United States v. Bikundi ( 2016 )


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  •                               UNITED STATES DISTRICT COURT
    FOR THE DISTRICT OF COLUMBIA
    UNITED STATES OF AMERICA,
    v.                                 Criminal Case No. 14-030 (BAH)
    FLORENCE BIKUNDI,                                        Judge Beryl A. Howell
    MICHAEL D. BIKUNDI, SR.,
    Defendants.
    MEMORANDUM OPINION
    Following their conviction at a jury trial of conspiring to defraud and defrauding the
    District of Columbia Medicaid program, in violation of 
    18 U.S.C. §§ 2
    , 1347 and 1349, and
    conspiring to engage in and engaging in the laundering of monetary instruments, in violation of
    
    18 U.S.C. §§ 2
    , 1956(a)(1)(B)(i), 1956(h), the defendants Florence Bikundi and her spouse,
    Michael D. Bikundi, Sr. (“Michael Bikundi”), filed separately the pending motions for a
    judgment of acquittal or, alternatively, a new trial, under Federal Rules of Criminal Procedure
    29(a) and 33(a), respectively. Michael Bikundi’s Mot. New Trial (“Def. MB’s R. 33 Mot.”),
    ECF No. 391; Michael Bikundi’s Renewed Mot. J. Acquittal (“Def. MB’s R. 29 Mot.”), ECF
    No. 392; Florence Bikundi’s Renewed R. 29 Mot. J. Acquittal (“Def. FB’s R. 29 Mot.”), ECF
    No. 393; Florence Bikundi’s Mot. New Trial (“Def. FB’s R. 33 Mot.”), ECF No. 394. The
    defendants also joined in each other’s motions. See Minute Order (Dec. 15, 2016) (granting
    Florence Bikundi’s motions, ECF Nos. 395, 396, to join and adopt Michael Bikundi’s
    motions); Minute Order (Jan. 6, 2016) (granting Michael Bikundi’s motion, ECF No. 412, to
    1
    join and adopt Florence Bikundi’s motions). For the reasons set forth below, the defendants’
    four motions are denied.
    I.       BACKGROUND
    Ten months after the original indictment was returned against only defendant Florence
    Bikundi, Indictment, ECF No. 1, the government filed a multi-count Superseding Indictment
    against Florence Bikundi, her spouse and co-defendant at trial, Michael Bikundi, and seven
    additional co-defendants, Superseding Indictment, ECF No. 44. 1 Both Florence and Michael
    Bikundi were charged in thirteen counts, with, from about August 2009 to about February 2014,
    conspiring to commit health care fraud and committing health care fraud by, inter alia,
    submitting and causing to be submitted false and fraudulent claims for payment to the D.C.
    Medicaid program, in violation of 
    18 U.S.C. §§ 2
    , 1347, 1349, 
    id.
     ¶¶ 67–75 (Counts One and
    Two); conspiring to commit money laundering and committing money laundering to conceal
    proceeds illegally derived from the health care fraud, in violation of 
    18 U.S.C. §§ 2
    ,
    1956(a)(1)(B)(i), 1956(h), 
    id.
     ¶¶ 83–89 (Counts Fifteen through Twenty-Two); and engaging in
    monetary transactions with proceeds illegally derived from the health care fraud, in violation of
    
    18 U.S.C. §§ 2
    , 1957, 
    id.
     ¶¶ 90–91 (Counts Twenty-Three through Twenty-Five).
    Defendant Florence Bikundi was also charged separately in two counts with committing
    health care fraud by concealing her exclusion from participation in all federal health care
    programs and making other false and fraudulent representations to obtain payments from the
    D.C. Medicaid program, in violation of 
    18 U.S.C. §§ 2
    , 1347, and 42 U.S.C. § 1320a-7b(a)(3).
    1
    Of the seven co-defendants, two remain fugitives (Christian S. Asongcha and Atawan Mundu John) and
    five entered pleas of guilty to Count Two of the Superseding Indictment charging Health Care Fraud, in violation of
    
    18 U.S.C. §§ 2
    , 1347. See Plea Agreement of Elvis Atabe, ECF No. 174; Plea Agreement of Melissa Williams, ECF
    No. 186; Plea Agreement of Carlson Igwacho, ECF No. 179; Plea Agreement of Irene Igwacho, ECF No. 163; Plea
    Agreement of Berenice Igwacho, ECF No. 240. A sixth cooperating defendant entered a plea in a separate case.
    See United States v. White, No. 14-cr-216, Plea Agreement of Nicola White, ECF No. 8.
    2
    
