United States v. Matilda Prince ( 2019 )


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  •            Case: 18-13656   Date Filed: 08/12/2019   Page: 1 of 20
    [DO NOT PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    ________________________
    No. 18-13656
    Non-Argument Calendar
    ________________________
    D.C. Docket No. 2:15-cr-00037-RWS-JCF-1
    UNITED STATES OF AMERICA,
    Plaintiff-Appellee,
    versus
    MATILDA PRINCE,
    Defendant-Appellant.
    ________________________
    Appeal from the United States District Court
    for the Northern District of Georgia
    ________________________
    (August 12, 2019)
    Before ROSENBAUM, JILL PRYOR and FAY, Circuit Judges.
    PER CURIAM:
    Case: 18-13656     Date Filed: 08/12/2019   Page: 2 of 20
    Matilda Prince appeals her convictions for 29 counts of health care fraud, in
    violation of 18 U.S.C. § 1347. We affirm.
    I. BACKGROUND
    Prince was charged in a superseding indictment by a grand jury with 29
    counts of health care fraud by filing 29 false claims for payment with Medicare
    and Medicaid, in violation of 18 U.S.C. § 1347. The superseding indictment
    alleged the following. Prince was the owner and operator of Pickens Eye Clinic, a
    company located in Jasper, Georgia, which purported to provide a variety of
    optometry and ophthalmology services to a primarily senior citizen population.
    Her brother, Martin Prince, owned an eye care company called The Eye Gallery,
    which provided the same services and for which Prince worked, advertised, and
    provided eye care services. Prince was never licensed in Georgia as a physician,
    optometrist, ophthalmologist, or dispensing optician.
    In order to obtain reimbursement for the eye care services allegedly
    performed by Pickens Eye Clinic and The Eye Gallery, Prince entered “Current
    Procedural Terminology Manual” (“CPT”) codes identifying medical services and
    procedures on claims she electronically submitted to Medicare and Medicaid,
    which, through fiscal intermediaries, relied on the codes in paying the claims. The
    claims were submitted to Medicare and Medicaid using the names, identities, and
    uniquely assigned provider numbers of two medical providers who were licensed
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    optometrists that Prince had hired through a third-party physician contracting
    agency. Prince made claims to Medicare and Medicaid for optometry services that
    had not been provided.
    In November 2010, Prince was ordered in a proceeding in the Superior Court
    of DeKalb County, Georgia, not to receive any benefits, or be employed or
    involved with, any entity that received Medicaid or Medicare funding for a period
    of five years and to pay restitution in the amount of $109,712.26 to Georgia
    Medicaid. She and Pickens Eye Clinic were also excluded by the U.S. Department
    of Health and Human Services from participating in Medicare, Medicaid, and all
    federal health care programs, making them ineligible to submit claims for any
    services provided after September 20, 2011.
    The superseding indictment also alleged that Prince generated business by
    offering on-site eye exams and prescription glasses at no charge to Medicare and
    Medicaid recipients at public housing complexes with large senior citizen
    populations. After receiving Medicare and Medicaid numbers from recipients, she
    used their identities and the identities of the licensed optometrists to submit claims
    for optometry services, such as “closure of the lacrimal punctum by plug,” and
    backdated claims for optometry services that were not rendered. The indictment
    included a table of the Medicare and Medicaid claims by date of service, date the
    claim was submitted, CPT code, and patient, separated into 29 counts. Counts 2
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    through 4 alleged that Prince had made fraudulent claims with respect to a patient
    named “W.M.” for services dated June 27, July 18, and August 8, 2011.
