your Honor.
    THE COURT: They are before another judge, correct?
    MR. CHU: Yes, Your Honor.
    THE COURT: And the cap on that is ten years, right?
    MR. CHU: Yes, Your Honor.[5]
    THE COURT: Even the guidelines might be extremely
    high, even higher than this defendant, correct?
    MR. CHU: Yes, Your Honor.
    THE COURT: They are capped the max because they
    pled to one count. And here there are two counts. By
    the way, I want the record to reflect any defendant has
    an absolute right to plead not guilty in federal or state
    court. It’s an absolute right. It’s not meant as any kind
    of a criticism either to the government or to the
    system.
    This marked the second time that the district court noted Gozes-Wagner’s
    decision to go to trial during the sentencing hearing.
    The court then discussed the many remaining objections, granting some
    and overruling others. Shortly thereafter, the court noted during a discussion
    about Gozes-Wagner’s attempt to cooperate with the Government: “I mean, the
    5 The prosecutor’s response was incorrect. Although Shiforenko’s maximum sentence
    was ten years (120 months), Voronov’s and Brodsky’s maximum sentences were five years
    (60 months).
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    government didn’t file a downward departure because she — you know, your
    client pled not guilty, which was her absolute right.” This was the third time
    the court referenced Gozes-Wagner’s decision to go to trial.
    Just before the court allowed Gozes-Wagner’s counsel to begin arguing
    for a below-Guidelines sentence, the court commented on the dozens of
    character letters it received on behalf of the defendant. The court stated:
    THE COURT: I have read all of this. I will say, as far
    as the letters go, they were correctly drafted, every
    single one. I read 81 of them.[6] All of them just went
    to your client’s background, not that she was actually
    not guilty or didn’t mean to do it or whatever. And
    that’s unusual. I mean, they were carefully crafted. I
    don’t mean that as a negative. I mean that as a
    positive. I read them all.
    Finally, the hearing proceeded to arguments. Gozes-Wagner’s counsel
    began by recognizing that Gozes-Wagner faced a possible sentence that was
    “humbling, if not outright frightening.” The court responded by accurately
    describing the Guidelines range and commenting that it was “a high-end case.”
    A little while later, Gozes-Wagner’s counsel argued that his client was “not a
    bad human being” and that he “really believe[d]” that she was “not somebody
    we should be afraid of.” To this, the court responded: “What about the havoc,
    the havoc that is wreaked by operations like this on our healthcare system, on
    Medicare, and Medicaid . . . .”
    After discussing a few more issues, Gozes-Wagner’s counsel moved on to
    his “sentencing disparity” argument. This led to the following exchange:
    MR. DUPONT [Gozes-Wagner’s trial counsel]: I
    supplied the Court with [the co-conspirators’]
    sentencing situations. Mr. Shiforenko is facing a ten-
    6  Gozes-Wagner’s counsel later noted that eighty-seven, not eighty-one, letters were
    filed on her behalf. The court responded: “Well, I’m just saying I read them all.”
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    year cap, and the Court acknowledged that. But Mr.
    Brodsky and Mr. Voronov are facing five-year caps.
    THE COURT: That’s what they pled to, right? They
    pled guilty, correct?
    MR. DUPONT: Well, with help from the government.
    THE COURT: I’m just saying they pled guilty. That
    was their option. Once again, all I want to do is try
    cases. So I’m not saying anyone has waxed the right to
    a jury trial because I’ll give them a jury trial. But that
    was their option. They pled guilty, and they accepted
    because their guidelines may be higher than this,
    which the guidelines in this case is up to 30 years with
    no parole. So, yeah. So they must have pled, what, to
    two five-year counts and another one to a ten-year
    count.
    MR. DUPONT: One pled to a new complaint, and the
    other pled to a plea agreement.
    THE COURT: Well, we are not — I’m not the charging
    authority.
    MR. DUPONT: I understand. I say that to say, Your
    Honor, sentencing disparity is going to be one of the
    main themes I’m coming to Your Honor with today.
    THE COURT: Well, with sentencing disparities —
    because I hear this a lot. Sentencing disparities, that
    basically means everybody on the same footing,
    correct, and it doesn’t take into account, I don’t believe,
    guilty pleas with a plea agreement with the
    government.
    This was the fourth time the district court referenced Gozes-Wagner’s decision
    to go to trial compared to her co-conspirators’ decisions to plead guilty. But it
    was the first time the court made such a reference when directly responding to
    the sentencing disparity argument raised by Gozes-Wagner’s counsel.
    Shortly thereafter, when Gozes-Wagner’s counsel referred to her as a
    “marginal participant[]” in the conspiracy, the court interrupted and stated:
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    “But she didn’t get a marginal role.” After a short back-and-forth, Gozes-
    Wagner’s counsel continued:
    MR. DUPONT: Okay, Your Honor. I say that to say if
    we’re going to put it up on a chalkboard to understand
    it, Shiforenko, who gained $1.19 million, is looking at
    ten years. Voronov, who got $973,000, is looking at five
    years. Brodsky, $1.4 million, he is looking at five years.
    And it’s undisputed the evidence that was introduced
    before you in trial, Your Honor, she made $385,000
    over five years. If we break that down to averages,
    Your Honor, that means about $5,000 a month, $1,300
    a week, and maybe $32 an hour.
    THE COURT: But again, bottom line, Counsel, she
    exercised the constitutional rights that she has in the
    United States to plead not guilty.
    This marked the fifth and final time the district court referenced Gozes-
    Wagner’s decision to go to trial during the sentencing hearing.
    After a discussion about the proper amount of restitution, Gozes-
    Wagner’s counsel argued that there were “legitimate personal reasons and
    reasons about this young lady’s life” that warranted a downward variance. The
    court identified the “reasons” as “children’s concerns and health concerns.”
    The “children’s concerns” were a reference to the fact that Gozes-Wagner
    was, prior to her arrest, the primary caretaker of her two minor children, a son
    and a daughter. At the time of her sentencing, her son was a teenager, and her
    daughter was eleven years old. The “health concerns” were, among other
    things: vitiligo, described in the record as “a long-term skin condition
    characterized by patches of skin losing its pigment;” a lymph node cyst; the
    fact that she only had one kidney “due to a genetic condition that
    simultaneously affects her heart and joints (similar to Marfan’s syndrome);”
    hypothyroidism; a Vitamin D deficiency; and poor eyesight.
    After Gozes-Wagner’s counsel read aloud to the court a letter written by
    her daughter, he asked that she be sentenced to time served. In the alternative,
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    he asked for a sentence between thirty-one and forty-four months. Finally, if
    those two options were rejected, he requested that she be sentenced to sixty
    months, in line with the statutory maximums faced by Voronov and Brodsky.
    When it came time for the prosecutor to speak, he described how health
    care fraud is “sucking away money from the people that need it.” He also noted
    that it was misleading to compare Gozes-Wagner to Brodsky because his
    participation in the conspiracy ended in 2012, whereas hers continued until
    her arrest in 2015. The prosecutor did not mention Shiforenko or Voronov. He
    concluded by asking for the 240-month sentence that was erroneously
    described as the “sentencing maximum.”
