United States v. Ashot Minasyan ( 2021 )


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  •                   FOR PUBLICATION
    UNITED STATES COURT OF APPEALS
    FOR THE NINTH CIRCUIT
    UNITED STATES OF AMERICA,                No. 19-50185
    Plaintiff-Appellee,
    D.C. No.
    v.                   2:14-cr-00329-ODW-3
    ASHOT MINASYAN,
    Defendant-Appellant.                OPINION
    Appeal from the United States District Court
    for the Central District of California
    Otis D. Wright II, District Judge, Presiding
    Argued and Submitted February 5, 2021
    Pasadena, California
    Filed July 9, 2021
    Before: Ronald M. Gould, John B. Owens, and
    Lawrence VanDyke, Circuit Judges.
    Opinion by Judge Gould
    2                UNITED STATES V. MINASYAN
    SUMMARY *
    Criminal Law
    The panel affirmed the district court’s judgment and
    sentence in a case in which the defendant pleaded guilty to
    conspiracy to commit health care fraud.
    The defendant entered into a plea agreement in which he
    waived the right to appeal his conviction except on the
    ground that his plea was involuntary, and waived the right to
    appeal most aspects of his sentence if the district court
    determined that the offense level was no greater than 25.
    The defendant contended that his plea was involuntary
    because the district court did not give him a full and fair
    opportunity to contest the loss amount at his sentencing
    hearing. He appeared to contend both that his inability to
    contest the loss amount violated due process, rendering the
    sentence illegal, and that his plea was involuntary because
    the district court’s sentencing procedure was inconsistent
    with Fed. R. Crim. P. 32 and the Sentencing Guidelines. The
    panel wrote that neither contention is persuasive because the
    defendant had an adequate opportunity to contest the loss
    amount at the sentencing hearing. The panel disagreed with
    the defendant’s contention that the cumulative result of the
    district court’s refusal to withdraw his guilty plea, denial of
    motions for substitute counsel and continuances, and
    statements at sentencing demonstrate that the district court
    did not take seriously his challenge to the evidence on
    *
    This summary constitutes no part of the opinion of the court. It
    has been prepared by court staff for the convenience of the reader.
    UNITED STATES V. MINASYAN                     3
    intended loss. The panel wrote that the district court
    permissibly denied the defendant’s motions, and therefore
    the denials do not support the voluntariness claim, that the
    defendant did not carry his burden to show that a “fair and
    just reason” existed for the withdrawal, and that the district
    court’s comments at sentencing—that the defendant should
    not have pleaded guilty if he wanted to contest the amount
    of loss—may have been casual or imprudent, but did not
    render the guilty plea involuntary.
    The defendant also contended that his plea was
    involuntary because—in light of United States v. Miller, 
    953 F.3d 1095
     (9th Cir. 2020)—the plea agreement improperly
    stated the elements of the offense by stating that the requisite
    intent for the defendant’s offense was “to deceive or cheat,”
    instead of “to deceive and cheat.” The panel wrote that even
    assuming Miller is controlling authority that would render
    any error here plain, the defendant is unable to show his
    substantial rights were affected, as he does not provide
    evidence that he would not have pleaded guilty if he had
    known the requisite intent was conjunctive, rather than
    disjunctive.
    The defendant contended that the appellate waiver is
    unenforceable because the government breached the plea
    agreement by attempting to influence the court to give a
    higher sentence than the prosecutor’s recommendation and
    by making statements at sentencing that were impermissibly
    inconsistent with its position at trial. The panel held that the
    government did not breach the plea agreement—explicitly
    or implicitly—and that the defendant’s argument that a
    breach occurred cannot render his appeal waiver
    unenforceable.
    4              UNITED STATES V. MINASYAN
    COUNSEL
    Kathryn Ann Young (argued), Deputy Federal Public
    Defender; Cuauhtemoc Ortega, Federal Public Defender;
    Office of the Federal Public Defender, Los Angeles,
    California; for Defendant-Appellant.
    Kelley Brooke Hostetler (argued), Attorney, Appellate
    Section; Brian C. Rabbitt, Acting Assistant Attorney
    General; Emily Z. Culbertson, Robyn N. Pullio, and Claire
    Yan, Fraud Section, Criminal Division; Jeremy R. Sanders,
    Appellate Counsel, Fraud Section; United States Department
    of Justice, Washington, D.C.; for Plaintiff-Appellee.