    Prince entered a not-guilty plea. The government filed a notice of intent to
    introduce evidence under Federal Rule of Evidence 404(b). It then filed a motion
    in limine to admit at trial intrinsic evidence or, in the alternative, to admit similar
    acts evidence under Rule 404. The exhibits included a single-count indictment
    from DeKalb County Superior Court on December 10, 2009, charging Prince with
    Medicaid fraud, in violation of § 49-4-146 of the Georgia Code. The exhibits also
    included Prince’s state court criminal judgment and a later consent order to modify
    her sentence, which showed that Prince pled guilty to the count and was sentenced
    as a “first offender” to a ten-year term of probation, required to pay restitution of
    $109,172.26, and barred from owning, deriving income from, or being employed
    by any business that received Medicare or Medicaid funds for five years.
    The district court granted the motion with respect to Prince’s 2010
    conviction for Medicaid fraud and sentencing under the Georgia First Offender Act
    and evidence of her exclusion from federal health care programs in 2011. It
    reasoned that the evidence was intrinsic because it was inextricably intertwined
    with the charged offenses and was therefore not prohibited by Rule 404(b). It also
    concluded that, even if it was not intrinsic, the evidence was still admissible under
    Rule 404(b).
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    Walter Morton and Debbie Sanders, residents of the Summerville Housing
    Authority apartment building, testified about their experiences with The Eye
    Gallery and Prince. They both testified that they received eye exams and ordered
    glasses when Prince visited their apartment building in May 2012. They each saw
    Prince a few more times when she came to their apartment building to deliver
    glasses, fit some residents for sunglasses, and deliver sunglasses. Prince billed
    Medicare and Medicaid for providing Morton and Sanders with the service of
    closing the lacrimal punctum by plugs multiple times and listed Dr. Carl Llabres as
    the treating optometrist. While Morton could not recall whether he had very small
    plugs placed in his tear ducts, Sanders confirmed that she did not receive that
    procedure, nor had she seen any residents getting plugs in their eyes during
    Prince’s visits. Sanders identified three forms she had signed but not read, which
    she was required to bring to Prince on May 23, 2012, for the free eye exam and
    eyeglasses. The documents were claim forms, which showed she had plug
    procedures to close her tear duct openings on June 27, July 18, and August 8, 2011,
    billed through Pickens Eye Clinic. On cross-examination, she confirmed that she
    did sign the documents.
    Dorothy Swift, an investigative analyst with the Department of Health and
    Human Services, Office of the Inspector General, testified regarding Prince and
    Pickens Eye Clinic’s exclusion from Medicare in September 2011 based on her
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    state conviction. The government asked the district court to give a limiting
    instruction regarding her testimony about Prince’s state court conviction and
    exclusion from federal health care programs. The district court instructed the jury
    that it could consider evidence of other violations or potential alleged violations of
    the law for the limited purpose of determining whether Prince had the intent to
    commit the crime charged, whether there was some accident or mistake on her part
    in committing the charged crime, and as proof of some method or means of
    accomplishing an illegal act, but not to decide whether she actually committed the
    crimes charged.
    Mary Davis, Linda Romine, and Cindy Hightower also testified that they
    had attended Prince’s clinic at their apartment complex, Calhoun Gardens, where
    they received eye exams, and some received glasses. They each testified that they
    had not received punctum plugs.
    Betty Lue Gordon, an employee at PRN Eye Associates, a referral services
    for optometrists, testified that she sent two optometrists, Dr. Llabres and Dr.
    Desarae Bonds, to Pickens Eye Clinic and The Eye Gallery. In every case, she
    always dealt with Prince, not her brother. Prince only requested optometrists to
    perform simple eye exams, never anything more invasive or complex. Dr. Bonds
    also testified regarding working for Prince from 2010 to 2013 and how the
    punctum plugs procedure works. She was not aware that Prince had submitted
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    claims for payment to Medicare and Medicaid under her name for performing the
    punctum plug procedure, and she never authorized Prince to bill Medicare or
    Medicaid under her name for those procedures.