    Having heard arguments from counsel, the court proceeded to pronounce
    its sentence.
    THE COURT: I do want to state that I have read this
    entire file and that right now the defendant could be
    facing up to 360 months. There is no parole in federal
    court. Parole was done away with at the — in 1987.
    We don’t even have a parole commission. So nobody
    gets out on parole. The most they can get is 54 days a
    year good time after the first year.
    I will say this, whether I agree with the
    defendant or not, I’m going to read from my own notes.
    I don’t lean off what the government says. I don’t lean
    off what the government says or the defense says. But
    if I read, I’m reading from the notes I have, and it
    sounds — if it sounds somewhat familiar to either one,
    I can assure everybody here I’m not leaning, taking the
    government’s word for it or the defendant’s word for it.
    It is what I thought on my own.
    Under the guidelines — and a judge needs to
    stay within the guidelines, unless under a Supreme
    Court decision, which came out about eight years ago
    called the Booker case, the Judge has some flexibility
    to either issue an upward or downward departure or,
    what is it, an upward or downward variance on the
    judge’s his or her own volition, giving some reasons.
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    But the guidelines is generally where it’s holding right
    now at 324 to 360 months under the guidelines.
    I do want to state some notes that I have here. I
    think most of them I have covered. Again, I have read
    the full study from Rabbi Bryski. I have read letters
    from Rabbi Blacher, the Executive Director of the
    Chabad at The Woodlands; and Rabbi Fygenson the —
    no. One is — hold it a second. I want to get this
    straight because I appreciate all this coming in. And I
    know right where to go to the letters. Right. Rabbi
    Fygenson is a director of Chabad at Sugar Land. So I
    appreciate everybody taking the time to be here.
    And you can remain — everybody can remain
    seated at this point.
    After considering the factors under 18 United
    States Code Section 3553(a), I will issue a variance in
    this case, which I believe serves the underlying
    requirements of the factors of this particular statute.
    It is the order of the Court that the defendant is
    hereby committed to the custody of the Bureau of the
    Prisons — and this is how I had it broken down in my
    notes — for a term of 120 months as to Count 1S [the
    conspiracy to commit health fraud count]. And instead
    of 204 months, 120 months as to Count 2S [the
    conspiracy to commit money laundering count] to run
    consecutively, one after the other, for a total of 240
    months.
    After pronouncing the restitution order, the court asked Gozes-Wagner’s
    counsel if he had anything else to add. He stated: “We object to the sentence
    just to preserve the objection.”
    Gozes-Wagner’s sentence is by far the lengthiest among her co-
    conspirators. Shiforenko was sentenced to 72 months (six years). Voronov was
    sentenced to the statutory maximum 60 months (five years). And Brodsky has
    not been sentenced yet. But given that he faces a 60-month statutory cap, his
    sentence will be significantly shorter than Gozes-Wagner’s.
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    II. Discussion
    Gozes-Wagner’s primary argument on appeal is that the district court
    violated her constitutional rights by improperly sentencing her more severely
    than her “more culpable” co-conspirators simply because she exercised her
    right to go to trial and they did not. She contends that this amounted to an
    unconstitutional “trial penalty.” Gozes-Wagner also argues that her sentence
    is infected with procedural and substantive error. For these reasons, she asks
    us to vacate her sentence and remand her case for re-sentencing before a
    different judge. Gozes-Wagner also challenges several aspects of the order of
    restitution. We address each argument in turn.
    A. Trial Penalty
    The Sixth Amendment gives criminal defendants “the right to a speedy
    and public trial.” U.S. CONST. amend. VI. And the Supreme Court has stated
    that “[t]o punish a person because he has done what the law plainly allows him
    to do is a due process violation of the most basic sort.” Bordenkircher v. Hayes,
    
    434 U.S. 357
    , 363 (1978). Thus, “a defendant cannot be punished by a more
    severe sentence because he unsuccessfully exercises his constitutional right to
    stand trial.” United States v. Devine, 
    934 F.2d 1325
    , 1338 (5th Cir. 1991). 7
    7  We pause here to note that the Government asks us to review this claim for plain
    error, while Gozes-Wagner insists that de novo review should apply. A panel of this court in
    an unpublished opinion applied plain error review to a claim similar to Gozes-Wagner’s that
    was not raised before the district court. United States v. Guy, 633 F. App’x 851, 855 (5th Cir.
    2015) (per curiam). Here, even though Gozes-Wagner’s counsel did not use the “trial penalty”
    phrase at the sentencing hearing, nor did he expressly frame his argument in constitutional
    terms, he did zealously argue that it was unfair to sentence Gozes-Wagner more harshly than
    her pleading co-conspirators even though they pled guilty and she went to trial. Arguably,
    defense counsel’s complaint about Gozes-Wagner’s sentence was sufficient to trigger the more
    lenient review standard applicable to preserved errors. In any event, we need not decide this
    issue, because Gozes-Wagner’s claim fails even under de novo review.
    15
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    No. 19-20157
    These broad principles guide our inquiry. And yet, in this particular case,
    we have little guidance from either the Supreme Court or prior panels of this
    court. The Supreme Court has never addressed a “trial penalty” claim like
    Gozes-Wagner’s. But cf. Alabama v. Smith, 
    490 U.S. 794
    , 795 (1989)
    (considering whether a “presumption of vindictiveness” applies when a
    defendant receives one sentence after pleading guilty and then a harsher
    sentence following a trial that arose after the guilty plea was vacated on
    appeal); 
    Bordenkircher, 434 U.S. at 358
    (“The question . . . is whether the Due
    Process Clause . . . is violated when a state prosecutor carries out a threat made
    during plea negotiations to reindict the accused on more serious charges if he
    does not plead guilty to the offense with which he was originally charged.”);
    North Carolina v. Pearce, 
    395 U.S. 711
    , 713 (1969) (“When at the behest of the
    defendant a criminal conviction has been set aside and a new trial ordered, to
    what extent does the Constitution limit the imposition of a harsher sentence
    after conviction upon retrial?”), overruled in part by 
    Smith, 490 U.S. at 795
    .
    In fact, the phrase “trial penalty” has never been used by either the
    Supreme Court or this court to describe a claim like Gozes-Wagner’s. It is
    unsurprising, then, that most of the in-circuit caselaw cited by her for support
    is not directly on point. E.g., Thomas v. United States, 
    368 F.2d 941
    , 942 (5th
    Cir. 1966) (vacating sentence where district court sentenced the defendant to
    “the maximum term permitted by law” after the defendant chose to go to trial
    after being advised by the court that it had “no doubt whatsoever as to his
    guilt” and “if he persisted in his denial that he participated in the crime, the
    court would . . . take that into account” at sentencing); United States v. Rogers,
    
    504 F.2d 1079
    , 1085 (5th Cir. 1974) (vacating sentence where the district court
    told the defendant, who had been convicted as part of a marijuana conspiracy,
    that it “would not consider a lesser sentence” until he cooperated with the
    Government to bring “others involved in the conspiracy to justice.”).