    Id.
     ¶¶ 78–82 (Counts Thirteen and Fourteen, respectively). The latter two charges were based on
    allegations that Florence Bikundi, a former licensed practical nurse, 
    id. ¶¶ 36, 38
    , was excluded
    in April 2000 by the United States Department of Health and Human Services Office of
    Inspector General (“HHS-OIG”) from participating in all federal health care programs, and
    thereby “prohibited . . . from submitting or causing the submission of claims to, and receiving
    funds from, Federal health care programs such as Medicaid,” 
    id. ¶ 45
    . Despite her exclusion,
    Florence Bikundi allegedly “was a director, administrator, officer, and primary
    owner/stockholder of” Flo-Diamond, Inc. (“Flo-Diamond”) and Global Healthcare, Inc.
    (“Global”), which between July 2007 and December 2014, received over $78 million in
    payments from Medicaid programs. 
    Id. ¶ 20
    .2
    Following extensive motions practice, the case proceeded to trial against Florence and
    Michael Bikundi on October 13, 2015. 3 Over the course of the month-long trial, the jury was
    2
    The Court ruled that the government would be permitted to use at trial for impeachment purposes, under
    Federal Rule of Evidence 609(a)(2), Florence Bikundi’s conviction of Personal Identifying Information Theft upon
    her plea of guilty in May 2003 in the Circuit Court of Maryland for Baltimore City, for which conviction she was
    sentenced to one year imprisonment. See Minute Order (Sept. 18, 2015). The factual basis for this conviction was
    that the defendant fraudulently used the personal identification information and Maryland Registered Nurse license
    of a long-time acquaintance, without her consent, unlawfully to obtain employment as a registered nurse (“RN”)
    through at least three nursing staff agencies. See Gov’t Notice, Ex. A, ECF No. 247-1. The government did not
    seek to use the defendant’s two prior convictions for Theft of Property with less than $300.00 Value in District
    Court for Montgomery County, or for Practicing Nursing without a License in Prince George’s County Circuit Court
    in 1998 and 2002, respectively. See Gov’t Notice at 5 n.2, ECF No. 247. The record is not entirely clear whether
    the defendant’s 1998 Maryland conviction prompted the revocation of her licensed practical nurse (“LPN”) license
    in Virginia on August 4, 1999, see Gov’t Exs. 103, 104, but the Virginia revocation led to her indefinite exclusion
    by HHS-OIG from participation in federal health care programs, see Gov’t Ex. 108.
    3
    Prior to trial, the Court resolved, inter alia, the following motions: (1) granting (a) the United States’
    Motion to Disqualify Sheryl Wood as Counsel for Michael Bikundi, ECF No. 78; (b) the United States’ Request for
    Defendants to Provide Notice Whether They Intend to Seek Jury Determination on Forfeitability of Specific
    Property, ECF Nos. 198, 213; (c) the United States’ Motion to Permit a Designated Law Enforcement Agent to be
    Present at Counsel Table During Trial, ECF No. 259, as conceded; (d) the United States’ Motion to Forego Certain
    Redactions in its Filings, ECF No. 260, as conceded; and (e) the United States’ Notice of Intent to Use Defendant’s
    Conviction for Identity Theft as Impeachment Evidence, ECF No. 247; (2) denying (a) Michael Bikundi’s First
    Motion to Sever His Case From Florence Bikundi Based Upon Disparity of Evidence, ECF No. 155; (b) Michael
    Bikundi’s Motion to Sever Counts in the Indictment, ECF No. 208; (c) Florence Bikundi’s Motion to Dismiss
    Indictment and/or Pretrial Release for Violation of her Statutory and Constitutional Rights to Speedy Trial, ECF No.
    211; (d) Florence Bikundi’s Motion for Immediate Production of Brady Material, ECF No. 201; (e) Florence
    Bikundi’s Motion to Strike Surplusage or in the Alternative to Preclude the Government From Introducing Evidence
    at Trial, ECF No. 209, without prejudice to renew; (f) the United States’ Motion in Limine to Preclude the
    3
    presented with over three hundred exhibits and heard from forty witnesses, three of whom were
    called by the defendants. 4 Among the witnesses were local and federal officials responsible for
    administering federal health care programs, the D.C. Medicaid program, and the licensing of
    home care agencies (“HCAs”) and nurses; cooperating witnesses and co-defendants, who were
    formerly employed at Global, which was owned and managed by Florence and Michael Bikundi;
    beneficiaries of the D.C. Medicaid program, who received personal care services through Global
    and admitted to receiving regular kickback payments from Global employees to certify
    timesheets of personal care aids (“PCAs”) that falsely indicated the number of hours worked by
    the PCAs; and Special Agents of the various law enforcement agencies that participated in the
    execution of search warrants on Global’s office and defendants’ homes and the analysis of seized
    records. The voluminous trial evidence is only briefly summarized below as necessary to assess
    the defendants’ pending motions challenging the sufficiency of the evidence and provide context
    for review of the challenged rulings before and during trial.
    A.       OVERVIEW OF REGULATORY REQUIREMENTS FOR D.C.
    MEDICAID AND HOME PERSONAL CARE AIDS
    Medicaid is a health insurance program administered at the federal level by the Centers
    for Medicare and Medicaid Services, an agency within HHS, and by each individual state. Trial
    Defendants From Arguing That the Government Targeted Family Members & From Commenting on the Status of
    Co-Defendants Christian Asongcha & Atawan Mundu John, ECF No. 274; (g) the United States’ Motion to Forego
    Redaction to Exhibit, ECF No. 275, with instructions to redact the child’s name; and (h) the United States’ Motion
    in Limine to Exclude Defendant’s Proposed Experts From Trial, ECF No. 277; and (3) granting in part and denying
    in part (a) the United States’ Motion to Admit Other Crimes Evidence Pursuant to Federal Rule of Evidence 404(b),
    ECF No. 206; (b) the United States’ Motion In Limine for Willful Blindness Instruction to Counts Thirteen &
    Fourteen & Permission for the Government to Refer to Willful Blindness in its Opening Statement When Discussing
    These Counts, ECF No. 205; and (c) Michael Bikundi’s Motion to Partially Vacate the Seizure Warrant & to Permit
    Use of a Portion of Funds From Seized Bank Accounts for Purposes of Household Necessities, & Request for a
    Pretrial Evidentiary Hearing, ECF No. 149. See Minute Order (July 31, 2015); Minute Order (Sept. 18, 2015);
    United States v. Bikundi, 
    80 F. Supp. 3d 9
     (D.D.C. 2015); United States v. Bikundi, No. 14-cr-030, 
    2015 U.S. Dist. LEXIS 136768
     (D.D.C. Oct. 7, 2015); United States v. Bikundi, No. 14-cr-030, 
    2015 U.S. Dist. LEXIS 114181
    (D.D.C. Aug. 28, 2015).
    4
    To be exact, 297 government exhibits were admitted and fifteen defense exhibits. The pending defense
    motions challenge the admission of a single government exhibit.
    4
    Tr. (“Tr.”) (Oct. 15, 2015 PM) at 96–97 (Test. of Donald Shearer), ECF No. 309.5 In the District
    of Columbia, D.C. Medicaid is jointly funded by the federal and District of Columbia
    governments and administered by the D.C. Department of Health Care Finance (“DHCF”). 
    Id. at 69
    ; Tr. (Oct. 15, 2015 AM) at 4–5 (Shearer), ECF No. 310; Tr. (Nov. 4, 2015 PM) at 37 (Test. of
    Paul Toulouse), ECF No. 345. D.C. Medicaid provides health insurance coverage to
    beneficiaries, who are D.C. residents with incomes that fall below a certain financial threshold.
    Tr. (Oct. 15, 2015 AM) at 5 (Shearer), ECF No. 310. D.C. Medicaid is a “‘health care benefit
    program’ as defined in 
    18 U.S.C. § 24
    (b),” Superseding Indictment ¶ 1, and a “‘Federal health
    care program’ as defined in 42 USC § 1320a-7b(f),” id. See Tr. (Oct. 15, 2015 AM) at 5–6
    (Shearer), ECF No. 310.
    D.C.’s Department of Health (“DOH”), Health Regulation and Licensing Authority
    (“HRLA”) licenses HCAs in the District of Columbia to provide home care services, including
    personal care services, to D.C. Medicaid beneficiaries. Id. at 12–13; Tr. (Oct. 16, 2015 AM) at
    46 (Test. of Sharon Mebane), ECF No. 311. To become licensed, an HCA must submit a
    provider enrollment application and an executed provider agreement to HRLA to obtain a unique
    D.C. Medicaid provider number as an identifier for billing purposes. See Tr. (Oct. 15, 2015 AM)
    at 6–14, 22–24 (Shearer), ECF No. 310; Tr. (Oct. 15, 2015 PM) at 5–8 (Shearer), ECF No. 309.
    As part of the review of the application, DHCF checks that no individual holding a five percent
    or greater ownership with the applicant company has been excluded from participation in any
    federal health care program by comparing the names of affiliated individuals to an “Exclusion
    List” maintained by HHS-OIG. Tr. (Oct. 15, 2015 AM) at 7–10 (Shearer). Licensed HCAs are
    5
    For ease of reference, the name of the witness whose testimony is cited as well as docket numbers for trial
    transcripts are provided throughout the opinion since these transcripts are numerous and not docketed in
    chronological order.
    5
    subject to audits or annual licensure surveys to ensure that the company is operating within the
    rules and regulations of the District. Id. at 18; Tr. (Oct. 16, 2015 AM) at 46, 49–50 (Mebane),
    ECF No. 311.
    PCAs employed by HCAs assist D.C. Medicaid beneficiaries in performing activities of
    daily living (“ADLs”), which are defined to include the ability to get in and out of bed, bathe,
    dress, eat, take medication prescribed for self-administration, and engage in toileting. Tr. (Oct.
    15, 2015 AM) at 14, 18 (Shearer), ECF No. 310. To qualify for personal care services covered
    by D.C. Medicaid, a beneficiary must obtain a prescription from a licensed physician who has
    determined after a physical examination that the beneficiary has functional limitations in one or
    more ADLs, and that the medical, nursing, and social needs of the beneficiary could be
    adequately and safely met in the beneficiary’s home. Id. at 17; Tr. (Oct. 16, 2015 AM) at 47
    (Mebane), ECF No. 311. The prescription is then presented by the beneficiary to an HCA, which
    assigns a PCA to the beneficiary and arranges for a registered nurse to conduct an assessment of
    the beneficiary’s functional status and needs in order to prepare a plan of care (“POC”) that is
    tailored to address the individual needs of the beneficiary. Tr. (Oct. 15, 2015 AM) at 16–17
    (Shearer), ECF No. 310; Tr. (Oct. 16, 2015 AM) at 47–48 (Mebane), ECF No. 311. Approval of
    the POC by a physician or advanced practice registered nurse is supposed to occur within thirty
    days after the start of personal care services being provided and must be recertified by the
    prescribing physician or advanced practice registered nurse at least once every six months
    thereafter. See Tr. (Oct. 15, 2015 PM) at 12, 16–19 (Shearer), ECF No. 309; see also Tr. (Oct.
    21, 2015 AM) at 123 (Test. of Elvis Atabe), ECF No. 318; Tr. (Oct. 16, 2015 PM) at 81 (Test. of
    James Mbide), ECF No. 312. Generally, at least once every 30 days, a nurse is required to visit
    the patient at home to determine if the patient is receiving the requisite services and to confer
    6
    with the PCA to ensure that the required services are delivered competently. Tr. (Oct. 16, 2015
    AM) at 48 (Mebane), ECF No. 311.
    The PCAs providing personal care services to D.C. Medicaid beneficiaries in the
    beneficiary’s home are required to document the services provided and the amount of time spent
    with the beneficiary on a timesheet submitted to the HCA. Tr. (Oct. 15, 2015 AM) at 14
    (Shearer), ECF No. 310. The timesheet is required to be signed by both the PCA and the
    beneficiary to certify that personal care services were provided as reflected on the timesheet.
    See Tr. (Oct. 16, 2015 AM) at 7–8 (Shearer), ECF No. 311; Tr. (Oct. 16, 2015 AM) at 69
    (Mebane), ECF No. 311. The HCA uses these certified timesheets to submit claims to D.C.
    Medicaid for payment. Tr. (Oct. 22, 2015 PM) at 78 (Test. of Edward Mokam), ECF No. 320
    (testifying that he submitted claims to D.C. Medicaid on Global’s behalf based on “timesheets
    that they have given me and I assume that the timesheets are correct”). Personal care services
    are billed in 15 minute increments, with each increment representing one unit of service. Tr.
    (Oct. 15, 2015 AM) at 15 (Shearer), ECF No. 310. D.C. Medicaid authorizes a maximum of 32
    units (or 8 hours) of personal care services per beneficiary per day, and a maximum of 64 units
    (or 16 hours) of personal care services per beneficiary per day for beneficiaries who qualify for
    the Elderly and Individuals with Physical Disabilities (“EPD”) waiver. Id. at 34–35, 38. Federal
    law prohibits HCAs and PCAs from paying money to beneficiaries to either recruit or retain
    them. Tr. (Oct. 16, 2015 AM at 37 (Shearer), ECF No. 311.
    B.      EXCLUSION OF FLORENCE BIKUNDI
    The defendant Florence Bikundi obtained nursing licenses from Virginia and other
    jurisdictions, including Washington, D.C., under her maiden name, “Florence Igwacho,” and the
    revocation of her Virginia licenses led to her exclusion from participation in any federal health
    7
    care program. 6 Specifically, by letter dated June 22, 1999, the Virginia Board of Nursing
    notified Florence Bikundi (at the time “Florence Igwacho”) of a hearing regarding the revocation
    of her licensed practical nurse (“LPN”) license from the Commonwealth of Virginia. Tr. (Oct.
    26, 2015 PM) at 10–11 (Test. of Nancy Durrett), ECF No. 327; Gov’t Ex. 101. This letter was
    sent to the defendant’s address at 9127 Edmonton Terrace, #304, Greenbelt, Maryland
    (“Greenbelt address”). Gov’t Ex. 101. Subsequently, on August 4, 1999, the order revoking the
    defendant’s LPN license was sent to the same Greenbelt address and required return of her
    license. Tr. (Oct. 26, 2015 PM) at 12 (Durrett), ECF No. 327; Gov’t Ex. 104. The defendant
    complied with the order and returned her license in a letter received by the Virginia Board of
    Nursing on October 12, 1999. Tr. (Oct. 26, 2015 PM) at 13–14 (Durrett), ECF No. 327; Gov’t
    Ex. 102. The return address of the defendant’s letter enclosing her license was the same
    Greenbelt address. Id. Florence Bikundi applied to reinstate her license in 2004, but the
    Virginia Board of Nursing denied this request in December 2004. Tr. (Oct. 26, 2015 PM) at 16
    (Durrett), ECF No. 327.
    HHS-OIG received notice of Virginia’s revocation of Florence Bikundi’s LPN license on
    September 2, 1999. Tr. (Oct. 26, 2015 PM) at 23–24 (Test. of Teresa Hoffman), ECF No. 327.
    On September 7, 1999, Teresa Hoffman, an HHS-OIG investigations analyst, sent a letter to
    “Florence Igwacho” at the same Greenbelt address used by the Virginia Board of Nursing. Id. at
    26; Gov’t Ex. 106. The HHS-OIG letter required the defendant to respond within 30 days. Tr.
    (Oct. 26, 2015 PM) at 29 (Hoffman); Gov’t Ex. 106. Florence Bikundi did, in fact, respond to
    6
    For example, the District of Columbia issued an LPN license to Florence Bikundi in the name of “Florence
    Igwacho” in November 2002, and an RN license to her in the name of “Florence I. Ngwe” in September 2003. Tr.
    (Nov. 2, 2015 PM) at 38–39 (Test. of Karen Scipio-Skinner), ECF No. 340. Both of these licenses were revoked in
    May 2005 and have not been reinstated. Id.
    8
    HHS-OIG in a letter, received by HHS on October 8, 1999, that used the same Greenbelt
    address. Gov’t Ex. 107. In her response, the defendant requested that she be afforded additional
    time to obtain an attorney and asked that she be informed of HHS’ decision. Id. Hoffman
    testified that she attempted to call the defendant several times to discuss the requested extension,
    but her calls were never returned. Tr. (Oct. 26, 2015 PM) at 29 (Hoffman), ECF No. 327.
    Consequently, Hoffman proceeded with the exclusion process, which culminated in a letter sent
    on March 31, 2000, to Florence Igwacho notifying her of her exclusion. Id. at 31–33; Gov’t Ex.
    108. The letter was sent via U.S. Mail to the same Greenbelt address that the defendant used in
    her letter requesting additional time to respond. Tr. (Oct. 26, 2015 PM) at 31–33 (Hoffman),
    ECF No. 327.7 The letter was never returned to HHS as undeliverable. Id. at 33.
    As a result, Florence Bikundi is excluded from participation in Medicare, Medicaid, and
    all federal health care programs, as defined in 42 USC § 1320a-7b(f). Tr. (Oct. 26, 2015 PM) at
    22, 32 (Hoffman), ECF No. 327. Persons “excluded” from federal health care programs cannot
    be an administrator, director, or officer of any Medicaid provider. Id. at 19. An excluded person
    may be an owner of a Medicaid provider, provided that he or she hold no more than a five
    percent interest and are not involved in the day-to-day operations of the company. Id. HHS-OIG
    makes publicly available the names of excluded individuals in an online database, which has
    been available since March 1999. Tr. (Oct. 26, 2015) at 51, 56 (Test. of Joanne Francis), ECF
    No. 327. In addition, from 1993 until December 2006, the agency published the names of
    excluded persons in the Federal Register. Id. at 53, 56, 61.
    7
    An attorney at HHS-OIG testified that certified mail was not required to be used for sending the notice of
    exclusion that applied to Florence Bikundi and that the practice of HHS-OIG is to use regular mail to send such
    notices. Tr. (Nov. 4, 2015 AM) at 128–29, 139 (Test. of Susan Gillin), ECF No. 344.
    9
    C.      GLOBAL’S CREATION AND OPERATIONAL PROBLEMS
    In June 2009, Florence Bikundi, using the name “Florence Bikundi,” which was not the
    name under which she had been excluded by HHS-OIG and, timing-wise, was several months
    prior to her legal marriage to Michael Bikundi, see Gov’t Ex. 27 at 3 (Florence and Michael
    Bikundi’s Virginia marriage certificate, dated September 5, 2009), submitted a D.C. Medicaid
    provider application on behalf of Global to DHCF, along with a D.C. Medicaid provider
    agreement, see Gov’t Ex. 1; Tr. (Oct. 29, 2015 AM) at 65 (Test. of Ernest Igwacho), ECF No.
    332 (Florence Bikundi’s brother identifying handwriting as that of Florence Bikundi). As part of
    the application, Global was required to identify all individuals “having direct or indirect
    ownership or controlling interest” in the company, but none were listed. Gov’t Ex. 1. The
    application and agreement were purportedly signed by “James Mbide” as Global’s authorized
    representative, and contained other signatures of “individuals responsible to enforce compliance
    with these conditions,” including the purported signatures of “James Mbide,” “Dr. Ernest
    Igwacho,” and “Nicola White.” Id. These three individuals testified at trial that they did not sign
    and did not authorize anyone to sign their names on this document, and were unaware that their
    names had been used on this application until so advised by law enforcement agents in the course
    of the investigation. Tr. (Oct. 16, 2015 PM) at 95–96 (Mbide), ECF No. 312; Tr. (Oct. 29, 2015
    AM) at 65–67 (Ernest Igwacho), ECF No. 332; Tr. (Oct. 20, 2015 PM) at 37–38 (Test. of Nicola
    White), ECF No. 316.
    Donald Shearer, as the Director of Health Care Operations at DHCF approved the D.C.
    Medicaid provider application and executed the D.C. Medicaid provider agreement on behalf of
    D.C. Medicaid, effective on August 13, 2009, and Global was assigned a D.C. Medicaid provider
    number to submit claims for PCA services. Tr. (Oct. 15, 2015 PM) at 89 (Shearer), ECF No.
    10
    309. Shearer testified that had he known that the signatures on the agreement were forged, he
    would not have approved the Global provider agreement. Id. at 7–8. Similarly, Sharon Mebane,
    a HRLA program manager, testified that if, during Global’s initial licensing application, DOH
    had learned or knew that the administrator, president or director of Global had been an excluded
    person, “we would recommend that that entity not be licensed.” Tr. (Oct. 16, 2015 AM) at 40,
    73 (Mebane), ECF No. 311.
    Global’s difficulties in complying with requirements to maintain its HCA license were
    noted by regulators conducting licensure surveys almost at the outset of its business operations
    and continuously thereafter. These surveys were critical to the continued operation of Global,
    and one former employee testified that Florence Bikundi “was always there during surveys.” Tr.
    (Oct. 22, 2015 AM) at 48 (Atabe), ECF No. 319. During HRLA’s first annual survey of Global,
    which took place from December 1 through 7, 2010, the HRLA surveyors noted major
    deficiencies in Global’s record-keeping, its policies and procedures, and its employee and patient
    files, including, for example, evidence that Global was missing complete background checks and
    health certificates for employees and that patient services were not being provided consistent
    with POCs. Tr. (Oct. 16, 2015 AM) at 57–63, 65–66, 70 (Mebane), ECF No. 311; Tr. (Oct. 22,
    2015 PM) at 18–19 (Test. of Roland Follot), ECF No. 320; Gov’t Ex. 22.
    In follow-up surveys conducted in February and September 2011, persistent significant
    record-keeping deficiencies were reported by surveyors. Gov’t Exs. 23, 24. Roland Follot, a
    HRLA surveyor who participated in these two follow-up surveys, testified about the changing
    information provided to him in response to his questions. For example, during the February
    2011 survey, Follot was given conflicting information by both defendants about the role of
    James Mbide: Michael Bikundi told Follot that Mbide was a “director,” who had been out for
    11
    six months, while Florence Bikundi said that Mbide was ill and had been working up until the
    last week. Tr. (Oct. 22, 2015 PM) at 19–22 (Follot), ECF No. 320. Follot testified that Mbide’s
    role “was hard to determine. I—I would get different answers on different days and I was
    referring to different documents.” Id. at 23. Unbeknownst to Follot, Michael Bikundi had fired
    Mbide several months prior to the survey, “towards the end of 2010.” Tr. (Oct. 16, 2015 PM) at
    105 (Mbide), ECF No. 312; Tr. (Oct. 19, 2015 AM) at 23 (Mbide), ECF No. 314.
    Also, on the first day of the survey, February 14, 2011, Follot met Florence Bikundi at
    Global’s office and she avoided answering his question about her title, while Michael Bikundi
    introduced himself as “just the president.” Tr. (Oct. 22, 2015 PM) at 11–13, 15 (Follot), ECF
    No. 320. When Follot asked Florence Bikundi for her personnel file, she responded that she did
    not have one, id. at 15–16, but the following day told Follet that Global employee Elke Johnson
    had “shredded her file on the day before,” id. at 16, 27–28. Indeed, Elke Johnson confirmed
    during her testimony that, during a survey, Michael Bikundi handed Florence Bikundi’s
    personnel file containing “her driver’s license, it had her passport and her Social Security,” to
    Johnson and instructed her to shred it, without explaining why, and Johnson complied with this
    instruction. Tr. (Oct. 20, 2015 AM) at 55–58 (Test. of Elke Johnson), ECF No. 315. Any one of
    those credentials in Florence Bikundi’s personnel file may have reflected her maiden name,
    under which she had been excluded by HHS-OIG.
    Additionally, Follot sought, as part of the February 2011 survey, to review board of
    director minutes in order to assess Global’s compliance with “the plan of correction for the
    December survey,” in which Global had been “cited . . . for various policy issues for which the
    board of directors was responsible.” Tr. (Oct. 22, 2015 PM) at 25 (Follot), ECF No. 320.
    Florence Bikundi told Follot that the board of directors had met since the December 2010 survey
    12
    and, variously, that Nicola White or James Mbide had taken notes at the meeting. Id. at 24, 29.
    After two days of asking for the minutes, White finally handed the purported board minutes to
    the surveyors. Id. at 26. Although Follot was unaware at the time, those board minutes were
    fabricated. Global’s board of directors meeting minutes, dated January 8, 2010 and January 28,
    2011, show “Nicola White” as the “Recording Secretary,” and the latter minutes further indicate
    that White was present at the meeting. Gov’t Exs. 270, 271. White testified, however, that she
    had never been asked to join the board, was not the recording secretary and had never attended a
    Global board meeting. Tr. (Oct. 20, 2015 PM) at 41–44 (White), ECF No. 316. Moreover,
    White was not familiar with the names listed for several other board members purportedly
    present at the same meeting with her. Id. She admitted to signing the January 28, 2011 minutes
    at the instructions of Florence Bikundi, id. at 43, but denied that she had signed her name on
    subsequent board minutes that nevertheless reflected her purported signature, id. at 46–48, 50.
    Similarly, James Mbide, whose attendance at board meetings is noted on certain board minutes
    reflecting his purported signature, denied that he was ever a member of the Global board,
    attended any board meetings or signed any minutes. Tr. (Oct. 19, 2015 AM) at 23–26 (Mbide),
    ECF No. 314; Gov’t Exs. 271, 272.
    A follow-up survey scheduled for August 30, 3011 had to be “aborted” because Global
    employees advised that the requested files were not available. Gov’t Ex. 26; Tr. (Oct. 22, 2015
    AM) at 101–02 (Test. of Theresa Waters), ECF No. 319.
    At the next follow-up survey in September 2011, Follot issued a notice of infraction,
    which was sent to Michael Bikundi, due to continuing major deficiencies related to missing
    health certificates for employees, and a missing comprehensive background check in one of the
    sampled employee files. Tr. (Oct. 22, 2015 PM) at 44–48 (Follot), ECF No. 320; Gov’t Ex. 18.
    13
    The surveyors observed that it took a noticeably long time for the Global employees to provide
    the files randomly selected by the surveyors to review. Id. at 41–42 (Follot); Tr. (Oct. 22, 2015
    AM) at 102 (Waters), ECF No. 319. The explanation for the delay was revealed by former
    Global employees who testified about the flurry of document alterations underway even when
    the surveyors were present in other parts of Global’s offices.
    D.      FALSIFICATION OF GLOBAL PATIENT AND EMPLOYEE RECORDS
    In addition to forged signatures on Global’s Medicaid application and agreement and the
    fraudulent Global board of directors minutes presented to HRLA surveyors, each of the
    cooperating Global employees, six of whom entered guilty pleas in connection with this case, see
    supra n.1, testified about the rampant falsification of patient and employee records at Global in
    order to avoid Medicaid licensure issues for the company during surveys and to ensure
    reimbursement from D.C. Medicaid. The falsified documents for patients included POCs,
    recertifications for POCs, nursing notes and, as discussed in more detail infra in Part I.E, PCA
    timesheets. The falsified documents for Global employees included key records in PCA
    personnel files, such as health certificates, training certificates, and background checks. Further,
    these witnesses detailed the intimate involvement of both Florence and Michael Bikundi in
    falsifying records to facilitate this fraud scheme.
    1.      James Mbide
    James Mbide is a registered nurse (“RN”) and was identified as Global’s Director of
    Nursing on Global’s Medicaid provider application. Gov’t Ex. 1. He was hired for that position
    by Florence Bikundi in late 2009. Tr. (Oct.16, 2015 PM) at 89–90 (Mbide), ECF No. 312. He
    had met Florence Bikundi earlier in 2009, when she was using her maiden name, Florence
    Igwacho, and operating Flo-Diamond in Maryland. Id. Sometime after the defendants got
    14
    married, Michael Bikundi became Global’s CEO, id. at 101, and Mbide continued to work full-
    time as Global’s Director of Nursing until Michael Bikundi dismissed him at the end of 2010, id.
    at 105, at which point Mbide continued to provide services to Global through his own staffing
    agency, Eban Health Service (“Eban”), id. at 106. At Florence Bikundi’s request, in the summer
    of 2012, Mbide returned to work part-time, two days per week as Global’s Director of Nursing.
    Id. at 103–06.
    Mbide testified about his own and others’ activity during his tenure at Global in falsifying
    records for patient files in order to appear compliant for surveys “[s]o that the company will not
    be charged to do reimbursement.” Id. at 83. If Mbide was not in the Global office when the
    surveyors arrived, either Florence or Michael Bikundi would call Mbide to come to Global’s
    offices to assist by creating missing nurse notes to say that a nurse visit was done, even when it
    was not, and to recertify a patient’s continuing need for PCA services. Id. at 80–84; see also Tr.
    (Oct. 19, 2015 AM) at 12–15 (Mbide), ECF No. 314. Mbide testified that Florence Bikundi
    offered and paid Mbide $15 per false recertification and nurse note. Tr. (Oct. 16, 2015 PM) at
    81–83 (Mbide), ECF No. 312; Tr. (Oct. 19, 2015 PM) at 49 (Mbide), ECF No. 313. Florence
    Bikundi also instructed Mbide that when he created fake nurse notes for patients whom he had
    not actually visited, he was supposed to write down that the PCA was present, because this was a
    Medicaid requirement. Tr. (Oct. 16, 2015 PM) at 84–85 (Mbide), ECF No. 312; Tr. (Oct. 19,
    2015 AM) at 19–20 (Mbide), ECF No. 314. Mbide testified that Florence Bikundi assisted in the
    creation of fake nurse notes, and sat at a table with him and other Global nurses to create fake
    nurse notes for visits that did not take place. Tr. (Oct. 19, 2015 AM) at 13–14 (Mbide), ECF No.
    314.
    15
    Mbide confirmed that Michael Bikundi was present when he and other Global nurses
    were creating nurse notes in preparation for surveys. Id. at 14–15. Either of the defendants
    “would go through charts. If they found out there was a hole in the charts . . . he would give it to
    me or to anybody around to do the notes.” Tr. (Oct. 16, 2015 PM) at 84 (Mbide), ECF No. 312.
    In one instance, Mbide testified that, after Michael Bikundi told him that $3,000 had been
    returned to Medicaid due to a lapsed POC for a patient funneled to Global through Eban, Mbide
    observed Elvis Atabe creating counterfeit documents by “cutting and pasting” and backdating
    POCs for the same patient. Tr. (Oct. 19, 2015 AM) at 31–32 (Mbide), ECF No. 314. Elvis
    Atabe informed Mbide that Michael Bikundi had given him the patient’s file “to . . . cut and
    paste” and backdate. Id. at 32.
    In addition to fake nurse notes, Mbide testified about the falsification of other Global
    records in employee files, including annual physicals and CPR certificates for nurses and PCAs,
    to make the documents appear current, which was a Medicaid requirement for those who had
    patient contact. Id. at 33–35.
    Mbide recounted a conversation with Michael Bikundi about how the Global business
    was to be operated. At a meeting with Michael Bikundi and another Global employee, Mbide
    advised that some Medicaid beneficiaries “appeared not to be qualified to receive personal care
    services” because they were “able-bodied,” and that they needed to be discharged. Id. at 21–22.
    Mbide testified that he asked Michael Bikundi, “Give me the authority. Let me go out there, and
    let me do a reassessment so that we can begin to discharge some of the patients.” Id. at 22. In
    response, Michael Bikundi asked Mbide “to put a business hat on [his] head,” which Mbide
    understood to mean “I’m here to make money, don’t interrupt.” Id. Thereafter, Mbide never
    16
    complained to Michael Bikundi again because Michael Bikundi had “established what he
    want[ed] to do for his business.” Id.
    2.     Elvis Atabe
    In April 2011, Elvis Atabe applied to work at Global. Tr. (Oct. 21, 2015 AM) at 109–10
    (Atabe), ECF No. 318. On the day of his interview, James Mbide introduced Atabe to Florence
    Bikundi, who then sent him to be interviewed by Michael Bikundi, who actually hired him. Id.
    at 111–12. Atabe started work at Global about a week later and was advised by Florence
    Bikundi that he would be doing quality assurance. Id. at 113–14. Atabe shared an office with
    Florence Bikundi. Id. at 114. A few days after he started at Global, Atabe “was introduced to
    the various things like wiping out, changing signatures on the computer, and all that.” Tr. (Oct.
    21, 2015 PM) at 94–95 (Atabe), ECF No. 317. Atabe testified that when he found discrepancies
    in patient folders given to him by Florence Bikundi to review, Florence Bikundi showed him
    what he was “supposed to do.” Tr. (Oct. 21, 2015 AM) at 114–15 (Atabe), ECF No. 318.
    Florence Bikundi explained that if a POC did not conform to the 30-day period required by
    Medicaid, he was to use white-out to alter the dates to make sure the dates conform to
    Medicaid’s requirements. Id. In his presence, Florence Bikundi used white-out to alter patient
    files. See id. at 115–16. Afterwards, Nicola White showed Atabe how to erase a signature on a
    computer and put in another signature, although Atabe told Nicola White that he was not very
    good with the computer. Id. at 116. Atabe testified that, at times, he sat with Florence Bikundi
    and Irene Igwacho—one of Florence Bikundi’s sisters—“in that little office” to try to figure out
    ways to better alter the documents. Id. at 119. Atabe and Florence Bikundi sat side by side, with
    their chairs “rubbing each other” while they created fake documents. Id. at 120. Irene Igwacho,
    Nicola White, and Eveline Takang assisted in creating fake documents too. Id. at 120–21.
    17
    According to Atabe, Global had so many charts, that when surveyors were coming, one
    person could not do the job of fixing the charts, “it was like a [sic] teamwork.” Id. at 121. Atabe
    further testified that POCs mailed to Global’s offices were delivered to Michael Bikundi and, if
    the dates “were not good enough,” Michael Bikundi directed Atabe to alter the dates. Id. at 125.
    Atabe testified that the “whole system was bad in Global.” Tr. (Oct. 21, 2105 PM) at 25
    (Atabe), ECF No. 317. Office workers participated in the fraudulent scheme at various levels.
    Id. at 25–26. Elke Johnson altered personnel files and Eveline Takang created false nurse visit
    notes. Id. at 26–28. Atabe created cut-outs of doctors’ signatures that were used by nurses to do
    corrections on the POCs that were not signed with compliant dates. Id. at 31; Gov. Ex. 413. The
    use of cut-outs was kept a secret from the surveyors. Tr. (Oct. 21, 2105 PM) at 32 (Atabe), ECF
    No. 317. Michael Bikundi knew that Global employees were using the cut-outs “because he
    used to come and oversee sometimes what we are doing.” Id. at 32–33. Florence Bikundi knew
    that Atabe used the cut-outs to alter documents because he did it “right in front of her.” Id. at 33.
    Atabe further stated that Irene Igwacho, Nicola White and Chris Asongcha knew that Global was
    using the cut-outs because “we were doing it together.” Id. During surveys, while surveyors
    were in another part of the office, Atabe and other Global employees, including Irene Igwacho,
    James Mbide, Eveline Takang and Vanessa Sona sat in the chart room, where patient files were
    maintained, and created fake documents, such as nurse visit notes, to help Global pass the
    surveys. Id. at 57–58. Michael Bikundi knew that the Global employees were in the chart room
    altering documents while the surveyors were in the other room waiting for the files because
    “once in a while” he would walk around to check on the progress. Id. at 84.
    18
    3.      Elke Johnson
    Elke Johnson, who is an undocumented immigrant, started working for Florence Bikundi
    at Flo-Diamond in 2005, before working at Global as the HR Coordinator. Tr. (Oct. 19, 2015
    PM) at 139–41 (Johnson), ECF No. 313; Tr. (Oct. 20, 2015 AM) Tr. at 8, 14, 85 (Johnson), ECF
    No. 315. Johnson testified that Florence Bikundi and Michael Bikundi hired as PCAs other
    undocumented immigrants, who used fake credentials that actually belonged to people
    authorized to work in this country, and who were paid less than documented workers. Tr. (Oct.
    20, 2015 AM) at 14–18 (Johnson), ECF No. 315. Background checks for undocumented PCAs
    were performed using the credentials of the assumed identity, not the actual PCA. Id. In
    preparation for surveys, both Florence and Michael Bikundi directed Johnson to make sure that
    she altered expired dates on any CPR or physical examinations in employee files so that Global
    would not be cited by the surveyors since such citations could result in a fine of as much as $500
    per employee file. Id. at 51–53. To alter the dates, Johnson “would Wite-Out the current date,
    make a photocopy, then put a present date to make it look like it’s valid, and then make another
    copy and put it in the file.” Id.; see also id. at 86–87. In preparation for surveys, Johnson
    observed Irene Igwacho altering dates on POCs, id. at 53–54, 88, and testified that Michael
    Bikundi told the employees “to get everything in order, do whatever it takes to make them right”
    because he did not “want to be cited,” id. at 55.
    4.      Nicola White
    Nicola White began working for Florence and Michael Bikundi at Flo-Diamond in 2006,
    when Elke Johnson worked there, and both White and Johnson continued working for the
    defendants at Global. Tr. (Oct. 20, 2015 PM) at 25–28, 34 (White), ECF No. 316. White was an
    administrative assistant at Global responsible for collecting the employees’ timesheets, preparing
    19
    their checks and putting the checks together with the timesheets to present to the Bikundi’s for
    approval and signature. Id. at 50. She testified that when the Medicaid surveyors were expected,
    Florence Bikundi told her “to actually fix the POC” and alter any dates that were out of
    compliance. Id. at 70–72. She would also change doctors’ signatures on POCs by cutting and
    pasting doctors’ signatures onto POCs, so that they would appear to have been approved by the
    doctors. Id. at 73.
    White testified that she heard “an argument” between Florence and Michael Bikundi,
    during which Michael Bikundi complained that White’s “cut and paste” jobs on the computer did
    not look “real enough.” Id. at 73–74. In an effort to improve the apparent authenticity of the
    fake documents, Florence Bikundi would take the forged POCs and fax them to one of Flo-
    Diamond’s offices and have them faxed back to her so that the POCs would look “more real.”
    Id. at 74–75. On another occasion, Florence Bikundi told White that “Mr. Michael Bikundi
    saying that the documents that -- you know, the way how I’m doing it, it doesn’t even look real
    enough because of whenever I do the signature, it appear bigger than what the original signature
    looked like.” Id. at 75. After that, Elvis Atabe took over the task of altering doctors’ signatures
    on POCs. Id. at 75–76. Michael Bikundi instructed White to order all of the supplies that Atabe
    needed, such as white-out and different pens to perform this document alteration task. Id.
    In addition to altering POCs, White also changed dates on employees’ CPR certifications
    “to make it current,” in accordance with Florence Bikundi’s direction “to make sure all of those -
    - everything is okay, or during the survey we will have -- we will just make those document
    changes and then bring it to the surveyors.” Id. at 77. The alteration of these documents would
    sometimes occur with the surveyors in Global’s offices. Id.
    20
    On two occasions when White was on maternity leave from August through November,
    2011, Florence and Michael Bikundi went to White’s home to retrieve POCs that White had
    created. Id. at 95–97; Tr. (Oct. 21, 2015 AM) at 82–83 (White), ECF No. 318. The POCs were
    so numerous that they could not be emailed and did not fit into an envelope. Tr. (Oct. 20, 2015
    PM) at 96–97 (White), ECF No. 316; Tr. (Oct. 21, 2015 AM) at 84 (White), ECF No. 318.
    White corroborated the testimony of Atabe, Mbide and others that Florence Bikundi directed her,
    as well as other employees, to falsify documents when the surveyors were still present in
    Global’s offices to avoid the imposition of fines. Tr. (Oct. 20, 2015 PM) at 76–77 (White), ECF
    No. 316.
    5.     Melissa Williams
    Melissa Williams first began working for Florence Bikundi as a PCA at Flo-Diamond,
    using false credentials since she was an undocumented immigrant. Tr. (Oct. 29, 2015 PM) at
    32–33 (Test. of Melissa Williams), ECF No. 334. Florence Bikundi was aware of her
    undocumented status since she provided Williams with paychecks under Williams’ assumed
    name used for credentials. Id. at 36–37. Williams continued her PCA work at Global after she
    received her work authorization in December 2008. Id. at 42. Through her relationship with
    Michael Bikundi’s son, Williams is the mother of Michael Bikundi’s grandchild and calls
    Michael Bikundi “Dad.” Id. at 102.
    In approximately April 2011, Florence Bikundi permitted Williams to work in Global’s
    office rather than working with patients as a PCA and promoted her to Human Resources
    Coordinator. Id. at 53–55, 78. During the first survey that Williams observed at Global, she saw
    nurses creating false nurse notes when notes were missing from patient files. Id. at 60–61.
    Florence Bikundi, Chis Asongcha and Elvis Atabe were in the chart room at the time that the
    21
    fake nurse notes were created and then inserted into the patient files. Id. at 61–62. Williams also
    observed Elvis Atabe change dates on POCs in Florence Bikundi’s presence, id. at 64–65, and
    Chris Asongcha alter employee physical examinations and CPR certificates in employee files in
    Florence Bikundi’s presence, id. at 66. Williams testified that “we knew that we had an
    obligation to make sure that our folders were kept updated at all times. And whenever we had a
    survey and it was not so, it was expected of us to forge the paperwork.” Tr. (Nov. 2, 2015 AM)
    at 12 (White), ECF No. 338; id. at 22–23 (testifying that, for every survey, “it was always the
    same thing, just with my employees’ folders, just making the adjustments for whatever folders
    that the surveyors needed that were not updated . . . [meaning they] Frauded the paperwork”).
    During surveys, Florence Bikundi supervised this activity of Global employees “making
    adjustments, Wite-Out, whatever it is, to the physical or whatever paperwork that needed to be
    updated in the eyes of the surveyors” and, on one occasion asked Chris Asongcha why a
    document was not done and approved Williams altering the document. Id. at 13.
    Williams testified that in order to manage costs, Florence Bikundi canceled Global’s
    contract with Kroll—a company with which it had contracted to conduct criminal background
    checks on PCAs—and required PCAs to provide their own background checks. Tr. (Oct. 29,
    2015 PM) at 84–86 (Williams), ECF No. 334; Tr. (Oct. 20, 2015 PM) at 83 (White), ECF No.
    316. Subsequently, during surveys, when criminal background checks were missing from
    employee files, Chris Asongcha and Nicola White started creating phony criminal background
    checks to insert in the employee files. Tr. (Oct. 29, 2015 PM) at 86–87 (Williams), ECF No.
    334; see also Tr. (Nov. 2, 2015 AM) at 115 (Williams), ECF No. 338. This aspect of Williams’
    testimony was corroborated by Nicola White, who admitted to making fraudulent background
    checks for Global employees, see Tr. (Oct. 20, 2015 PM) at 84 (White), ECF No. 316, as well as
    22
    by a Kroll representative, who testified that out of 31 Kroll background checks in Global
    employee files, a review confirmed that only three were authentic, see Tr. (Nov. 2, 2015 PM) at
    15 (Test. of Craig Olsen), ECF No. 340; Gov’t Ex. 440.
    E.      FALSIFICATION OF TIMESHEETS AND ILLEGAL PAYMENTS TO
    GLOBAL PATIENTS
    In addition to the fraudulent alteration of patient and employee files that took place
    within Global’s offices, extensive testimony was provided at trial about the kickbacks paid to
    beneficiaries for their false certification of PCA timesheets for work that was not performed and
    about the defendants’ knowledge of these kickbacks and fraudulent timesheets. Florence and
    Michael Bikundi required that the timesheets supporting each employee’s work be attached to
    the employee’s paycheck before the paycheck would be approved and signed. Tr. (Oct. 20, 2015
    PM) at 50 (White), ECF No. 316; Tr. (Oct. 21, 2015 AM) at 78, 90 (White), ECF No. 318; Tr.
    (Nov. 2, 2015 AM) at 122 (Williams), ECF No. 338; Tr. (Oct. 20, 2015 AM) at 39 (Johnson),
    ECF No. 315. Thus, the defendants were aware of which PCAs claimed to work 16-hour days
    and which PCAs claimed on their timesheets to be providing services to a beneficiary when
    those PCAs were actually on vacation, in the office, in school or at another job. When Florence
    or Michael Bikundi concluded that PCAs had submitted timesheets for services not provided,
    they would at times withhold the PCAs’ paychecks but would not terminate them, void the
    claims or initiate reversals to repay Medicaid for the hours that Global billed for these aides. Tr.
    (Oct. 19, 2015 AM) at 39–40 (Mbide), ECF No. 314; Tr. (Oct. 20, 2015 AM) at 39–40, 49–50,
    110 (Johnson), ECF No. 315; Tr. (Oct. 20, 2015 PM) at 120–21 (White), ECF No. 316; Tr. (Oct.
    28, 2015 PM) at 31–32 (Test. of Carlson Igwacho), ECF No. 335; Tr. (Nov. 2, 2015 AM) at 35–
    39 (Williams), ECF No. 338. Summarized below is testimony from the cooperating witnesses
    and beneficiaries about the fraudulent timesheets and kickbacks to Global’s patients.
    23
    1.      Melissa Williams
    While working as a PCA at Global, Melissa Williams was assigned, by Elke Johnson, to
    patient Carolyn Baldwin (beneficiary no. xxxx2921, see Def. FB’s R. 29 Mem. at 11;
    Superseding Indictment ¶ 75(3)). Tr. (Oct. 29, 2015 PM) at 44 (Williams), ECF No. 334. After
    a few weeks of working with Baldwin, Baldwin demanded money from Williams. Id. Baldwin
    explained to Williams that she had been previously receiving money from Elke Johnson and
    Florence Bikundi, id. at 45–46, and if she were not paid, “she would leave Global and go to a
    different home health aide company,” id. at 46. Williams stated that she gave Baldwin money
    from her paycheck and money given to her by Johnson. Id. at 46.
    Carolyn Baldwin largely corroborated the testimony of Johnson and Williams. She
    testified that Florence Bikundi came to her house with her then-boyfriend, “a tall fellow,” to
    recruit her as a patient. Tr. (Nov. 3, 2015 AM) at 30 (Test. of Carolyn Baldwin), ECF No. 343.
    At the time, Florence Bikundi told her, “I take care of my girls.” Id. When Baldwin asked what
    that meant, Florence Bikundi replied, “you know, I give them a little money.” Id. at 31.
    Thereafter, Baldwin became a patient and Florence Bikundi mailed Baldwin a check of about
    $75 to $150. Id. Baldwin recalled picking up money from “Elke” one time when the business
    was located on Georgia Avenue, id., and also from Williams, who was assigned to be her PCA,
    id. at 32–33, 44–45.
    Williams explained the reason for the kickbacks to Global patients was “[i]n order to
    maintain or keep these patients, because the patients will tell you that -- just even as an aide, if
    you don’t pay me, I’m going to take my services somewhere else. So in order to keep the
    patient, money would be given to the patient . . . . So in order for the patient to stay with the
    company, which is Global, the -- Florence would -- because she wouldn’t want the patient to go
    24
    to a different agency where services would be rendered under a different company name, then
    she would pay to keep the patients happy.” Tr. (Nov. 2, 2015 AM) at 20 (Williams), ECF No.
    338.
    Williams provided details about the blatant nature of this fraud activity. For example, she
    saw Irene Igwacho socializing with Michael and Florence Bikundi at times when Irene Igwacho
    was supposed to be providing PCA services to Global patients. Tr. (Oct. 29, 2015 PM) at 103–
    04 (Williams), ECF No. 334. The defendants were aware of this since Michael Bikundi did not
    sign Irene Igwacho’s paychecks without seeing the timesheets, because “without time sheets, you
    don’t get paid.” Id. at 104. Similarly, Berenice Igwacho—another of Florence Bikundi’s
    sisters—attended social functions at the defendants’ residence at times that coincided with when
    she claimed on timesheets to be providing PCA services to Global patients. Id. at 105. Both
    Florence and Michael Bikundi observed Berenice Igwacho at the social functions. Id. In another
    instance Williams testified that, from December 22, 2012 through January 6, 2013, she
    accompanied Florence Bikundi, Michael Bikundi, Carlson Igwacho, who is Florence Bikundi’s
    son, Violet Igwacho, who is Carlson Igwacho’s wife, and others on a family vacation to
    California, and timesheets for this period were submitted by certain of the vacationers for PCA
    services. Id. at 105–07. As another example, Williams testified that there were times that she
    submitted timesheets indicating she had provided home health services to a patient at certain
    hours that coincided with the hours that she was actually working in the office. Tr. (Nov. 2,
    2015 AM) at 116 (Williams), ECF No. 338. At one point, Florence Bikundi told Williams that
    Williams could no longer work with the patient, but did not fire Williams. Id.
    25
    2.      Nicola White
    Nicola White testified that she would submit timesheets for working with patients during
    the week and weekends, despite working full-time in the office during the week and not working
    on the weekends. Tr. (Oct. 20, 2015 PM) at 89–90, 94 (White), ECF No. 316; Tr. (Oct. 21, 2015
    AM) at 78 (White), ECF No. 318. Michael and Florence Bikundi knew that Nicola White was
    working full-time in the office yet also submitting timesheets used to bill Medicaid for PCA
    services. Tr. (Oct. 20, 2015 PM) at 94–95 (White), ECF No. 316. Although Michael Bikundi
    told her to stop, he did not ask for return of the money or initiate a refund to D.C. Medicaid. Id.
    at 95. White’s testimony was corroborated by Williams, who testified that when Michael
    Bikundi learned that White had submitted a timesheet claiming that she had provided services to
    a Global patient while White was actually in Jamaica, Michael Bikundi decided that he was not
    going to allow Global office workers to work as PCAs on the weekends anymore. Tr. (Nov. 2,
    2015 AM) at 32–33 (Williams), ECF No. 338.
    Nicola White testified about the regular, “numerous of times” that Florence Bikundi
    asked her to cash checks and “[s]he would normally give me a list with the total amount for each
    individual and write the check in my name.” Tr. (Oct. 21, 2015 AM) at 92 (White), ECF No.
    318. “Sometimes she would be the one to give to those individuals and sometimes she asked me
    to do it.” Id. at 93. Cash would be paid to “aides that weren’t legally to work in the United
    States,” to Carlson Igwacho, and “every two weeks” to Medicaid beneficiaries who “actually
    come to the office for it; some of the time they will send a family member.” Id.
    3.      Elke Johnson
    Elke Johnson testified that Florence Bikundi gave her cash to pay at least three Medicaid
    beneficiaries—Carolyn Baldwin, William Smith, and Gary Miller—for becoming or remaining
    26
    clients of Global in order “to build her list of recipients.” Tr. (Oct. 20, 2015 AM) at 27–28
    (Johnson), ECF No. 315. Florence Bikundi instructed Johnson to pay $300 to William Smith
    (beneficiary no. xxxx4279, see Def. FB’s R. 29 Mem. at 10, Superseding Indictment ¶ 75(1)), a
    patient of Carlson Igwacho, when Carlson Igwacho was in Cameroon and his timesheet, which
    falsely reflected the provision of PCA services during that period, had already been submitted for
    reimbursement from Medicaid. Id. at 30–32. In other words, Carlson Igwacho submitted post-
    dated timesheets for the beneficiary which contained the beneficiary’s signature in advance of
    him leaving on a trip to Cameroon. Id. at 31.
    Johnson further testified that Berenice, Irene, Carlson and Violet Igwacho were working
    in the office or attending school at times they indicated on timesheets that they were performing
    PCA work. Id. at 46–48.
    4.      Francis James
    Francis James testified that, after his girlfriend Elke Johnson suggested that he become a
    home health aide, he met with Florence Bikundi, who told him that she had a patient for him,
    Gary Miller (beneficiary no. xxxx0062, see Def. FB’s R. 29 Mem. at 11; Superseding Indictment
    ¶ 75(2)), whom she had already been paying. Tr. (Oct. 19, 2015 PM) at 74–75, 107 (Test. of
    Francis James), ECF No. 313. James already had a full-time job working in construction, and
    Florence Bikundi told James that he did not have to see his patient for the full eight hours each
    day that Medicaid would be billed, id. at 75, 86–88, 106; see also id. at 84 (“Miss Florence told
    me, it’s okay for to go – for to work and – I mean, I could put eight hours and I don’t have to
    work.”). James paid his patient $100 to $150 every pay period in return for the patient certifying
    timesheets weekly for services that James did not perform. Id. at 77, 80, 107. After James began
    working at Global, Michael Bikundi told him that he would have to pay Michael Bikundi $300
    27
    every two weeks, which James understood he would be required to do in order to keep his job.
    Id. at 88–89, 120, 125. James therefore paid Michael Bikundi the $300 kickback every two
    weeks, either by the office building or by a Kentucky Fried Chicken. Id. at 89, 107, 115, 120,
    125.
    5.      Irene Igwacho
    Irene Igwacho, who is an RN and the sister of Florence Bikundi, testified about
    submitting false timesheets for two Global patients, Joan Gross and Sergio Zuniga (beneficiary
    no. xxxx7041, see Def. FB’s R. 29 Mem. at 12; Superseding Indictment ¶ 75(9)), reflecting time
    she had purportedly performed work when she was actually in school, as Florence Bikundi was
    well aware. Tr. (Oct. 27, 2015 AM) at 44–45 (Test. of Irene Igwacho), ECF No. 328. Gross
    agreed to sign the timesheets falsely certifying that Irene Igwacho had performed work in return
    for biweekly payments of $150. Id. at 47. Irene Igwacho never met Sergio Zuniga even though
    she was supposed to provide PCA services to him on the weekends and submitted timesheets
    reflecting that work. Id. at 53. She simply paid another aide $50 to have Zuniga sign the
    timesheets, including for time periods when Irene Igwacho was traveling out of the country and
    both defendants knew this. Id. at 53, 55–56.
    Irene Igwacho’s testimony was corroborated by Sergio Zuniga, who suffers from a spinal
    deformity. Tr. (Oct. 20, 2015 PM) at 4–5 (Test. of Sergio Zuniga), ECF No. 316. Zuniga
    testified that he was recruited to use Global for PCA services through an aide named Darnell
    Williams. Id. at 5, 19. Darnell Williams would visit Zuniga “roughly every two weeks,” and
    give him $175, which helped him financially. Id. at 7–8. Zuniga “signed the timesheets to
    basically continue receiving the help that he was . . . giving.” Id. at 11. Darnell Williams also
    told Zuniga that a different aide, Irene Igwacho, would be assigned to work with him on the
    28
    weekends, but that aide never went to see him and the timesheets for that aide’s work did not
    contain his signature. Id. at 15–16. After Darnell Williams stopped paying him every two week,
    Zuniga never sought another home health aide. Id. at 18.
    6.      Carlson Igwacho
    Carlson Igwacho, the son of Florence Bikundi, is an RN and worked as a Global PCA in
    May 2009, following his discharge from military service. See Tr. (Oct. 28, 2015 AM) at 129–30,
    132 (Carlson Igwacho), ECF No. 329. He denied recognizing a number of documents, including
    a health certificate, school certificates and other information contained in his Global personnel
    file, some of which documents reflected his forged signature. Id. at 135–39. He also denied that
    he was aware of having an ownership interest in Flo-Diamond, as reflected in the Medicaid
    provider agreement that Flo-Diamond had with Maryland. Id. at 140.
    Carlson Igwacho testified that he was assigned to work eight hours per day, seven days
    per week with beneficiary William Smith, who appeared to know Florence Bikundi by asking
    “How’s Miss Flo?” Tr. (Oct. 28, 2015 PM) at 9, 15 (Carlson Igwacho), ECF No. 335. Smith
    told Carlson Igwacho that he did not want his PCA around all of the time and threatened to use a
    different HCA unless he received payments. Id. at 10–13. Carlson Igwacho visited him only
    one to two days per week, and paid him to certify false timesheets reflecting PCA services for 56
    hours per week. Id. at 13–15.
    Carlson Igwacho also paid other beneficiaries, Glenn Scott and Mary Drayton
    (beneficiary no. xxxx2282, see Def. FB’s R. 29 Mem. at 11; Superseding Indictment ¶ 75(5)), for
    falsely certifying timesheets for PCA work not performed. Id. at 21–26. He paid Mary Drayton
    $300 every pay period to sign fraudulent timesheets stating that she received 56 hours of services
    per week from him. Id. at 25. In sum, from January 2010 to March 2012, Carlson Igwacho
    29
    submitted timesheets reflecting that he worked 16 hours per day, every day, divided into eight
    hour shifts between Mary Drayton and William Smith, even though during this same time period,
    from Fall 2009 through Spring 2011, and in the summer, he was (1) attending school, for which
    Florence Bikundi contributed funds; (2) had alcohol-related arrests, about which the defendants
    were aware; (3) was hospitalized for malaria; and (4) traveled to Cameroon, a trip Florence
    Bikundi knew about, and on vacation with the defendants. See id. at 27–40, 43–48; Gov’t Ex.
    245.
    This testimony was corroborated by multiple witnesses. Nicola White testified that
    Carlson Igwacho was assigned to work as a PCA with two patients, for a total of sixteen hours
    every day. Tr. (Oct. 20, 2015 PM) at 100–01 (White), ECF No. 316. Melissa Williams
    recounted a conversation between herself and Nicola White, during which White informed her
    that Florence Bikundi had assigned Carlson Igwacho to be the PCA for Mary Drayton, who had
    previously been assigned to White. Tr. (Nov. 2, 2015 AM) at 21 (Williams), ECF No. 338.
    White explained that because Mary Drayton had been a former client of Flo-Diamond, Florence
    Bikundi knew she would accept money to certify false timesheets and had sent money over to
    Mary Drayton. Id. Likewise, Elke Johnson confirmed that, during a period when Carlson
    Igwacho was in Cameroon and unable to visit his patient, Florence Bikundi told Johnson to pay
    the patient $300 because Carlson Igwacho’s timesheet, which falsely indicated that he had
    provided services to the patient, had already been submitted. Tr. (Oct. 20, 2015 AM) at 30–32
    (Johnson), ECF No. 315. Finally, Mary Drayton, the beneficiary herself, confirmed that she, and
    her son, R.C., were both paid money in exchange for signing timesheets that falsely indicated
    that Carlson Igwacho (and, for some period, Violet Igwacho), had provided sixteen hours of
    service every day. Tr. (Oct. 28, 2015 AM) at 39–44 (Test. of Mary Drayton), ECF No. 329.
    30
    7.     Other PCAs Falsifying Timesheets
    The testifying former Global employees admitted to paying kickbacks to patients for
    certifying false timesheets and also provided evidence of other Global employees who engaged
    in the same illegal activity. In addition to beneficiaries Carolyn Baldwin, Mary Drayton and
    Sergio Zuniga, other former Global patients testified about being recruited to be Global patients
    and the kickbacks they received to certify false timesheets. Tywonda Fenner (beneficiary no.
    xxxx0699, see Def. FB’s R. 29 Mem. at 12; Superseding Indictment ¶ 75(8)) testified that
    initially, when she told a prospective home health aide about attending class during the day, the
    aide’s “boss,” a female, advised Fenner over the telephone that services could not be provided
    unless Fenner were home. Tr. (Nov. 2, 2015 PM) at 43–45 (Test. of Tywonda Fenner), ECF No.
    340. Nevertheless, Berenice Igwacho subsequently showed up with doctors’ forms for Fenner to
    sign. Id. at 47–48, 59. Berenice Igwacho paid Fenner approximately $140 every two weeks and,
    in exchange, Fenner signed Berenice Igwacho’s timesheets. Id. at 49–51. Fenner did not ever
    receive any PCA services from any Global PCA. See id.
    Another Global patient, Alma McPherson (beneficiary no. xxxx4210, see Def. FB’s R. 29
    Mem. at 13; Superseding Indictment ¶ 75(14)), testified that a woman named “Yvette” visited
    her at home to ask if she wanted to make some extra money. Id. at 62–63, 75 (Test. of Alma
    McPherson). Sometime thereafter, McPherson, along with two others, went to a clinic with
    Yvette, who told McPherson to walk with a cane, even though she did not need one. Id. at 63–
    66. She met with a doctor who prescribed home health services that she did not need. Id. at 65–
    67. After the doctor visit, “Yvette” paid McPherson $100. Id. at 66. Thereafter, McPherson and
    her husband were each assigned a PCA, who came approximately once a week and had
    McPherson sign a timesheet. See id. at 67–70. “Linda,” Yvette’s sister, or, at times, Yvette
    herself, would then pay McPherson $200 in exchange for the signed timesheets. See id.
    31
    F.     EVIDENCE SUPPORTING MONEY LAUNDERING CHARGES
    The government presented the testimony of Department of Justice Special Agent Nicole
    Hinson of the U.S. Attorney’s Office for the District of Columbia, along with underlying bank
    and financial records, to support the money laundering charges against the defendants. Tr. (Nov.
    3, 2015 AM) at 113 (Test. of Nicole Hinson), ECF No. 343. From November 2009 to February
    2014, D.C. Medicaid paid Global a total of $80,620,929.20. Id. at 130; Gov’t Ex. 5. Over this
    time period, D.C. Medicaid payments to Global increased from $1,359,726.88 in 2009, to
    $9,956,505.60 in 2010, to $14,277,324.23 in 2011, to $23,696,990.89 in 2012, and to
    $27,166,587.08 in 2013. Tr. (Nov. 3, 2015 AM) at 89–90 (Hinson), ECF No. 343; Gov’t Ex.
    133. In January and February 2014, alone, D.C. Medicaid paid a total of $4,193,079.12 to
    Global. Tr. (Nov. 3, 2015 AM) at 90 (Hinson), ECF No. 343; Gov’t Ex. 133.
    D.C. Medicaid payments were transferred directly to three different Global accounts—
    PNC Bank (“PNC”) account #5874, and Bank of America (“BOA”) account #2254 and account
    #2241 (“Intake Accounts”)—for which Florence and Michael Bikundi were the sole signatories.
    Tr. (Nov. 3, 2015 AM) at 132–33 (Hinson), ECF No. 343; Gov. Ex. 184. These defendants then
    moved D.C. Medicaid funds from these three Intake Accounts into additional Global corporate
    accounts to pay operational expenses and into two Flo-Diamond accounts (BOA account #2267
    and PNC account #6271). Tr. (Nov. 3, 2015 AM) at 133–34 (Hinson), ECF No. 343; Gov. Ex.
    184. From these secondary accounts, Florence and Michael Bikundi distributed the D.C.
    Medicaid funds to over one hundred other financial accounts they controlled, where they
    conducted “tens of thousands of transactions,” including to pay for personal expenses. Tr. (Nov.
    3, 2015 AM) at 130–31, 134 (Hinson), ECF No. 343; Tr. (Nov. 4, 2015 AM) at 72–73 (Hinson),
    ECF No. 344; Tr. (Oct. 20, 2015 PM) at 125–26 (White), ECF No. 316; Gov. Ex. 184.
    32
    Approximately ninety percent of the funds that went into the defendants’ accounts came from
    D.C. Medicaid. Tr. (Nov. 3, 2015 AM) at 131 (Hinson), ECF No. 343.8
    The types of financial institution accounts controlled by Florence and Michael Bikundi
    included accounts in the names of multiple corporations, personal bank accounts, life insurance
    accounts, investment accounts, trust accounts, college savings plans, annuities, IRAs, and
    international bank accounts. Id. at 119, 127–30; Gov’t Ex. 184. From November 2009 to
    February 2014, the defendants purchased over $7,700,000 in cashier’s checks from funds from
    some of these accounts. Tr. (Nov. 3, 2015 PM) at 27, 93–94 (Hinson), ECF No. 342; Gov’t Ex.
    154. Among the accounts to which the defendants transferred D.C. Medicaid funds were three
    accounts in the name of CFC Home Trade & Investment, LLC (“CFC”) and two accounts in the
    name of Tri-Continental Trade & Development (“Tri-Continental”). Tr. (Nov. 3, 2015 AM) at
    139, 143 (Hinson), ECF No. 343; Gov’t Exs. 151, 152, 184, 250. Agent Hinson expressed her
    belief that “the use of Tri-Continental and CFC were attempts to use a false name” to conceal the
    source of illegal funds and make it appear that the funds were coming from another corporation,
    and that tracing the funds could not be easily accomplished by those without the “ability to
    subpoena all the records involved.” Tr. (Nov. 4, 2015 AM) at 28, 32, 69, 71–72 (Hinson), ECF
    No. 344; id. at 79 (testifying that “essentially that is important in money laundering because
    money coming from Global Health Care is being provided to Florence Bikundi and Michael
    Bikundi under the name of a second company”). No evidence was uncovered that these two
    companies, CFC and Tri-Continental, which were formed to conduct altogether different lines of
    business than Global, generated any income on their own. Id. at 78.
    8
    Agent Hinson testified that she spent months of working seven days per week to trace all of the funds in the
    accounts controlled by the defendants. Tr. (Nov. 4, 2015 AM) at 74 (Hinson), ECF No. 344. Indeed, she detailed
    that she obtained over 80 seizure warrants for financial institution accounts and five cars traceable to funds paid
    from D.C. Medicaid to Global. Tr. (Nov. 3, 2015 AM) at 118 (Hinson), ECF No. 343.
    33
    1.      CFC Accounts
    According to its Articles of Organization, dated October 17, 2012, CFC was a real estate
    investment business. Gov’t Ex. 249. Carlson Igwacho testified that he formed this company
    with his mother, Florence Bikundi, and Chris Asongcha, with the name “CFC” derived from the
    first letters of each of their first names, and with the intent to do residential real estate business in
    Baltimore, Maryland. Tr. (Oct. 28, 2015 PM) at 66–67 (Carlson Igwacho), ECF No. 335. 9 He
    testified, however, that, to his knowledge, CFC never actually did any business because he could
    not borrow the money needed to invest in real estate. Id. A property in Baltimore was titled in
    the name of CFC, but was purchased on June 5, 2013, with funds transferred from Global Intake
    Account, BOA account #2254. Gov’t Ex. 172; Tr. (Oct. 29, 2015 PM) at 23–27 (Test. of
    Andrew Levy), ECF No. 334; Tr. (Nov. 3, 2015 AM) at 141–43 (Hinson), ECF No. 343.
    Although the registered agent listed on CFC’s Articles is Carlson Igwacho, someone else
    signed his name on the Articles and “one of Global’s office[]” addresses was listed as the CFC
    company address. Gov. Ex. 249; Tr. (Oct. 28, 2015 PM) at 68–70 (Carlson Igwacho), ECF No.
    335. Florence and Michael Bikundi were listed as CFC’s “managing members” and were both
    signatories on CFC’s three bank accounts. Gov’t Ex. 250; Tr. (Nov. 3, 2015 AM) at 143
    (Hinson), ECF No. 343. Review of these CFC accounts revealed no payments to title or
    insurance companies, home inspectors, or cleaning services, and no deposits from tenants or
    property sales. Tr. (Nov. 3, 2015 AM) at 144 (Hinson), ECF No. 343. The only expenditures
    from the three CFC accounts consistent with real estate investment were three checks totaling
    approximately $40,000 that may have been related to home renovations. Id. at 143–44.
    9
    Michael Bikundi was not supposed to have a role in CFC, which is why his name was not included in the
    company name. See Tr. (Oct. 29, 2015 AM) at 5 (Carlson Igwacho), ECF No. 332.
    34
    Although no evidence indicates that any business relationship existed between Global
    and CFC, or that CFC provided any services to Global, id. at 149, over $6,300,000 was
    transferred to CFC’s BOA account #6749, which was opened on April 25, 2013, and closed on
    February 20, 2014, from four different Global accounts controlled by the defendants, id. at 145;
    Gov’t Ex. 151 at 1. During that time period, an additional $150,000 was transferred from a Tri-
    Continental account, Citibank account #3303, to the same CFC BOA account #6749. Gov’t Ex.
    151 at 1; Tr. (Nov. 3, 2015 AM) at 146 (Hinson), ECF No. 343 (Hinson). A total of
    $6,653,612.08 was deposited into that CFC account. Id.
    As support for Count Nineteen, Agent Hinson summarized the flow of D.C. Medicaid
    funds in the amount of $463,131.90 deposited on May 10, 2013 by DHCF into Global Intake
    Account, BOA account #2241. Tr. (Nov. 3, 2015 PM) at 46–47 (Hinson), ECF No. 342; Gov’t
    Ex. 177. The same day, $460,000 was wire transferred from that intake account to a secondary
    Global account, from which $370,000 was then wire transferred the same day to CFC’s BOA
    account #6749. Tr. (Nov. 3, 2015 PM) at 46–47 (Hinson), ECF No. 342.
    As support for Count Twenty, Agent Hinson summarized the flow of D.C. Medicaid
    funds in the amount of $503,224.44 deposited on June 7, 2013 by DHCF into Global Intake
    Account, BOA account #2241. Id. at 47–48; Gov’t Ex. 178. The same day, $450,000 was wire
    transferred from that intake account to a secondary Global account and a check for $400,000
    signed by Florence Bikundi from that secondary Global account was deposited into CFC’s BOA
    account #6749. Tr. (Nov. 3, 2015 PM) at 47–48 (Hinson), ECF No. 342.
    As support for Count Twenty-One, Agent Hinson summarized the flow of D.C. Medicaid
    funds in the amount of $511,481.30 deposited on June 21, 2013 by DHCF into Global Intake
    Account, BOA account #2241. Id. at 48–49; Gov’t Ex. 179. The same day, $510,000 was wire
    35
    transferred from that intake account to a secondary Global account and a check for $240,000
    signed by Florence Bikundi from that secondary Global account was deposited into CFC’s BOA
    account #6749. Tr. (Nov. 3, 2015 PM) at 48–49, ECF No. 342.
    As support for Count Twenty-Two, Agent Hinson summarized the flow of D.C. Medicaid
    funds in the amount of $530,052.90 deposited on August 2, 2013 by DHCF into Global Intake
    Account, BOA account #2241. Id. at 49–50; Gov’t Ex. 180. The same day, $430,000 was wire
    transferred from that intake account to a secondary Global account and a check for $360,000
    signed by Florence Bikundi from that secondary Global account was deposited into CFC’s BOA
    account #6749. Tr. (Nov. 3, 2015 PM) at 49–50 (Hinson), ECF No. 342.
    Approximately $2,390,000 in checks were written from CFC’s BOA account #6749 to
    Florence Bikundi and $517,000 in checks were written to Michael Bikundi. Gov’t Ex. 151 at 2–
    57; Tr. (Nov. 3, 2015 AM) at 146 (Hinson), ECF No. 343. These checks included a $50,000
    check payable to Florence Bikundi referencing “mortgage;” a $150,000 check payable to
    Florence Bikundi referencing “Citibank savings/checking;” a $300,010 check payable to
    Florence Bikundi referencing “M&T Savings;” a $10,000 check payable to Michael Bikundi
    referencing “contractor pay [b]onus;” a $10,000 check payable to Florence Bikundi referencing
    “pay [b]onus;” a $91,000 check payable to Florence Bikundi; a $100,000 check payable to
    Florence Bikundi referencing “Money Market Savings (M&T Bank);” a $30,000 check payable
    to Florence Bikundi referencing “contractor’s pay;” a $15,000 check payable to Michael
    Bikundi; and a $300,000 check payable to Florence Bikundi. Gov’t. Ex. 151 at 7–8, 11, 18–19,
    21, 30, 40, 48, 53; Tr. (Nov. 3, 2015 AM) at 147–49 (Hinson), ECF No. 343.
    36
    2.     Tri-Continental Account
    According to its Articles of Incorporation, Tri-Continental was an import/export business,
    created in May 2008 and located at the same address as Flo-Diamond. Tr. (Nov. 3, 2015 AM) at
    135–36 (Hinson), ECF No. 343; Gov’t Ex. 187. Florence Bikundi served as the resident agent.
    Id. Tri-Continental had two bank accounts, for which both Florence and Michael Bikundi were
    signatories. Tr. (Nov. 3, 2015 AM) at 139 (Hinson), ECF No. 343. Citibank account #3303 in
    the name of Tri-Continental was opened on August 23, 2012, and closed on February 20, 2014.
    Gov’t Ex. 152 at 1; Tr. (Nov. 3, 2015 AM) at 136 (Hinson), ECF No. 343. During that time
    period, a total of $6,390,028.31 was deposited into the account. Gov’t Ex. 152 at 1; Tr. (Nov. 3,
    2015 AM) at 137 (Hinson), ECF No. 343.
    Although no evidence indicates any business relationship existed between Global and
    Tri-Continental or that Tri-Continental provided any services to Global, over $3,000,000 was
    deposited into Tri-Continental’s Citibank account #3303 from two different Global accounts,
    almost $1,400,000 from a Flo-Diamond account, and $30,000 from a CFC account, all
    controlled by the defendants. Gov’t Ex. 152; Tr. (Nov. 3, 2015 AM) at 136–37 (Hinson), ECF
    No. 343; Tr. (Nov. 4, 2015 AM) at 77–78 (Hinson), ECF No. 344.
    As support for Count Sixteen, Agent Hinson summarized the flow of D.C. Medicaid
    funds in the amount of $528,552.72 deposited on November 5, 2012 by DHCF into Global
    Intake Account, PNC account #5874. Tr. (Nov. 3, 2015 PM) at 42–43 (Hinson), ECF No. 342;
    Gov’t Ex. 174. The next day, $531,000 was wire transferred from that intake account to a
    secondary Global account; then $400,000 was wire transferred to a Flo-Diamond account; and a
    check from the Flo-Diamond account was written in the same amount for deposit into Tri-
    Continental’s Citibank account #3303. Tr. (Nov. 3, 2015 PM) at 42–43 (Hinson), ECF No. 342.
    37
    As support for Count Seventeen, Agent Hinson summarized the flow of D.C. Medicaid
    funds in the amount of $524,354.30 deposited on March 15, 2013 by DHCF into Global Intake
    Account, BOA account #2241. Id. at 44–45; Gov’t Ex. 175. The same day, $500,000 was wire
    transferred from that intake account to a secondary Global account, and then Michael Bikundi
    wrote a check in the amount of $500,000 from the secondary Global account for deposit into Tri-
    Continental’s Citibank account #3559. Tr. (Nov. 3, 2015 PM) at 44–45 (Hinson), ECF No. 342.
    As support for Count Eighteen, Agent Hinson summarized the flow of D.C. Medicaid
    funds in the amount of $478, 958.40 deposited on April 26, 2013 by DHCF into Global Intake
    Account, BOA account #2241. Id. at 45–46; Gov’t Ex. 176. The same day, $400,000 was wire
    transferred from that intake account to a secondary Global account and, three days later, Florence
    Bikundi wrote a check in the amount of $400,000 from the secondary Global account for deposit
    into Tri-Continental’s Citibank account #3303. Tr. (Nov. 3, 2015 PM) at 45–46 (Hinson), ECF
    No. 342.
    Agent Hinson also testified about various transactions supporting Counts Twenty-Three
    through Twenty-Five, but the defendants were acquitted of those charges. 10
    G.       DEFENSE CASE
    The defendants called three witnesses. First, Joseph Igwacho testified that his daughter,
    Florence Bikundi, started using “Bikundi” over ten years ago, about the same time that Michael
    Bikundi, who had been Florence Igwacho’s boyfriend, expressed his intentions to marry her by
    providing a gift of dowry in “[a]bout 2003, 2005, thereabout,” in accord with Cameroonian
    10
    At the close of the government’s case-in-chief, the defendants moved for judgment of acquittal, under
    Federal Rule of Criminal Procedure 29(a), on all charges, which motion was denied in part and reserved in part. Tr.
    (Nov. 4, 2015 PM) at 3–8, 10–18, ECF No. 345. Specifically, the Court reserved decision, under Federal Rule of
    Criminal Procedure 29(b), on the defendants’ motions for acquittal on all the money laundering charges in Counts
    Sixteen through Twenty-Five. Id. at 18.
    38
    custom. Tr. (Nov. 4, 2015 PM) at 21–22 (Test. of Joseph Igwacho), ECF No. 345. Second, the
    defense called Special Agent Christopher Steinbauer, who testified that an active arrest warrant
    was outstanding for Chris Asongcha for his role in the Global health care fraud case. Id. at 32–
    33 (Test. of Christopher Steinbaughter). Finally, the defense called Paul Toulouse, an attorney
    who was retained by Michael Bikundi to handle civil and regulatory matters for Global. Id. at
    35–36 (Toulouse). He testified about his successful representation of Global to defeat the
    District’s efforts to revoke Global’s license as a home care agency. See id. at 34–36, 39–41, 51–
    53. Global continued to operate until execution of search warrants in connection with the
    investigation of this case in February 2014. Id. at 53. 11
    H.       THE VERDICT
    The jury returned guilty verdicts against both Florence and Michael Bikundi on: Count
    One (conspiracy to commit health care fraud), finding unanimously that the object of the
    conspiracy was to violate 
    18 U.S.C. §§ 1347
     and 1035, and that Florence Bikundi also conspired
    to violate 42 U.S.C. § 1320a-7b(b), Verdict Form at 1, ECF No. 361; Count Two (health care
    fraud), id. at 2; Count Fifteen (money laundering conspiracy), finding unanimously that the
    object of the conspiracy was to violate 
    18 U.S.C. §§ 1956
    (a)(1)(B)(i) and 1957, id.; and Counts
    Sixteen through Twenty-Two (laundering of monetary instruments), 
    id.
     at 3–4. Florence
    Bikundi was also found guilty of Counts Thirteen (health care fraud – exclusion from program)
    and Fourteen (Medicaid fraud – false statements, concealing and failing to disclose). 
    Id. at 2
    .
    The jury acquitted the defendants of Counts Twenty-Three through Twenty-Five
    (engaging in monetary transactions in property derived from specified unlawful activity) related
    11
    At the close of all the evidence, the defendants renewed their motions for judgment of acquittal, which the
    Court denied as to Counts One, Two, Thirteen and Fourteen, and reserved as to the money laundering charges. See
    Minute Entry (Nov. 5, 2015).
    39
    to checks, dated January 28, 2013, June 24, 2013 and July 2, 2013, drawn on accounts into which
    Global funds had allegedly been deposited. 
    Id. at 5
    . 12
    *        *        *
    In accordance with the briefing schedule set by the Court, the parties timely filed their
    pending post-trial motions. 13
    II.      LEGAL STANDARDS
    A.       RULE 29 MOTION FOR JUDGMENT OF ACQUITTAL
    Federal Rule of Criminal Procedure 29(a) requires a court to grant a defendant’s motion
    for a judgment of acquittal of any “offense for which the evidence is insufficient to sustain a
    conviction” and, further, authorizes the court “on its own” to “consider whether the evidence is
    insufficient to sustain a conviction.” FED. R. CRIM. P. 29(a). The Supreme Court has
    emphasized that, in evaluating the sufficiency of the evidence, “[t]he reviewing court considers
    only the ‘legal’ question ‘whether, after viewing the evidence in the light most favorable to the
    prosecution, any rational trier of fact could have found the essential elements of the crime
    beyond a reasonable doubt.’” Musacchio v. United States, 
    136 S. Ct. 709
    , 715 (2016) (emphasis
    in original) (quoting Jackson v. Virginia, 
    443 U.S. 307
    , 319 (1979)); see United States v.
    Thompson, 
    279 F.3d 1043
    , 1050–51 (D.C. Cir. 2002) (“[T]he court need only determine whether,
    after viewing the evidence in the light most favorable to the prosecution, any rational trier of fact
    could have found the essential elements of the crime beyond a reasonable doubt.”); United States
    v. Singleton, 
    702 F.2d 1159
    , 1163 (D.C. Cir. 1983) (articulating standard as “whether, viewing
    12
    After the jury returned its verdict, the Court denied the defendants’ motions for acquittal, which had
    previously been reserved, on the money laundering charges in Counts Sixteen through Twenty-Two. Minute Entry
    (Nov. 12, 2015).
    13
    A motion for new trial under Rule 33 must be filed within 14 days after the verdict, unless the motion is
    “grounded on newly discovered evidence,” in which case the motion must be filed within three years. FED. R. CRIM.
    P. 33(b). The Court granted the defendants’ motion for additional time to file any motion for a new trial until
    December 7, 2015. Minute Order (Nov. 16, 2015).
    40
    the evidence in the light most favorable to the Government, according the Government the
    benefit of all legitimate inferences, and recognizing that it is the jury’s province to determine
    credibility and to weigh the evidence, a reasonable jury must necessarily entertain a reasonable
    doubt on the evidence presented” (emphasis omitted)); see also United States v. Shmuckler, 
    792 F.3d 158
    , 161–62 (D.C. Cir. 2015) (same); United States v. Gooch, 
    665 F.3d 1318
    , 1326 (D.C.
    Cir. 2012) (same).
    This standard preserves “the factfinder’s role as weigher of the evidence” and “gives full
    play to the responsibility of the trier of fact fairly to resolve conflicts in the testimony, to weigh
    the evidence, and to draw reasonable inferences from basic facts to ultimate facts.” Jackson, 
    443 U.S. at 319
    . As “expressed more fully,” the role of a reviewing court “faced with a record of
    historical facts that supports conflicting inferences must presume—even if it does not
    affirmatively appear in the record—that the trier of fact resolved any such conflicts in favor of
    the prosecution, and must defer to that resolution.” McDaniel v. Brown, 
    558 U.S. 120
    , 133
    (2010) (quoting Jackson, 
    443 U.S. at 326
    ); see also United States v. Bostick, 
    791 F.3d 127
    , 137
    (D.C. Cir. 2015) (noting that “evidence need not exclude every reasonable hypothesis of
    innocence or be wholly inconsistent with every conclusion except that of guilt” to suffice to
    sustain guilty verdict) (quoting United States v. Kwong-Wah, 
    924 F.2d 298
    , 302 (D.C. Cir.
    1991)); United States v. Laureys, 
    653 F.3d 27
    , 31 (D.C. Cir. 2011) (noting that even when
    “evidence in this case may be susceptible of more than one interpretation, . . . we cannot say it
    was insufficient for the jury to find the necessary intent beyond a reasonable doubt”). Thus, the
    evidence does “not need to be overwhelming” to clear the bar for the sufficiency of evidence.
    United States v. Pasha, 
    797 F.3d 1122
    , 1135 n.9 (D.C. Cir. 2015). In short, “[t]he standard for
    such challenges is very high.” 
    Id.
    41
    B.      RULE 33 MOTION FOR NEW TRIAL
    Federal Rule of Criminal Procedure 33 provides that “[u]pon the defendant’s motion, the
    court may vacate any judgment and grant a new trial if the interest of justice so requires.” FED.
    R. CRIM. P. 33(a). As reflected by the use of the word “may” in Rule 33, “[t]rial courts enjoy
    broad discretion in ruling on a motion for a new trial.” United States v. Wheeler, 
    753 F.3d 200
    ,
    208 (D.C. Cir. 2014) (citing Gaither v. United States, 
    413 F.2d 1061
    , 1078 (D.C. Cir. 1969)).
    While the rules “do not define ‘interests of justice,’” the D.C. Circuit has instructed that
    “granting a new trial motion is warranted only in those limited circumstances where ‘a serious
    miscarriage of justice may have occurred.’” Wheeler, 753 F.3d at 208 (quoting United States v.
    Rogers, 
    918 F.2d 207
    , 213 (D.C. Cir. 1990)).
    A new trial motion based, in particular, on the sufficiency of the evidence, requires the
    court to “weigh[] the evidence and evaluate[] the witnesses’ credibility and decide[] whether ‘a
    serious miscarriage of justice may have occurred.’” United States v. Dale, 
    991 F.2d 819
    , 838
    (D.C. Cir. 1993) (quoting Rogers, 
    918 F.2d at 213
    )). When “the court denies the new trial
    motion because the court’s decision accords with the jury’s,” any appellate “review of the
    district court’s decision is particularly narrow.” Id.; see also United States v. Pettiford, 
    517 F.3d 584
    , 591 (D.C. Cir. 2008) (“In reviewing the District Court’s decision on a new trial
    motion, [the D.C. Circuit] appl[ies] a deferential standard, and will reverse only if the court
    abused its discretion or misapplied the law.” (quoting United States v. Lafayette, 
    983 F.2d 1102
    ,
    1105 (D.C. Cir. 1993))); United States v. Kelly, 
    748 F.2d 691
    , 701 (D.C. Cir. 1984) (holding
    that, as long as the weight of the evidence clearly weighs in favor of conviction, not against it,
    there is no abuse of discretion in denying a new trial motion).
    42
    III.     DISCUSSION
    Florence and Michael Bikundi generally raise overlapping arguments in support of their
    motions for acquittal and for a new trial, including their claims that the government presented
    insufficient evidence to support their convictions, with related arguments regarding the inherent
    unbelievability of the government’s witnesses, the prejudicial impact of admitting one of the
    government’s almost three hundred exhibits, a supposed variance in proof on the health care
    fraud conspiracy charge in Count One, and the purported need for a unanimity instruction on the
    substantive health care fraud charge in Count Two. See generally Florence Bikundi’s Mem.
    Supp. Mot. New Trial (“Def. FB’s R. 33 Mem.”), ECF No. 394-1; Florence Bikundi’s Mem.
    Supp. Mot. J. Acquittal (“Def. FB’s R. 29 Mem.”), ECF No. 393-1; Def. MB’s R. 33 Mot.14
    Michael Bikundi also seeks a new trial for failure to sever his trial from that of his spouse and for
    selective prosecution. Def. MB’s R. 33 Mot. at 47–53. Each of these arguments is addressed
    below.
    A.      CHALLENGES TO HEALTH CARE FRAUD CONVICTIONS
    As noted, the defendants raise a number of inter-related arguments regarding the
    sufficiency of the evidence presented to support their convictions for conspiracy to commit and
    committing health care fraud. For the reasons discussed below, these arguments are unavailing.
    1.       Cooperators’ Testimony Was Not “Inherently Incredible”
    As a threshold issue, Florence and Michael Bikundi attack the credibility of the
    government’s cooperating witnesses in an effort to have this testimony discounted or put aside in
    14
    Since each defendant joined any argument made by the other in support of their motions, the arguments
    will generally be considered as made by both defendants. See Minute Order (Dec. 15, 2016) (granting Florence
    Bikundi’s motions to join and adopt Michael Bikundi’s motions); Minute Order (Jan. 6, 2016) (granting Michael
    Bikundi’s motion to join and adopt Florence Bikundi’s motions); see also Def. MB’s R. 29 Mot. ¶ 4 (adopting “all
    relevant arguments made on behalf of co-defendant Florence Bikundi”); Def. FB’s R. 33 Mem. at 3 n.1 (adopting
    “arguments made in Mr. Michael Bikundi’s Rule 29(c) and Rule 33 Motions, as to the arguments that apply to Mrs.
    Bikundi as well”).
    43
    evaluating the sufficiency of the evidence supporting the defendants’ convictions on Counts One
    and Two. They urge that their health care fraud conspiracy and substantive charges be vacated
    due to the “questionable” credibility of the cooperating witnesses, whose testimony they
    characterize as “inherently incredible.” Def. FB’s R. 33 Mem. at 10; see also Michael Bikundi’s
    Reply Opp’n Renewed Mot. J. Acquittal (“Def. MB’s R. 29 Reply”) at 8, ECF No. 416 (“[T]he
    inherently incredible testimony of the cooperators should be disregarded as it was in its entirety
    highly questionable and utterly lacking in belief.”). As support, these defendants revive
    arguments about the credibility of multiple “purported co-conspirators,” who “had a previous
    health care fraud experience prior to joining Global” by “engag[ing] in identical conduct in their
    prior employment.” Def. FB’s R. 33 Mem. at 10. These same arguments were made at trial,
    rejected by the jury, see, e.g., Tr. (Nov. 9, 2015 PM) at 98–113, ECF No. 376 (Florence
    Bikundi’s summation); Tr. (Nov. 10, 2015 AM) at 11–30, ECF No. 377 (Michael Bikundi’s
    summation), and certainly fare no better under more stringent standards applicable to the
    doctrine of inherent unbelievability invoked by the defendants.
    Consistent with the standard to be applied in evaluating the sufficiency of the evidence—
    i.e., “whether, after viewing the evidence in the light most favorable to the prosecution, any
    rational trier of fact could have found the essential elements of the crime beyond a reasonable
    doubt,” Wright v. West, 
    505 U.S. 277
    , 284 (1992) (emphasis omitted) (quoting Jackson, 
    443 U.S. at 319
    )—the defendants’ invocation of the inherent unbelievability doctrine essentially asks this
    Court to conclude that no rational juror could have relied upon the challenged testimony. Accord
    Millar v. FCC, 
    707 F.2d 1530
    , 1539 (D.C. Cir. 1983) (noting “that a witness’s testimony may be,
    under the circumstances of the case, so incredible, or contrary evidence may be so
    overwhelming, that demeanor could not convince a reasonable factfinder that the witness was
    44
    telling the truth”). This is a heavy burden, since generally the jury has the responsibility “fairly
    to resolve conflicts in the testimony, to weigh the evidence, and to draw reasonable inferences
    from the basic facts to ultimate facts.” Jackson, 
    443 U.S. at 319
    . As the Supreme Court
    “[e]xpressed more fully, this means” that when the record contains “facts that support[]
    conflicting inferences,” a reviewing court “must presume . . . that the trier of fact resolved any
    such conflicts in favor of the prosecution, and must defer to that resolution.” McDaniel, 
    558 U.S. at 133
     (quoting Jackson, 
    443 U.S. at 326
    ).
    Thus, the D.C. Circuit has rejected defense claims that testimony must be set aside as
    inherently incredible based upon lack of clarity in timing or chronology of events or
    inconsistencies, which “are not so glaring that the . . . testimony must be a fabrication.” United
    States v. Streater, 
    70 F.3d 1314
    , 1318 (D.C. Cir. 1995) (internal quotation omitted); see also
    Johnson v. United States, 
    426 F.2d 651
    , 654 (D.C. Cir. 1970) (“Having made this determination
    based on testimony which was not inherently incredible, the case was for the trier and not the
    trial judge, and the motion for a directed verdict of acquittal was properly denied.”); accord
    Farrar v. United States, 
    275 F.2d 868
    , 869 (D.C. Cir. 1959) (reversing rape conviction upon
    finding that “[i]t is nearly or quite incredible that appellant could have used a knife as
    extensively as the girl said he did without her ever seeing it”). In Jackson v. United States, 
    353 F.2d 862
     (D.C. Cir. 1965), which involved review of judicial, rather than jury, fact-finding, the
    Court explained that the inherently incredible doctrine may apply “if the person whose testimony
    is under scrutiny made allegations which seem highly questionable in the light of common
    experience and knowledge, or behaved in a manner strongly at variance with the way in which
    we would normally expect a similarly situated person to behave.” 
    Id. at 867
    .
    45
    Set against these legal principles, the defendants are unable to demonstrate anything in
    the testimony of the government’s cooperating witnesses that is inherently improbable or simply
    too incredible for a rational juror to accept. Specifically, Florence Bikundi points out that
    Melissa Williams denied that Florence Bikundi knew about her fraudulent patient sharing
    activities with four other Global employees and for a patient at another company, Vizion One. 15
    Def. FB’s R. 33 Mem. at 11; Def. FB’s R. 29 Mem. at 4–5. This testimony that Williams did not
    actively broadcast her illegal schemes within the Global office to her bosses, Florence and
    Michael Bikundi, may be exculpatory of the defendants but that does not make the testimony
    “incredible.” In addition, Florence Bikundi challenges Williams’ testimony about being present
    with Florence Bikundi during surveys as belied by the fact that Williams was not working in the
    office for the December 2010 survey or a follow-up survey in February 2011, and Florence
    Bikundi was not present during the September 2011 survey. Def. FB’s R. 33 Mem. at 11; Def.
    FB’s R. 29 Mem. at 5. The three dates cited by Florence Bikundi were not, however, the only
    visits of the surveyors to the Global offices since they also conducted (or attempted to conduct)
    surveys in Global’s offices on August 30, 2011 and March 13–15, 2012. See, e.g., Gov’t Ex. 21
    at 6 (noting face-to-face meeting on March 13, 2012, with “Administrator . . . [and] Office
    Manager/Human Resource Coordinator”); Gov’t Ex. 26 (noting “a follow-up survey was
    initiated on August 30, 2011” but “had to be aborted due to the agency’s failure to have files
    available for review”). At most, Florence Bikundi’s attack on Melissa Williams’s testimony that
    she helped Florence Bikundi falsify documents for HRLA surveys shows a lack of clarity in the
    15
    Williams testified about “patient sharing” with other PCAs and described the arrangements to be that
    Williams and the other PCAs would all contribute to the kickbacks and benefit from the patients’ false certification
    of timesheets. See, e.g., Tr. (Nov. 2, 2015 AM) at 6–9, 39–40 (Williams), ECF No. 338.
    46
    witness’ recollection of survey timing that was fully disclosed during Williams’ testimony. Tr.
    (Nov. 2, 2015 AM) at 82 (Williams), ECF No. 338.
    Florence Bikundi also challenges the testimony of Francis James, who recounted his
    conversation with Florence Bikundi when he was hired as a Global PCA. According to James,
    Florence Bikundi “gave [him] the job” as a PCA and told him that “she have a client and she
    would assign me to him,” but “that I don’t have to go and work the whole time. And she already
    paid -- pays him, and if I want, I could just use discretion and give him a little something.” Tr.
    (Oct. 19, 2015 PM) at 74 (James), ECF No. 313. James testified he understood that although the
    patient, Gary Miller, was supposed to have PCA services eight hours per day, James did not have
    to work those hours. Id. at 75.
    Florence Bikundi proffers what she describes as a “more plausible explanation” for
    James’ employment as a PCA, Def. FB’s R. 33 Mem. at 12, that places all the blame on Elke
    Johnson, who “[a]s staffing coordinator, . . . brought Mr. James into Global, falsified his
    documents and set him up with a patient. Elke Johnson explained to Mr. James how to fill out
    timesheets, and even filled them out for him at times,” Def. FB’s R. 29 Mem. at 8; see also Def.
    FB’s R. 33 Mem. at 12. Elke Johnson conceded her role in using James’ credentials to get paid
    as a PCA and recruiting him to join her in the Global fraud scheme of paying patients to sign-off
    on false timesheets in order to bill D.C. Medicaid for PCA service not performed. Tr. (Oct. 20,
    2015 AM) at 49 (Johnson), ECF No. 315. This does not render “incredible” that Florence
    Bikundi spoke to James with assurances that he could continue his full-time construction work
    while also submitting false timesheets to enable Global to increase its billing to D.C. Medicaid
    for PCA services. See generally Tr. (Oct. 19, 2015 PM) at 74–86 (James), ECF No. 313.
    Indeed, Florence Bikundi was aware from reviewing Elke Johnson’s timesheets that Johnson
    47
    used Francis James’ name, and his pertinent credentials, to get paid. See Tr. (Oct. 20, 2015 AM)
    at 15, 49 (Johnson), ECF No. 315.
    The defendants next describe Elvis Atabe as “an admitted perjurer.” Def. FB’s R. 33
    Mem. at 12; see Def. MB’s R. 33 Mot. at 22. As such, the defendants urge that Atabe’s
    testimony that Florence Bikundi would show him how to create false documents “within weeks
    of being hired at Global” be rejected as “inherently incredible.” Def. FB’s R. 33 Mem. at 12; see
    Def. FB’s R. 29 Mem. at 7 (“[T]here is no juror that could have found beyond a reasonable doubt
    that after a couple weeks of working at Global, Mrs. Bikundi would sit in a chart room with Mr.
    Atabe, a man she does not know, and begin altering documents as part of a health care fraud
    conspiracy.”). Yet, this focus on the short time Florence Bikundi had personally known Atabe
    before engaging in illegal document alterations, ignores other salient information known to the
    defendants about Atabe, namely that he was a friend of, and had been recruited to Global by,
    James Mbide, who already knew the score about the fraudulent alteration of documents at
    Global. See Tr. (Oct. 19, 2015 AM) at 5 (Mbide), ECF No. 314; Tr. (Oct. 21, 2015 PM) at 86,
    93 (Atabe), ECF No. 317. Indeed, Atabe had worked with Mbide at another company, T&N
    Reliable Nursing Services (“T&N”), where Mbide had engaged in the creation of false nurse
    notes, Tr. (Oct. 16, 2015 PM) at 89 (Mbide), ECF No. 312, the same service he performed at
    Global, Tr. (Oct. 19, 2015 PM) at 25, 48–49, 54 (Mbide), ECF No. 313. In other words, the jury
    could reasonably conclude that Atabe was a known commodity when he was hired and, as a
    result, the defendants trusted that Atabe would do what was necessary, including falsifying
    documents, to extract money from D.C. Medicaid. This trust turned out to be well-placed since
    Atabe testified about his creation of fake nurse notes and POCs at Global within his first week of
    48
    work there. Tr. (Oct. 21, 2015 AM) at 115–16 (Atabe), ECF No. 318; Tr. (Oct. 21, 2015 PM) at
    48–58 (Atabe), ECF No. 317.
    Similar to their challenge of Melissa Williams, the defendants contest Atabe’s testimony
    that he assisted Florence Bikundi in falsifying documents during surveys since he only began
    working at Global in April 2011. Def. FB’s R. 33 Mem. at 12. This does not render Atabe’s
    testimony about the fraudulent survey-related activity “incredible” since the HRLA surveyors
    made subsequent visits to Global on, at least, August 30, 2011, September 27, 2011, and March
    13–15, 2012. See Gov’t Exs. 21, 26, 202.
    Florence Bikundi expresses disbelief at “the demeanor and testimony of James Mbide,”
    who despite his “sudden” shame had engaged “in falsifying documents not just at Global but also
    at T&N Reliable.” Def. FB’s R. 33 Mem. at 13; see also Def. FB’s R. 29 Mem. at 6. To the
    extent that the defendants seek to discount Mbide’s testimony about the defendants’ involvement
    in the fraud scheme by ascribing Mbide’s illegal acts to his own efforts “to continue to
    perpetuate his own fraud,” Def. FB’s Mem. at 13, they ignore the extensive corroboration by
    other cooperating witnesses of Mbide’s testimony regarding Florence and Michael Bikundi’s
    supervision of, and involvement in, falsifying documents and their management of Global’s
    business to maximize reimbursements from D.C. Medicaid.
    With respect to the beneficiaries’ testimony, Florence Bikundi dismisses Carolyn
    Baldwin’s testimony about receiving pay-offs, explaining that Florence Bikundi “was not paying
    Ms. Baldwin for signing timesheets, but instead for fixing a broken chair or providing a gift after
    Ms. Baldwin’s husband passed away.” Def. FB’s R. 33 Mem. at 13. In light of the
    corroborating testimony of Melissa Williams and Elke Johnson about payments from Florence
    Bikundi to Baldwin for false timesheet certifications, the jury could have reasonably concluded
    49
    that Baldwin’s testimony on this issue was credible. See supra Parts I.E.1, 3. Florence Bikundi
    also challenges beneficiary Alma McPherson’s testimony about complaining to Global about not
    receiving PCA services when she “continued to collect money every week from her aides instead
    of transferring to another agency to receive the services that she claimed she needed.” Def. FB’s
    R. 33 Mem. at 13–14. Again, nothing about this testimony is “incredible.” Both Baldwin and
    McPherson fully acknowledged that they used the payments made by the PCAs in return for
    certifying false timesheets for services not performed. See Tr. (Nov. 2, 2015 PM) at 69
    (McPherson), ECF No. 340 (testifying that she used the kickbacks on “food for the house” and
    buy “dog food”); Tr. (Nov. 3, 2015 AM) at 53 (Baldwin), ECF No. 343 (testifying she used the
    kickbacks “for myself” and “might have sent it to somebody in jail”); see also Tr. (Oct. 20, 2015
    PM) at 6–9 (Zuniga), ECF No. 316 (testifying that, though he needed help because of his
    disability, he also needed “help . . . financially”).
    The defendants conveniently ignore the testimony from these and other witnesses that
    demonstrates the defendants’ knowledge and direction of the overall fraud scheme and the
    corroboration by the cooperating witnesses of key details of each other’s testimony. For
    example, James Mbide, Elvis Atabe, Elke Johnson and Nicola White all corroborated each other
    about their participation in and observations of others, including Florence Bikundi, actually
    creating fake documents for both patient and Global employee files. Mbide also testified that
    Michael Bikundi was present when false nurse notes were created to avoid problems with
    surveys, Tr. (Oct. 19, 2015 AM) at 14 (Mbide), ECF No. 314, testimony further corroborated by
    Nicola White who testified about Michael Bikundi being unsatisfied with the appearance of
    falsified documents in the Global files, Tr. (Oct. 20, 2015 PM) at 73-74 (White), ECF No. 316.
    Additionally, the testimony of the beneficiaries was confirmed by multiple cooperating
    50
    witnesses. Melissa Williams and Elke Johnson corroborate that they made payments to Carolyn
    Baldwin, Tr. (Oct. 29, 2015 PM) at 46 (Williams), ECF No. 334; Tr. (Oct. 20, 2015 AM) at 27–
    28 (Johnson), ECF No. 315, a beneficiary who testified that she was recruited directly by
    Florence Bikundi, who was accompanied by her “tall” “boyfriend,” to be a patient of Flo-
    Diamond and then became a patient of Global. Tr. (Nov. 3, 2015 AM) at 30 (Baldwin), ECF No.
    343. After receiving payments from Florence Bikundi, Baldwin testified that she received
    payments from “Elke” and from “Melissa.” Id. at 31–33, 45.
    Moreover, the defendants’ post-trial challenges to the credibility of the government’s
    witnesses were fully presented at trial, where the defendants had and exercised the opportunity to
    impeach the witnesses about these subjects. “Simply put, credibility judgments are the sole
    province of the jury,” which “ultimately decided whom to believe, and how important this issue
    was to its verdict.” Radtke v. Lifecare Mgmt. Partners, 
    795 F.3d 159
    , 167 (D.C. Cir. 2015); see
    United States v. Anderson, 
    498 F.2d 1038
    , 1039 n.1 (D.C. Cir. 1974) (affirming “trial court’s
    refusal to grant a motion for judgment of acquittal” based on defense argument that “testimony
    of the complaining witness was ‘inherently incredible,’” since “[t]he question of credibility was
    for the jury” and sufficient evidence sustained the verdicts). Consequently, the defendants’
    effort to persuade this Court to supplant the jury’s assessment of the credibility of any or all of
    the government’s cooperating witnesses in evaluating the sufficiency of the evidence is rejected.
    2.      Ample Evidence Supports The Defendants’ Health Care Fraud
    Convictions In Counts One And Two
    Florence and Michael Bikundi contend that their health care fraud convictions in Counts
    One and Two for conspiracy and substantive health care fraud, respectively, were not supported
    by sufficient evidence, warranting a judgment of acquittal or a new trial. Def. FB’s R. 29 Mem.
    51
    at 3.16 Contrary to the defendants’ contention, the evidence of the defendants’ involvement in
    the health care fraud scheme at Global was overwhelming and supported by the corroborating
    testimony of multiple former Global employees and patients and documentary proof.
    As summarized supra in Part I.C through E, Florence Bikundi initiated the health care
    fraud at Global by submitting an application and agreement with fraudulent signatures, at a time
    when she was excluded from participation in any federal health care program. She also issued
    instructions to certain Global employees, including Francis James and Elke Johnson, to pay D.C.
    Medicaid beneficiaries in return for certifying timesheets for services not performed. Francis
    James admitted to submitting false timesheets for beneficiary Gary Miller (beneficiary no.
    xxxx0062, see Def. FB’s R. 29 Mem. at 11; Superseding Indictment ¶ 75(2)), after Florence
    Bikundi hired James, assigned a patient to him, told him she had already been paying the patient,
    and told him that he should do the same and he would not have to go to work for the full eight
    hours for which Medicaid would be billed. Tr. (Oct. 19, 2015 PM) at 74-75 (James), ECF No.
    313. Elke Johnson testified that Florence Bikundi instructed her to pay $300 to beneficiary
    William Smith (beneficiary no. xxxx4279, see Def. FB’s R. 29 Mem. at 10, Superseding
    Indictment ¶ 75(1)), a patient of Carlson Igwacho’s who had signed timesheets, which had
    already been submitted for payment, for a time period when Carlson Igwacho was in Cameroon.
    Tr. (Oct. 20, 2015 AM) at 30-31 (Johnson), ECF No. 315. Thus, contrary to defendant’s
    16
    Michael Bikundi presents no explicit argument challenging the sufficiency of the evidence underlying the
    health care fraud convictions but instead, as noted supra in note 14, “adopts any additional relevant arguments rasied
    [sic] by co-defendant Florence Bikundi.” Def. MB’s R. 33 Mot. at 53 (emphasis omitted). The sufficiency
    challenge to the defendants’ health care fraud convictions is, consequently, construed as applying to both
    defendants. In addition, in response to the government’s contention that admission of an exhibit, even if erroneous,
    was harmless, Michael Bikundi notes “the paucity of evidence introduced against Michael Bikundi” and “several
    exculpatory items of information that were brought to the attention of the jury.” Michael Bikundi’s Reply Gov’t
    Opp’n Mot. New Trial (“Def. MB’s R. 33 Reply”), at 6–7, ECF No. 417. The Court will consider these aspects of
    the defendant’s argument as part of the challenge to the sufficiency of the evidence for the health care fraud
    convictions.
    52
    assertion that there “was no evidence presented that Mrs. Bikundi knew that Carlson Igwacho
    was not providing PCA services” to this patient, Def. FB’s R. 29 Mem. at 10, Elke Johnson’s
    testimony establishes that Florence Bikundi had knowledge that Carlson Igwacho was not
    providing the PCA services for which he was submitting timesheets.
    Notwithstanding this evidence, Florence Bikundi contends that “there was insufficient
    evidence to show that Mrs. Bikundi participated in these alleged kickbacks or aided and abetting
    [sic] any of the other indicted or unindicted co-conspirators to do the same,” as charged in Count
    Two. Def. FB’s R. 29 Mem. at 10–13. She is wrong. Both beneficiary, Carolyn Baldwin, and
    Melissa Williams testified that Florence Bikundi had been paying Baldwin (beneficiary no.
    xxxx2921, see Def. FB’s R. 29 Mem. at 11; Superseding Indictment ¶ 75(3)) before Melissa
    Williams became Baldwin’s PCA and continued the payments for certification of false
    timesheets. Tr. (Oct. 29, 2015 PM) at 46 (Williams), ECF No. 334; Tr. (Nov. 3, 2015 AM) at
    31-33 (Baldwin), ECF No. 343. Both Carlson Igwacho and Violet Igwacho submitted timesheets
    for PCA services to Mary Drayton (beneficiary no. xxxx2282, see Def. FB’s R. 29 Mem. at 11;
    Superseding Indictment ¶ 75(5)), even when Violet Igwacho was on vacation in California with
    Florence and Michael Bikundi. See Gov’t Ex. 443. Melissa Williams testified that she was
    present at the defendants’ home with Irene Igwacho at times on the weekend when Irene
    Igwacho should have been with her patient, Sergio Zuniga (beneficiary no. xxxx7041, see Def.
    FB’s R. 29 Mem. at 12; Superseding Indictment ¶ 75(9)), who also confirmed that he falsely
    certified timesheets in return for kickbacks. Tr. (Nov. 2, 2015 AM) at 99-100 (Williams), ECF
    No. 338; Tr. (Oct. 20, 2015 PM) at 15-16 (Zuniga), ECF No. 316.
    Other witnesses provided additional testimony about both defendants’ knowledge of the
    fraudulent timesheets being submitted by PCAs. Both defendants required that timesheets be
    53
    submitted for approval of payroll checks and, thus, were aware of the dates and times when the
    PCAs claimed on their timesheets to be providing services to patients. Tr. (Oct. 20, 2015 PM) at
    50 (White), ECF No. 316; Tr. (Oct. 21, 2015 AM) at 78, 90 (White), ECF No. 318; Tr. (Nov. 2,
    2015 AM) at 122 (Williams), ECF No. 338; Tr. (Oct. 20, 2015 AM) at 39 (Johnson), ECF No.
    315. Yet, Melissa Williams, Irene Igwacho and Carlson Igwacho testified variously that they
    worked in Global’s offices and attended school, vacations or family social events at the same
    time that timesheets indicated they were providing PCA services. Tr. (Oct. 29, 2015 PM) at 103-
    107 (Williams), ECF No. 334; Tr. (Oct. 27, 2015 AM) at 44-45 (Irene Igwacho), ECF No. 328;
    Tr. (Oct. 28, 2015 PM) at 29-30, 34-37, 39-40 (Carlson Igwacho), ECF No. 335. Similarly,
    Nicola White testified that, when Carlson Igwacho was assigned to work for a total of sixteen
    hours every day of the week for two separate patients at the same time he was known to be
    elsewhere, Florence Bikundi told White that she was just “trying to help Carlson” out. Tr. (Oct.
    20, 2015 PM) at 100 (White), ECF No. 316.
    Both Florence and Michael Bikundi also supervised Global employees in falsifying
    records in patient and employee files, as well as other records necessary for maintaining Global’s
    license as a D.C. Medicaid provider. Elvis Atabe testified that Florence Bikundi showed him
    how to white-out documents. Tr. (Oct. 21, 2015 AM) at 114-115 (Atabe), ECF No. 318. Nicola
    White testified that Florence Bikundi told her to cut and paste doctors’ signatures onto plans of
    care, so that they would appear to have been approved by the doctors. Tr. (Oct. 20, 2015 PM) at
    73 (White), ECF No. 316. White even heard Florence and Michael Bikundi arguing about
    Michael Bikundi’s view that the documents did not look real enough. Id. at 73–74. Florence
    Bikundi would then take the forged plans of care and fax them to one of Flo-Diamond’s offices
    and have them faxed back to her so that the plans of care would look more real. Id. at 74–75.
    54
    White also testified about at least two occasions during her maternity leave when Florence
    Bikundi was driven by Michael Bikundi to White’s home to retrieve so many altered POCs,
    which White had created, that they could not be emailed or fit in an envelope for mailing. Id. at
    95–97; Tr. (Oct. 21, 2015 AM) at 82–84 (White), ECF No. 318.
    The defendants point to certain exculpatory testimony and evidence in a feeble effort to
    undermine the vast amount of other evidence against them. Specifically, Michael Bikundi notes,
    first, that his name was not on Global’s Medicaid Provider Agreement. Gov’t Ex. 1. Def. MB’s
    R. 33 Reply at 6. Yet, the evidence is indisputable that Michael Bikundi was integrally involved
    as a “boss” at Global: he exercised hiring and firing authority, including hiring Elvis Atabe and
    firing James Mbide, see Tr. (Oct. 21, 2015 AM) at 109-110 (Atabe), ECF No. 318; Tr. (Oct. 16,
    2015 AM) at 105 (Mbide), ECF No. 312; he reviewed timesheets and approved checks for
    Global employees, see Tr. (Oct. 20, 2015 PM) at 50 (White), ECF No. 316; Tr. (Oct. 21, 2015
    AM) at 90 (White), ECF No. 318; Tr. (Nov. 2, 2015 AM) at 122 (Williams), ECF No. 338; Tr.
    (Oct. 20, 2015 AM) at 39 (Johnson), ECF No. 315; and he gave instructions to employees to
    further the fraud scheme by checking the appearance of falsified documents for authenticity,
    instructing Nicola White to order supplies for other Global employees to alter documents, Tr.
    (Oct. 20, 2015 PM) at 75–76 (White), ECF No. 316, and instructing Elke Johnson to shred
    Florence Bikundi’s personnel file to avoid review by surveyors, Tr. (Oct. 20, 2015 AM) at 55–58
    (Johnson), ECF No. 315. See also Tr. (Oct. 19, 2015 PM) at 153 (Johnson), ECF No. 313
    (testifying that Michael Bikundi would frequently say “I’m the boss here”); Tr. (Oct. 20, 2015
    PM) at 28 (White), ECF No. 316 (testifying about Michael Bikundi that “I just know him as my
    boss”).
    55
    Second, the defendants assert that they were not present and did not participate when
    Global PCAs paid money to beneficiaries for certifying timesheets for services not performed.
    Def. MB’s R. 33 Reply at 6; Def. FB’s R. 29 Mem. at 3, 10–13. The jury could reasonably have
    found this assertion to be spurious since the defendants’ review of the timesheets as part of the
    process of approving and signing paychecks would make apparent that multiple PCAs were
    billing for time spent with Global patients when they were known to the defendants to be
    elsewhere. The defendants also point out that Michael Bikundi instructed Elke Johnson “to
    make sure [PCAs] were at work” and Nicola White to “stop the practice of billing for services
    that were not provided,” and that he “fired aids for not going to work,” and hired field
    supervisors to ensure PCAs were performing their work. Def. MB’s R. 33 Reply at 7. These
    instructions by Michael Bikundi demonstrate only that he was fully aware of the fraudulent
    timesheets being submitted for reimbursement by D.C. Medicaid and that, rather than return
    money to D.C. Medicaid, he took minimal steps to address the problem. Finally, the defendants
    cite Melissa Williams’ testimony that she did not tell Florence and Michael Bikundi about her
    illegal schemes with other Global employees and at Vizion One for patient sharing and
    kickbacks from job applicants. Def. FB’s R. 29 Mem. at 4. This testimony likely bolstered
    rather than undermined Williams’ credibility since in other instances she provided evidence of
    the defendants’ knowledge and participation in the ongoing fraud at Global.
    In any event, the defendants made each of these points at trial and, as such, they were
    subject to evaluation and weighing by the jury. To the extent this evidence may be considered
    exculpatory, in light of the ample evidence presented of the defendants’ culpability, the jury
    reasonably determined that the defendants were guilty of the charged health care fraud counts.
    That jury determination will not be disturbed.
    56
    3.     Ample Evidence Supports Florence Bikundi’s Health Care Fraud
    Convictions In Counts Thirteen And Fourteen
    Florence Bikundi was convicted in Count Thirteen of engaging in health care fraud by
    “conceal[ing] her exclusion from participation in all federal health care programs in order to
    make money through payments from D.C. Medicaid,” in violation of 
    18 U.S.C. § 1347
    ,
    Superseding Indictment ¶ 79; and in Count Fourteen of failing to disclose her exclusion with
    intent fraudulently to secure payments from D.C. Medicaid, including by “actively participating
    in the management and administration of GLOBAL while she was excluded” and “submit[ing]
    D.C. Medicaid provider agreements that contained false and fraudulent representations and . . .
    forged signatures of individuals responsible for certifying that all claims for payment submitted
    to D.C. Medicaid by GLOBAL complied with” applicable regulations, in violation of 42 U.S.C.
    §1320a-7b(a)(3), id. ¶ 82. To sustain a guilty verdict on these charges, the government had to
    prove, beyond a reasonable doubt, that Florence Bikundi knew about her exclusion from
    participation in all federal health care programs: for Count Thirteen, that she knowingly
    attempted or carried out a scheme to conceal her exclusion; and, for Count Fourteen, that she
    concealed or failed to disclose the exclusion with the fraudulent intent to secure a payment from
    a federal health care program either in a greater amount than due or when no such payment was
    authorized. See Jury Instructions at 20–21, ECF No. 350.
    Underlying both charges in Counts Thirteen and Fourteen is the fact that Florence
    Bikundi is excluded from participation in all federal health care programs. She does not contest
    this fact; she contends only that the evidence was not sufficient to prove beyond a reasonable
    doubt that she knew about her excluded status. Def. FB’s R. 29 Mem. at 13.
    According to Florence Bikundi, even though she communicated with HHS-OIG using the
    Greenbelt address regarding consideration of her exclusion on October 8, 1999, by the time that
    57
    HHS-OIG sent via regular mail the final decision of exclusion by letter, dated March 31, 2000, to
    that address, “she was no longer living at the [Greenbelt] address and there is no evidence that
    she received notice that she was in fact excluded.” Id. at 14. In support, the defendant cites two
    documents showing that Florence Bikundi used an address on Cherryville Terrace in Beltsville,
    Maryland (“Beltsville address”), on February 23, 2000 and March 8, 2000. Id. (citing Defs.’ Ex.
    46 (stipulation that, on March 8, 2000, a lawsuit filed in District Court of Maryland for
    Montgomery County showed this defendant’s address to be the Beltsville address) and Gov’t Ex.
    112 (showing that the defendant’s application for a nursing license, dated February 23, 2000,
    listed her Beltsville address)).
    Notwithstanding these two documents reflecting the defendant’s use of an address other
    than the Greenbelt address several weeks before HHS-OIG sent the exclusion notice to the
    Greenbelt address, sufficient evidence was submitted at trial for the jury to conclude that
    Florence Bikundi was fully aware of her exclusion. First, this defendant was indisputably aware
    that proceedings were underway to exclude her since she communicated with HHS-OIG about
    requesting additional time to respond in a letter, which was received by HHS-OIG on October 8,
    1999, and reflected the same Greenbelt address. See Gov’t Ex. 107.
    Second, the exclusion notice was not returned to HHS-OIG as undeliverable, Tr. (Oct. 26,
    2015 PM) at 33 (Hoffman), ECF No. 327, lending support to the inference that if Florence
    Bikundi had, in fact, moved from the Greenbelt address to the Beltsville address, her mail,
    including the exclusion notice, was forwarded to her.
    Third, information about the defendant’s exclusion was not limited to the notice sent to
    her in the mail but was also publicly available, including online. HHS-OIG published notice of
    the defendant’s exclusion in the Federal Register using the name, “Florence N. Igwacho.” Gov’t
    58
    Ex. 113 (
    65 Fed. Reg. 19008
     (April 10, 2000)). In addition, her name is contained in an online,
    searchable database maintained by HHS-OIG of excluded persons. Gov’t Exs. 114–17. Indeed,
    a document seized from the defendant’s home reflects the handwritten web address for access to
    the exclusion database, “http://oig.hhs.gov/fraud/exclusions.asp,” in the same red color ink as
    other handwriting that the defendant’s own brother identified as written by the defendant. Gov’t
    Ex. 428; Tr. (Oct. 29, 2015 AM) at 71 (Ernest Igwacho), ECF No. 332; Tr. (Oct. 29, 2015 AM)
    at 51 (Test. of Robert Mosley), ECF No. 332.
    Fourth, while disputing whether she received notice from HHS-OIG in March 2000 of
    her exclusion, Florence Bikundi raises no dispute about her awareness of the revocation in May
    2005 of both her D.C. LPN and RN licenses in the name of “Florence Ngwe aka Florence
    Igwacho.” Gov’t Ex. 120; Tr. (Nov. 2, 2015 PM) at 38–39 (Test. of Karen Scipio-Skinner), ECF
    No. 340. Given that Global required certain employees to execute “Certificates of Eligibility to
    Participate in Federal Health Care Programs,” to certify that the employee was “not subject to
    exclusion or debarment under federal law or designated in a nurse aid registry as having a
    finding concerning abuse, neglect, or mistreatment of a patient or misappropriation of a patient’s
    property,” Gov’t Ex. 119 (certificates, dated June 5, 2012, for five Global employees), the jury
    could reasonably infer that Florence Bikundi, as Global’s owner and boss, was well versed in
    this exclusion bar.
    Finally, documents introduced as evidence at trial reflect that the defendant avoided using
    her maiden last name “Igwacho,” under which she was excluded, in communications with
    government agencies in connection with Global. 17 Instead, she used her married last name
    “Bikundi,” before she was actually married in executing Global documents. See Gov’t Ex. 27 at
    17
    She also used her middle name “Ngwe” as her last name, rather than “Igwacho,” in the Flo-Diamond 2005
    application, for a certificate of authority to transact business in D.C. See Gov’t Ex. 335.
    59
    3 (Florence and Michael Bikundi’s Virginia marriage certificate, dated September 5, 2009); Tr.
    (Nov. 3, 2015 AM) at 126 (Hinson), ECF No. 343. Global’s “Medicaid Provider Agreement”
    was signed by “Florence Bikundi” on June 2, 2009, Gov’t Ex. 1.18 Likewise, when registering
    Flo-Diamond as doing business in D.C., in April 2008, the defendant listed herself as a
    “director” and signed her name as “Florence Bikundi.” Gov’t Ex. 335. At the same time that the
    defendant used the last name “Bikundi” in communications with government agencies about
    Global, she used her maiden name “Igwacho” in other contexts. See, e.g., Tr. (Oct. 16, 2015
    PM) at 92 (Mbide), ECF No. 312 (Mbide testifying that when he first joined Global in 2009, the
    defendant used the name “Florence Igwacho”).
    In sum, when viewing the evidence in the light most favorable to the government, the
    jury had ample evidence to find beyond a reasonable doubt that Florence Bikundi knew she was
    excluded from federal health care programs under the name “Florence Igwacho” and, as the
    government posits, deliberately used the name “Florence Bikundi” in order “to deceive Medicaid
    officials regarding her true identity” and “obtain payments from D.C. Medicaid in violation of
    her excluded status.” Gov’t Opp’n Def. Florence Bikundi’s Renewed R. 29 Mot. J. Acquittal
    (“Gov’t Opp’n FB’s R. 29 Mot.”) at 33–34, ECF No. 405.
    4.       Government Utilization Report (Gov’t Ex. 439) Was Properly
    Admitted
    Florence and Michael Bikundi claim that the admission of Government Exhibit 439, a 13-
    page document titled “Claim Summary for Dates of service 1/1/2012-2/28/2014 For
    Beneficiaries receiving services in 2/2014,” out of nearly three hundred government exhibits,
    18
    Florence Bikundi asserts that Global’s “DDS Waiver Application actually lists Florence Igwacho as one of
    the shareholders, and therefore the government should have known at the time of Global submitting its application
    that Mrs. Bikundi was excluded.” Def. FB’s R. 29 Mem. at 15. This document was never admitted into evidence,
    however. See Tr. (Oct. 16, 2015 AM) at 30, ECF No. 311 (government’s withdrawal of the exhibit).
    60
    was so “extremely” and “severely prejudicial” that a new trial is required in “the interests of
    justice.” Def. FB’s R. 33 Mem. at 4, 7; Def. MB’s R. 33 Mot. at 38 (seeking new trial due to
    “prejudicial impact” of Gov’t Ex. 439). The defendants’ hyperbole notwithstanding, this exhibit
    was properly admitted.
    The challenged exhibit, called the “PCA Services Utilization Report,” Tr. (Nov. 3, 2015
    PM) at 13, ECF No. 342, was admitted, over defense objection, during the government’s case-in-
    chief when DHCF’s Director of Health Care Operations Administration, Donald Shearer, was
    recalled as a witness. Tr. (Nov. 4, 2015 AM) at 101, ECF No. 344 (ruling “allow[ing]
    introduction of the report”). He testified that, on February 20, 2014, law enforcement conducted
    search warrants at four HCAs, including Global, which together had billed D.C. Medicaid for
    PCA services for 3,200 Medicaid beneficiaries. Tr. (Nov. 4, 2015 AM) at 99 (Shearer), ECF No.
    344. When these four HCAs were shut down, D.C. Medicaid attempted to reach the Medicaid
    beneficiaries, who were patients of the closed HCAs, to re-assign the beneficiaries to other
    HCAs and ensure the continuation of needed services. 
    Id. at 100
    . DHCF generated the PCA
    Services Utilization Report to show the beneficiaries who received services from Global prior to
    the execution of the search warrant, but who were not subsequently receiving services from
    another HCA from March 31, 2014 through December 31, 2014. 
    Id.
     at 100–01. The PCA
    Services Utilization Report shows a total of 567 D.C. Medicaid beneficiaries for whom Global
    was paid for providing services who did not continue to receive PCA services after February 28,
    2014, 
    id. at 100
    , excluding those beneficiaries who had died, 
    id. at 115
    . This report also shows
    the amount of $29,498,252.91, that D.C. Medicaid paid Global for these 567 beneficiaries from
    January 2012 through February 2014. 
    Id. at 104
    . After March 31, 2014, through December 31,
    61
    2014, D.C. Medicaid paid no other HCA any money for the listed 567 Medicaid beneficiaries.
    