    OPINION
    GOULD, Circuit Judge:
    We consider the enforceability of an appeal waiver, and
    that subject requires us to touch upon the justifications for
    the plea-bargaining process and its significance in the
    current American system of criminal justice. Ashot
    Minasyan pleaded guilty to conspiracy to commit health care
    fraud, in violation of 18 U.S.C. § 1349, and entered into a
    plea agreement with the United States government. Under
    the plea agreement, Minasyan waived the right to appeal his
    conviction except on the ground that his plea was
    involuntary. Minasyan also waived the right to appeal most
    aspects of his sentence if the district court determined that
    the offense level was no greater than 25. The district court
    sentenced him to 78 months’ imprisonment and three years’
    supervised release.
    UNITED STATES V. MINASYAN                           5
    We hold that Minasyan’s appeal waiver is enforceable.
    In so holding, we reject Minasyan’s contentions that (1) the
    waiver was not knowing and voluntary, either by reason of
    the district court’s sentencing procedure or its misstatement
    of the intent element during the plea colloquy; and (2) the
    government implicitly breached the plea agreement.
    Because Minasyan’s appeal waiver is enforceable and the
    language of the waiver encompasses his right to appeal on
    the grounds raised, we affirm the district court’s judgment
    and sentence.
    I
    A. Offense Conduct
    In June 2015, the government filed its Second
    Superseding Indictment against Dr. Robert Glazer, Marina
    Merino, Angela Avetisyan, and Minasyan. 1            The
    government alleged that between approximately 2006 and
    May 2014, the co-defendants conspired to fraudulently bill
    Medicare for services not rendered and for “medically
    unnecessary” services.
    Minasyan jointly owned Fifth Avenue Home Health
    (“Fifth Avenue”), a home health services agency
    incorporated in 2006, with Avetisyan. Avetisyan was the
    office manager and Minasyan was responsible for day-to-
    day operations.      Fifth Avenue was located next to
    Dr. Glazer’s clinic, which was housed at 5250 Santa Monica
    1
    We addressed Glazer and Merino’s cases in separate memorandum
    dispositions. See United States v. Glazer, No. 19-50335, 
    2021 WL 982269
    , at *1 (9th Cir. Mar. 16, 2021); United States v. Merino, 846 F.
    App’x 494 (9th Cir. 2021). Avetisyan’s case was addressed by another
    panel. See United States v. Avetisyan, No. 19-50199, 
    2021 WL 2375923
    ,
    at *1 (9th Cir. June 10, 2021).
    6              UNITED STATES V. MINASYAN
    Boulevard in Los Angeles, California. Glazer’s clinic
    accepted only Medicare-eligible patients. Avetisyan and
    Minasyan paid “marketers” to recruit these patients and
    bring them to the clinic and Fifth Avenue. The government
    alleged that once the patients were recruited, Glazer billed
    Medicare for medically unnecessary services and referred
    the individuals to Fifth Avenue and other providers for
    medically unnecessary home health services.
    Between March 2010 and May 2014, Medicare paid
    Fifth Avenue $4.2 million for home health care services,
    most of which came from Glazer’s referrals. In 2015, a
    Medicare contractor reviewed a sample of Fifth Avenue’s
    Medicare billings from between January 2011 and
    September 2014. As a result of the review, Medicare denied
    all 240 claims for the 55 sampled beneficiaries.
    B. Pre-Trial Motions and Plea Hearing
    The 2015 indictment charged Minasyan with one count
    of health care fraud conspiracy, in violation of 18 U.S.C.
    §§ 1347 and 1349; seven counts of health care fraud, in
    violation of 18 U.S.C. §§ 1347 and 2; and one count of
    money laundering, in violation of 18 U.S.C. § 1956(h).
    On August 15, 2018, Minasyan moved to replace his
    appointed counsel. His counsel reported that Minasyan was
    uncooperative and angry when counsel tried to communicate
    the government’s offer. Minasyan contended that over
    several years his attorney had pushed him to cooperate
    against Glazer. The district court denied the motion and
    explicitly told Minasyan that he was free to ignore counsel’s
    advice.
    Before the trial was set to begin, Minasyan agreed to
    plead guilty to conspiracy to commit health care fraud. The
    UNITED STATES V. MINASYAN                    7
    plea agreement set out the elements of the offense and
    Minasyan agreed that he understood that all of those
    elements must be met for him to be guilty of the offense.
    The parties agreed to a base offense level of 6 under the
    advisory Sentencing Guidelines, two additional levels for
    abuse of trust, see U.S.S.G. § 3B1.3, and the appropriate
    adjustment for acceptance of responsibility, see U.S.S.G.
    § 3E1.1. The government agreed to dismiss the remaining
    counts for money laundering and health care fraud, but
    Minasyan agreed that the district court could still consider
    the conduct underlying those charges “in determining the
    applicable Sentencing Guidelines range, the propriety and
    extent of any departure from that range, and the sentence to
    be imposed.”