    16
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    The Government, meanwhile, points us to in-circuit precedents directing
    us not to compare Gozes-Wagner with her cooperating co-conspirators when
    assessing her trial penalty claim. United States v. Johnson, 
    679 F.2d 54
    (5th
    Cir. 1982) (“The government is permitted to encourage guilty pleas by offering
    substantial benefits to a defendant, and Johnson, having rejected the offer of a
    plea bargain, cannot complain that his codefendants received the benefit of a
    lighter sentence.”); United States v. Devine, 
    934 F.2d 1325
    (5th Cir. 1991)
    (refusing to compare the defendants’ sentences to their co-conspirators who
    pleaded guilty and cooperated with the Government because the cooperators’
    “sentences [were] obviously the result of leniency and are not relevant to the
    present constitutional inquiry.”); United States v. Guy, 633 F. App’x 851, 855
    (5th Cir. 2015) (per curiam) (unpublished) (rejecting a due process challenge to
    a sentence imposed that was harsher than those imposed on the defendant’s
    co-conspirators because they “received leniency from the government based on
    their agreement to cooperate”).
    Thus, to the extent Gozes-Wagner’s claim depends on a comparison with
    her co-conspirators, only Voronov is relevant, because he did not cooperate, he
    pled guilty, and he received a sentence substantially lower than Gozes-Wagner
    even though his participation in the conspiracy was similar to hers. 8
    Given the scarcity of Fifth Circuit cases germane to Gozes-Wagner’s
    claim, she understandably seeks support from our sister circuits. See United
    States v. Mazzaferro, 
    865 F.2d 450
    (1st Cir. 1989); Government of the Virgin
    Islands v. Walker, 
    261 F.3d 370
    (3d Cir. 2001); United States v. Hernandez, 
    894 F.3d 1104
    (9th Cir. 2018). But these decisions are readily distinguishable.
    8 Like Gozes-Wagner, Voronov helped oversee the fraudulent scheme by assisting with
    the operation of testing facilities. He recruited doctors and other medical professionals to
    further the conspiracy. He supervised “seat warmers.” He helped hide the fraudulent nature
    of the scheme through the use of numerous bank accounts. The record shows that Gozes-
    Wagner “took over” for Voronov when he left the conspiracy in 2014.
    17
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    No. 19-20157
    Walker involved a district court that improperly inserted itself into the plea
    negotiation process by refusing to accept guilty pleas from both Walker and his
    co-defendant, sentencing Walker to the statutory maximum after he was
    convicted at 
    trial. 261 F.3d at 374
    –76. And in Hernandez, unlike here, the
    Ninth Circuit emphasized that the district court’s comments about the
    defendant’s decision to go to trial “comprised virtually the entirety of the
    explanation for the 
    sentence.” 894 F.3d at 1111
    . “Indeed, the court did not
    reference any particular ‘facts of this case’ or ‘particular record’ beyond
    Hernandez’s exercise of his constitutional rights.”
    Id. (emphasis added). Finally,
    Mazzaferro involved three defendants all charged with the same
    offense. Here, however, Gozes-Wagner and Voronov were ultimately charged
    with different crimes that carried different statutory maximum sentences.
    Although they may have participated similarly in the conspiracy, our job is not
    to look at their two sentences and decide whether we think Voronov and Gozes-
    Wagner should have been punished more equally based on their conduct. 9
    Instead, our duty is to determine whether the district court sentenced Gozes-
    Wagner more harshly than it otherwise would have because she went to trial
    instead of pleading guilty. And on this record, we cannot say that it did. 10
    9  In fact, we question whether it is appropriate on appellate review to weigh, as Gozes-
    Wagner requests, the ultimate sentences of each defendant when, at the time of sentencing,
    the district court only had the guilty pleas—not the ultimate sentences received by the
    others—to consider. Because our decision does not turn on the ultimate sentences received
    by each defendant but instead on the facts presented before the district court at the time of
    sentencing, we need not decide whether, in comparing co-defendants in a trial penalty claim,
    it is improper to consider sentencing outcomes that the district court did not have the benefit
    of considering.
    10 To the extent the scope of co-defendants participation in criminal activity is relevant
    to determining whether the district court improperly punished a defendant for going to trial,
    Mazzaferro is further distinguishable on the ground that the defendant there received a
    “sentence twice as long as that of” his co-defendant even though the defendant “had a much
    more limited role in the drug operation.” 
    865 F.2d 450
    , 457–58. Yet, as discussed, the record
    indicates Gozes-Wagner and Voronov’s participation in the fraudulent scheme was similar.
    18
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    No. 19-20157
    We cannot compare apples to oranges when deciding whether a sentence
    is “more severe” for trial penalty purposes. Nevertheless, a comparison of any
    kind is not strictly necessary to make out a trial penalty claim. For example, if
    the district court plainly stated that it was punishing the defendant more
    severely than it otherwise would because she went to trial, that would clearly
    amount to a constitutional violation even absent a comparison to others
    similarly situated to the defendant. See 
    Thomas, 368 F.2d at 942
    . But that did
    not happen here.
    We recognize that most—if not all—cases will not be so cut-and-dried,
    and that a defendant’s constitutional rights may be violated even absent such
    an explicit statement. In those cases, it is the comparison to others that
    necessarily sheds light on whether a constitutional violation occurred. If the
    only meaningful difference between defendants was that one went to trial and
    the others did not, and the trial-standing defendant received a much more
    severe sentence than the pleading defendants, it could very well be the case
    that vacatur of the sentence will be required on trial penalty grounds. But a
    defendant who cooperates with the Government is not similarly situated to one
    who refuses to do so. 
    Devine, 934 F.2d at 1338
    –39. Nor are defendants similarly
    situated when they are convicted under different statutes that carry different
    maximum sentences. If the case were otherwise, we would be holding that the
    Constitution mandates that defendants convicted of committing different
    crimes be sentenced similarly if the conduct underling those convictions is
    similar. We see no such mandate in the Constitution or in the Due Process
    caselaw addressing claims like Gozes-Wagner’s.
    We are aware that the district court judge in this case presided over a
    four-day jury trial before sentencing the defendant. This gave the court a full
    appreciation of Gozes-Wagner and the conduct that led to her conviction. See
    
    Alabama, 490 U.S. at 801
    (“[I]n the course of the proof at trial the judge may
    19
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    gather a fuller appreciation of the nature and extent of the crimes charged. The
    defendant’s conduct during trial may give the judge insights into his moral
    character and suitability for rehabilitation.”). We recognize that this very
    fact—that the district court presided over the defendant’s trial—also serves as
    the primary ammunition for Gozes-Wagner’s claim. But we cannot help but
    observe the tension created by the fact that the court here was much more
    informed than most sentencing courts, which usually lack the benefit of a full-
    fledged trial before sentencing. See Lafler v. Cooper, 
    566 U.S. 156
    , 170 (2012)
    (“[C]riminal justice today is for the most part a system of pleas, not a system
    of trials.”). We do not mean to suggest that a trial penalty claim is never
    tenable because the district court was highly informed at sentencing. Instead,
    we simply note the challenge both for defendants presenting such claims and
    for reviewing courts analyzing them. In the end, on this record, Gozes-Wagner
    has failed to show that the district court imposed an unconstitutional trial
    penalty on her at sentencing. 11
    B. Procedural Unreasonableness
    “In assessing reasonableness [of a sentence] on appeal, the court first
    must find no significant procedural error by the district court.” United States
    v. Lavalais, No. 19-30161, 
    2020 WL 2609858
    , at *5 (5th Cir. May 22, 2020). “If
    there is no procedural error, the court may then review the substantive
    reasonableness of the sentence.”