    Id.
    The defendants argue that the PCA Services Utilization Report should not have been
    admitted (1) under Federal Rule of Criminal Procedure 16, due to the government’s untimely
    disclosure, Def. FB’s R. 33 Mem. at 2, 6; Def. MB’s R. 33 Mot. at 29–34; (2) under Federal Rule
    of Evidence 404(b), because the exhibit was used “for the improper purpose of demonstrating a
    pattern and propensity for this type of activity,” Florence Bikundi’s Reply Gov’t Opp’n Def.’s R.
    33 Mot. New Trial (“Def. FB’s R. 33 Reply”) at 2, ECF No. 418; and (3) under Federal Rule of
    Evidence 403, because the exhibit misleadingly suggested that “567 beneficiaries listed in
    Exhibit 439 . . . did not need services,” 
    id. at 3
    , and “was speculative at best and subject to
    numerous possible interpretations,” 
    id. at 4
    ; see Def. MB’s R. 33 Mot. at 36–38. Each of these
    argument is addressed seriatim below.
    (a)     Timing Of Disclosure of Government Exhibit 439 Did Not Violate
    Federal Rule Of Criminal Procedure 16
    The defendants have a legitimate point about the timeliness of disclosure of the PCA
    Services Utilization Report only the day before the close of the government’s case-in-chief. See
    Tr. (Nov. 3, 2015 PM) at 14, ECF No. 342 (government counsel stating, “[t]hat report was
    apparently ready today”); Tr. (Nov. 4, 2015 AM) at 113 (Shearer), ECF No. 344 (Shearer
    testifying that report was generated “yesterday”). In response to the Court’s query about the
    delay in production, the government explained that the report had been requested “before the
    trial started,” but since “a lot of the information was commingled,” the effort apparently took
    time. Tr. (Nov. 3, 2015 PM) at 17, ECF No. 342. Shearer subsequently confirmed during his
    testimony that, in September, before the trial started government counsel requested that Shearer’s
    62
    department “try to quantify the amount that we . . . could determine was the amount of actual
    fraud.” Tr. (Nov. 4, 2015 AM) at 113 (Shearer), ECF No. 344.19
    The government agreed to the Court’s suggestion to postpone the testimony of Shearer
    until the next day and make this witness available for an interview by defense counsel, Tr. (Nov.
    3, 2015 PM) at 18, ECF No. 342, and this schedule was imposed, 
    id. at 111
     (Court noting that
    “the ability of defense counsel to talk to Mr. Shearer helps address some of the timeliness issues
    with production of this particular report”). At no time did either defendant request a longer
    continuance in order to respond to the information in the PCA Services Utilization Report. On
    the contrary, counsel for Michael Bikundi expressed the view that no continuance would “cure
    the problem,” of being “ambushed.” 
    Id. at 19
    .
    Under Rule 16(a)(1)(E), the government must disclose “documents, data . . . if the item is
    within the government’s possession, custody, or control and . . . (ii) the government intends to
    use the item in its case-in-chief at trial . . . .” FED. R. CRIM. P. 16(a)(1)(E). The sanction for
    failure “to comply with this rule, may” include permitting discovery, subject to “just terms and
    conditions,” a continuance, barring introduction of the undisclosed evidence or “any other order
    that is just under the circumstances.” FED. R. CRIM. P. 16(d)(2). In this case, despite a timely
    request to the local government agency to prepare a report before trial, the government simply
    did not possess the PCA Services Utilization Report until the day the report was disclosed.
    Based on the clear text of Rule 16, the D.C. Circuit has stressed that “the government
    cannot be required to disclose evidence that it neither possesses nor controls.” United States v.
    Marshall, 
    132 F.3d 63
    , 68 (D.C. Cir. 1998). Thus, in Marshall, the Court held “that the United
    19
    Shearer indicated that, after he figured out a method for responding to government’s counsel’s request, the
    task of compiling the information for, and then generating, the report, was completed in about two weeks. Tr. (Nov.
    4, 2015 AM) at 114 (Shearer), ECF No. 344.
    63
    States did not violate Rule 16 when it failed to turn over evidence it neither possessed nor
    controlled,” which evidence was held by a local law enforcement agency and only uncovered
    during a “new line of investigation” initiated during trial. 
    Id.
     While the Court cautioned that
    this holding “is not an invitation for the United States to engage in gamesmanship in discovery
    matters” and that “a prosecutor may not sandbag a defendant by the simple expedient of leaving
    relevant evidence to repose in the hands of another agency while utilizing his access to it in
    preparing his case for trial,” 
    id. at 69
     (internal quotation omitted), no suggestion has been made
    by the defendants in this case that any delay in production of the challenged report was the result
    of bad faith or “gamesmanship,” and this Court perceives none.
    In any event, the Court took appropriate steps to ensure that the defendants had an
    opportunity to conduct an interview of Shearer prior to his testimony at trial and, as discussed
    infra in Part III.A.4(c), they made good use of their cross-examination of this witness regarding
    Government Exhibit 439. The complete prohibition on the government introducing this exhibit,
    as requested by the defendants as a sanction for a Rule 16 disclosure violation, was not
    warranted in these circumstances and certainly does not militate in favor of a new trial. 20
    (b)      Government Exhibit 439 Was Not Subject To Exclusion Under Rule
    404(b)
    Although Florence Bikundi made no mention of Federal Rule of Evidence 404(b) in her
    moving papers, she asserts in reply that admission of Government Exhibit 439 amounted to an
    “improper use of 404(b) evidence, for which the Government did not give notice” and, therefore,
    20
    Florence Bikundi’s relies on United States v. McCrory, 
    930 F.2d 63
     (D.C. Cir. 1991), for the proposition
    that “[t]he appropriate remedy” in the instant case “would have been to preclude the government from introducing
    the evidence at trial as a violation of” Rule 16. Def. FB’s R. 33 Mem. at 6. The Court disagrees. In McCrory, the
    D.C. Circuit concluded that the trial court had properly excluded undisclosed evidence, which was known to the
    government before trial and rendered the defense theory at trial of misidentification “unavailable.” 
    930 F.2d at 68
    .
    By contrast, in this case, the PCA Services Utilization Report was not available before trial and the defendants have
    identified no defense theory rendered unavailable due to its admission.
    64
    this exhibit “should not have been admissible.” Def. FB’s R. 33 Reply at 2. The defendant
    reasons that this exhibit supports the inference “that the 567 beneficiaries listed in the report . . .
    did not need service,” when evidence presented at trial was somewhat different, namely: “that
    there were certain beneficiaries who did not receive service” when, in fact, “they did need the
    services.” 
    Id.
     at 2–3 (emphasis in original). This belated argument first made in reply is
    considered waived. See United States v. Bell, 
    795 F.3d 88
    , 100 n.14 (D.C. Cir. 2015) (“Because
    his . . . Rule 403 argument is first made in his Reply, . . . the argument is waived.”); In re
    Asemani, 
    455 F.3d 296
    , 300 (D.C. Cir. 2006) (finding argument “waived because it was made
    for the first time in his reply brief”); Rollins Envtl. Servs. v. EPA, 
    937 F.2d 649
    , 653 n.2 (D.C.
    Cir. 1991) (“Issues may not be raised for the first time in a reply brief.”).
    In any event, this argument is without merit. The gravamen of the health care fraud
    charges in Counts One and Two is that the defendants “submitted and caused to be submitted
    false and fraudulent claims to D.C. Medicaid seeking payment for the costs of personal care
    services that were not provided.” Superseding Indictment ¶¶ 70(f), 74 (f). Whether these
    services were or were not actually needed is beside the point. Indeed, the government presented
    testimony at trial both of D.C. Medicaid beneficiaries who actually needed personal care services
    and those who did not. For example, Sergio Zuniga, Tywonda Fenner, Carolyn Baldwin and
    Mary Drayton all testified about their underlying health reasons for needing PCA services. See,
    e.g., Tr. (Oct. 20, 2015 PM) at 8 (Zuniga), ECF No. 316 (Sergio Zuniga testifying that, due to his
    spina bifida condition and being in a wheelchair, there are times when he “really need[s] help”);
    Tr. (Nov. 2, 2015 PM) at 43–44, 48 (Fenner), ECF No. 340 (Tywonda Fenner testifying, that due
    to her diabetes and being “slow,” she needs help at home to take her medications); Tr. (Nov. 3,
    2015 AM) at 35, 39 (Baldwin), ECF No. 343 (Carolyn Baldwin, who is in a wheelchair,
    65
    testifying that PCAs assist in her home); Tr. (Oct. 28, 2015 AM) at 39, 43 (Drayton), ECF No.
    329 (Mary Drayton testifying that, after a “knee operation,” she needed an aide to help).
    Another beneficiary testified about being recruited to become a Global patient even
    though she did not need PCA services. See Tr. (Nov. 2, 2015 PM) at 64-66 (McPherson), ECF
    No. 340 (Alma McPherson testifying about being paid $100, along with two other people, to visit
    doctor “play acting” need for a cane and “to say that I had some kind of disease”). Likewise,
    James Mbide testified that, based on his own observations, some Global patients did not need
    PCA services and should have been discharged from D.C. Medicaid, but he was told by Michael
    Bikundi to “put on his business hat,” which Mbide understood as an instruction to continue
    billing D.C. Medicaid for the services when they were not needed. Tr. (Oct. 19, 2015 AM) at 22
    (Mbide), ECF No. 314. Each of the beneficiary witnesses admitted to falsely certifying
    timesheets for personal care services, which were not provided, in return for regular cash
    payments. See Tr. (Oct. 20, 2015 PM) at 9-11 (Zuniga), ECF No. 316; Tr. (Oct. 28, 2015 AM) at
    42-43 (Drayton), ECF No. 329; Tr. (Nov. 2, 2015 PM) at 49-50 (Fenner), ECF No. 340; Tr.
    (Nov. 2, 2015 PM) at 68-69 (McPherson), ECF No. 340; Tr. (Nov. 3, 2015 AM) at 32-33, 41
    (Baldwin), ECF No. 343.
    Thus, even if the PCA Services Utilization Report were construed to support the
    inference suggested by the defendants—that 567 Global patients did not need PCA services—
    this evidence would only bolster the same point already made by other evidence presented at
    trial. In other words, this exhibit would not be subject to Rule 404(b) and is instead plainly
    intrinsic to the charged health care fraud offenses. Rule 404(b) bars the admission of another
    “crime, wrong, or act” offered to “prove a person’s character in order to show that on a particular
    occasion the person acted in accordance with the character,” FED. R. EVID. 404(b)(1), but permits
    66
    such evidence to be admitted for “another purpose” as long as the government provides notice of
    its intent to offer the evidence, FED. R. EVID. 404(b)(2), which gives the defense the opportunity
    to request limiting instructions. These requirements do not apply, however, if the court
    determines that the acts are intrinsic to the charged crime. As the D.C. Circuit recently
    explained, “[a] threshold question in determining the admissibility of evidence of other crimes
    and bad acts is whether the evidence, in actuality, relates to acts unconnected with those for
    which the defendant is charged, or instead is intertwined with the commission of the charged
    crimes. Acts ‘extrinsic’ to the crime charged are subject to Rule 404(b)’s limitations; acts
    ‘intrinsic’ to the crime are not.” United States v. McGill, No. 06-3190, 
    2016 U.S. App. LEXIS 3734
    , at *53 (D.C. Cir. Mar. 1, 2016); see also United States v. Moore, 
    651 F.3d 30
    , 63 (D.C.
    Cir. 2011) (“When evidence of such acts is ‘intrinsic’ to the charged crime, it is not evidence of
    ‘other’ acts and is thus wholly unregulated by Rule 404(b).”); United States v. Bowie, 
    232 F.3d 923
    , 929 (D.C. Cir. 2000); FED. R. EVID. 404(b) advisory committee’s note to 1991 amendment
    (“The amendment does not extend to evidence of acts which are ‘intrinsic’ to the charged
    offense.” (citation omitted)). “Generally intrinsic evidence includes ‘act[s] that [are] part of the
    charged offense’ or ‘some uncharged acts performed contemporaneously with the charged crime
    . . . if they facilitate the commission of the charged crime.’” Bell, 795 F.3d at 100 (quoting
    Bowie, 
    232 F.3d at 929
    ).
    To the extent that the PCA Services Utilization Report reflects patients for whom Global
    received D.C. Medicaid reimbursements when the listed patients did not need PCA services, that
    evidence is an integral part of the health care fraud charges, rather than evidence of “other” acts
    subject to Rule 404(b). Consequently, admission of Government Exhibit 439 did not violate
    Rule 404(b).
    67
    (c)     Government Exhibit 439 Was Not Unduly Prejudicial Under Federal
    Rule Of Evidence 403
    The defendants contend that admission of the PCA Services Utilization Report was
    unduly prejudicial and erroneous under Federal Rule of Evidence 403. Def. FB’s R. 33 Mem. at
    6; Def. MB’s R. 33 Mot. at 36. At the outset, the weakness in this argument is demonstrated by
    simple comparison of the numbers at issue. To the extent that the challenged report suggests that
    the level of the fraud committed at Global amounted to $29,498,252.91, this amount was less
    than half the full amount of the fraud claimed by the government. Specifically, the government
    argued at trial that, due to Florence Bikundi’s exclusion from participation in any federal health
    care program, her status as an owner and manager of Global, and the fraudulent Medicaid
    provider agreement (Gov’t Ex. 1), this company should never have been accepted as a Medicaid
    provider and was not entitled to receive any funds, let alone over $80,000,000, from D.C.
    Medicaid. Tr. (Oct. 15, 2015 AM) at 36–37 (Gov’t Opening Statement), ECF No. 347; Tr. (Nov.
    9, 2015 AM) at 16 (Gov’t Closing Statement), ECF No. 376. The defendants ignore this obvious
    point, that Government Ex. 439 shows a lower amount of overall fraud than the amount claimed
    by the government, to argue nonetheless that this exhibit created undue prejudice. The
    defendants’ argument is predicated on two inter-related points, neither of which is persuasive.
    First, the defendants argue that Shearer could not and did not provide a definitive
    explanation for “why [the 567 listed beneficiaries] were no longer receiving services from
    Medicaid” leaving the jury “to speculate as to why the services were not provided.” Def. MB’s
    R. 33 Mot. at 36. As support, the defendants note that “[t]he D.C. Government attempted to
    reach all 3200 beneficiaries and place them with new agencies but they did not reach everyone,”
    making Shearer’s testimony “inconclusive and speculative.” Def. FB’s R. 33 Mem. at 6. Since
    no definitive explanation was given for why the beneficiaries listed on PCA Services Utilization
    68
    Report stopped receiving services between March 1 and December 31, 2014, the jury could have
    concluded “that the beneficiaries never needed the services to begin with,” which the
    government argued “would establish the ‘full extent of the fraud.’” Id. at 5 (quoting government
    counsel at Tr. (Nov. 3, 2015 PM) at 15, ECF No. 342).
    The defendants’ argument ignores important context. Government Exhibit 439 was not
    the only evidence that raised the issue of the scope of the fraudulent and corrupt activity at
    Global and, in particular, the level of fraudulent billing to D.C. Medicaid and the defendants’
    knowledge of this fraudulent scheme. Eight cooperating, former Global employees and five
    cooperating, former Global patients, all testified about falsified Global patient records and
    timesheets, which information was corroborated by the numerous record-keeping deficiencies
    cited by HRLA surveyors and administrators. In addition to the testimony about Global patients
    not receiving or needing PCA services, summarized supra in Part III.A.4(b), this issue was
    highlighted in questions focused on the actual number of Global employees and/or patients
    involved in the falsifying of records to ensure continued billing to D.C. Medicaid. For example,
    Melissa Williams testified that about thirty percent of patients wanted payments to certify
    timesheets, Tr. (Oct. 29, 2015 PM) at 121 (Williams), ECF No. 334, and that twenty-five PCAs
    did not provide services, id. at 123. Nicola White testified that between 2009 and 2014, “about
    50 percent of those” POCs in patient files were altered. Tr. (Oct. 21, 2015 AM) at 85–86
    (White), ECF No. 318. Elke Johnson testified that when she made calls to patients’ homes to
    check whether the PCA was present, she found about an eighty percent compliance on weekdays,
    but less, about fifty to sixty percent, on the weekends. Tr. (Oct. 20, 2015 AM) at 37, 44, 77, 105
    (Johnson), ECF No. 315. Thus, as the government points out, Government Exhibit 439 could not
    be a “surprise” in light of the government’s—and the defendants’ on cross-examination—efforts
    69
    to quantify the extent of the fraud at Global. Gov’t Opp’n Def. Michael Bikundi’s R. 33 Mot.
    New Trial (“Gov’t Opp’n MB’s R. 33 Mot.”) at 9, ECF No. 407.
    Moreover, the defendants effectively exploited the opportunity on cross-examination to
    detail the limits of any conclusions and inferences to be drawn from Government Exhibit 439.
    On direct examination, Shearer made clear that not all 3,200 beneficiaries, who were patients of
    the four HCAs shut down on execution of search warrants, were reached to determine if new
    HCA assignments were needed. Tr. (Nov. 4, 2015 AM) at 100 (Shearer), ECF No. 344. He also
    offered no opinion as why former Global patients “didn’t continue to get services after the
    execution of the search warrants,” id. at 102–03, after D.C. Medicaid had paid Global
    $29,498,252.91 for those 567 beneficiaries between January 1, 2012 and February 14, 2014, id.
    at 104. On cross-examination, the defendants elicited testimony that Shearer did not know (1)
    how many former Global patients were contacted, id. at 106; (2) how many former Global
    patients were determined to need PCA services, id. at 108; (3) why the former Global patients
    were no longer receiving services, id. at 115; (4) how many former Global patients were
    excluded due to death, id.; and (5) how many former Global patients no longer received PCA
    services because they were no longer eligible, possibly due to an increase in income, re-location
    outside D.C., or the use of a family member to provide PCA services, id. at 115–16. The
    defendants’ criticism of the limits of any conclusions to be drawn from Government Exhibit 439
    are clearly probative of the weight to be given to this evidence rather than its admissibility.
    Second, the defendants contend that if they “had been given time and had the ability to
    investigate” why the listed beneficiaries were no longer receiving PCA services, the “jurors
    could have been properly educated about . . . the usefulness of the report.” Def. MB’s R. 33
    Mot. at 37; see also id. at 35 (asserting that defendant “was deprived of an ability to investigate
    70
    the substance of Exhibit 449 [sic]”); Def. FB’s R. 33 Mem. at 6 (acknowledging that “the Court
    allowed Mrs. Bikundi overnight to speak with Mr. Shearer prior to his testimony the next
    morning” but nevertheless contending she “was not allowed the appropriate time to investigate
    and interview the beneficiaries listed in the report to determine whether they did in fact need the
    services”). Yet, the defendants made no request for any continuance to conduct such an
    investigation, choosing instead to ask only that the report be excluded. Moreover, as the
    government points out, “the defense had access to the same claims data as the government and
    could have interviewed any of the many Medicaid beneficiaries contained in that data.” Gov’t
    Opp’n Def. Florence Bikundi’s R. 33 Mot. New Trial (“Gov’t Opp’n FB’s R. 33 Mot.”) at 8,
    ECF No. 404; Gov’t Opp’n MB’s R. 33 Mot. at 9.
    Accordingly, notwithstanding the defendants’ vigorous and continuing objection to
    Government Exhibit 439, this document was properly admitted at trial and, thus, no new trial is
    warranted on this basis.
    5.      The Defendants Fail To Show Any Variance In Proof For Charged
    Health Care Fraud Conspiracy
    Count One of the Superseding Indictment charged Florence and Michael Bikundi with
    conspiring with six other Global employees (i.e., Christian Asongcha, Melissa Williams, Elvis
    Atabe, Carlson Igwacho, Irene Igwacho and Berenice Igwacho), from August 2009 through
    February 2014 “to unlawfully enrich themselves by submitting false and fraudulent claims to
    D.C. Medicaid,” Superseding Indictment ¶ 69, in violation of 
    18 U.S.C. § 1347
     (Health Care
    Fraud), 
    18 U.S.C. § 1035
     (False Statements in Health Care matters) and 42 U.S.C. § 1320a-7b(b)
    (Illegal Payments in Connection with Federal Health Care Program). Having failed to make any
    request at trial for a multiple conspiracy instruction, Florence Bikundi now urges that her guilty
    verdict on this charge “be vacated and a new trial ordered in the interest of justice,” Def. FB’s R.
    71
    33 Mem. at 9, because the evidence “established multiple conspiracies rather than the single one
    and this variance prejudiced Mrs. Bikundi,” id. at 8; see also Def. FB’s R. 29 Mem. at 3
    (renewing acquittal motion because “evidence presented by the government demonstrates that
    there were multiple conspiracies occurring that Mrs. Bikundi was neither aware of or a part
    of”). 21
    Specifically, Florence Bikundi points to evidence regarding illegal “patient sharing
    arrangements” that Melissa Williams had with other PCAs at Global and another company,
    Vizion One, to pay beneficiaries to sign-off on timesheets verifying more hours than the PCAs
    had actually worked. Def. FB’s R. 33 Mem. at 9. In addition, Florence Bikundi complains of a
    prejudicial “spillover effect” from other evidence that she claims revealed conspiracies in which
    Chris Asongcha, who remains a fugitive in this case, Nicola White, Elvis Atabe and other Global
    employees were involved and that were “distinct and varied from the conspiracy charged in the
    superseding indictment” and had “nothing to do with Mrs. Bikundi.” Id. Contrary to the
    defendant’s contention, “[f]rom the overwhelming evidence of the defendants’ common goal,
    interdependence, and overlapping core of participants, a reasonable jury could easily conclude
    that the defendants were part of a single . . . conspiracy.” Bostick, 791 F.3d at 138.
    In evaluating a defendant’s challenge to a conspiracy conviction on grounds of a variance
    between the single conspiracy charged and the purported proof of multiple conspiracies, courts
    must determine whether “the evidence was sufficient for the jury to conclude that the
    [defendants] joined in a single conspiracy.” United States v. Tarantino, 
    846 F.2d 1384
    , 1394
    21
    Florence Bikundi reiterates that insufficient evidence was submitted at trial that she participated “in any
    conspiracy with Melissa Williams or any of the individuals named in the indictment” or that she “entered into an
    unlawful agreement with any other individual to commit health care fraud.” Def. FB’s R. 33 Mem. at 8. This
    challenge to the sufficiency of the evidence to support the defendants’ convictions on Count One is addressed,
    supra, in Part III.A.2.
    72
    (D.C. Cir. 1988). The D.C. Circuit has identified “a variety of factors” to aid in this evaluation,
    the “most important of these is whether the conspirators share a common goal.” Id. at 1393.
    Additional factors include “the degree of dependence inherent in the conspiracy,” the
    conspirators’ “link to other conspirators” and “the overlap of participants in the various
    operations claimed to comprise a single conspiracy.” Id.; see also Bostick, 791 F.3d at 137–38
    (“We consider three factors to determine whether the evidence supports a conclusion that the
    defendants belonged to a single conspiracy: whether the alleged participants had (1) a common
    goal, (2) interdependence, and (3) overlap, such as the presence of core participants linked to all
    the defendants.” (internal quotation and citation omitted)); United States v. Eiland, 
    738 F.3d 338
    ,
    358 (D.C. Cir. 2013) (“In determining whether the evidence supports a finding of a single
    conspiracy or instead only demonstrates multiple conspiracies, we look at whether the
    defendants shared a common goal, any interdependence between the alleged participants, and
    any overlap among alleged participants, such as the presence of core participants linked to all the
    defendants.” (quoting United States v. Gatling, 
    96 F.3d 1511
    , 1520 (D.C. Cir. 1996)). When
    making a variance challenge, the defendant bears the burden of showing, first, a variance
    between the charged single conspiracy and the existence of multiple conspiracies and, second,
    that “because of the multiplicity of defendants and conspiracies, the jury was substantially likely
    to transfer evidence from one conspiracy to a defendant involved in another.” Eiland, 738 F.3d
    at 358 (quoting Tarantino, 846 F.2d at 1391). The defendants simply cannot meet this burden
    here. 22
    22
    Without any discussion, Florence Bikundi cites United States v. Tarantino, 
    846 F.2d 1384
     (D.C. Cir. 1988),
    and Kotteakos v. United States, 
    328 U.S. 750
     (1946), as support for her variance challenge. Def. FB’s R. 33 Mem.
    at 9. These cases are not helpful to her argument for different reasons. In Tarantino, the D.C. Circuit rejected the
    defendants’ claim of a prejudicial variance of multiple conspiracies, finding instead that “even though they may not
    have known the precise identity of all the other conspirators” in the single charged narcotics distribution and money
    laundering conspiracy, each defendant—like the defendants in the instant case—“played a vital role in the
    conspiracy’s success,” and “shared the conspiracy’s objects.” 
    846 F.2d at
    1293–94. In Kotteakos, the government
    73
    First, consideration of the Tarantino factors confirms that a single conspiracy, as charged
    in Count One, was established. With respect to the first factor, the evidence showed that the
    conspirators shared a common goal of using Global to defraud D.C. Medicaid of funds through
    use of various means, including submitting and approving false timesheets for PCAs seeking
    reimbursement from D.C. Medicaid for work not performed, recruiting and paying kickbacks to
    Medicaid beneficiaries to incentivize them to sign-off on PCAs’ false timesheets, and falsifying
    multiple documents required to maintain licensure as a D.C. Medicaid provider and obtain
    continuing reimbursement from D.C. Medicaid. Even if each participant in this corrupt
    operation did not know precisely what other participants were doing to facilitate this fraud and
    spur the exponential growth of Global’s reimbursements from D.C. Medicaid, the co-
    conspirators shared the common single goal of using Global to make as much money as possible
    from this federal health care program. Moreover, even if certain co-conspirators made their own
    illegal arrangements with PCAs and beneficiaries to submit false timesheets, the defendants’
    attempt to characterize these arrangements as side-deals wholly separate from the charged
    conspiracy is incorrect. Instead, those arrangements were building blocks for the entire criminal
    enterprise and had the effect of increasing the number of Medicaid beneficiaries and PCAs
    willing to engage in the falsification of timesheets and other records to continue bilking D.C.
    Medicaid for reimbursement to which the defendants and their co-conspirators were not entitled.
    As the government correctly notes, “[w]hile members of the conspiracy may have played
    different roles (Melissa Williams and Elvis Atabe, for example, primarily assisted in falsifying
    conceded a serious variance between the indictment, which charged over ten defendants in a single conspiracy, and
    the proof showing at least eight separate conspiracies, 
    328 U.S. at
    755–56, which were not “tied together as stages in
    the formation of a larger, all-inclusive combination, all directed to achieving a single unlawful end or result,”
    Blumenthal v. United States, 
    332 U.S. 539
    , 558 (1947). In this circumstance, the Supreme Court reversed the
    convictions, finding it “highly probable that the error had substantial and injurious effect.” Kotteakos, 
    328 U.S. at 776
    . By contrast here, the government insists that the jury correctly concluded that the defendants were members of
    a single conspiracy, which is firmly established by the evidence. See supra Part III.A.2.
    74
    documents, while Carlson Igwacho, Berenice Igwacho, and Irene Igwacho, as home health aides,
    submitted payments to beneficiaries and obtained signed timesheets falsely indicating that they
    had worked the full hours with the client), each had an overall goal of defrauding the Medicaid
    program.” Gov’t Opp’n FB’s R. 33 Mot. at 11–12.
    The Supreme Court’s consideration of a variance challenge in Blumenthal v. United
    States, 
    332 U.S. 539
     (1947), is illustrative of the weakness in the defendants’ instant assertion
    that evidence of illegal arrangements engaged in by charged co-conspirators amounts to a
    variance of proof warranting a new trial. In Blumenthal, five defendants were convicted of a
    single conspiracy of selling two carloads of whiskey in violation of the price cap set by statute.
    