    On the third day of trial, the government informed the court that it would be
    calling witnesses to talk about Prince’s state conviction and asked the district court
    about giving another limiting instruction. Prince’s counsel did not request one, and
    the district court did not give one to avoid over-emphasizing the evidence. Robert
    Jones, a Georgia Medicaid investigative auditor, testified that Prince’s restitution
    for her state conviction was paid in two lump payments. Additionally, Darlene
    Herndon, a Georgia Medicaid Fraud Control Unit auditor, testified over Prince’s
    objection as to Prince’s conviction in state court and explained that Prince was
    prohibited from owing or receiving any money from Medicare or Medicaid for ten
    years based on her state conviction.
    The government submitted death certificates for Adrian Pickle and James
    Edwards, the other patients referred to in Counts 8 through 10 and 26 through 29
    of the indictment, who died before trial. Dr. Llabres did not testify at trial.
    The government rested, and the defense made a Federal Rule of Criminal
    Procedure 29 motion challenging the sufficiency of the evidence. The district
    court denied the motion. The defense then called V.J. Henville, an investigator
    with the Federal Defender Program, who testified that Lacrimedics, a company that
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    sold punctum plugs, provided records showing that Prince ordered several hundred
    punctum plugs from 2002 to 2010. Lisa Riley, an employee of Prince from 2011
    to 2013, testified that she observed a physician named Dr. Llabres perform the
    punctum plug procedure on residents at Calhoun Gardens.
    After the defense rested and the court instructed the jury, Prince renewed her
    Rule 29 motion, which the district court denied. In its charge to the jury, the
    district court again gave a limiting instruction on how the jury could consider
    Prince’s similar acts leading to her state court conviction. After 3 days of trial, the
    jury convicted Prince on all 29 counts. The district court sentenced Prince to a
    below-guidelines term of 40 months of imprisonment for each count, to run
    concurrently, followed by 3 years of supervised release and ordered her to pay
    $607,347.51 in total restitution to Medicare and Georgia Medicaid.
    On appeal, Prince first argues that her indictment for health care fraud was
    multiplicitous because it charged one crime in multiple counts. Second, she argues
    that the district court abused its discretion by admitting evidence of her state
    conviction because it was not intrinsic evidence and was inadmissible under
    Federal Rule of Evidence 404(b). She also argues that its probative value was
    substantially outweighed by the risk of undue prejudice. Third, she argues that
    there was insufficient evidence to sustain a guilty verdict as to her submitting three
    false insurance claims under the name Walter Morton.
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    II. DISCUSSION
    A. Multiplicity
    Whether an indictment is multiplicitous is a question of law that we review
    de novo. United States v. Pacchioli, 
    718 F.3d 1294
    , 1307 (11th Cir. 2013). If a
    defendant fails to raise a claim that the indictment was multiplicitous before trial
    under Federal Rule of Criminal Procedure 12(b)(3)(B) and (c), we may review the
    forfeited claim for plain error. United States v. Gonzalez, 
    834 F.3d 1206
    , 1218
    (11th Cir. 2016). “We may correct a plain error only when (1) an error has
    occurred, (2) the error was plain, . . . (3) the error affected substantial rights,” and
    (4) “the error seriously affect[ed] the fairness, integrity, or public reputation of
    judicial proceedings.” 
    Id. (alteration in
    original) (quoting United States v. Cotton,
    
    535 U.S. 625
    , 631-32, 
    122 S. Ct. 1781
    , 1785 (2002)). “[A]n error cannot meet the
    ‘plain’ requirement of the plain error rule if it is not clear under current law.”
    United States v. Frank, 
    599 F.3d 1221
    , 1239 (11th Cir. 2010) (quoting United
    States v. Castro, 
    455 F.3d 1249
    , 1253 (11th Cir. 2006)). Therefore, if the explicit
    language of the statute or rule does not specifically resolve the issue, and there is
    no precedent from us or the Supreme Court directly resolving it, there is no plain
    error. 
    Id. As for
    sentencing challenges, we have held multiplicity to be “harmless
    error” where the conviction on one of the counts would stand and the defendant’s
    sentences were concurrent. 
    Pacchioli, 718 F.3d at 1308
    .