    Id. We therefore address
    Gozes-Wagner’s
    procedural arguments before turning to her substantive argument.
    11This conclusion is reinforced by the context in which the district court juxtaposed
    Gozes-Wagner’s decision to go to trial with her co-conspirators’ decisions to plead guilty.
    Although the district court referenced that decision several times during the sentencing
    hearing, the court did so prior to imposing its sentence. We infer that the district court’s
    remarks regarding Gozes-Wagner’s decision not to accept a plea were designed to explain
    why someone in her position could receive a heavier sentence, not that she should receive a
    lengthier sentence for exercising her right to a trial.
    20
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    Gozes-Wagner’s position is that the district court made three procedural
    errors when sentencing her: first, it misunderstood the discretionary nature of
    the Guidelines and improperly treated them as presumptively reasonable;
    second, it improperly failed to respond to her sentencing disparity argument
    with anything other than comments about her decision to go to trial compared
    to her co-conspirators’ decisions to plead guilty; and third, it erred when it did
    not explain its decision to run her sentences consecutively. We address each
    argument separately.
    1. Discretionary Nature of the Guidelines
    Just before the district court pronounced Gozes-Wagner’s sentence, it
    made the following comment:
    Under the guidelines — and a judge needs to stay
    within the guidelines, unless under a Supreme Court
    decision, which came out about eight years ago called
    the Booker case, the Judge has some flexibility to
    either issue an upward or downward departure or,
    what is it, an upward or downward variance on the
    judge’s his or her own volition, giving some reasons.
    But the guidelines is generally where it’s holding right
    now at 324 to 360 months under the guidelines.
    Focusing on the “a judge needs to stay within the guidelines” language, Gozes-
    Wagner contends that the district court procedurally erred by failing to fully
    appreciate the discretionary nature of the Guidelines. Even though the court
    ultimately granted her a downward variance, Gozes-Wagner argues that her
    sentence was so affected by a presumption that her Guidelines range was
    reasonable that her sentence must be vacated.
    The parties dispute the standard of review. Gozes-Wagner argues that
    she preserved the error, so abuse of discretion review should apply. See Gall v.
    United States, 
    552 U.S. 38
    , 51 (2007) (explaining that preserved procedural
    errors, e.g., “treating the Guidelines as mandatory,” should be reviewed “under
    an abuse-of-discretion standard”). The Government responds that plain error
    21
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    review should apply because Gozes-Wagner failed to raise this precise objection
    after the district court made the comment about “need[ing]“ to stay within the
    Guidelines.
    Federal Rule of Criminal Procedure 51(b) provides: “A party may
    preserve a claim of error by informing the court—when the court ruling or
    order is made or sought—of the action the party wishes the court to take, or
    the party’s objection to the court’s action and the grounds for that objection.”
    FED R. CRIM. P. 51(b) (emphasis added). In arguing for a downward variance
    in her pre-sentencing memorandum, Gozes-Wagner noted:
    In United States v. Booker, 
    543 U.S. 220
    (2005), the
    Supreme Court declared that the federal guidelines
    should be advisory, and excised the limitations
    contained in 18 U.S.C. § 
    3553(b). 543 U.S. at 245
    , 259–
    60. The sentencing court’s discretion is now
    significantly broadened and the court must make an
    individualized assessment of the facts of each case.
    Gall v. United States, 
    552 U.S. 38
    , 46 (2007).
    At the sentencing hearing, and before the court pronounced its sentence,
    Gozes-Wagner’s counsel reminded the court that there were “legal mechanisms
    via departures or variances” that the court could use to sentence Gozes-Wagner
    well below her Guidelines range. In our view, these actions were sufficient to
    preserve this error for appeal. Accordingly, we review for abuse of discretion.
    A district court commits procedural error when it fails to recognize its
    discretion to vary from the Guidelines. United States v. Clay, 
    787 F.3d 328
    , 332
    (5th Cir. 2015). As the Supreme Court has explained, “[t]he Guidelines are not
    only not mandatory on sentencing courts; they are also not to be presumed
    reasonable.” Nelson v. United States, 
    555 U.S. 350
    , 352 (2009) (per curiam).
    The district court’s comments during the sentencing hearing reflect that
    it has a healthy respect for the Guidelines. As it should. Under
    18 U.S.C. § 3553(a)(4), district courts are bound to consider a defendant’s
    22
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    No. 19-20157
    applicable Guidelines range when determining a defendant’s sentence. See
    Pepper v. United States, 
    562 U.S. 476
    , 490 (2011) (“[A] sentencing court must
    ‘give respectful consideration to the Guidelines[.]’”) (quoting Kimbrough v.
    United States, 
    552 U.S. 85
    , 101 (2007)). Failure to do so may constitute both
    procedural and substantive error.
    There is obvious tension between statutory law requiring district courts
    to consider applicable Guidelines ranges and caselaw prohibiting the same
    judges from presuming such ranges to be reasonable. But caselaw helps
    illuminate the window of acceptable conduct that involves considering the
    applicable Guidelines range but refusing to presume that it is reasonable for a
    particular defendant.
    For example, in Nelson, the district court expressly stated that “the
    Guidelines are considered presumptively reasonable,” so “unless there’s a good
    reason in the [statutory sentencing] factors . . . , the Guideline sentence is the
    reasonable 
    sentence.” 555 U.S. at 350
    –51 (internal quotation marks omitted).
    The Court held that this was procedural error.
    Id. at 352.
    It thus vacated the
    district court’s “bottom of the range” sentence.
    Id. at 350, 352.
    Similarly, the
    Seventh Circuit vacated a within-Guidelines sentence even where the district
    court “obviously knew that the Guidelines [were] advisory” because the court
    noted that the defendant’s attorney “had to deal with the statutory scheme that
    is presumptively reasonable. . . . So, that is where we start; and, in this case,
    that is where we end.” United States v. Panice, 
    598 F.3d 426
    , 441 (7th Cir.
    2010). The district court in Panice also expressed discomfort in sentencing the
    defendant within the Guidelines, saying “I guess I just keep talking because I
    do not want to get to where I have to go here, but I have to go there. I have to.”
    Id. Taken together, the
    Seventh Circuit held that these comments, among
    others, left “too much doubt about whether the judge impermissibly” presumed
    the Guidelines range to be reasonable.