    Id. at 542
    . The defendants played different roles in the “channel for distributing the liquor and
    giving that unlawful process a legal façade,” 
    id. at 548
    , even though some of the defendants “did
    not know, when they joined the scheme, who those people were or exactly the parts they were
    playing in carrying out the common design and object of all,” 
    id. at 558
    . Since “the several
    agreements were essential and integral steps” for the success of the overall conspiracy, however,
    the Court concluded that “[b]y their separate agreements, if such they were, they became parties
    to the larger common plan, joined together by their knowledge of its essential features and broad
    scope, though not of its exact limits, and by their common single goal.” 
    Id.
     Consequently, the
    Court rejected the defendants’ contention that “the proof, in variance from the indictment, shows
    that there was more than one conspiracy,” 
    id. at 542
    , and affirmed the convictions, 
    id. at 559
    .
    Similarly here, even if the proof at trial showed that co-conspirators engaged in illegal deals to
    which Florence and Michael Bikundi were not made fully aware, these activities helped further
    the overall goal of the single, charged conspiracy and do not amount to a variance in proof. See
    also United States v. Graham, 
    83 F.3d 1466
    , 1471 (D.C. Cir. 1996) (holding that drug
    75
    distributing cliques that were in competition with one another were still part of a single
    conspiracy in part because they shared the common goal of selling one defendant’s cocaine for
    profit).
    With respect to the second factor, the evidence established interdependence among the
    charged conspirators to carry out the fraud scheme. The D.C. Circuit has explained that this
    factor “requires that each defendant’s actions ‘facilitate the endeavors of other alleged
    coconspirators or facilitate the venture as a whole.’” United States ex rel. Miller v. Bill Harbert
    Int’l Constr., Inc., 
    608 F.3d 871
    , 900 (D.C. Cir. 2010) (quoting United States v. Carnagie, 
    533 F.3d 1231
    , 1238 (10th Cir. 2008) (internal quotation omitted)). This factor is easily met here.
    Florence Bikundi obtained the D.C. Medicaid license for Global to operate and recruited at least
    some Medicaid beneficiaries to obtain their PCA services through Global. Carolyn Baldwin, one
    of the beneficiaries who had received payoffs from Florence Bikundi in the past, became a
    patient of Global and continued to receive payoffs for signing off on false timesheets for Melissa
    Williams. The co-conspirators who worked as PCAs, including Carlson, Berenice and Irene
    Igwacho, Melissa Williams and Frances James, operated similarly to Florence Bikundi and paid-
    off beneficiaries to sign false timesheets, which were then submitted for approval to both
    Florence and Michael Bikundi and ultimately to D.C. Medicaid for reimbursement. In order to
    maintain Global’s license as a Medicaid provider, Florence and Michael Bikundi facilitated the
    creation of false documentation by Elvis Atabe, Nicola White, Elvis Atabe, Irene Igwacho and
    others, including false background checks and POCs, to present to HRLA surveyors. As Elvis
    Atabe testified, “the whole system was bad in Global.” Tr. (Oct. 21, 2015 PM) at 25 (Atabe),
    ECF No. 317. This testimony was corroborated by Melissa Williams, who testified that it was
    understood that whatever documents needed to be forged would be forged. Tr. (Oct. 29, 2015
    76
    PM) at 86–88 (Williams), ECF No. 334. Each role played by the co-conspirators was integral to
    facilitating the larger fraud scheme.
    The “final factor of lesser significance is the overlap of participants in the various
    operations claimed to comprise a single conspiracy.” Tarantino, 
    846 F.2d at 1393
    . The D.C.
    Circuit has explained that this factor requires “only that the main conspirators work with all the
    participants.” Bill Harbert Int’l Constr., Inc., 
    608 F.3d at 901
     (quoting United States v.
    Hemphill, 
    514 F.3d 1350
    , 1363 (D.C. Cir. 2008)). Here, all of the conspirators were Global
    employees so they all worked together under the supervision and management of Florence and
    Michael Bikundi. This status gave the conspirators a strong incentive for Global to continue in
    business and flourish in order to keep their jobs. Indeed, some of the conspirators were not
    legally entitled to work in this country, a vulnerable circumstance that made them even more
    willing to comply with instructions to engage in illegal activities to maintain their employment.
    Tr. (Oct. 19, 2015 PM) at 140–41 (Johnson), ECF No. 313; Tr. (Oct. 29, 2015 PM) at 31
    (Williams), ECF No. 334.
    Thus, the Tarantino factors all confirm that a single conspiracy was proven at trial and
    that there was no variance in proof, as Florence Bikundi now, belatedly claims.
    Second, even if some variance in the evidence occurred, the defendants fail to show any
    substantial prejudice from the “spillover” evidence of the other illegal activity in which some of
    the co-conspirators engaged. Indeed, “not every variance between the crime charged and the
    crime proven is fatal to the validity of the resulting conviction.” United States v. Cross, 
    766 F.3d 1
    , 5 (D.C. Cir. 2013); see also United States v. Mathis, 
    216 F.3d 18
    , 25 (D.C. Cir. 2000) (finding
    “a variance between the indictment charging a single conspiracy and the trial evidence indicating
    more than one conspiracy,” but nonetheless concluding “the variance did not substantially
    77
    prejudice the appellants”). Requiring a “material[]” variance that causes “substantial prejudice”
    to trigger the need for a new trial, United States v. Emor, 
    573 F.3d 778
    , 786 (D.C. Cir. 2009),
    comports with the well settled law that the guilty verdict will be upheld “if the evidence
    adequately supports the jury’s finding that a single conspiracy existed,” Eiland, 738 F.3d at 359,
    and “[w]hether the evidence proved a single conspiracy ‘is primarily a question of fact for the
    jury,’” Bostick, 791 F.3d at 137 (quoting United States v. Childress, 
    58 F.3d 693
    , 709 (D.C. Cir.
    1995)). As summarized supra in Part III.A.2, the evidence regarding Florence and Michael
    Bikundi’s involvement in the over-arching conspiracy was overwhelming. In this circumstance,
    the defendants simply cannot show any substantial prejudice from the alleged variance based on
    “insufficient evidence for a reasonable jury to find [the defendant] guilty of the conspiracy
    charged in the indictment beyond a reasonable doubt.” Cross, 766 F.3d at 5.
    Moreover, while spillover prejudice “may occur when a jury imputes evidence from one
    conspiracy to a defendant involved in another conspiracy,” United States v. Gaviria, 
    116 F.3d 1498
    , 1533 (D.C. Cir. 1997), this risk is minimized when, as here, the co-conspirators
    themselves denied to the jury that the defendants were advised or even aware of the other illegal
    conspiracies cited by the defendants. For example, Melissa Williams testified that, while both
    Florence and Michael Bikundi were fully aware of some of her illegal activities to facilitate the
    goals of the charged conspiracy, she did not tell them or otherwise make them aware of her
    illegal arrangements (1) with Atawan Mundu John to use a Medicaid patient of Vizion One to
    sign false timesheets for PCA services not actually provided, Tr. (Nov. 2, 2015 AM) at 40–41
    (Williams), ECF No. 338; or (2) her patient sharing arrangements with certain Global PCAs, 
    id.
    at 6–7, 100. 23
    23
    To the extent that Florence Bikundi tries to attribute to Chris Asongcha some undefined “separate and
    distinct conspiracy from the conspiracy charged in the superseding indictment,” Def. FB’s R. 33 Mem. at 9, this is
    78
    In sum, the defendants fail to carry their burden of showing either a variance or prejudice
    and are, consequently, not entitled to a new trial on this basis.
    6.        The Jury Was Properly Instructed On The Health Care Fraud In
    Count Two
    Florence Bikundi contends that the jury was given erroneous instructions for Count Two,
    charging the defendants with health care fraud, in violation of 
    18 U.S.C. §§ 2
     and 1347, by not
    instructing the jury “that it had to unanimously agree to each manner and means alleged by the
    government.” Def. FB’s R. 33 Mem. at 7. The defendant designates each “manner and means”
    charged in Count Two as “six different acts” and then posits that the government “must prove
    beyond a reasonable doubt at least one of the theories to the satisfaction of the entire jury.” 
    Id.
    Absent a unanimity instruction for Count Two, the defendant argues that “it is unclear on which
    set of facts form the guilty verdict,” requiring “vacat[ur of] the judgment on Count 2 and . . . a
    new trial.” 
    Id. at 8
    . The defendant is incorrect as a matter a law.
    Count Two charges that, from at least in or around August 2009, continuing until in or
    around February 2014, in the District of Columbia and elsewhere, the defendants Florence and
    Michael Bikundi, aiding and abetting each other, and others, known and unknown to the Grand
    Jury, “did knowingly and willfully execute, and attempt to execute, a scheme and artifice to
    defraud and to obtain, by means of materially false and fraudulent pretenses, representations, and
    promises, money and property owned by, and under the control of, the D.C. Medicaid program, a
    health care benefit program, as defined in Title 18, United States Code, Section 24(b), in
    connection with the delivery of and payment for health care benefits, items, and services, namely
    merely a revival of the defendants’ unsuccessful effort at trial to put the blame for the illegal activities occurring at
    Global on an absent fugitive. See, e.g., Tr (Nov. 9, 2015 PM) at 109, 113–14, ECF No. 376 (Florence Bikundi’s
    Closing Statement); Tr. (Nov. 10, 2015 AM) at 29, ECF No. 377 (Michael Bikundi’s Closing Statement). The jury
    plainly rejected this blame-shifting argument for sound reason based on the ample evidence of the defendants’ own
    involvement in the charged conspiracy.
    79
    personal care services.” Jury Instructions at 14–15. “The indictment alleges that it was a
    purpose of the scheme for the defendants Florence Bikundi and Michael Bikundi and others to
    unlawfully enrich themselves by, among other things, submitting and causing to be submitted
    false and fraudulent claims for payment to D.C. Medicaid for personal care services that were
    not provided as claimed.” 
    Id. at 15
    . The “manner and means by which defendants sought to
    accomplish the purpose of the fraud scheme,” 
    id.,
     were enumerated as follows:
    a. Defendants and co-conspirators offered and caused to be offered cash
    payments to patient recruiters in return for referring D.C. Medicaid
    beneficiaries to serve as patients of Global.
    b. Defendants and co-conspirators recruited and caused to be recruited
    D.C. Medicaid beneficiaries who were willing to receive cash
    payments in exchange for certifying that the personal care aides had
    provided services as prescribed when the services were not provided.
    c. Defendants and co-conspirators falsified and caused to be falsified
    Global patient files to make it appear that D.C. Medicaid beneficiaries
    were qualified for and received personal care services that were not
    provided.
    d. Defendants and co-conspirators falsified and caused to be falsified
    Global employee files to make it appear that Global employees were
    qualified to provide personal care services to D.C. Medicaid
    beneficiaries, when they were not qualified to provide those services.
    e. Defendants and co-conspirators created and caused to be created false
    and fraudulent personal care aide timesheets which falsely certified
    that personal care services were provided to D.C. Medicaid
    beneficiaries when the services were not provided.
    f. Defendants and co-conspirators submitted and caused to be submitted
    false and fraudulent claims to D.C. Medicaid seeking payment for the
    costs of personal care services that were not provided.
    Id.; see Superseding Indictment ¶ 74(a)–(f).
    Neither the jury instructions nor the verdict form instructed the jury to reach unanimous
    agreement on the specific “manner and means” listed in (a) through (f), which each defendant
    80
    was charged with using to commit the health care fraud offense. 
    Id.
     at 14–18; Verdict Sheet at 2,
    ECF No. 361. At the same time, as the government correctly points out, the defendants failed to
    request any specific unanimity instruction as to Count Two, even though they requested, and
    such an instruction was given, for Count One. Gov’t Opp’n FB’s R. 33 Mot. at 9; see Parties’
    Joint Pretrial Statement, Ex. 2 (Joint Proposed Jury Instructions) at 80–82 (proposed instructions
    for Count Two), ECF No. 271. This failure to request a unanimity instruction as to the “manner
    and means” in Count Two, and to object to the final instructions on this basis, would “preclude[]
    appellate review,” FED. R. CRIM. P. 30(d), unless the absence of a unanimity instruction
    constitutes “[a] plain error that affects substantial rights,” FED. R. CRIM. P. 52(b). No error, let
    alone plain error, occurred here and, consequently, no new trial is required in the “interest of
    justice.” FED. R. CRIM. P. 33(a).
    The Supreme Court explained in Richardson v. United States, 
    526 U.S. 813
     (1999), that
    “[f]ederal crimes are made up of factual elements, which are ordinarily listed in the statute that
    defines the crime” and “[c]alling a particular kind of fact an ‘element’ carries . . . [t]he
    consequence that . . . a jury in a federal criminal case cannot convict unless it unanimously finds
    that the Government has proved each element.” 
    Id. at 817
    . Not every fact that describes
    criminal activity amounts to an element, however. The Court clarified that “a federal jury need
    not always decide unanimously which of several possible sets of underlying brute facts make up
    a particular element, say, which of several possible means the defendant used to commit an
    element of the crime.” 
    Id.
     By way of example, the Court observed that while “an element of
    robbery is force or the threat of force, some jurors might conclude that the defendant used a knife
    to create the threat; others might conclude he used a gun. But that disagreement—a
    disagreement about means—would not matter as long as all 12 jurors unanimously concluded
    81
    that the Government had proved the necessary related element, namely that the defendant had
    threatened force.” Id.; see also Schad v. Arizona, 
    501 U.S. 624
    , 631 (1991) (“We have never
    suggested that in returning general verdicts in such cases the jurors should be required to agree
    upon a single means of commission, any more than the indictments were required to specify one
    alone.”). In Richardson, the Court held that each individual predicate violation making up the
    requisite “series of violations,” under the continuing criminal enterprise statute, 
    21 U.S.C. § 848
    (a), was an element of that offense requiring juror unanimity to sustain the conviction. 
    526 U.S. at 815
    .
    By contrast, when the indictment merely describes the means used to carry out a crime,
    those factual allegations—or “brute facts”—do not amount to “elements” requiring unanimity.
    As the Seventh Circuit bluntly put it: “jurors don’t have to agree on means.” United States v.
    Schiro, 
    679 F.3d 521
    , 533 (7th Cir. 2012). The Schiro court gave its own example, explaining,
    “Suppose a defendant on trial for murder had first choked his victim and then shot him, and some
    jurors think the choking killed him and others that he was alive until he was shot. It is enough
    that they are unanimous that the defendant killed him.” 
    Id.
    The defendant’s challenge to the lack of a unanimity instruction raises the question of
    whether the “manner and means” used to execute the charged health care fraud are part of the
    elements of the charged crime requiring a specific unanimity instruction to ensure all jurors
    agreed to at least one enumerated “means,” or, instead, are merely, as titled, the means of
    committing the offense. If the latter, then the general unanimity instruction requiring the jury to
    unanimously find the defendants guilty beyond a reasonable doubt is sufficient, even if the jurors
    were less than unanimous regarding one or more of the enumerated means. See Jury Instructions
    82
    at 30 (“[I]n order to return a verdict, each juror must agree on the verdict. In other words, your
    verdict must be unanimous on each of the 15 charges.”).
    The D.C. Circuit has not addressed this precise question in the context of a health care
    fraud offense or more general fraud offense, but in analogous circumstances has found that the
    means used to commit an offense, as described in an indictment, are not subject to a specific
    unanimity instruction. See, e.g., United States v. Kayode, 
    254 F.3d 204
    , 213–14 (D.C. Cir. 2001)
    (finding no error in district court’s declining to give unanimity instruction requiring jury to agree
    on which five documents satisfied all elements of the offense of possession of false identification
    documents since “[t]he statute makes relevant only the number of false identification documents
    intended to be used, not the identity of each particular document”); United States v. Harris, 
    959 F.2d 246
    , 255 (D.C. Cir. 1992) (per curiam) (agreeing with government that jury did not have to
    agree on which five (or more) persons belonged to a continuing criminal enterprise but only that
    the defendant had acted in concert with “five or more persons”); see also United States v. Adams,
    No. 14-cr-44, 
    2015 U.S. Dist. LEXIS 167211
    , at *12–14 (D.D.C. Dec. 15, 2015) (concluding
    that defendant was “not entitled to unanimity instruction on the particular means he employed to
    obstruct or impede the internal-revenue laws”).
    Four other Circuits have considered the need for a unanimity instruction regarding the
    means used to execute a fraudulent scheme and concluded that “[a] jury, faced with divergent
    factual theories in support of the same ultimate issue, may decide unanimously . . . that the
    government has proven a scheme to defraud even if they may not be unanimous as to the precise
    manner in which it occurred.” United States v. Daniel, 
    749 F.3d 608
    , 613 (7th Cir. 2014)
    (ellipsis in original) (quoting United States v. LaPlante, 
    714 F.3d 641
    , 647 (1st Cir. 2013)). In
    Daniel, the Seventh Circuit held that the district court did not abuse its discretion in declining to
    83
    give an additional specific unanimity instruction on the specific fraudulent representations or
    omissions the defendant committed since these “were ʻunderlying brute facts’ of the verdict
    against him” and “merely the means he used to commit an element of the crime” of wire fraud.
    