    As to the loss calculation, the parties agreed only to a
    very broad range between $250,000 and $9,500,000,
    yielding an addition of between 12 and 18 offense levels
    pursuant to U.S.S.G. § 2B1.1.(b)(1), and potentially an
    additional two-level enhancement for fraud involving a
    federal health care program pursuant to U.S.S.G.
    § 2B1.1.(b)(7) (yielding either a 0 or +2 offense levels).
    Given the lack of agreement on the loss amount, the
    agreement was structured such that the government agreed
    to recommend a low-end sentence if the district court
    calculated Minasyan’s offense level to be at least 17, while
    Minasyan’s waivers and obligations took effect only if the
    district court calculated his offense level as 25 or below. If
    Minasyan’s term of imprisonment fell within or below the
    range corresponding to an offense level of 25, Minasyan
    agreed to waive most of his rights to appeal his sentence.
    Specifically, Minasyan agreed to waive: “the procedures and
    calculations used to determine and impose any portion of the
    sentence”; “the term of imprisonment imposed by the
    Court”; any fine within the statutory maximum; “to the
    8              UNITED STATES V. MINASYAN
    extent permitted by law, the constitutionality or legality” of
    any sentence under the statutory maximum; “the amount and
    terms of any restitution order, provided it requires payment
    of no more than $4,283,674.00”; and any term of probation
    or supervised release under the statutory maximum. Perhaps
    most importantly for our disposition of the case, he also
    waived the right to appeal his conviction on any basis other
    than that the plea was involuntary.
    At the October 2019 plea hearing, Minasyan stated “No”
    when asked whether anyone made promises to him that were
    not set forth in the plea agreement. After the prosecution set
    out the elements of the offense, which mirrored those in the
    plea agreement, and the potential penalties, Minasyan stated
    that he had no questions. The district court then specifically
    asked Minasyan if he understood the portion of the plea
    agreement in which he agreed that he could appeal his
    conviction only on the basis that his plea was involuntary,
    and the portion in which he waived his right to appeal most
    aspects of his sentence if the district court calculated an
    offense level that was at or below 25. Minasyan said that he
    understood these points.
    After the district court accepted Minasyan’s guilty plea,
    the probation office recommended an 18-level increase for a
    loss between $3.5 and $9.5 million, and a corresponding
    sentencing range of 63 to 78 months. Consistent with its
    obligations under the plea agreement, the government
    recommended sentencing Minasyan to 63 months, the
    bottom of the range. Minasyan’s sentencing memorandum,
    however, argued that the government had to prove the value
    of the loss by clear and convincing evidence and that the
    appropriate offense level was 17, reflecting between
    $250,000 and $550,000 of loss. He argued for a sentence at
    the low end of the resulting 27-to-33-month range.
    UNITED STATES V. MINASYAN                             9
    Minasyan objected to the Presentence Investigation Report’s
    (“PSR”) assertions regarding loss amount and whether
    evidence existed that Fifth Avenue was legitimately
    providing home healthcare services to patients.
    In March 2019, and again in April 2019, Minasyan made
    unopposed motions to continue the sentencing hearing to
    prepare expert reports that examined financial and patient
    records. The district court denied both motions. Eleven days
    before the scheduled sentencing hearing, Minasyan
    requested new counsel and moved to withdraw his guilty
    plea. 2 Minasyan’s counsel renewed his request for a
    continuance if the district court denied the motion for
    substitute counsel.
    The district court held a hearing on Minasyan’s motion
    on May 9, 2019. Minasyan was assisted by an Armenian
    interpreter. His attorney reiterated that he and Minasyan
    were having significant difficulty communicating. The
    district court discussed the plea colloquy with Minasyan, and
    he alternately answered “Yes” and “No” when asked if he
    had “plead[ed] guilty because [he was] guilty.” Minasyan
    said his attorney “pushed” him to plead guilty. Avetisyan’s
    attorney intervened to state that Minasyan acknowledged
    “some amount of wrongdoing” but was objecting to the
    monetary loss attributed to him.
    2
    Our law generally permits withdrawal of a plea before sentencing
    only for “fair and just reason[s].” Fed. R. Crim. P. 11(d)(2)(B). Also, in
    determining whether new counsel should be appointed, we consider:
    “(1) the adequacy of the district court’s inquiry; (2) the extent of the
    conflict between the defendant and counsel; and (3) the timeliness of
    defendant’s motion.” United States v. Reyes-Bosque, 
    596 F.3d 1017
    ,
    1033 (9th Cir. 2010). We address whether the district court permissibly
    denied these motions in Part II.A.