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    “An indictment is multiplicitous if it charges a single offense in more than
    one count. A multiplicitous indictment not only subjects the defendant to
    numerous sentences for one offense, but also ‘prejudice[s] the defendant and
    confuse[s] the jury by suggesting that not one but several crimes have been
    committed.’” United States v. Williams, 
    527 F.3d 1235
    , 1241 (11th Cir. 2008).
    (alterations in original) (citations omitted) (quoting United States v. Hearod, 
    499 F.2d 1003
    , 1005 (5th Cir. 1974)). “A multiplicitous indictment therefore violates
    the principles of double jeopardy because it gives the jury numerous opportunities
    to convict the defendant for the same offense.” 
    Id. We use
    the Blockburger 1 test
    to determine whether an indictment is multiplicitous and verify that each count
    requires an element of proof that the other counts do not require. Id.; see also
    United States v. Costa, 
    947 F.2d 919
    , 926 (11th Cir. 1991) (holding that charges
    are not multiplicitous where they differ by even a single element or alleged fact).
    What constitutes an “execution” of a scheme to defraud is a fact-specific
    inquiry. United States v. De La Mata, 
    266 F.3d 1275
    , 1287 (11th Cir. 2001).
    Whether a particular transaction is an “execution” of the scheme or merely a
    component of the scheme depends on “the ultimate goal of the scheme, the nature
    of the scheme, the benefits intended, the interdependence of the acts, and the
    number of parties involved.” 
    Id. at 1288.
    1
    Blockburger v. United States, 
    284 U.S. 299
    , 304, 
    52 S. Ct. 180
    , 182 (1932).
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    We have interpreted the similarly worded bank fraud statute to allow for a
    defendant to be charged in separate counts for each “execution” of a scheme to
    defraud. See 
    id. at 1287;
    United States v. Sirang, 
    70 F.3d 588
    , 595-96 (11th Cir.
    1995). Although we did not rule directly on the issue of multiplicity in De La
    Mata, we defined what constituted a single “execution” of bank 
    fraud. 266 F.3d at 1289
    . Specifically, we held that each signing of a lease with the victim bank, as
    opposed to each lease payment, constituted an execution of bank fraud because
    only the signing of the lease exposed the bank to new financial risks. 
    Id. Similarly, in
    Sirang, the defendant was charged with four separate counts of bank
    fraud for withdrawing four checks from an account and depositing them into the
    receiving bank on the same 
    day. 70 F.3d at 595-96
    . We rejected his multiplicity
    claim, holding that each check involved a separate movement of money and
    created a separate risk for the receiving bank, and thus, each check was a separate
    execution of the scheme. 
    Id. A person
    commits health care fraud when she:
    knowingly and willfully executes, or attempts to execute, a scheme or
    artifice—
    (1)    to defraud any health care benefit program; or
    (2)    to obtain, by means of false or fraudulent pretenses,
    representations, or promises, any of the money or property
    owned by, or under the custody or control of, any health care
    benefit program,
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    in connection with the delivery of or payment for health care benefits,
    items, or services, [and as a result, the individual] shall be fined under
    this title or imprisoned not more than 10 years, or both.
    18 U.S.C. § 1347(a).
    Because Prince failed to raise a claim that the indictment was multiplicitous
    before trial, we review Prince’s challenge only for plain error. See 
    Gonzalez, 834 F.3d at 1218
    . Notably, Prince does not challenge her total sentences, and any
    possible error in her sentences was harmless because the alleged multiplicitous
    counts resulted in concurrent sentences. See 
    Pacchioli, 718 F.3d at 1308
    . Prince
    cannot show there was any error in the indictment because each false claim she
    filed with Medicare or Medicaid was a separate execution of her scheme to defraud
    the government.