    Id. at 614
    ; see also LaPlante, 714 F.3d at 647 (“The court was not required to give that
    unanimity instruction because the jury is not required to agree on the means—the specific false
    statement—[the defendant] used to carry out her fraudulent scheme.”); United States v. Rice, 
    699 F.3d 1043
    , 1048 (8th Cir. 2012) (holding that jurors were properly instructed “that they needed
    to agree that one of the means had been used [to defraud victims], but that not all needed to agree
    on the same one”); United States v. Lyons, 
    472 F.3d 1055
    , 1068 (9th Cir. 2007) (holding that in a
    scheme to defraud, “the jury need not be unanimous on the particular false promise”).
    While these out-of-Circuit decisions are not binding, they are persuasive in their
    application of the Supreme Court’s precedent in Richardson and Schad distinguishing “brute
    facts,” which describe the means of committing a crime, from the factual elements required by
    the statute to be proven beyond a reasonable doubt to a unanimous jury. Indeed, more recently,
    the Supreme Court took pains to avoid any suggestion “that the Government adds an element to a
    crime for purposes of sufficiency review when the indictment charges different means of
    committing a crime in the conjunctive.” Musacchio, 
    136 S.Ct. at
    715 n.2.
    Accordingly, the defendants were not entitled to a unanimity instruction for the “manner
    and means” allegedly used to commit the health care fraud offense, even had they timely
    requested such an instruction.
    B.      CHALLENGES TO EIGHT MONEY LAUNDERING CONVICTIONS
    Both Florence and Michael Bikundi seek a judgment of acquittal and a new trial on their
    eight convictions for conspiring to commit and committing money laundering, in violation of 18
    