    10             UNITED STATES V. MINASYAN
    The district court asked Minasyan whether he was
    concerned that he might be “held responsible for conduct of
    other people,” and Minasyan replied, “Yes.” Minasyan
    acknowledged that he might have done something wrong,
    but “the numbers are not correct.” The district court told
    Minasyan that he could challenge the government’s request
    about loss at the sentencing hearing. The district court also
    rejected Minasyan’s claim for new counsel, explaining that
    Minasyan’s current attorney was in the best position to
    prepare arguments about the loss amount before sentencing.
    The district court called the proceedings on Minasyan’s
    motions “an exercise of gamesmanship that has wasted the
    Court’s time.”
    C. Sentencing Hearing
    At the sentencing hearing on June 10, 2019, Minasyan’s
    counsel argued that the evidence was insufficient to support
    the government’s proposed loss of $4.2 million as to
    Minasyan under the clear and convincing evidence standard.
    Minasyan’s counsel also argued that the Medicare contractor
    who was tasked with analyzing Fifth Avenue claims was not
    neutral and that there was insufficient evidence to go from
    the contractor’s relatively small sample to saying that
    everything at Fifth Avenue was fraudulent. The district
    court summarized Minasyan’s argument as contending that
    Minasyan and Avetisyan had decided at some point to
    operate Fifth Avenue as a legitimate business, which is why
    only some of the claims submitted to Medicare were
    fraudulent.
    The district court, however, rejected this argument based
    in part on evidence from Glazer’s trial. The district court
    focused on the presence of a “light box,” which can be used
    for tracing signatures, found through a search warrant near
    Avetisyan’s desk at Fifth Avenue. Referring to this evidence
    UNITED STATES V. MINASYAN                     11
    from Glazer’s trial, the district court explained that “finding
    a box like that in a doctor’s office is not out of place” because
    it could be used to read X-rays, but in this case the light box
    was instead found “at or near . . . Ms. Avetisyan’s desk
    area.” Because the evidence of fraud was still present when
    the search warrant was executed, the district court concluded
    that the “box was used to trace patient[s’] signatures all over
    the place and on everything.” The district court also noted
    the presence of blank pre-signed forms at Fifth Avenue,
    determining that the scheme “was an ongoing problem—an
    ongoing fraud.”
    During its presentation, the government highlighted the
    Medicare contractor’s audit, but the district court expressed
    concerns about the audit’s validity, given that the auditor
    was paid based on the amount of money it saved Medicare.
    The government also pointed to Minasyan’s plea agreement,
    in which he agreed that he paid kickbacks to patient
    recruiters and acknowledged that he knew Medicare does not
    pay for claims procured by kickbacks. Minasyan responded
    by stressing that, while there was no dispute about the factual
    basis of the plea—that Minasyan paid kickbacks to patient
    recruiters who brought patients to Glazer to get unnecessary
    prescriptions for home health care—the amount of loss “has
    always been in dispute.”
    The district court recognized that Minasyan wanted to be
    held accountable only for the loss for which he was
    responsible, but it noted that pleading to a conspiracy means
    that “what you are responsible for is going to be broadened
    somewhat.” The district court stated:
    [I]t would seem to me that pleading guilty is
    just exactly the wrong thing to do, that what
    you need to be able to do is put on a case or
    at least be able to cross-examine the
    12              UNITED STATES V. MINASYAN
    government’s case and contest this loss
    amount. But to plead guilty, you are pretty
    much admitting these allegations. [The
    sentencing hearing] is a strange time to try to
    then contest it after you have admitted to all
    of this wrongdoing.
    The district court calculated Minasyan’s advisory
    guidelines range as 63 to 78 months, based on an offense
    level of 25. The district court then determined that Minasyan
    should be sentenced at the high end of the range, despite the
    government’s low-end recommendation. The district court
    ordered Minasyan to pay roughly $4.2 million in restitution.
    The district court adopted the PSR’s analysis in full, at times
    reading from the PSR, and emphasized that “according to the
    government there is no known evidence that Fifth Avenue
    was legitimately providing home health care services,” and
    further, there were no known mitigating factors.
    After sentencing, at the request of defense counsel, the
    district court at first set an evidentiary hearing for August 16,
    2019. But on August 5, 2019, the district court denied an
    evidentiary hearing on the ground that Minasyan’s plea was
    not conditioned on such a hearing.
    Minasyan timely appealed.
    II
    The crux of this case concerns whether the appeal waiver
    was valid and enforceable. If so, then there is no need to
    address any other claims encompassed by the appeal waiver.
    Because we conclude that Minasyan’s appeal waiver was
    UNITED STATES V. MINASYAN                         13
    knowingly and voluntarily made and that it encompasses
    Minasyan’s remaining claims, 3 we affirm the district court.