    Although Prince’s scheme targeted only Medicare and Medicaid, she
    achieved the ultimate goal in her scheme and the benefits she intended, obtaining
    payment, with each fraudulent claim she made to Medicare or Medicaid. De La
    
    Mata, 266 F.3d at 1288
    . Like the scheme in Sirang, Prince’s scheme involved
    separate movements of money for each fraudulent claim against Medicare or
    Medicaid. See 
    Sirang, 70 F.3d at 595-96
    . Moreover, for each count alleged in the
    indictment, the government was required to prove each element of § 1347 with
    respect to each separate claim, including that each transaction was fraudulent. See
    
    Williams, 527 F.3d at 1241
    . Accordingly, each claim was properly treated as a
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    separate execution of the scheme. the district court did not err, much less plainly
    err, by allowing the government to proceed under the superseding indictment. See
    
    Frank, 599 F.3d at 1239
    .
    B. State Conviction Evidence
    We review the district court’s decision to admit or exclude evidence for an
    abuse of discretion. United States v. Crabtree, 
    878 F.3d 1274
    , 1287 (11th Cir.
    2018). We will affirm an evidentiary decision unless the district court made a clear
    error of judgment or applied the wrong legal standard. United States v. Frazier,
    
    387 F.3d 1244
    , 1259 (11th Cir. 2004) (en banc). The abuse of discretion standard
    gives district courts considerable leeway, and they have a range of choice about
    whether to admit or exclude evidence. 
    Id. at 1258-59.
    One reason for granting
    district courts discretion in their evidentiary rulings is that district courts may have
    knowledge about the case that is not conveyed in the record. United States v.
    Brown, 
    415 F.3d 1257
    , 1265 (11th Cir. 2005). “[A]ll doubt should be resolved in
    favor of admissibility” if the proffered evidence has substantial probative value and
    does not tend to prejudice or confuse the jury. 
    Frazier, 387 F.3d at 1303
    (quoting
    United States v. Terebecki, 
    692 F.2d 1345
    , 1351 (11th Cir. 1987) (Hill, J.,
    dissenting)).
    Rule 404(b) prohibits evidence of other crimes, wrongs, or acts from being
    admitted to prove a defendant’s character in order to show action in conformity
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    with her character. Fed. R. Evid. 404(b). However, such evidence may be
    admitted for other purposes, such as proving motive, opportunity, intent,
    preparation, plan, knowledge, identity, absence of mistake, or lack of accident. 
    Id. With respect
    to intent, we have authorized admission of evidence of similar frauds
    committed by a defendant to show that she had the intent to commit the fraud
    charged in an indictment. See United States v. Brown, 
    665 F.3d 1239
    , 1242-43,
    1248 (11th Cir. 2011) (holding that evidence of the defendant’s involvement in two
    prior bank fraud schemes was admissible to show his fraudulent intent and absence
    of mistake in committing the charged fraud scheme). A defendant places her intent
    at issue by pleading not guilty. See United States v. Edouard, 
    485 F.3d 1324
    , 1345
    (11th Cir. 2007).
    Evidence of criminal activity other than the charged offense is not subject to
    Rule 404(b) if it is: (1) evidence of an uncharged offense which arose out of the
    same transaction or series of transactions as the charged offense; (2) evidence that
    is necessary to complete the story of the crime; or (3) evidence that is inextricably
    intertwined with evidence regarding the charged offense. United States v. Ford,
    
    784 F.3d 1386
    , 1393 (11th Cir. 2015). Evidence concerning uncharged conduct is
    intrinsic evidence when the uncharged conduct was part of the same scheme or
    series of transactions as the charged offense and used the same modus operandi.
    
    Id. at 1394.
    Evidence is inextricably intertwined with the evidence of the charged
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    offense when “it forms an integral and natural part of the witness’s accounts of the
    circumstances surrounding the offenses for which the defendant was indicted.”
    
    Edouard, 485 F.3d at 1344
    (quotation marks omitted).
    Whether offered under Rule 404(b) or as intrinsic evidence, the district court
    must find that the probative value of the proffered evidence is not substantially
    outweighed by unfair prejudice and that it meets the other requirements of Rule
    403. 