    Id. at 444.
    Other circuits have reached
    23
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    the same result when considering equally problematic comments by district
    courts at sentencing. United States v. Marrero, 313 F. App’x 557, 558–59 (3d
    Cir. 2009) (unpublished) (vacating within-Guidelines sentence when court
    stated, among other things, “I take no pleasure, but I am going to follow the
    guideline range here”); United States v. Raby, 
    575 F.3d 376
    , 378 (4th Cir. 2009)
    (vacating a within-Guidelines sentence when the district court stated, among
    other things, that it understood a precedential opinion to hold that “the
    guidelines [were] presumptively correct” and that it seemed to think it was
    required to “completely ignore . . . the advisory nature of the guidelines”).
    The district court’s statement here that “a judge needs to stay within the
    guidelines” comes close to creating ambiguity about whether the district court
    presumed the Guidelines range to be reasonable. But in context, the record
    shows that the district court neither failed to appreciate the discretionary
    nature of the Guidelines nor improperly presumed them to be reasonable. 12
    For starters, the court ultimately varied downward seven years from the
    bottom of Gozes-Wagner’s Guidelines range. It also cited Booker immediately
    after making the comment-in-question. As stated by the Seventh Circuit in
    Panice, the district court “obviously knew that the Guidelines are advisory.”
    
    See 598 F.3d at 441
    . Unlike in Panice, however, the record here shows that the
    court did not improperly presume the Guidelines range to be reasonable.
    Two points during the sentencing hearing warrant emphasis. First,
    when Gozes-Wagner’s counsel described her Guidelines range as “humbling, if
    not outright frightening,” the court responded:
    Well, we know there are federal sentencing guidelines.
    The guidelines itself, the guidelines in this case start
    12 We emphasize that although a district court’s comments at sentencing are an
    important factor of our review, we must consider them in the context of the entire hearing.
    One stray comment does not create error when it can be understood in the context of a lengthy
    sentencing hearing.
    24
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    — start at 324 months. All right. 324 months. That’s
    27 years in the federal penitentiary with no parole, up
    to a maximum of 360 months, which is 30 years in the
    penitentiary with no parole. That’s the guidelines
    themselves. So, yeah, it’s a high-end case.
    We think these comments reflect the district court’s opinion that Gozes-
    Wagner’s applicable Guidelines range was not reasonable but instead was
    unreasonably long. Second, even more reflective of the court’s belief about the
    Guidelines range was its response to the Government’s request that Gozes-
    Wagner be sentenced at the low end of the range. It was then that the court
    responded: “Low end of the guidelines? What? 324 months? That’s 27 years.”
    Of course, perhaps nothing is more probative of the district court’s
    thoughts on the Guidelines range than its decision to impose a significant
    downward variance. Considering the ultimate sentence imposed and the
    aforementioned comments by the court, we are convinced that the court did not
    improperly presume the Guidelines range to be reasonable. Thus, the district
    court did not abuse its discretion. 13
    2. Responsiveness to Sentencing Disparity Argument
    Gozes-Wagner next argues that the district court procedurally erred by
    responding to her sentencing disparity arguments with nothing more than
    references to the fact that she went to trial and her co-conspirators pled guilty.
    Because she preserved this error, we review for abuse of discretion. 14
    13   We note that even if the district court’s “needs to stay within the guidelines”
    comment was sufficient to constitute procedural error, we believe the comment was harmless
    in light of the significant downward variance it ultimately imposed. There is no indication
    that the court’s comment affected the below-Guidelines sentence it ultimately rendered. See
    
    Clay, 787 F.3d at 332
    (noting that “the court may affirm the sentence in spite of a procedural
    error if that error is harmless” and that “[t]he proponent of the sentence has the burden of
    establishing that the error was harmless.”) (quoting United States v. Robinson, 
    741 F.3d 588
    ,
    601 (5th Cir. 2014)).
    14 Again, the Government argues that Gozes-Wagner failed to preserve this error. We
    disagree. Her counsel focused on this issue to the exclusion of most others at the sentencing
    25
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    At sentencing, the district court must “state in open court the reasons for
    its imposition of the particular sentence.” 18 U.S.C. § 3553(c). When the
    sentence imposed falls outside of the applicable Guidelines range, the court
    must go further, stating “the specific reason” for imposition of a non-Guidelines
    sentence.
    Id. § (c)(2). Additionally,
    when fashioning a defendant’s sentence, the
    court must consider certain enumerated factors.
    Id. § 3553(a). Among
    them is
    “the need to avoid unwarranted sentence disparities among defendants with
    similar records who have been found guilty of similar conduct.”
    Id. § 3553(a)(6). In
    United States v. Mondragon-Santiago, this court held that the district
    court procedurally erred when it “did not give any reasons for its sentence
    beyond a bare recitation of the Guideline’s calculation. This despite the fact
    that Mondragon-Santiago raised arguments before the district court
    concerning his family, his work history, and his prior convictions, all of which
    are relevant considerations under § 3553(a).” 
    564 F.3d 357
    , 363 (5th Cir. 2009).
    Of particular concern was the district court’s failure to even “mention” the
    defendant’s § 3553(a) arguments.
    Id. Gozes-Wagner argues that
    the district court here erred in the same
    respect as the district court in Mondragon-Santiago. We disagree. The record
    shows that the court entertained and responded to Gozes-Wagner’s sentencing
    disparity arguments at the sentencing hearing. In particular, when told by
    Gozes-Wagner’s counsel that “sentencing disparity is going to be one of the
    main themes I’m coming to Your Honor with today,” the court responded:
    “Well, with sentencing disparities — because I hear this a lot. Sentencing
    disparities, that basically means everybody on the same footing, correct, and it
    hearing. Gozes-Wagner did not need to request an explanation for the sentencing disparity
    after her sentence had been pronounced to preserve this error. It was enough that she
    informed the court of the action she wished it to take and it rejected her invitation. See FED.
    R. CRIM. P. 51(b).
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    doesn’t take into account, I don’t believe, guilty pleas with a plea agreement
    with the government.” This was after the court had already determined that
    Gozes-Wagner was not on the same footing as her co-conspirators. Earlier in
    the hearing, the court emphasized that Gozes-Wagner was convicted on two
    counts carrying a maximum combined sentence of thirty years, while none of
    her co-conspirators were convicted of more than one count, and none faced a
    maximum sentence higher than ten years. The court also highlighted the fact
    that some of the co-conspirators—namely, Shiforenko and Brodsky—
    cooperated with the Government, while Gozes-Wagner did not. This was yet
    another reason that she was not on the same footing as them for sentencing
    disparity purposes. United States v. Cisneros-Gutierrez, 
    517 F.3d 751
    , 767 (5th
    Cir. 2008) (holding that a district court did not abuse its discretion in
    considering a sentencing disparity argument even though the appellant’s co-
    defendant was “more deeply involved in the conspiracy” and “received a
    sentence ten years less than his” because the co-defendant “pled guilty,
    provided information to law enforcement authorities, and did not flee before
    trial,” making the two not “similarly situated”); United States v. Ivory, 783 F.