    An appeal waiver in a plea agreement “is enforceable if
    the language of the waiver encompasses [the defendant’s]
    right to appeal on the grounds raised, and if the waiver was
    knowingly and voluntarily made.” United States v. Watson,
    
    582 F.3d 974
    , 986 (9th Cir. 2009) (citation omitted).
    Minasyan contends that the appellate waiver is
    unenforceable for three reasons. First, Minasyan asserts that
    the plea was not knowing, intelligent, and voluntary because
    the district court impermissibly curtailed his right to present
    evidence on the loss amount. Second, he maintains that his
    plea was involuntary because he was misinformed about the
    elements constituting the crime for which he was charged.
    Third, he claims that the government implicitly breached the
    plea agreement, rendering the waiver unenforceable. None
    of Minasyan’s claims have merit.
    3
    Minasyan waived “any right to appeal [his] conviction,” except for
    a claim that his plea was involuntary. This waiver encompasses
    Minasyan’s claims that the district court erred in refusing to allow him
    to withdraw his plea or to substitute counsel. See United States v.
    Odachyan, 
    749 F.3d 798
    , 804 (9th Cir. 2014) (dismissing challenges to
    sentence that were not specified as exceptions to an appeal waiver).
    Minasyan also waived the right to appeal “the procedures and
    calculations used to determine and impose any portion of the sentence”
    and “the term of imprisonment imposed by the Court.” This portion of
    the waiver encompasses his claims related to sentencing, including his
    claims that his sentence is unlawful, his sentence is substantively
    unreasonable, and his claims related to the district court’s loss
    calculation. E.g., United States v. Kelly, 
    874 F.3d 1037
    , 1051 (9th Cir.
    2017) (upholding appeal waiver that encompassed the sentencing issue
    raised by defendant). Minasyan does not appear to dispute that the
    waiver encompasses his remaining claims.
    14                UNITED STATES V. MINASYAN
    Because Minasyan did not make these arguments before
    the district court, we review them for plain error. United
    States v. Minore, 
    292 F.3d 1109
    , 1117 (9th Cir. 2002).
    “Relief for plain error is available if there has been (1) error;
    (2) that was plain; (3) that affected substantial rights; and
    (4) that seriously affected the fairness, integrity, or public
    reputation of the judicial proceedings.” United States v.
    Cannel, 
    517 F.3d 1172
    , 1176 (9th Cir. 2008).
    A
    Minasyan contends that his plea was involuntary because
    the district court did not give him a full and fair opportunity
    to contest the loss amount at his sentencing hearing.
    Minasyan appears to contend both that his inability to
    contest the loss amount violated due process, rendering the
    sentence illegal, and that his plea was involuntary because
    the district court’s sentencing procedure was inconsistent
    with Rule 32 of the Federal Rules of Criminal Procedure and
    the Sentencing Guidelines. 4
    Neither contention is persuasive because Minasyan had
    an adequate opportunity to contest the loss amount at the
    sentencing hearing. It is true that the “sentencing process
    . . . must satisfy the requirements of the Due Process
    Clause.” Gardner v. Florida, 
    430 U.S. 349
    , 358 (1977). But
    4
    The government urges that Minasyan’s argument about a full and
    fair opportunity to contest the loss amount is an effort to “avoid his
    appeal waiver to raise his true complaint that the district court erred in
    denying him an evidentiary hearing at sentencing.” Because this is so,
    the government argues that this claim is either precluded by the appeal
    waiver or should be reviewed for abuse of discretion. While this
    assessment is plausible, we conclude that Minasyan made arguments in
    the briefs that were specific enough to preserve a claim based on the
    voluntariness of his plea.
    UNITED STATES V. MINASYAN                    15
    the record reflects that Minasyan was able to present
    evidence before and at the sentencing hearing to combat the
    government’s proposed loss amount. It also shows that the
    hearing itself conformed to the federal rules and guidelines.
    Notwithstanding these opportunities, Minasyan contends
    that the cumulative result of the district court’s refusal to
    withdraw his guilty plea, denial of his motions for substitute
    counsel and continuances, and statements at sentencing
    demonstrate that the district court did not take seriously
    Minasyan’s challenge to the evidence on intended loss. We
    disagree.
    First, we conclude that the district court permissibly
    denied Minasyan’s motions, and therefore the denials do not
    support his voluntariness claim. A defendant may withdraw
    his guilty plea before sentencing only if he “can show a fair
    and just reason for requesting the withdrawal.” Fed. R.