    Ford, 784 F.3d at 1393
    . Evidence is excludable if its probative value is
    substantially outweighed by a danger of unfair prejudice. See Fed. R. Evid. 403.
    The district court did not abuse its discretion by ruling that evidence of
    Prince’s 2010 state guilty plea to Medicaid fraud and subsequent sentencing as a
    first-time offender was admissible as evidence of her resulting exclusion from
    federal health care programs in 2011. The district court correctly determined that
    the evidence was intrinsic, as Prince used a similar modus operandi to accomplish
    her fraud, even though she used a company incorporated under her brother’s name
    to conceal it. See 
    Ford, 784 F.3d at 1393
    -94. Importantly, her exclusion from
    federal health care programs as a result of her state conviction explained why she
    backdated claims and used The Eye Gallery, instead of Pickens Eye Clinic, to
    submit the instant fraudulent claims.
    In addition, evidence of her state guilty plea and restitution obligation,
    alongside her lump sum payments of restitution, showed her intent and motive for
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    committing the instant fraud. Therefore, Prince’s state conviction was necessary to
    complete the story of her crime. See 
    id. Furthermore, the
    district court correctly
    concluded that, in the alternative, the evidence was admissible under Rule 404(b)
    as evidence of Prince’s intent, identity, knowledge, lack of accident, and absence
    of mistake. See Fed. R. Evid. 404(b). As in Brown, evidence of Prince’s guilty
    plea, first-offender sentence, and resulting exclusion from Medicare and Medicaid
    showed her fraudulent intent and absence of mistake in committing the charged
    offenses under the cover of the new company, The Eye Gallery, and in her
    brother’s name. See 
    Brown, 665 F.3d at 1242-43
    , 1248.
    Finally, the probative value of the evidence was not substantially
    outweighed by the risk of undue prejudice. See Fed. R. Evid. 403. First, Prince
    placed her knowledge and intent at issue by pleading not guilty. 
    Edouard, 485 F.3d at 1345
    . The government was required to rely on probative circumstantial
    evidence of her intent to commit fraud, given the lack of direct evidence of her
    intent. 
    Id. Her argument
    that the government did not need to show she pleaded
    guilty to show that she owed restitution has merit. However, as mentioned above,
    the government entered into evidence the state criminal judgment for multiple
    reasons, including to show why the claims were linked to The Eye Gallery and her
    brother, and to prove that the claims were backdated. See 
    Ford, 784 F.3d at 1393
    -
    94. Therefore, the district court did not abuse its discretion when it concluded that
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    the probative value of the state court judgment evidence was not substantially
    outweighed by the risk of undue prejudice. See Fed. R. Evid. 403.
    The district court also limited the prejudicial effect of the evidence by giving
    a limiting instruction before the evidence was first presented and again in the jury
    charge. Thus, the district court acted within its discretion when it declined to
    exclude the evidence of Prince’s state conviction and sentence. See 
    Crabtree, 878 F.3d at 1287
    .
    C. Sufficiency of the Evidence
    We review de novo whether sufficient evidence supports a conviction,
    drawing all reasonable factual inferences from the evidence in favor of the verdict.
    United States v. Beckles, 
    565 F.3d 832
    , 840 (11th Cir. 2009). We assume that the
    jury made all credibility choices in support of the verdict. United States v.
    Thompson, 
    473 F.3d 1137
    , 1142 (11th Cir. 2006). Evidence is sufficient if a
    reasonable trier of fact could find that it established guilt beyond a reasonable
    doubt. 
    Beckles, 565 F.3d at 840
    . In rebutting the government’s evidence, a
    defendant must do more than put forth a reasonable hypothesis of innocence,
    because the issue is whether a reasonable jury could have convicted, not whether a
    conviction was the only reasonable result. 
    Id. at 840-41.