    App’x 325, 330 (5th Cir. 2019) (per curiam) (unpublished) (holding that “the
    court did not abuse its discretion by failing to consider disparities in the
    sentences of similarly-situated offenders” because the defendant did not
    demonstrate that “he and his co-conspirator were similarly situated”).
    For these reasons, this case also is distinguishable from the out-of-circuit
    authority relied on by Gozes-Wagner. See United States v. Robles-Alvarez, 
    874 F.3d 46
    , 52 (1st Cir. 2017) (“The court ultimately sentenced the appellant to
    life imprisonment without so much as mentioning the disparity issue.”); United
    States v. Wallace, 
    597 F.3d 794
    , 802 (6th Cir. 2010) (“Nowhere in the
    sentencing hearing did the district judge discuss why sentencing Wallace to
    twice as long as White-Baber was appropriate.”); United States v. Smith, 541
    27
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    F. App’x 306, 308 (4th Cir. 2013) (per curiam) (unpublished) (holding that
    district court’s explanation for its sentence resulted in procedural error where
    the court “provided only a brief response to Smith’s argument that his limited
    criminal history warranted a downward variance sentence, and it did not
    specifically address Smith’s assertion that his criminal history score was
    exaggerated”).
    As the Supreme Court has said, “it is perfectly clear that the District
    Judge considered the need to avoid unwarranted disparities, but also
    considered the need to avoid unwarranted similarities among other co-
    conspirators who were not similarly situated.” 
    Gall, 552 U.S. at 55
    . The district
    court therefore did not abuse its discretion.
    3. Lack of Explanation for Consecutively Run Sentences
    When the district court pronounced Gozes-Wagner’s sentence, it did not
    explain its decision to run the two 120-month (10-year) sentences, one for each
    count of conviction, consecutively, for a total of 240 months (20 years) in prison.
    In fact, it did not provide any reason for the sentence after it was pronounced.
    Gozes-Wagner argues that this was procedural error. Because she did not raise
    this argument below, we review for plain error. FED. R. CRIM. P. 52 (b) (“A plain
    error that affects substantial rights may be considered even though it was not
    brought to the court's attention.”); Molina-Martinez v. United States, 
    136 S. Ct. 1338
    , 1344, 1346–47 (2016) (applying plain error review to an unpreserved
    procedural sentencing argument). To succeed on plain error review, Gozes-
    Wagner must show: (1) error occurred; (2) it was plain, i.e., clear or obvious; (3)
    the error affected her substantial rights, i.e., she must show a reasonable
    probability that but for the error her sentence would have been different; and
    (4) that this court should exercise its discretion to correct the forfeited error
    because it seriously affected the fairness, integrity, or public reputation of the
    proceedings. United States v. Randall, 
    924 F.3d 790
    , 795–96 (5th Cir. 2019).
    28
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    The Supreme Court has held that district courts should “adequately
    explain the chosen sentence to allow for meaningful appellate review and to
    promote the perception of fair sentencing.” 
    Gall, 552 U.S. at 50
    . This helps
    ensure compliance with 18 U.S.C. § 3553(c), which requires district courts to
    state in open court the reasons for imposing particular sentences. But neither
    the Supreme Court nor this court has ever held that a district court’s failure to
    explain its rationale for imposing consecutive sentences constitutes procedural
    error. 15 Assuming, without deciding, that the district court did plainly err in
    failing to explain why it chose to sentence Gozes-Wagner to two consecutive
    sentences, such an error would not warrant vacatur of Gozes-Wagner’s
    sentence. This is because she has failed to show “a reasonable probability that
    but for the error her sentence would have been different.” See 
    Randall, 924 F.3d at 796
    . The district court sentenced Gozes-Wagner to a total of 240
    months in prison. It got there by sentencing her to 120 months on both the
    conspiracy to commit health care fraud and the conspiracy to commit money
    laundering counts. The conspiracy to commit money laundering conviction
    carried the higher statutory maximum—240 months (20 years)—as opposed to
    120 months (10 years) for the conspiracy to commit health care fraud
    conviction.
    Under U.S.S.G. § 5G1.2(d), “[i]f the sentence imposed on the count
    carrying the highest statutory maximum is less than the total punishment,
    then the sentence imposed on one or more of the other counts shall run
    consecutively, but only to the extent necessary to produce a combined sentence
    15Several of our sister circuits have, however. See, e.g., United States v. Cochrane, 
    702 F.3d 334
    , 346 (6th Cir. 2012) (“When deciding to impose consecutive sentences, . . . a district
    court must indicate on the record its rationale, either expressly or by reference to a discussion
    of relevant considerations contained elsewhere. Otherwise, meaningful appellate review
    becomes impossible.”); United States v. Conkins, 
    9 F.3d 1377
    , 1385 (9th Cir. 1993) (same);
    United States v. Rose, 
    185 F.3d 1108
    , 1112 (10th Cir. 1999) (same).
    29
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    equal to the total punishment.” The PSR, which was adopted by the court at
    the sentencing hearing except to the extent it explicitly granted Gozes-
    Wagner’s objections to it, noted this instruction. Thus, when the court chose to
    sentence Gozes-Wagner to 240 months total, but only 120 months on the count
    carrying the highest statutory maximum, the Guidelines directed it to impose
    the two sentences consecutively. Gozes-Wagner therefore has failed to show a
    reasonable probability that an explanation by the district court for running the
    sentences consecutively would have changed her total punishment. For that
    reason, she cannot overcome plain error review on this claim of error.
    C. Substantive Unreasonableness
    Finding no reversible procedural error, we turn now to Gozes-Wagner’s
    argument that her 240-month sentence is substantively unreasonable. “We
    review the substantive reasonableness of the sentence under an abuse-of-
    discretion standard.” United States v. Simpson, 
    796 F.3d 548
    , 557 (5th Cir.
    2015). Our review is “highly deferential” to the sentencing judge.
    Id. (quoting United States
    v. Campos–Maldonado, 
    531 F.3d 337
    , 339 (5th Cir. 2008) (per
    curiam)). “The fact that we might reasonably conclude ‘that a different
    sentence was appropriate is insufficient to justify reversal of the district
    court.’” Id. (quoting 
    Gall, 522 U.S. at 51
    ).
    We presume that below-Guidelines sentences are substantively
    reasonable.
    Id. Nevertheless, a defendant
    can rebut this presumption by
    showing that her sentence: “(1) does not account for a [18 U.S.C. § 3553(a)]
    factor that should have received significant weight, (2) gives significant weight
    to an irrelevant or improper factor, or (3) represents a clear error of judgment
    in balancing the sentencing factors.”
    Id. at 558
    (quoting United States v.
    Warren, 
    720 F.3d 321
    , 332 (5th Cir. 2013)).