    Crim. P. 11(d)(2)(B). Although this standard is liberal, it
    must be consistent with “Rule 11’s purpose of ensuring some
    finality at the time pleas are accepted.” United States v.
    Ensminger, 
    567 F.3d 587
    , 593 (9th Cir. 2009) (citation
    omitted). We have held that “[o]nce the plea is accepted,
    permitting withdrawal is, as it ought to be, the exception, not
    an automatic right.” 
    Id.
     Importantly, the burden is on the
    defendant to show a permissible reason to withdraw the
    guilty plea, which includes reasons like “inadequate Rule 11
    plea colloquies, newly discovered evidence, intervening
    circumstances, or any other reason for withdrawing the plea
    that did not exist when the defendant entered his plea.” 
    Id. at 590
    –91 (citations omitted). Here, Minasyan understood
    at the time of his plea that he and the government disagreed
    on the amount of loss.           Before his plea, he also
    acknowledged that the district court retained discretion to
    sentence him up to the statutory maximum.
    16             UNITED STATES V. MINASYAN
    Minasyan did not carry his burden to show that a “fair
    and just reason” existed for withdrawing his plea. See
    United States v. Briggs, 
    623 F.3d 724
    , 728, 729 (9th Cir.
    2010) (upholding denial of motion to withdraw plea where
    the defendant “only wanted to change his plea once he was
    face-to-face with the full consequences of his conduct”).
    Regarding the motion for new counsel, the district court
    adequately considered both the alleged communication
    difficulties between Minasyan and his attorney and whether
    continuances to the sentencing hearing were justified. See
    United States v. Mendez-Sanchez, 
    563 F.3d 935
    , 942–43 (9th
    Cir. 2009) (concluding that the district court did not abuse
    its discretion where the inquiry into the alleged conflict was
    adequate).
    Second, while the district court’s comments at
    sentencing—namely, that Minasyan should not have pleaded
    guilty if he wanted to contest the amount of loss—may have
    been casual or imprudent, the statements did not render his
    guilty plea involuntary.
    Minasyan was well aware when he pleaded guilty that he
    and the government sharply disagreed on the loss calculation
    and that he had not been promised a full evidentiary hearing
    on the loss. Under the plea agreement, which Minasyan said
    he understood, he was entitled to file objections to the PSR
    and to comment on loss at the sentencing hearing.
    Consistent with these rights, Minasyan did file a sentencing
    memorandum before the hearing contesting the
    government’s proposed loss calculation. Minasyan also had
    an opportunity at the hearing to raise any legal or factual
    matters that would bear on his sentence. His counsel argued
    the company that analyzed billing samples from Fifth
    Avenue was not neutral, and that it was a “leap of faith” to
    extrapolate from the sample reviewed that all claims
    UNITED STATES V. MINASYAN                  17
    submitted by Fifth Avenue were fraudulent. Minasyan’s
    counsel incorporated by reference the arguments contained
    in the sentencing memorandum and acknowledged that the
    district court had also heard evidence of the fraud scheme
    that was presented at Glazer’s trial.
    We conclude that Minasyan had a full and fair
    opportunity to be heard. Contrary to Minasyan’s contention,
    the sentencing hearing also conformed to Federal Rule of
    Criminal Procedure 32. Rule 32(i)(1)(C) provides that the
    district court “must allow the parties’ attorneys to comment
    on the probation officer’s determinations and other matters
    relating to an appropriate sentence.” Fed. R. Crim. P.
    32(i)(1)(C). But Rule 32(i)(2) also states that the district
    court “may permit the parties to introduce evidence” on
    objections to the PSR. 
    Id. at 32
    (i)(2) (emphasis added).
    While the district court was required to allow Minasyan to
    challenge the probation office’s findings on intended loss,
    the district court had discretion to determine whether
    presenting evidence to support the challenge would be
    helpful or necessary. See United States v. Salcido, 
    506 F.3d 729
    , 735 (9th Cir. 2007) (per curiam) (finding no error under
    Rule 32 where the defendant “was permitted to file written
    objections to the presentence report and was given the
    opportunity to make additional arguments at the sentencing
    hearing”).
    The district court gave Minasyan a fair opportunity to
    contest the government’s loss calculation even if it was not
    the full evidentiary hearing that Minasyan wanted—but to
    which he was not entitled. We conclude that Minasyan’s
    plea was not involuntary due to the district court’s
    sentencing procedure and comments, nor did Minasyan’s
    sentence, in the context of Minasyan’s opportunities to be
    heard, violate his due process rights.
    18             UNITED STATES V. MINASYAN
    B
    Minasyan next contends that his plea was involuntary
    because—in light of our recent decision in United States v.