    84 U.S.C. §§ 2
    , 1956(a)(1)(B)(i), and 1956(h), as charged in Counts Fifteen through Twenty-Two.
    The defendants challenge these money laundering convictions on three grounds: (1) the
    government presented insufficient evidence to support these convictions, Def. FB’s R. 33 Mem.
    at 14; Def. FB’s R. 29 Mem. at 19–22; Def. MB’s R. 33 Mot. at 38–44; (2) “the underlying facts
    of money laundering were also used to support a conviction for health care fraud,” Def. FB’s R.
    33 Mem. at 14; see Def. MB’s R. 33 Mot. at 45–46; and (3) these convictions are inconsistent
    with the jury’s acquittal of the defendants on Counts Twenty-Three through Twenty-Five, Def.
    FB’s R. 29 Mem. at 17.24 Each of these challenges is addressed seriatim below.
    1.       Sufficient Evidence Was Presented To Sustain Money Laundering
    Convictions
    The defendants challenge the sufficiency of the evidence supporting their money
    laundering convictions, stating that “the government failed to prove any agreement to conspire to
    commit money laundering as alleged in Count 15, and further failed to prove any intent to
    conceal the source of the funds alleged in Counts 16-22.” Def. FB’s R. 33 Mem. at 14; see Def.
    MB’s R. 33 Mot. at 44. Evidence supporting the money laundering charges was presented
    principally through the testimony of Agent Hinson, who traced the transfer by the defendants of
    the fraudulently obtained D.C. Medicaid funds from deposits in Global bank accounts to over
    one hundred non-Global accounts controlled by either or both defendants. Tr. (Nov. 3, 2015
    AM) at 131, 134 (Hinson), ECF No. 343; Gov’t Ex. 184. In considering the defendants’
    challenge, the Court first reviews the specific money laundering convictions, before assessing the
    sufficiency of the evidence supporting these convictions.
    24
    Florence Bikundi also complains that the jury found her “guilty without specifying which object of the
    conspiracy there was a unanimous agreement.” Def. FB’s R. 29 Mem. at 17. She is mistaken. The verdict form
    completed by the jury shows that, on Count Fifteen, the jury twice answered “YES” to unanimously finding that an
    object of the money laundering conspiracy was to violate 
    18 U.S.C. § 1956
    (a)(1)(B)(i) and to violate § 1957.
    Verdict Form at 2.
    85
    The defendants’ conviction of the money laundering conspiracy charged in Count Fifteen
    required proof, first, that Florence and Michael Bikundi agreed to try to accomplish an unlawful
    plan to conceal and disguise the nature, location, source, ownership and control of the proceeds
    of health care fraud, in violation of 
    18 U.S.C. § 1956
    (a)(1)(B)(i), or to engage in monetary
    transactions in criminally derived property, which had a value greater than $10,000 and was
    derived from health care fraud, in violation of 
    18 U.S.C. §1957
    ; and, second, that each defendant
    intentionally joined in that agreement. See Jury Instructions at 21–22, 24.
    The remaining substantive money laundering convictions are based on seven separate
    transactions involving (1) three checks, dated November 7, 2012, March 18, 2013 and April 29,
    2013, transferring a total of $1,300,000 from two Global bank accounts to two Tri-Continental
    bank accounts, in Counts Sixteen, Seventeen and Eighteen; and (2) three checks, dated June 7,
    2013, June 21, 2013, and August 2, 2013, and a wire transaction on May 10, 2013, transferring a
    total of $1,370,000 from a Global bank account to a CFC bank account, in Counts Nineteen
    through Twenty-Two. See 
    id.
     at 25–26.
    Contrary to the defendants’ contention, the requisite agreement between the defendants
    for their money laundering conspiracy conviction was supported by sufficient evidence. The
    proof at trial showed that both defendants were fully aware of fraudulent timesheets submitted by
    Global for reimbursement by D.C. Medicaid and that Global’s patient and employee files were
    replete with falsified documents. In short, both defendants knew that the monies received by
    Global from D.C. Medicaid were obtained by fraud. The proof at trial further showed that in the
    handling of those fraudulently-obtained proceeds, these two defendants worked in lockstep to (1)
    manage the Global operations, including reviewing and approving timesheets, issuing checks,
    supervising employees, and other aspects of the business, see supra Parts I.C–E; (2) control
    86
    Global’s bank accounts, for which both defendants were signatories over the lifespan of the
    accounts, Gov’t Ex. 184; (3) control bank accounts for CFC and Tri-Continental over the
    lifespan of the accounts, see supra Part I.F; and (3) transfer funds from Global accounts to non-
    Global accounts that one or both of the defendants controlled, see id. This jointly undertaken
    activity provided sufficient evidence of the defendants’ agreement to work together for the same
    illegal goals for a rational jury to conclude, beyond a reasonable doubt, that they had an
    agreement, satisfying this element for a conviction on Count Fifteen.
    The crux of the defendants’ challenge to the money laundering convictions, including for
    money laundering conspiracy, is that the “government clearly failed to prove . . . that Mrs.
    Bikundi attempted to ‘conceal or disguise’ the alleged fraudulently obtained funds.” Def. FB’s
    R. 29 Mem. at 18; Def. MB’s R. 33 Mot. at 44 (“There was no evidence of concealment.”).
    Indeed, to sustain a conviction under 
    18 U.S.C. § 1956
    (a)(1)(B)(i), the government must prove,
    beyond a reasonable doubt, that the defendant knew “that the transaction [was] designed in
    whole or in part — (i) to conceal or disguise the nature, the location, the source, the ownership,
    or the control of the proceeds of specified unlawful activity.” 
    18 U.S.C. § 1956
    (a)(1)(B)(i). The
    defendants criticize the proof on this “design to conceal or disguise” element because of the
    apparent ease with which the D.C. Medicaid funds were traced by law enforcement and the
    defendants’ use of their own names on the accounts to which the funds were transferred. 25 On
    25
    Specifically, the defendants point out that “Special Agent Hinson with no prior experience before this case
    as a money laundering investigator testified that the transactions were easily traceable to Mrs. Bikundi.” Def. FB’s
    R. 29 Mem. at 18; see also Def. MB’s R. 33 Mot. at 41 (noting that although Hinson “was not a C.P.A., never
    performed services” or was trained as a “professional bookkeeper” and had only “worked on two money laundering
    cases during her career,” she “had no difficulty finding the accounts and some of the accounts were opened prior to
    2009”); 
    id. at 44
     (noting that “[t]here was no evidence of concealment” since the “United States had no difficulty
    either locating or seizing the funds”). The funds were easily traceable due to the fact that the “deposits and
    withdrawals to various financial accounts” were “all done openly” without the “use [of] false names, third parties, or
    any particularly complicated financial maneuvers, which are usual hallmarks of an intent to conceal.” Def. FB’s R.
    29 Mem. at 19–20; see Def. MB’s R. 33 Mot. at 44 (“All of the recovered funds were in accounts controlled either
    by Florence or Michael Bikundi, or both.”). In particular, the checks transferring funds from Global to Tri-
    87
    this essential element for money laundering, the Court opined at the close of the government’s
    case-in-chief that the evidence regarding the defendants’ use of “many different bank accounts to
    conceal the source of the illegally obtained funds” was “slim.” Tr. (Nov. 4, 2015 PM) at 17,
    ECF No. 345.26 Yet, upon close review of the applicable case law and the trial evidence the
    Court “cannot say it is more likely than not that no reasonable juror would have found the
    requisite concealment in transactions occurring after proceeds existed.” United States v. Baxter,
    