    Gozes-Wagner argues that her sentence is substantively unreasonable
    because the district court did not account for a factor that should have received
    30
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    significant weight. More specifically, she argues that the court did not
    sufficiently account for “the need to avoid unwarranted sentence disparities
    among defendants with similar records who have been found guilty of similar
    conduct” under 18 U.S.C. § 3553(a)(6). But we have already held that, for
    § 3553(a)(6) purposes, none of her co-conspirators were similarly situated to
    her. In any event, this court has held that when a defendant is sentenced below
    her applicable Guidelines range, the unwarranted disparity factor “is not
    afforded significant weight.” United States v. Waguespack, 
    935 F.3d 322
    , 337
    (5th Cir. 2019).
    As this court has made clear, “an argument premised primarily on
    sentencing disparity is insufficient to render a sentence substantively
    unreasonable.” United States v. Hernandez, 
    633 F.3d 370
    , 379 (5th Cir. 2011)
    (citing United States v. Key, 
    599 F.3d 469
    , 475–76 (5th Cir. 2010)). Gozes-
    Wagner’s reliance on distinguishable in-circuit and out-of-circuit health care
    fraud cases in which defendants received shorter sentences than hers is
    unpersuasive in this context. She has thus failed to show that her sentence
    was substantively unreasonable. See United States v. Emordi, No. 19-10400,
    
    2020 WL 2488181
    , at *7 (5th Cir. May 14, 2020) (holding that the defendant
    failed to rebut the presumption that her below-Guidelines sentence was
    substantively unreasonable even though an allegedly “more culpable”
    defendant received a sentence just twelve months longer than her 85-month
    sentence).
    Amici curiae, the Aleph Institute and other legal scholars, raise
    additional arguments not specifically espoused by Gozes-Wagner to support
    the claim that her sentence is substantively unreasonable. They first argue
    that the district court failed to properly consider “the nature and circumstances
    of the offense and the history and characteristics of the defendant” under
    § 3553(a)(1). But the record shows that the district court had a firm grasp of
    31
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    both the nature and circumstances of Gozes-Wagner’s offense and her history
    and characteristics. The court noted that Gozes-Wagner did not play merely “a
    marginal role” in the conspiracy, expressing particular distaste for health care
    fraud operations “like this one” that wreak “havoc” on Medicare and Medicaid.
    And having presided over the trial, read and adopted the PSR that described
    in detail the nature of the offense and her personal history, and read more than
    80 character letters submitted on Gozes-Wagner’s behalf, discussing several at
    length during the sentencing hearing, the district judge no doubt understood
    and considered her history and characteristics when imposing her sentence. 16
    Amici also argue that the court failed to consider “the kinds of sentences
    available” under § 3553(a)(3), explaining that neither of the statutes under
    which Gozes-Wagner was convicted mandate prison time. But we think the
    record shows that the district court spent considerable time fashioning Gozes-
    Wagner’s sentence and considering alternatives. In addition to expressly
    stating—albeit summarily—that it had considered all the § 3553(a) factors, it
    also noted that at the outset of its pronouncement that “I do want to state that
    I have read this entire file and that right now the defendant could be facing up
    to 360 months.” When explaining how it reached its sentencing decision, the
    court noted that the product was a result of “what I thought on my own.” The
    court’s failure to explicitly state that it had considered a sentence of no prison
    time at all does not constitute substantive unreasonableness under these
    circumstances.
    Finally, amici argue that Gozes-Wagner’s sentence is substantively
    unreasonable because the district court improperly focused on her decision to
    go to trial—an “improper factor” to consider—and, overall, the combination of
    16 The district court did note before pronouncing its sentence that it had considered
    the § 3553(a) factors.
    32
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    these errors reflects “a clear error of judgment in balancing the sentencing
    factors.” See 
    Simpson 796 F.3d at 558
    . We do not find these arguments
    persuasive. Nothing in the record suggests that the court went out of its way
    to punish Gozes-Wagner for going to trial. To the contrary, when presented
    with arguments that she was similarly situated to her co-defendants, the
    district court correctly pointed out that for various reasons, including the fact
    that her co-conspirators pleaded guilty to charges carrying lower maximum
    sentences, she was not similarly situated to them at sentencing. The record
    does not reflect a clear error of judgment in the district court’s balancing of the
    § 3553(a) factors. Accordingly, amici’s additional arguments, which we
    consider in our broad discretion, do not persuade us that Gozes-Wagner’s
    sentence is substantively unreasonable.
    D. Restitution: Procedural Claims
    The PSR calculated the restitution Gozes-Wagner should owe based on
    “the bills Medicare paid within the limits in her count of conviction,” i.e.,
    between January 2010 and February 2015, the time period for which Gozes-
    Wagner was charged in the superseding indictment with participating in the
    conspiracy. Because “the Medicaid losses [were] undetermined,” the Medicare
    losses constituted the full amount for restitution calculation purposes at the
    sentencing hearing. For Gozes-Wagner, according to the PSR, that amounted
    to $19,808,841.87. The PSR recommended that she be held accountable “jointly
    and severally” with her convicted co-conspirators in varying amounts.
    At the sentencing hearing, the district court noted Gozes-Wagner’s
    objections to both the “responsibility” of restitution and the amount. At one
    point, the prosecutor explained that there was “one thing [he] wanted to raise.”
    He asked the court to consider awarding restitution in the amount of
    $15,283,985 instead of $19,808,841.87. The court carefully noted the request,
    and Gozes-Wagner’s counsel objected “to the calculations as modified.”
    33
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    After pronouncing her sentence, the district court turned to the matter
    of restitution. It stated:
    The defendant is being held responsible for
    restitution to the United States Medicare system in
    the total amount of $15,283,985 jointly and severally
    with Mikhail Shiforenko, S-h-i-f-o-r-e-n-k-o, up to an
    amount of $21,800,000; Alexandr Voronov, V-o-r-o-n-
    o-v, up to $18 million; and Boris Brodsky up to the
    amount of $6 million.
    It’s further ordered the defendant pay to the
    United States a special assessment set up by the U.S.
    Congress for $100 per count of conviction. So that’s
    $200. I find she does not have the ability to pay a fine,
    and I’ll waive a fine in this case.
    And that — now, it sounds completely
    unrealistic, but I need to set a budget of some sort for
    repayment. It sounds completely unrealistic because
    it’s subject to probation altering it later on. With that
    as a background, having assessed her ability to pay,
    pay in lump sum the amount of $200 due immediately.
    The balance due in 50 percent of any wages earned
    while in prison in accordance with the Bureau of the
    Prisons inmate financial responsibility program. Any
    balance remaining after release from imprisonment
    shall be due in monthly installments of $400 to
    commence 60 days after release from imprisonment to
    a term of supervision. Payment is to be made through
    the United States District Clerk, Southern District of
    Texas.
    No further reference was made to restitution at the sentencing hearing.
    On appeal, Gozes-Wagner raises three “procedural” challenges to the
    order of restitution. We address each before turning to her constitutional
    argument on the matter.