    Miller, 
    953 F.3d 1095
     (9th Cir. 2020)—the plea agreement
    improperly stated the elements of the offense. Specifically,
    the agreement stated that the requisite intent for Minasyan’s
    offense was “to deceive or cheat,” instead of “to deceive and
    cheat.” In Miller, we held that the wire fraud statute requires
    “not mere deception, but a scheme or artifice to defraud or
    obtain money or property, i.e., in every day parlance, to
    cheat someone out of something valuable.” 
    Id. at 1101
    . The
    government contends that any error could not have been
    plain because Miller concerned wire fraud under § 1343,
    rather than health care fraud under § 1349. United States v.
    Gnirke, 
    775 F.3d 1155
    , 1164 (9th Cir. 2015) (stating that
    plain error generally requires “controlling authority on
    point” (citation omitted)).
    Even assuming that Miller is controlling authority that
    would render any error here plain, Minasyan is unable to
    show his substantial rights were affected. See United States
    v. Roblero-Solis, 
    588 F.3d 692
    , 701 (9th Cir. 2009) (a
    showing that substantial rights have been affected requires
    “a reasonable probability that, but for the error, he would not
    have entered the plea” (citation omitted)). Minasyan does
    not provide evidence that he would not have pleaded guilty
    if he had known the requisite intent was conjunctive, rather
    than disjunctive. Indeed, his argument before and after the
    guilty plea was that Fifth Avenue is not entirely fraudulent,
    consistent with someone who deceived and cheated, albeit
    to a lesser extent. He can make no argument that his scheme
    was “mere deception” because it was a scheme “to cheat
    someone”—in this case, Medicare—“out of” money, which
    is unquestionably “something valuable.” See Miller,
    UNITED STATES V. MINASYAN                         19
    953 F.3d at 1101. Accordingly, the improperly stated
    elements in the plea agreement did not render Minasyan’s
    plea involuntary.
    C
    Finally, Minasyan contends that the appellate waiver is
    unenforceable because the government breached the plea
    agreement. Even though the government adhered to the
    explicit terms of the plea agreement by recommending a
    low-end sentence, Minasyan contends nonetheless that the
    prosecutor implicitly breached the plea agreement by
    “attempt[ing] . . . to influence the court to give a higher
    sentence than the prosecutor’s recommendation.” United
    States v. Johnson, 
    187 F.3d 1129
    , 1135 (9th Cir. 1999); see
    also United States v. Heredia, 
    768 F.3d 1220
    , 1231 (9th Cir.
    2014) (stating that the government “may not superficially
    abide by its promise to recommend a particular sentence
    while also making statements that serve no practical purpose
    but to advocate for a harsher one”).
    To support this claim of implicit breach, Minasyan
    asserts that the government included in its sentencing
    memorandum “negative information already set forth in the
    PSR,” details related to the dismissed money laundering
    offense, and “prejudicial details regarding offenses with
    which Minasyan was not involved.” He also contends that
    the government made self-serving and contradictory use of
    the “light box” evidence at the sentencing hearing. 5 At the
    hearing, the government agreed with the district court that
    the light box was a “hallmark of fraud,” even though the
    5
    To the extent Minasyan also argues the district court violated due
    process by relying upon materially untrue information relating to the
    “light box,” we disagree.
    20             UNITED STATES V. MINASYAN
    government had presented a witness in Glazer’s trial, ten
    days prior, who testified that the light box displayed no signs
    of tracing.
    We conclude that the government did not implicitly
    breach the plea agreement. To begin with, the government
    did not waive its right to argue for a higher loss calculation
    than Minasyan. The government’s discussion of the overall
    conspiracy and Minasyan’s role in it could properly assist
    the district court in its loss calculation. Details about the
    dismissed money laundering offense were also validly
    included in its sentencing position because the plea
    agreement had expressly stipulated that the district court
    could rely on evidence concerning dismissed charges “in
    determining the applicable Sentencing Guidelines range.”
    Here, information about the structured withdrawals that were
    relevant to the dismissed charge were also relevant to
    support the conclusion that Minasyan was not running a
    legitimate home health care service.
    The government’s endorsement of the district court’s
    statement that the light box was a “hallmark of fraud” did
    not implicitly breach the agreement. Based on the evidence
    presented at Glazer’s trial about the light box found at Fifth
    Avenue, the district court expressed skepticism about the
    defense position that aspects of Fifth Avenue’s care were
    legitimate. The district court acknowledged that finding a
    light box in a doctor’s office may not be indicative of fraud
    on its own, because a light box can be used to read X-rays.
    But in this case the box was found near Avetisyan’s desk,
    and it was still there when the search warrant was executed.