    761 F.3d 17
    , 32 (D.C. Cir. 2014) (affirming money laundering conviction); see also Pasha, 797
    F.3d at 1135 n.9 (affirming convictions over defendants’ challenge to the sufficiency of evidence
    since, even where “the evidence was not overwhelming,” the “standard for such challenges is
    very high”).
    The government concedes, as it must, that sustaining the money laundering convictions
    requires proof, beyond a reasonable doubt, that the defendants handled the fraud proceeds with
    the purpose, in whole or in part, to conceal or disguise the proceeds’ nature, location, source,
    ownership, or control. Gov’t Opp’n FB’s R. 29 Mot. at 42. The Supreme Court made this point
    plainly in Cuellar v. United States, 
    553 U.S. 550
    , 561–65 (2008), in construing a parallel
    provision of the same money laundering statute under which the defendants were convicted and
    focusing on the meaning of the language common to both provisions, namely: “is designed in
    whole or in part . . . to conceal or disguise the nature, the location, the source, the ownership, or
    the control of the proceeds of specified unlawful activity,” 
    18 U.S.C. § 1956
    (a)(2)(B)(i); accord
    Continental and CFC that are at issue in the substantive money laundering counts Sixteen through Twenty-Two “do
    not disguise the source or the recipient” and, consequently, show no effort to conceal or disguise the funds. Def.
    FB’s R. 29 Mem. at 20; see Def. MB’s R. 33 Mot. at 44 (“Funds deposited into accounts in the names of CFC
    Corporation and Tri-Continental were deposited without any attempt whatsoever to conceal the origin of the
    funds.”).
    26
    As noted, supra at nn. 10–12, the Court reserved decision on the defendants’ motions for acquittal on all of
    the money laundering charges, including those for which the defendants were ultimately acquitted by the jury. See
    Tr. (Nov. 4, 2015 PM) at 18, ECF No. 345.
    88
    § 1956(a)(1)(B)(i). In that case, the Court reversed the money laundering conviction of a
    defendant, who was caught driving in the direction of the Mexican border in a Volkswagen
    Beetle with approximately $81,000 in cash that was secreted in a concealed compartment built
    into the car’s rear floorboard, which was then covered in animal hair in an apparent “attempt to
    mask the smell of marijuana.” 
    553 U.S. at 554
    . “[G]uided by the words of the operative
    statutory provision,” 
    id. at 558
    , the Court concluded that “merely hiding funds during
    transportation is not sufficient to violate the statute, even if substantial efforts have been
    expended to conceal the money,” 
    id. at 563
    . Showing that the defendant “engaged in extensive
    efforts to conceal the funds en route to Mexico,” 
    id. at 568
    , and to “facilitate the transportation,”
    
    id. at 567
     (emphasis in original), falls short of the requisite proof that the funds were moved in
    this manner with the design or purpose of concealing a listed attribute of the funds. The Court
    stressed that “how one moves the money is distinct from why one moves the money. Evidence of
    the former, standing alone, is not sufficient to prove the latter.” 
    Id. at 566
     (emphasis in original).
    Notably, in Cuellar, “the Government failed to introduce any evidence that the reason drug
    smugglers move money to Mexico is to conceal or disguise a listed attribute of the funds.” 
    Id. at 567
    .
    The year before the Cuellar decision, the D.C. Circuit had occasion in United States v.
    Adefehinti, 
    510 F.3d 319
     (D.C. Cir. 2007), to address the sufficiency of the evidence to prove the
    same “essential element of the money laundering charge” that the defendants “attempted to
    ‘conceal or disguise’ the fraudulently obtained funds.” 
    510 F.3d at
    321–22. The defendants in
    Adefehinti had a bank fraud scheme to buy cheap properties using fake identities and then “flip”
    them by selling them to each other with artificially high prices, using fraudulently obtained bank
    loans to fund the purchase. 
    Id. at 321
    . In one such transaction underlying their money
    89
    laundering conviction, one defendant deposited a settlement check payable to and endorsed by
    the “fictional seller” to his company’s account, from which the funds were distributed among the
    defendants. 
    Id. at 322
    . The D.C. Circuit observed that “the necessary intent to conceal requires
    ‘something more’ than the mere transfer of unlawfully obtained funds, though that ‘something
    more’ is hard to articulate.” 
    Id.
     (quoting United States v. Esterman, 
    324 F.3d 565
    , 572 (7th Cir.
    2003)). The Court reversed the money laundering conviction, finding that the transaction
    “involve[d] nothing but the initial crime,” with the fraud proceeds “either cashed” or deposited
    “directly into accounts in the name of defendants or their associates without passing through any
    other person’s account” and without any evidence that the defendants “took steps to disguise or
    conceal the source or destination of the funds.” Id. at 323 (internal quotations and citations
    omitted). Rather than engage in efforts to conceal the listed attributes of the funds, the Court
    noted that the “money trail” was easily followed, law enforcement had no difficulty “doing so”
    and “[a]ll the transactions conspicuously lack the ‘convoluted’ character associated with money
    laundering.” Id. at 323–24.
    Similarly, in United States v. Law, 
    528 F.3d 888
     (D.C. Cir. 2008), the D.C. Circuit
    reversed the money laundering conviction of a defendant, who made monthly mortgage
    payments for, and collected the tenants’ rents from, the building, where he resided and operated
    his illegal narcotics business, even though he was not the actual owner of the building and made
    the mortgage payments in the actual owner’s name. 
    Id. at 893
    . The Court explained that “the
    evidence was insufficient to show the mortgage payments were designed to conceal the source of
    the funds rather than to profit[] from the excess rental income or[ to] maintain[] the premises to
    further drug trafficking,” discounting the fact that the defendant paid the mortgage in the owner’s
    name rather than his own. 
    Id.
     at 896–97 (internal quotations omitted; alterations in original).
    90
    The defendants cite to the reversal of the money laundering convictions in Cuellar,
    Adefehinti and Law to highlight that, as in those cases, the requisite “evidence of a design to
    conceal” is lacking when “an observer would easily discern the money trail . . . [and] all the
    transactions conspicuously lack the convoluted character associated with money laundering.”
    Def. FB’s R. 29 Mem. at 19–22; Def. MB’s R. 33 Mot. at 42. Instead, the traced money trail
    shows only the “trivial motivation” of the defendants’ “acquiring of assets,” and this activity of
    merely spending or disposing of illicitly obtained funds does not constitute money laundering.
    Def. FB’s R. 29 Mem. at 21–22 (citing Adefehinti and Law). Unlike the circumstances in
    Cuellar, however, where the government presented no evidence about the possible purpose to
    conceal a statutory listed attribute of funds hidden in a car’s concealed compartment, see 
    553 U.S. at 567
    , the government in this case presented Agent Hinson’s testimony, albeit limited,
    about funneling D.C. Medicaid funds through bank accounts of the “completely unrelated”
    business companies to conceal the source of the fraud proceeds, see Tr. (Nov. 4, 2015 AM) at
    78–79 (Hinson), ECF No. 344.
    Likewise, in Adefehinti, the financial transactions underlying the money laundering
    conviction were essentially the same transaction underlying the bank fraud and, thus, any efforts
    to conceal the defendants’ involvement in the transaction was understood as designed to conceal
    the fraud itself, not necessarily any statutory listed attribute of the fraud proceeds. See 
    510 F. 3d at 324
     (“Having carried out a fraud of which concealment was an integral part, defendants cannot
    be charged with the same concealment a second time, as if it were the sort of independent
    manipulation of the proceeds required for money laundering.”). Moreover, in Adefehinti, the
    fraud proceeds were easily traced from the initial check deposited directly into a defendant’s
    company account and then distributed directly to a co-defendant’s personal account, leading the
    91
    D.C. Circuit to conclude that “[t]here is no evidence that Adefehinti or [co-defendant] took steps
    to disguise or conceal the source or destination of the funds.” 
    Id. at 323
    . By contrast, and as
    discussed more fully infra in Part III.B.2, evidence of the transactions supporting the money
    laundering convictions here are wholly separate from the health care fraud scheme evidence.
    Moreover, the defendants’ fund transfers effectively moved fraudulently obtained D.C.
    Medicaid money out of Global’s accounts to shell companies that did no business, or otherwise
    had no relationship, with Global, except in terms of the defendants’ common ownership and
    control of these corporate entities. 27 Although the defendants attempt to minimize the import of
    these transfers as merely the spending of fraud proceeds, see Def. FB’s R. 29 Mem. at 21–22, a
    reasonable jury could conclude from review of the timing and amounts of the fund transfers from
    D.C. Medicaid to Global accounts and then to CFC and Tri-Continental accounts and the
    personal uses of the funds from the latter accounts that these transactions were designed, as
    Agent Hinson testified, to conceal the source of the fraud proceeds. See Tr. (Nov. 4, 2015 AM)
    at 78–79 (Hinson), ECF No. 344.
    Indeed, the defendants’ financial transactions reflect indicia of money laundering that the
    D.C. Circuit called “instructive,” including “the existence of more than one transaction, coupled
    with either direct evidence of intent to conceal or sufficiently complex transactions that such an
    27
    Michael Bikundi tries to argue that CFC and Tri-Continental were not sham or shell companies but that
    CFC “was a legitimate business entity,” Tri-Continental “was established as an import-export entity,” and “[t]he fact
    that neither business was profitable is irrelevant.” Def. MB’s R. 33 Mot. at 44. Any factual dispute over whether
    these two companies were a sham used by the defendants to launder fraud proceeds was resolved by the jury against
    the defendants, and that conclusion was well supported by the evidence that (1) neither company appeared to
    generate any income, Tr. (Nov. 4, 2015 AM) at 78–79 (Hinson), ECF No. 344; (2) millions of dollars from Global
    were transferred into the bank accounts of these two companies, which were in completely different lines of
    business from Global and transacted no business with Global, id.; (3) Carlson Igwacho’s name was forged as the
    registered agent on CFC’s Articles of Incorporation, Tr. (Oct. 28, 2015 PM) at 68–70 (Carlson Igwacho), ECF No.
    335; Gov’t Ex. 249; (4) Michael Bikundi was not supposed to have a role in CFC, but was a co-signatory with
    Florence Bikundi on CFC’s bank account, Tr. (Oct. 28, 2015 PM) at 71 (Carlson Igwacho), ECF No. 335; Tr. (Oct.
    29, 2015 AM) at 5 (Carlson Igwacho), ECF No. 332; Gov’t Ex. 250; and (5) CFC was supposed to be a real estate
    development company but only a miniscule number of checks and money were spent from CFC’s accounts related
    to real estate, Tr. (Nov. 3, 2015 AM) at 143–44 (Hinson), ECF No. 343.
    92
    intent could be inferred;” “funneling illegal funds through various fictitious business accounts”
    and “highly unusual transactions involving cashier’s checks, third party deposits, and trust
    accounts used to disguise source of funds.” Adefehinti, 
    510 F.3d at
    322–23 (internal quotations
    and citations omitted). Certainly, the government presented evidence of “tens of thousands of
    transactions,” Tr. (Nov. 3, 2015 AM) at 130 (Hinson), ECF No. 343, a number of which were
    funneled through multiple accounts of sham companies before reaching the defendants’ personal
    accounts, along with the use of 84 cashier’s checks totaling over $7,700,000 that were purchased
    with funds from some accounts controlled by the defendants and deposited into other account
    they controlled, which could reasonably be viewed as disguising the source of the funds, see Tr.
    (Nov. 3, 2015 PM) at 27 (Hinson), ECF No. 342; Tr. (Oct. 29, 2015 PM) at 27 (Levy), ECF No.
    334; Gov’t Ex. 154. This cumulative evidence amounts to more than “the mere transfer of
    unlawfully obtained funds,” Adefehinti, 
    510 F.3d at 322
    , and when viewed in the light most
    favorable to the government, see United States v. Mellen, 
    393 F.3d 175
    , 180 (D.C. Cir. 2004),
    suffices to support the money laundering convictions, see Baxter, 761 F.3d at 32 (affirming
    money laundering conviction where defendant transferred fraudulently obtained funds “to a front
    company . . . and to a frontman” before the proceeds were transferred to a co-conspirator’s
    personal account for payment of personal expenses since “[a] reasonable juror could conclude
    that those transactions involved unlawful proceeds and that those transfers by the fronts were
    designed to conceal the money’s illicit origins”); United States v. Baldwin, 
    563 F.3d 490
    , 490–
    91 (D.C. Cir. 2009) (affirming defendant’s convictions for, inter alia, health care fraud, 
    18 U.S.C. § 1347
    , and conspiracy to commit money laundering, 
    18 U.S.C. § 1956
    (h), where
    defendant and co-conspirators created sham business entities to submit fraudulent invoices for
    93
    reimbursement of health care benefits that were never furnished and “then created numerous
    bank accounts to receive the payments and launder the money”).
    Accordingly, the defendants’ motions for acquittal or for a new trial on their money
    laundering convictions due to insufficient evidence are denied.
    2.      Proof Of Health Care Fraud And Money Laundering Were Not
    Improperly Conflated
    The defendants also contend that proof of the health care fraud and money laundering
    charges “should not be conflated” but that such conflation occurred here because the activity
    underlying both sets of charges “occurred during the same time period and . . . was part of the
    same transaction or set of transactions.” Def. FB’s R. 33 Mem. at 14–15; see Def. MB’s R. 33
    Mot. at 46 (“The health care fraud and the money laundering conspiracies were not distinct from
    one another.”). This contention is unavailing.
    The D.C. Circuit has instructed, consistent with the consensus of other circuit courts, that
    the charged money laundering offense must be “distinct from the crimes that produced the funds
    that were laundered.” Baxter, 761 F.3d at 30; United States v. Hall, 
    613 F.3d 249
    , 254–55 (D.C.
    Cir. 2010) (“[T]he offense of money laundering must be separate and distinct from the
    underlying offense that generated the money to be laundered.”); Adefehinti, 
    510 F.3d at 324
    (“[The] transaction or transactions that created the criminally-derived proceeds must be
    distinct from the money-laundering transaction.” (quoting United States v. Seward, 
    272 F.3d 831
    , 836 (7th Cir. 2001))); see also United States v. Castellini, 
    392 F.3d 35
    , 47 (1st Cir. 2004)
    (“Money laundering requires there to be proceeds of illegal activity and cannot be the same as
    the illegal activity which produces the proceeds.”); United States v. Butler, 
    211 F.3d 826
    , 830
    (4th Cir. 2000) (“[T]he laundering of funds cannot occur in the same transaction through which
    those funds first become tainted by the crime.”); United States v. Mankarious, 
    151 F.3d 694
    , 706
    94
    (7th Cir. 1998) (“[A] money laundering transaction . . . must be separate from any transaction
    necessary for the predicate offense to generate proceeds.”); United States v. Edgmon, 
    952 F.2d 1206
    , 1213 (10th Cir. 1991) (“Congress appears to have intended the money laundering statute to
    be a separate crime distinct from the underlying offense that generated the money to be
    laundered.”). While the defendants are on solid legal ground in stating this requirement for a
    valid money laundering conviction, they falter in their application of this legal principle to the
    trial evidence.
    In support of their challenge, the defendants note, first, that “[t]he funds involved in the
    money laundering counts were the same funds that were received from D.C. Medicaid as a result
    of the health care fraud.” Def. FB’s R. 33 Mem. at 15; see Def. MB’s R. 33 Mot. at 46. The fact
    that the health care fraud produced the illegal proceeds, which were then used in money
    laundering transactions, is unremarkable. Violation of the federal money laundering statute, 
    18 U.S.C. § 1956
    , requires “that the money being laundered must in some way be associated with
    ‘unlawful activity.’” Hourani v. Mirtchev, 
    796 F.3d 1
    , 10 (D.C. Cir. 2015) (citing 
    18 U.S.C. § 1956
    (a)(1), which requires that a covered transaction “involves the proceeds of specified
    unlawful activity”). Thus, the defendants’ focus on the fact that both the health care fraud and
    money laundering counts involved proof of the same fraudulently obtained money from D.C.
    Medicaid is too myopic and ignores the additional proof underlying the money laundering counts
    of how the defendants handled their ill-gotten gains.
    The defendants next highlight that “the activities and transfers of money in and out of
    bank accounts occurred contemporaneously with each other and involved the same facts as
    alleged in the health care counts and money laundering counts.” Def. FB’s R. 33 Mem. at 15;
    see Def. MB’s R. 33 Mot. at 46 (“[B]oth health care fraud and money laundering were taking
    95
    place contemporaneously. . . . They were the same event.”). The government does not dispute
    that the defendants’ health care fraud and money laundering activities occurred over the same
    time period and involved the same fraudulently obtained funds from D.C. Medicaid. Gov’t
    Opp’n FB’s R. 33 Mot. at 17. Yet, as the government succinctly and correctly puts it: this is
    “not a basis to vacate the defendant’s conviction.” 
    Id.
     For money laundering, “it does not matter
    when all the acts constituting the predicate offense take place. It matters only that the predicate
    offense has produced proceeds in transactions distinct from those transactions allegedly
    constituting money laundering.” Mankarious, 
    151 F.3d at 706
    .
    The evidence underlying the money laundering convictions supplemented the
    documentary and testimonial evidence supporting the health care fraud charges by showing “the
    sort of independent manipulation of the proceeds required for money laundering.” Adefehinti,
    