    The first procedural claim is that the district court was under the false
    impression that it was obligated by law to hold Gozes-Wagner jointly and
    severally liable with her co-conspirators for various portions of the restitution
    34
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    award. The second is that the court imposed an improper payment schedule by
    conceding that it was “completely unrealistic.” And third, the court illegally
    included within the order loss attributable to conduct that occurred in 2010
    and 2011 even though a prosecutor during closing argument conceded that
    Gozes-Wagner may not have been fully aware of the scope of the conspiracy
    during those years.
    1. Joint and Several Liability with Co-Conspirators
    Gozes-Wagner argues that the district court erred by relying on language
    in the PSR suggesting that she had to be held jointly and severally liable for
    the full amount of the loss to Medicaid during her participation in the
    conspiracy. Because Gozes-Wagner did not raise this error below, we review
    for plain error. See United States v. Sheets, 
    814 F.3d 256
    , 259 (5th Cir. 2016)
    (recognizing that plain error review applies to alleged restitution order errors
    that were not raised below and thus “den[ied] the court the opportunity to
    identify and correct any errors”).
    There is no dispute that Gozes-Wagner owes some amount of restitution.
    Because her conviction involved “fraud or deceit,” the Mandatory Victims
    Restitution Act applies. 18 U.S.C. § 3663A(c)(1)(A)(ii). Further, under 18
    U.S.C. § 3664(h),
    If the court finds that more than 1 defendant has
    contributed to the loss of a victim, the court may make
    each defendant liable for payment of the full amount
    of restitution or may apportion liability among the
    defendants to reflect the level of contribution to the
    victim’s loss and economic circumstances of each
    defendant.
    Thus, not only was the court bound to render a restitution award against
    Gozes-Wagner, there is no doubt that it had the authority to hold her jointly
    and severally liable for the full loss to Medicaid that occurred during her
    participation in the conspiracy. Nevertheless, Gozes-Wagner asks us to
    35
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    No. 19-20157
    interpret the PSR’s statement that she “is accountable for restitution to
    Medicare . . . jointly and severally with” her convicted co-conspirators and the
    district court’s subsequent adoption of the PSR as an illegal determination by
    the district court that the law required it to hold her jointly and severally liable
    with her co-conspirators. We decline to do so. Thus, Gozes-Wagner has failed
    to show plain error.
    2. “Completely Unrealistic” Payment Schedule
    Next, Gozes-Wagner contends that it was error for the district court to
    impose a “completely unrealistic” payment schedule upon her. This is
    especially true in light of the fact that, at the time of sentencing, she possessed
    only $45,000 in assets and had low post-prison income-earning prospects.
    Because Gozes-Wagner failed to raise this argument below, we review for plain
    error. United States v. Arledge, 
    553 F.3d 881
    , 900 (5th Cir. 2008) (“Because
    Arledge failed to object to the district court’s setting of the payment schedule,
    we review for plain error.”).
    Under 18 U.S.C. § 3664(f)(2), the district court was obligated to set a
    payment schedule for Gozes-Wagner’s restitution award, despite the long odds
    that she will repay the full amount in her lifetime. It did the best it could. The
    PSR assessed Gozes-Wagner’s ability to pay, and the court adopted its findings.
    Then it ordered her to pay $200 immediately, 50 percent of her prison wages
    during her incarceration, and $400 a month shortly after her release. Under
    the circumstances, this payment schedule did not constitute plain error.
    3. Losses Attributed from 2010 and 2011
    In the final minutes of his closing argument, a prosecutor made the
    following remark:
    And so let’s give Ms. Wagner the benefit of the doubt.
    She is not a doctor. When she walks in, it may have
    taken her a bit longer, maybe all of 2010, maybe all of
    2011. But come on, even somebody without medical
    36
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    No. 19-20157
    training, by 2012, 2013, 2014 and part of 2015 is now
    receiving hundreds of thousands of dollars from
    Russians can’t find any patients [sic], doesn’t know
    what the clinics are doing, that’s taking your leave a
    little slow. At that point in time she knew what was
    going on, she had knowledge or she intentionally
    ignored it.
    Gozes-Wagner calls this a concession from the Government that Gozes-Wagner
    may not have known about the fraud involved in the conspiracy in 2010 and
    2011. The Government responds that this off-handed “benefit of the doubt”
    comment did not amount to a concession; instead, loss from those years was
    properly included within her restitution award because she was convicted of
    defrauding Medicaid during those years. Gozes-Wagner did not raise this claim
    below, so we review for plain error. See 
    Sheets, 814 F.3d at 259
    –60.
    We cannot say that the district court plainly erred by attributing loss
    amounts in the restitution order for losses that indisputably occurred during
    the time period for which Gozes-Wagner was convicted. To say the Government
    made an evidentiary concession during the final moments of its closing
    argument is, at best, a stretch. We find no plain error.
    E. Restitution: Eighth Amendment’s Excessive Fines Clause
    Gozes-Wagner argues for the first time on appeal that the district court’s
    restitution order violates the Excessive Fines Clause of the Eighth
    Amendment. We therefore review for plain error. See United States v.
    $78,882.00 In U.S. Currency, 464 F. App’x 382, 383 (5th Cir. 2012) (per curiam)
    (unpublished) (“Because the Salgados raise their Excessive Fines Clause
    theory for the first time on appeal, we review the district court’s order of
    forfeiture for plain error.”)
    The Eighth Amendment prohibits the Government from saddling
    defendants with “excessive fines.” U.S. CONST. amend. VIII (“Excessive bail
    shall not be required, nor excessive fines imposed, nor cruel and unusual
    37
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    punishments inflicted.”). But the Supreme Court has never held that the
    Excessive Fines Clause applies to restitution awards. See Paroline v. United
    States, 
    572 U.S. 434
    , 455–56 (2014) (“To be sure, this Court has said that ‘the
    Excessive Fines Clause was intended to limit only those fines directly imposed
    by, and payable to, the government.’”) (quoting Browning–Ferris Industries of
    Vt., Inc. v. Kelco Disposal, Inc., 
    492 U.S. 257
    , 268 (1989)). “As we ordinarily do
    not find plain error where there is an absence of authority on point, we decline
    to conclude that any error by the district court . . . was clear or obvious.” See
    United States v. Rubio-Sorto, 760 F. App’x 258, 260 (5th Cir. 2019) (per curiam)
    (unpublished). 17 Hence, we once again find no plain error.
    III. Conclusion
    For the foregoing reasons, we hold that Gozes-Wagner has failed to show
    that the district court reversibly erred. We therefore AFFIRM.
    17 We note that the only other circuit court to consider whether a restitution award
    could violate the Excessive Fines Clause squarely rejected it. See United States v. Green, 
    954 F.3d 1119
    , 1125 (8th Cir. 2020) (“As the Supreme Court pointed out in Paroline, mandatory
    restitution under § 2259 — when properly interpreted — does not violate the Eighth
    Amendment’s excessive-fines clause.”) (citing 
    Paroline, 572 U.S. at 455
    –56). We leave for
    another day, however, the discussion of whether a restitution order could ever violate the
    Excessive Fines Clause.
    38