United States v. Luthra ( 2020 )

United States Court of Appeals
For the First Circuit
No. 18-1980
UNITED STATES OF AMERICA,
Appellee,
v.
RITA LUTHRA,
Defendant, Appellant.
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MASSACHUSETTS
[Hon. Mark G. Mastroianni, U.S. District Judge]
Before
Thompson, Barron, and Boudin,
Circuit Judges.
Dana A. Curhan, with whom Thomas M. Hoopes and LibbyHoopes,
P.C. were on brief, for appellant.
Andrew E. Lelling, United States Attorney, with whom Mark T.
Quinlivan, Assistant United States Attorney, was on brief, for
appellee.
August 6, 2020
BOUDIN, Circuit Judge. This is an appeal by Rita Luthra,
a doctor based in Springfield, Massachusetts, whom a jury convicted
on two counts: aiding and abetting the wrongful disclosure of
individually identifiable health information, 18 U.S.C. § 2; 42
U.S.C. § 1320d-6, and obstructing a criminal investigation of a
health care offense, 18 U.S.C. § 1518(a).
At trial, the government presented a detailed case;
Luthra presented no case beyond her claims that the evidence did
not permit a conviction. The district court sentenced Luthra only
to a year's probation, but the convictions may adversely affect
Luthra in her professional capacity. The serious convictions and
the light penalty reflect a tension not uncommon in regulatory
cases.
Luthra's convictions stem from an investigation not into
Luthra's activities but those of Warner Chilcott, a pharmaceutical
company. Chilcott ran a speakers program aimed at publicizing the
company's drugs to clinicians. These prescription drugs included
Actonel and Atelvia, which treat osteoporosis. In 2010, Warner
Chilcott sales representative Jose Cid signed Luthra to serve as
a speaker about Actonel and Atelvia. Between October 2010 and
November 2011, Warner Chilcott paid Luthra $23,500 for speaking at
approximately 31 events.
In addition to speaking about Atelvia, Luthra prescribed
the drug to her patients. Many insurance companies, however, did
- 2 -
not cover Atelvia because a less expensive generic drug was
available. To get coverage, the prescribing physician needed to
complete a prior authorization form explaining why a patient
required Atelvia. As insurance companies denied coverage, the
prior authorization forms piled up.
Luthra asked Cid to help her medical assistant, Joanne
Rivera, complete the forms. Rivera testified that Cid assisted
Rivera on more than one occasion. Cid confirmed that Luthra saw
them working on the prior authorization forms in Luthra's office.
In one instance, Luthra stopped and spoke with Cid, who said that
he was helping Rivera while pointing to a patient's record on the
desk.
Eventually, the federal Department of Health and Human
Services ("HHS") began investigating Warner Chilcott for potential
kickback violations and health care fraud, and federal law
enforcement agents interviewed Luthra. Rivera testified that,
shortly after Luthra's interview, Luthra called her and said that
Cid got them in trouble. Luthra then asked Rivera to tell the
agents that they never showed Cid patient records. The next day
Luthra repeated her instruction and told Rivera to say that Luthra
was not in the office on Fridays.
The jury convicted Luthra on count one, aiding and
abetting the wrongful disclosure of individually identifiable
health information, and count three, obstructing a criminal
- 3 -
investigation of a health care offense. It acquitted her on count
two, witness tampering in violation of 18 U.S.C. § 1512(b)(3).
This appeal addresses Luthra's claim that the evidence was
insufficient for conviction.
We review the district court's decision de novo, drawing
all reasonable inferences in favor of the jury verdict, asking
whether any rational factfinder could have found the essential
elements of the crime beyond a reasonable doubt. United States v.
Martínez-Mercado, 919 F.3d 91, 98 (1st Cir. 2019). The credibility
of witnesses in support of the verdict is largely assumed. United
States v. Moran, 312 F.3d 480, 487 (1st Cir. 2002).
As to count one, Luthra concedes that Cid accessed
patient medical information but argues that the government failed
to prove that Luthra knew Cid accessed protected patient
information. On the contrary, Rivera and Cid collectively
testified that Luthra witnessed Cid assist Rivera complete the
prior authorization forms, which included protected patient
information; stopped at their desk and spoke with Cid, who told
Luthra that he was assisting Rivera and gestured to a patient file;
and signed at least one prior authorization form on which Cid wrote
a patient's current medications.
Further, Luthra instructed Rivera to not tell federal
law enforcement agents that they showed Cid patient records and to
inform agents that Luthra was not in the office on Fridays when
- 4 -
Cid assisted Rivera. Inferring from this evidence that Luthra
knew Cid accessed protected information is neither "unreasonable,
insupportable, [nor] overly speculative." United States v.
Spinney, 65 F.3d 231, 234 (1st Cir. 1995).
Luthra's critique of the count three conviction also
fails. The burden on the government was to show that Luthra
willfully prevent[ed], obstruct[ed], misl[ed],
delay[ed] or attempt[ed] to prevent, obstruct, mislead,
or delay the communication of information or records
relating to a violation of a Federal health care offense
to a criminal investigator[.]
18 U.S.C. § 1518. The government claimed that Luthra lied in her
second interview when she stated, to explain her compensation,
that Warner Chilcott paid her to author a research paper.
The government presented Warner Chilcott statements of
work that show that Luthra was paid for speaker events for the
time period during which she claimed she was paid to author a
paper. Luthra failed to produce the paper. These statements,
alongside testimony and notes from investigating agents, permitted
the jury to disbelieve Luthra's statement that she authored a
research paper for Warner Chilcott. Martínez-Mercado, 919 F.3d at
98.
Lastly, Luthra argues that the government failed to
prove that her statement was "relevant to or otherwise affected
the investigation." The undeveloped and perfunctory nature of
Luthra's argument, which consists of two sentences and a citation
- 5 -
to out-of-circuit precedent, offers reason enough for us to
disregard this claim. United States v. Zannino, 895 F.2d 1, 17
(1st Cir. 1990).
Modern medical practice entails endless regulation and
frightening penalties. But without minimizing the burdens on
overworked doctors who now risk much for their patients, a jury
could and did find that Luthra made statements she knew were not
true. The sentencing judge went as far as he could in softening
the sanction.
Affirmed.
- 6 -