    510 F.3d at 324
    . The health care fraud convictions rested on all of the evidence leading up to
    Global’s receipt of over $80,000,000 from D.C. Medicaid from 2009 until February 2014. At the
    point of receipt of the D.C. Medicaid funds, the health care fraud scheme was successfully
    completed. By contrast, the money laundering convictions rested on the documentary evidence
    and testimony of Agent Hinson regarding what Florence and Michael Bikundi then did with the
    fraud proceeds after those funds were deposited into Global’s Intake Accounts. The defendants’
    activity in fraudulently obtaining the money was not conflated with their conduct in “concealing
    it” by engaging in entirely different transactions that resulted in the distribution of the funds
    across over one hundred different accounts and financial instruments. These different actions
    constitute “two different activities which rarely are one and the same.” Adefehinti, 
    510 F.3d at 324
    . Since the money laundering offenses were separate and distinct from the health care
    96
    offenses that generated the laundered proceeds, the defendants’ contention otherwise fails and
    their money laundering convictions will not be disturbed on this ground.
    3.      Verdicts Are Not Inconsistent
    Finally, Florence Bikundi urges vacatur of her conviction on Count Fifteen because no
    reasonable juror would “be able to find beyond a reasonable doubt that Mrs. Bikundi is guilty of
    conspiracy to commit money laundering, including a violation of 
    18 U.S.C. §1957
     (Engaging in
    Monetary Transactions in Property Derived From Specified Unlawful Activity), but then” find
    her “not guilty of the underlying offense as shown in Counts 23-25.” Def. FB’s R. 29 Mem. at
    17. Even if the defendant correctly characterized the verdict on Count Fifteen as inconsistent
    with the acquittals on Counts Twenty-Three through Twenty-Five, “a factually inconsistent
    verdict,” is not, “by itself, grounds for reversal,” since that “may well be nothing more than ‘a
    demonstration of the jury’s leniency.’” United States v. Brown, 
    504 F. 3d 99
    , 102-103 (D.C. Cir.
    2007) (quoting United States v. Powell, 
    469 U.S. 57
    , 61 (1984)); see also Pitt v. District of
    Columbia, 
    491 F.3d 494
    , 506 (D.C. Cir. 2007) (“In both the civil and criminal contexts, courts
    have held that inconsistency alone is not a sufficient basis for setting aside a jury verdict.”);
    United States v. Dykes, 
    406 F.3d 717
    , 722–23 (D.C. Cir. 2005) (holding that a “criminal
    defendant convicted by a jury on one count [cannot] attack that conviction because it was
    inconsistent with the jury's verdict of acquittal on another count” (citations omitted)); United
    States v. Lewis, 
    716 F.2d 16
    , 21 (D.C. Cir. 1983) (“[C]ase law establishes that inconsistency in
    jury verdicts on multiple counts in a single indictment is not sufficient to overturn an otherwise
    valid conviction.”).
    The Supreme Court has explained that “[e]ach count in an indictment is regarded as if it
    was a separate indictment,” Powell, 
    469 U.S. at 62
    , and is therefore evaluated separately.
    97
    Protection against “jury irrationality or error,” which may be reflected in an inconsistent verdict
    is afforded “by the independent review of the sufficiency of the evidence undertaken by the trial
    and appellate courts” and no “further safeguards against jury irrationality are necessary.” 
    Id. at 67
    . Thus, the defendant’s attack on her conviction in Count Fifteen may be readily disposed of
    on this basis alone, namely, the Court’s finding, supra in Part III.B.1, that the money laundering
    convictions are supported by sufficient evidence.
    In any event, the defendant’s view of the verdicts as “inconsistent” is incorrect. The jury
    unanimously found, on Count Fifteen, that the defendants conspired to violate two different
    money laundering statutes, even though they also concluded that the defendants were not guilty
    of committing the substantive offense under one of those same statutes. The conspiracy charge
    required the jury to conclude, unanimously, only that the defendant intentionally joined an
    agreement to accomplish an unlawful purpose, and there was no necessity of finding that the
    defendant actually committed the separate and distinct unlawful act that was the goal of the
    illegal agreement.28 Indeed, the law is well settled that a criminal defendant may not attack his
    conviction on a compound offense solely because of a perceived inconsistency with the jury’s
    acquittal of the predicate offense. Over thirty years ago, in Powell, the Supreme Court refused to
    vacate a verdict convicting a defendant of using the telephone in “committing and in causing and
    facilitating” certain narcotics felonies, which the same jury had acquitted her of committing. 
    469 U.S. at 60, 69
    . Noting “the general reluctance to inquire into the workings of the jury, and the
    possible exercise of lenity,” the Court counseled “that the best course to take is simply to insulate
    jury verdicts from review on this ground.” 
    Id.
     at 68–69; see also United States v. Laing, 889
    28
    The government suggests that “the jury may have acquitted the defendant on the substantive section 1957
    counts because it found that the Government failed to establish one of the elements – such as that at least $10,000 of
    the property involved in the transaction was obtained or derived from a crime.” Gov’t Opp’n Def. FB’s R. 29 Mot.
    at 35 (citing Jury Instructions at 29–30).
    
    98 F.2d 281
    , 288–89 (D.C. Cir. 1989) (rejecting claim of inconsistent verdicts where defendant was
    convicted of offense of carrying a firearm in relation to a drug trafficking offense but acquitted
    of underlying drug trafficking offense).
    For all of these reasons, no inconsistent verdict claim by the defendants warrants a new
    trial or vacatur of their convictions for money laundering conspiracy in Count Fifteen.
    C.       DEFENDANTS WERE PROPERLY JOINED FOR TRIAL
    Defendant Michael Bikundi seeks a new and separate trial from Florence Bikundi
    because of what he characterizes as the “overwhelming” and “striking . . . enormity” of the
    “disparity of evidence between Mr. and Mrs. Bikundi” and “[t]he attendant prejudice to Michael
    Bikundi” from the “spillover effect.” Def. MB’s R. 33 Mot. at 47, 49.29 As this Court has
    previously concluded both before and during trial, Michael Bikundi was properly joined for trial
    with his spouse and ample evidence of his guilt was presented. Consequently, as explained in
    more detail below, Michael Bikundi is not entitled to any new and separate trial.
    1.       Legal Standard Applicable To Review Of Severance Motions
    Federal Rule of Criminal Procedure 8 permits joinder in the same indictment of two or
    more offenses that “are of the same or similar character, or are based on the same act or
    transaction, or are connected with or constitute parts of a common scheme or plan,” FED. R.
    CRIM. P. 8(a), as well as joinder of two or more defendants if they are alleged to have
    participated in the “same series of acts or transactions constituting an offense or offenses,”
    whether the defendants are charged in the same counts “together or separately” or “not charged
    29
    Michael Bikundi made motions for a severance prior to and during the trial on the same grounds and these
    motions were denied. See Michael Bikundi’s First Mot. Sever, ECF No. 155; Tr. (Oct. 28, 2015 AM) at 89–92, ECF
    No. 329; Tr. (Nov. 3, 2015 AM) at 80–81, ECF No. 343; Tr. (Nov. 10, 2015 AM) at 75, ECF No. 377; Minute Order
    (July 31, 2015); Minute Entry (Nov. 10, 2015).
    99
    in each count,” 
    id. 8
    (b). The D.C. Circuit has repeatedly instructed that “‘Rule 8 has generally
    been construed liberally in favor of joinder,’” while at the same time joinder “cannot be stretched
    to cover offenses . . . which are discrete and dissimilar and which do not constitute parts of a
    common scheme or plan.” Gooch, 
    665 F.3d at 1326
     (quoting United States v. Richardson, 
    161 F.3d 728
    , 733 (D.C. Cir. 1998)). The Supreme Court has recognized that joint trials “play a vital
    role in the criminal justice system,” noting the particular policy reasons underscoring the benefits
    of joinder to “promote efficiency and serve the interests of justice by avoiding the scandal and
    inequity of inconsistent verdicts.” Zafiro v. United States, 
    506 U.S. 534
    , 537 (1993) (internal
    quotations and citations omitted); see also United States v. Long, 
    905 F.2d 1572
    , 1580–81 (D.C.
    Cir. 1990) (stating that joinder promotes the judicial system’s “strong and legitimate interest in
    efficient and expeditious proceedings”); United States v. Robinson, 
    432 F.2d 1348
    , 1351 (D.C.
    Cir. 1970) ( “[Joinder] expedites the administration of justice, reduces the congestion of trial
    dockets, conserves judicial time, lessens the burden upon citizens who must sacrifice both time
    and money to serve upon juries, and avoids the necessity of recalling witnesses who would
    otherwise be called upon to testify only once.”). Indeed, there is a “presumption in favor of
    joinder,” McGill, 
    2016 U.S. App. LEXIS 3734
    , at *176, that “is especially strong where the
    respective charges require presentation of much of the same evidence, testimony of the same
    witnesses and involve defendants who are charged, inter alia, with participating in the same
    illegal acts,” 
    id.
     (quoting United States v. Richardson, 
    167 F.3d 621
    , 624 (D.C. Cir. 1999))
    (ellipsis omitted).
    Nevertheless, Federal Rule of Criminal Procedure 14(a) permits a court to order “separate
    trials of counts” or to “sever the defendants’ trials,” “if joinder of offenses or defendants in an
    indictment . . . appears to prejudice a defendant or the government.” FED. R. CRIM. P. 14(a).
    100
    While the standard of “appears to prejudice a defendant” set out in Rule 14(a) for consideration
    of severance, does not, on its face, provide an onerous test, the discretion afforded to district
    courts must be exercised with appreciation of the policy reasons favoring joinder. Thus, the D.C.
    Circuit has made clear that even if prejudice is shown, this “does not result in an automatic grant
    of the motion.” Gooch, 
    665 F.3d at 1326
    .
    Instead, the D.C. Circuit has instructed that for severance to be proper “[t]here must be ‘a
    serious risk that a joint trial would compromise a specific trial right of one of the defendants, or
    prevent the jury from making a reliable judgment about guilt or innocence.’” Bostick, 791 F.3d
    at 152–53 (affirming a district court’s denial of a defendant’s motion for a severed trial) (quoting
    Zafiro, 
    506 U.S. at 539
    ); see also United States v. Glover, 
    681 F.3d 411
    , 417 (D.C. Cir. 2012)
    (affirming district court’s denial of defense motion to sever trial citing same standard).
    2.      Substantial And Independent Evidence Of Michael Bikundi’s Guilt Was
    Presented At Trial
    As support for his motion for a new trial, Michael Bikundi points to the disparity of
    evidence against him in comparison to his wife due, first, to the separate charges, in Counts
    Thirteen and Fourteen, against Florence Bikundi for health care fraud and making false
    statements stemming from her nursing license revocations and resulting exclusion from the
    participation in all federal health care programs, Def. MB’s R. 33 Mot. at 47; and, second, to
    other evidence presented at trial involving only his wife, 
    id.
     at 47–49.
    At the outset, a disparity in the volume of evidence presented at trial among co-
    defendants simply does not suffice to warrant a severance, even when one defendant assumes the
    role of “second prosecutor” and accuses another of committing the charged crime. See Zafiro,
    
    506 U.S. at 544
     (Stevens, J., concurring); United States v. Glover, 
    736 F.3d 509
    , 516 (D.C. Cir.
    2013). On the contrary, “when there is ‘substantial and independent evidence of each
    101
    [defendant’s] significant involvement in the conspiracy,’ severance is not required.” Moore, 
    651 F.3d at 96
     (quoting Tarantino, 
    846 F.2d at 1399
    ); see also United States v. Slade, 
    627 F.2d 293
    ,
    310 (D.C. Cir. 1980) (finding severance not required despite disparity in evidence because
    evidence against defendant was “independent and substantial”). Thus, the defendant must point
    to “a serious risk” of such prejudice from certain evidence presented at trial only against
    Florence Bikundi that may have so colored the jury’s view as to “prevent the jury from making a
    reliable judgment about [his] guilt.” Bostick, 791 F.3d at 152–53.
    First, to the extent that Michael Bikundi attributes “immense prejudice” to the evidence
    regarding his wife’s exclusion from federal health care programs, Def. MB’s R. 33 Mot. at 47, he
    is wrong. 30 His briefing describes the basis for his wife’s exclusion as “related to the licensure
    fraud,” id., which is factually correct but those underlying facts were never presented to the jury
    nor was the term “licensure fraud” ever used before the jury. On the contrary, as summarized
    supra in Part I.B, three out of the total of 40 trial witnesses, testified about the exclusion process
    and communications with Florence Bikundi regarding her exclusion. These three witnesses from
    the Virginia Board of Nursing and the United States HHS-OIG did not provide any information
    30
    Neither defendant makes any argument in post-trial briefing that Counts Thirteen and Fourteen, which
    charge only Florence Bikundi with concealing her exclusion from participation in federal health care programs,
    failed to meet the requirement for joinder, under Rule 8(a), as “connected with or constitute[ing] parts of a common
    scheme or plan.” FED. R. CRIM. P. 8(a). Indeed, these two counts are predicated on Florence Bikundi’s knowledge
    of her exclusion, explain steps that she took to conceal this fact in obtaining licensing for and operating Global, and
    are relevant to showing how she facilitated the scheme to defraud the D.C. Medicaid program. In these
    circumstances, where offenses are of different types but connected to facilitate or contribute to another criminal act,
    the charges are properly tried together in a single trial. See, e.g., Blunt v. United States, 
    404 F.2d 1283
    , 1288 (D.C.
    Cir. 1968) (concluding that severance of robbery charge was not required, even though of “a wholly different nature
    from the forgery and uttering charges,” because “the theft of the checkbook used hours later to commit the fraud and
    forgeries is ‘connected together’ with these latter offenses”); United States. v. Howard, 
    245 F. Supp. 2d 24
    , 30
    (D.D.C. 2003) (denying severance of different charges since “all of the events concerning the money laundering
    activity were admissible to demonstrate the defendant’s intent to defraud.”); United States v. Adeosun, 
    49 F. Supp. 2d 7
    , 13 (D.D.C. 1999) (denying defendant’s motion to sever money laundering count from bank fraud and other
    counts of indictment since “it is clear on the face of the indictment that all of these offenses are ‘of the same or
    similar character or are based on the same act or transactions . . . or constituting parts of a common scheme or
    plan’”).
    102
    about the basis for that exclusion, let alone mention that Florence Bikundi had engaged in
    “licensure fraud.” See Tr. (Oct. 26, 2015 PM) at 4–16 (Durrett), ECF No. 327; 
    id.
     at 17–50
    (Hoffman); Tr. (Nov. 4, 2015 AM) at 125–39 (Gillin), ECF No. 344. The masking of the
    underlying reasons for Florence Bikundi’s exclusion reduced any risk of undue prejudice to
    Michael Bikundi from these two charges against his wife.
    Moreover, the two charges in Counts Thirteen and Fourteen related to Florence Bikundi’s
    exclusion are similar in nature and no more prejudicial than the serious felony charges of health
    care fraud and money laundering that the jury considered against Michael Bikundi. By contrast,
    where defendants have urged severance of their trials from co-defendants who are facing far
    more serious charges, including those punishable by death, the D.C. Circuit has affirmed the
    denial of severance. For example, in Moore, two defendants sought severance of their trials
    because co-defendants were charged with more numerous and serious death penalty eligible
    crimes. 
    651 F.3d at
    94–95. The defendants argued that evidence of these more serious charges
    presented against their co-defendants “could have a ‘spillover’ effect, akin to guilt-by-
    association, that would prejudice the jury against them.” 
    Id. at 95
    . The D.C. Circuit concluded,
    however, that denial of the severance motion was no abuse of discretion. 
    Id. at 96
    .
    Finally, any prejudice that may have been generated by the exclusion evidence against
    Florence Bikundi was addressed in the instructions given to the jury before the presentation of
    evidence and, again, in final instructions that the jury must consider the evidence against each
    defendant separately. Tr. (Oct. 15, 2015 AM) at 24 (Preliminary Instructions), ECF No. 347;
    Jury Instructions at 7–8. Such instructions have been held by the D.C. Circuit to afford adequate
    protection against any prejudicial spillover effect from evidence and charges brought against
    only one defendant and not the co-defendants. See McGill, 2016 U.S. App. LEXIS, at *179
    103
    (affirming denial of severance where court gave instructions “directing the jury to undertake an
    individualized consideration of the guilt of each defendant”); Gooch, 
    665 F.3d at
    1336–37 (citing
    Zafiro, 
    506 U.S. at
    540–41); Moore, 
    651 F.3d at
    95–96; United States v. Carson, 
    455 F.3d 336
    ,
    374–75 (D.C. Cir. 2006) (per curiam); United States v. Spriggs, 
    102 F.3d 1245
    , 1256 (D.C. Cir.
    1996); Slade, 
    627 F.2d at
    309–10. Thus, the fact that certain evidence was admitted at trial
    solely against Florence Bikundi in connection with her exclusion from participation in federal
    health care programs does not warrant a new and separate trial for Michael Bikundi.
    Second, Michael Bikundi contends that certain evidence warrants a new, severed trial,
    citing the 2009 Medicaid Provider Agreement for Global, which “Michael Bikundi was never
    alleged to have been involved in negotiating[,] . . . to have signed[,] . . . to have known anything
    about . . . [and] is not alleged to have forged anyone’s signature on the agreement.” Def. MB’s
    R. 33 Mot. at 48.31 According to Michael Bikundi, testimony regarding the forged signatures on
    this agreement “was powerfully prejudicial and incriminating.” 
    Id.
     This single, cherry-picked
    government exhibit out of a total of almost three hundred government exhibits introduced at trial
    falls far short of demonstrating the level of undue prejudice that would warrant a new trial.
    Numerous other documents presented at trial were proved to be fraudulent due to forged
    signatures and/or fabricated or altered information, including POCs, timesheets, background
    checks for Global employees, as well as their health certificates and training certificates, and
    Global board of director meeting minutes. See supra Part I.C–E. No evidence may have been
    31
    Michael Bikundi also mentions other evidence, including that he “was not alleged to have any contact with
    Carolyn Baldwin,” “merely drove Florence Bikundi to Ms. White’s home and did not personally receive the plans of
    care,” “did not issue blank CPR’s, was not involved in the alteration of timesheets and was locked in his office when
    surveys were conducted.” Def. MB’s R. 33 Mot. at 48. While this abbreviated summary of evidence may be
    exculpatory, when viewed in the context of other evidence presented about Michael Bikundi’s actions at Global, the
    jury determined that his guilt was established beyond a reasonable doubt, and the Court has concluded that this
    evidence is sufficient to sustain the jury verdict. See supra Part III.A.2, B.
    104
    presented of Michael Bikundi’s direct involvement in the creation or submission of Global’s
    2009 Medicaid Provider Agreement but ample evidence was submitted about his involvement in
    managing this company in a manner that facilitated the fraudulent payment of millions of dollars
    by the D.C. Medicaid program.
    Accordingly, Michael Bikundi’s motion for a new trial due to the “disparity and attendant
    prejudice” from certain charges and evidence against Florence Bikundi is denied.
    D.      SELECTIVE PROSECUTION
    In a last gasp effort to obtain a new trial and judgmental of acquittal, Michael Bikundi
    accuses the government, for the first time in this criminal proceeding, of selective prosecution.
    See Def. MB’s R. 33 Mot. at 50–54. Citing testimony of Donald Shearer, from DHCA, that
    three health care agencies other than Global were shut down upon execution of search warrants
    of those companies’ premises, but that those other companies were not prosecuted, Tr. (Nov. 4,
    2015 AM) at 104–05, 116–17 (Shearer), ECF No. 344, Michael Bikundi claims that he was
    “singl[ed] out,” Def. MB’s R. 33 Mot. at 50, since “other agents of other home health agencies
    who were also shut down for violations were not prosecuted,” id. at 53. This claim is not only
    untimely but also utterly fails to meet the requisite standard to undo the jury verdict and bar
    further process against him.
    At the outset, any defense or objection raising “a defect in instituting the prosecution,
    including . . . selective or vindictive prosecution,” “must be raised by pretrial motion if the basis
    for the motion is then reasonably available . . . .” FED. R. CRIM. P. 12(b)(3)(A)(iv). The
    defendants did not raise this claim at any time before or during trial, despite extensive pretrial
    motion practice. See supra n.3. Although the government does not raise a timeliness objection
    to the defendant’s claim of selective prosecution, see Gov’t Opp’n MB’s R. 33 Mot. at 14, Rule
    105
    12 is explicit that consideration of this type of challenge to a prosecution must be made before
    trial and, if not timely made, the court may consider the defense or objection only “if the party
    shows good cause.” FED. R. CRIM. P. 12(c)(3). Michael Bikundi has made no effort to show any
    reason, let alone good cause, for his belated selective prosecution claim. For this reason alone,
    his selective prosecution claim may be rejected. See United States v. Choi, 
    818 F. Supp. 2d 79
    ,
    89–90 (D.D.C. 2011) (holding that “[b]ecause respondent did not submit a pre-trial motion to
    dismiss on the basis of these [selective prosecution] claims, he generally could not raise them
    following the commencement of trial”); accord Jarkesy v. SEC, 
    803 F.3d 9
    , 26 (D.C. Cir. 2015)
    (noting that a selective prosecution claim is usually raised and addressed “pretrial”).
    Even if the merits were considered, this selective prosecution claim is insufficiently
    supported. A selective prosecution claim “that the prosecutor has brought the charge for reasons
    forbidden by the Constitution” “is not a defense on the merits to the criminal charge itself,”
    Jarkesy, 803 F.3d at 26 (quoting United States v. Armstrong, 
    517 U.S. 456
    , 463, (1996)), or a
    “refutation of the government’s case in chief,” but rather operates as “an independent
    constitutional bar to the prosecution,” United States v. Rashed, 
    234 F.3d 1280
    , 1285 (D.C. Cir.
    2000). To prevail on such a claim, the defendant must prove that he is “part of a protected class
    under the Equal Protection Clause, U.S. CONST. amend. XIV, § 1, and show not only that
    prosecutors acted with bad intent, but also that ‘similarly situated individuals [outside the
    protected category] were not prosecuted.’” Fog Cutter Capital Grp. v. SEC, 
    474 F.3d 822
    , 826–
    27 (D.C. Cir. 2007) (quoting Armstrong, 
    517 U.S. at 465
    ); see also Branch Ministries v. Rossotti,
    
    211 F.3d 137
    , 144 (D.C. Cir. 2000) (“To establish selective prosecution, the Church must ‘prove
    that (1) [it] was singled out for prosecution from among others similarly situated and (2) that
    [the] prosecution was improperly motivated, i.e., based on race, religion or another arbitrary
    106
    classification.’” (alterations in original) (quoting United States v. Washington, 
    705 F.2d 489
    , 494
    (D.C. Cir. 1983))).
    These requirements reflect the limits of judicial review of the exercise of prosecutorial
    discretion, which is “at the very core of the executive function [and] has long been held
    presumptively unreviewable.” In re Sealed Case, 
    131 F.3d 208
    , 214 (D.C. Cir. 1997). Thus,
    while prosecutorial decisions are “subject to constitutional limitations that district courts can
    enforce,” United States v. White, 
    71 F.3d 920
    , 923–24 (D.C. Cir. 1995), “[b]ecause such
    [selective prosecution] claims invade a special province of the Executive—its prosecutorial
    discretion—we have emphasized that the standard for proving them is particularly demanding,
    requiring a criminal defendant to introduce ‘clear evidence’ displacing the presumption that a
    prosecutor has acted lawfully,” Reno v. Am.-Arab Anti-Discrimination Comm., 
    525 U.S. 471
    ,
    489–90 (1999) (quoting Armstrong, 
    517 U.S. at
    463–65).
    In this case, Michael Bikundi has made no effort either to specify the protected class of
    which he is a member that was the purported motivation for his prosecution or to identify
    similarly situated individuals outside such protected category who were not prosecuted. Rather,
    he merely points out limited trial testimony that three health care companies were shut down
    along with Global but no individuals at those other companies appear to have been prosecuted.
    Clearly, all four of these companies were criminally investigated and subjected to court-
    authorized warrants for searches and seizures.
    Merely because individuals at Global, including the Florence and Michael Bikundi, who
    owned and operated Global, were prosecuted along with many of their employees, for serious
    criminal conduct, does not demonstrate improper motive by the government. To the contrary,
    the Supreme Court has made clear that “the conscious exercise of some selectivity in
    107
    enforcement is not in itself a federal constitutional violation so long as the selection was not
    deliberately based upon an unjustifiable standard such as race, religion, or other arbitrary
    classification.” Bordenkircher v. Hayes, 
    434 U.S. 357
    , 364–65 (1978) (internal quotations,
    alteration and citation omitted). The defendant Michael Bikundi has fallen far short of making
    even a threshold showing of any improper motive. Accordingly, his motions for a judgment of
    acquittal or a new trial based on his claim of selective prosecution are denied.
    IV.     CONCLUSION
    The defendants Florence and Michael Bikundi operated Global Healthcare, Inc. for over
    four years, reaping millions of dollars in reimbursement for the provision of home personal care
    services to D.C. Medicaid beneficiaries in the District of Columbia. The overwhelming evidence
    at trial demonstrated that Global’s receipt and maintenance of a license to operate as a health
    care agency and its billing were predicated on forged and fraudulent records, and amply supports
    the jury findings that these two defendants are guilty of conspiracy to commit and committing
    health care fraud. In addition, evidence at trial is sufficient to support their convictions of
    conspiracy to commit and committing money laundering. Moreover, none of the defendants’
    other challenges to their convictions merit disturbing the jury verdict.
    Accordingly, for the foregoing reasons, the defendants’ motions for a new trial or
    judgment of acquittal on their convictions are DENIED.
    An appropriate Order accompanies this Memorandum Opinion.
    SO ORDERED.
    Digitally signed by Hon. Beryl A. Howell
    DN: cn=Hon. Beryl A. Howell, o=U.S.
    District Court for the District of
    Columbia, ou=United States District
    DATED: March 7, 2016                                                       Court Judge,
    email=howell_chambers@dcd.uscourts
    .gov, c=US
    Date: 2016.03.07 18:08:10 -05'00'
    ______________________
    BERYL A. HOWELL
    United States District Judge
    108
    

Document Info

Docket Number: Criminal No. 2014-0030

Judges: Judge Beryl A. Howell

Filed Date: 3/7/2016

Precedential Status: Precedential

Modified Date: 3/8/2016

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