    Coupled with the many blank prescription pads that were
    already signed at the same location, the district court
    concluded that Minasyan was participating in “an ongoing
    fraud.”
    UNITED STATES V. MINASYAN                    21
    When the government was then given a chance to
    comment, it agreed with the district court’s observation that
    the light box and the blank signed prescription pads were
    “hallmarks of fraud.” The government had reserved the right
    to contest the loss amount at the sentencing hearing, so it was
    permissible for the government to support the district court’s
    conclusion that Minasyan and Avetisyan had not decided at
    some point to begin operating a legitimate business. Cf.
    United States v. Whitney, 
    673 F.3d 965
    , 971 (9th Cir. 2012)
    (holding that the government breached the plea agreement
    where the prosecutor “introduce[d] information that serve[d]
    no purpose but to influence the court to give a higher
    sentence” (internal quotation marks and citation omitted)).
    Despite this alternative purpose, Minasyan contends that
    the government’s statements still breached the plea
    agreement because they were impermissibly inconsistent
    with its position at trial—that Glazer knew about the fraud
    and his signatures had not been traced without his
    knowledge using the light box. We disagree. First, the
    government’s statement was not necessarily inconsistent
    with its position at trial. At Minasyan’s sentencing hearing,
    the government acknowledged only that a light box is a
    hallmark of fraud; it did not state that the light box in this
    case was used to trace Glazer’s or anyone else’s signature.
    But even if the government’s light box statement was
    inconsistent with its theory of the light box at Glazer’s trial,
    any error would not be plain. To be plain, the error must be
    “clear or obvious, rather than subject to reasonable dispute.”
    Puckett v. United States, 
    556 U.S. 129
    , 135 (2009).
    Furthermore, Minasyan could not show that reliance on the
    light box evidence affected his substantial rights. Cannel,
    
    517 F.3d at 1176
    . The government’s discussion of the light
    box was brief and was not a focal point of its presentation to
    22               UNITED STATES V. MINASYAN
    the district court. The government also coupled its statement
    about “hallmarks of fraud” with an emphasis on the signed
    blank prescription pads, which are undeniably hallmarks of
    fraud in this context.
    Because we hold that the government did not breach the
    plea agreement—explicitly or implicitly—Minasyan’s
    argument that a breach occurred cannot render his appeal
    waiver unenforceable.
    III
    We hold that Minasyan’s plea was voluntary and his
    appeal waiver is fully enforceable. See United States v. Lo,
    
    839 F.3d 777
    , 784 (9th Cir. 2016). Under the agreement,
    Minasyan waived the right to appeal his conviction except
    on the ground that his plea was involuntary. Minasyan also
    waived the right to appeal most aspects of his sentence if the
    district court determined that the offense level was no greater
    than 25, which the district court did. The plea bargain
    reached by the government and Minasyan was a finely tuned
    agreement between a criminal defendant and the prosecuting
    government party. Each gave up some rights and gained
    some benefits in the compromise that avoided the trial and
    appeal time for the parties and eliminated what would have
    been unavoidable uncertainties for the government. But at
    the same time, the compromise plea bargain limited charges
    and risks to Minasyan of incurring a larger penalty if he went
    to trial and lost. 6
    6
    The Supreme Court has described some of the benefits of fair plea
    bargaining in this way:
    The disposition of criminal charges by agreement
    between the prosecutor and the accused, sometimes
    UNITED STATES V. MINASYAN                          23
    Because a valid appeal waiver governs the remainder of
    Minasyan’s claims on appeal, and he has not raised any
    exception that would permit us to consider them, we do not
    address those claims. See Lo, 839 F.3d at 795.
    AFFIRMED.
    loosely called ‘plea bargaining,’ is an essential
    component of the administration of justice. Properly
    administered, it is to be encouraged. If every criminal
    charge were subjected to a full-scale trial, the States
    and the Federal Government would need to multiply
    by many times the number of judges and court
    facilities.
    Disposition of charges after plea discussions is
    not only an essential part of the process but a highly
    desirable part for many reasons. It leads to prompt and
    largely final disposition of most criminal cases; it
    avoids much of the corrosive impact of enforced
    idleness during pre-trial confinement for those who are
    denied release pending trial; it protects the public from
    those accused persons who are prone to continue
    criminal conduct even while on pretrial release; and,
    by shortening the time between charge and
    disposition, it enhances whatever may be the
    rehabilitative prospects of the guilty when they are
    ultimately imprisoned.
    Santobello v. New York, 
    404 U.S. 257
    , 260–61 (1971); see also
    Blackledge v. Allison, 
    431 U.S. 63
    , 71 (1977) (“Properly administered,
    [plea bargains] can benefit all concerned.”).