    To support a conviction for health care fraud under 18 U.S.C. § 1347, the
    government must prove that the defendant: (1) knowingly and willfully executed,
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    or attempted to execute, a scheme to (2) defraud a health care program or to obtain
    by false or fraudulent pretenses money or property under the custody or control of
    a health care program, (3) “in connection with the delivery of or payment for
    health care benefits, items, or services.” 18 U.S.C. § 1347. The government must
    show that the defendant knew that the submitted claims were false. United States
    v. Medina, 
    485 F.3d 1291
    , 1297 (11th Cir. 2007). In a mail fraud case, we
    explained that knowingly making false representations is one way in which a
    person may execute a scheme to defraud. United States v. Scott, 
    701 F.2d 1340
    ,
    1343-44 (11th Cir. 1983). In another mail fraud case, we explained that to prove
    that a defendant intentionally executed a scheme to defraud, the government must
    prove that she had the specific intent to defraud. United States v. Suba, 
    132 F.3d 662
    , 675 (11th Cir. 1998). However, the government may rely on circumstantial
    evidence to establish specific intent. 
    Id. In challenging
    whether sufficient evidence supported her convictions as to
    Counts 2 through 4 involving Morton, Prince appears to challenge only whether
    the claims described in those counts were false or fraudulent. Although Morton
    testified at trial that he could not be sure that he did not receive a punctum plug,
    and Dr. Llabres, who allegedly had performed the procedure, did not testify, there
    was sufficient evidence for a jury to find Prince guilty of health care fraud for the
    counts involving Morton. See 
    Williams, 527 F.3d at 1244
    . The circumstantial
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    evidence supported that Morton, like the other patients at the Summerville Housing
    Authority apartment, did not receive the punctum plug procedure billed by Prince.
    See 
    Beckles, 565 F.3d at 840
    . The evidence was uncontested that Prince billed for
    a punctum plug procedure performed on Morton. Meanwhile, Morton testified that
    he had only seen Prince twice, having an eye exam and receiving eye drops on the
    first visit and only picking up glasses on the second. He testified that he was
    “blown away” by the Medicare and Medicaid benefits statement claiming he had
    received the punctum plug procedure.
    Sanders testified that she was there on the same day that Morton received an
    eye exam and also received a benefits statement stating she had received the
    punctum plug procedure, even though she did not receive the procedure or see
    anyone who did. Thus, Morton’s testimony that he was surprised by the punctum
    plug claim and Sanders’s testimony that no one received the punctum plug
    procedure on the day she and Morton received their eye exams supports an
    inference that Morton did not receive the punctum plug procedure.
    Furthermore, Dr. Bonds testified that the procedure could not be performed
    at a community center. She testified that she was at the community center on the
    same day Morton allegedly received the procedure, did not perform the procedure
    or see anyone perform the procedure, did not see the necessary equipment for the
    procedure, and Prince was not qualified to perform the procedure. As reflected in
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    the testimony of Davis, Hightower, and Romine, Prince’s billing Medicare for
    services she did not perform for Morton and Sanders was consistent with her
    practice of billing services she did not provide to the Calhoun Gardens residents
    that same summer. Thus, the trial testimony established Prince’s pattern of
    fraudulent billing.
    Prince’s pattern of fraudulent billing alone was arguably insufficient to
    support an inference that she submitted false claims as to Morton. However, taken
    together with Sanders’s and Morton’s testimony also supporting an inference that
    Prince never performed the procedure during her visit to the Summerville Housing
    Authority apartment, the evidence was sufficient to support an inference that
    Morton, like Sanders, Davis, Hightower, and Romine, never received the punctum
    plug procedure on the date billed.
    Accordingly, based on the testimony of Sanders, Morton, Dr. Bond, Jones,
    Davis, Hightower, and Romine, a reasonable factfinder could infer that Dr. Llabres
    never performed the procedure on Morton that was billed to Medicare, even though
    Morton was unsure whether the procedure was performed on him and Dr. Llabres
    did not testify.
    Finding no merit in the arguments presented, we affirm the convictions and
    sentences.
    AFFIRMED.
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