United States v. Francisco Patino

Court of Appeals for the Sixth Circuit·Decided November 30, 2023·No. 23-1241·Unpublished

Opinion

NOT RECOMMENDED FOR PUBLICATION File Name: 23a0487n.06

No. 23-1241

UNITED STATES COURT OF APPEALS FILED FOR THE SIXTH CIRCUIT Nov 30, 2023 KELLY L. STEPHENS, Clerk

)

UNITED STATES OF AMERICA, )

Plaintiff-Appellee, ) ON APPEAL FROM THE ) UNITED STATES DISTRICT v. ) COURT FOR THE EASTERN ) DISTRICT OF MICHIGAN FRANCISCO PATINO, )

Defendant-Appellant. ) OPINION )

Before: MOORE, MURPHY, and MATHIS, Circuit Judges.

KAREN NELSON MOORE, Circuit Judge. After the conclusion of a nine-day trial, Francisco Patino filed a motion for a new trial pursuant to Federal Rule of Criminal Procedure 33(b)(1), arguing that his trial counsel was constitutionally ineffective. The district court denied the motion without holding an evidentiary hearing because Patino did not identify any evidence that could be considered “newly discovered” under Rule 33(b)(1). For the reasons outlined below, we AFFIRM the district court.

I. BACKGROUND

Patino was indicted on one count of conspiracy to commit health-care fraud and wire fraud in violation of 18 U.S.C. § 1349 (“Count One”); two counts of health-care fraud in violation of 18 U.S.C. § 1347 (“Counts Two and Three”); one count of conspiracy to defraud the United States and pay and receive health-care kickbacks in violation of 18 U.S.C. § 371 (“Count Four”); one count of conspiracy to commit money laundering in violation of 18 U.S.C. § 1956(h) (“Count

Five”); and one count of money laundering in violation of 18 U.S.C. §§ 1956(a)(1)(B)(i) and 2 (“Count Six”). R. 100 (Superseding Indictment ¶¶ 41–78) (Page ID #1006–24).

At trial, the government presented evidence that Patino, who was a doctor for pain management, was recruiting patients from vulnerable populations to receive care at his clinics by paying them between twenty and fifty dollars. R. 211 (Trial Tr. Vol. IV at 11) (Page ID #8090). Patino would then prescribe these patients opioids or other similar medications.1 R. 212 (Trial Tr. Vol. VI at 107, 139–40) (Page ID #8344, 8376–77). The patients became addicted and returned monthly to Patino’s clinics to renew their prescriptions. R. 210 (Trial Tr. Vol. III at 82) (Page ID #8049); R. 211 (Trial Tr. Vol. IV at 81–82) (Page ID #8160–61); R. 212 (Trial Tr. Vol. VI at 139– 40) (Page ID #8376–77).

Typically, Patino required the patients to receive injections in order to obtain a prescription renewal. R. 210 (Trial Tr. Vol III at 79–81) (Page ID #8046–48); R. 211 (Trial Tr. Vol. IV at 26, 130) (Page ID #8105, 8209); R. 212 (Trial Tr. Vol. VI at 134) (Page ID #8371). During each monthly visit, most patients would receive injections of Marcaine or some other anesthetic, which provided a few hours of “temporary numbness.” R. 211 (Trial Tr. Vol. IV at 70) (Page ID #8149); R. 214 (Trial Tr. Vol. VII at 33) (Page ID #8442); R. 215 (Trial Tr. Vol. V at 52–53) (Page ID #8579–80). Patino’s clinics then billed Medicare as if the doctors had administered facet joint injections. R. 215 (Trial Tr. Vol. V at 52–53) (Page ID #8579–80); R. 221 (Trial Tr. Vol. VIII at 78–79) (Page ID #8798–99). Patino’s clinics also billed Medicare as if the doctors administered more shots than each patient actually received, at times billing for as many as twelve injections

1 Most patients were prescribed Oxycodone, R. 210 (Trial Tr. Vol. III at 80) (Page ID #8047); however, some patients were prescribed Vicodin, Xanax, Fentanyl, or Percocet, R. 211 (Trial Tr. Vol. IV at 26) (Page ID #8105); R. 214 (Trial Tr. Vol. VII at 56) (Page ID #8465).

per visit. R. 221 (Trial Tr. Vol. VIII at 80–81) (Page ID #8800–01). To reduce the risk that the clinics would be audited, Patino instructed his doctors and staff to ensure that the patients’ medical files justified administering facet joint injections. R. 210 (Trial Tr. Vol. III at 89–93) (Page ID #8056–60); R. 211 (Trial Tr. Vol. IV at 138–39) (Page ID #8217–18).

Patients testified that the injections did not meaningfully reduce their pain, but they agreed to receive them because the injections were a prerequisite to obtaining a prescription renewal. See, e.g., R. 212 (Trial Tr. Vol. VI at 105, 108) (Page ID #8342, 8345). Some of the doctors who worked at Patino’s clinics considered the shots medically unnecessary. R. 210 (Trial Tr. Vol. III at 82–83) (Page ID #8049–50); R. 211 (Trial Tr. Vol. IV at 132) (Page ID #8211).

During the same time period, Patino’s clinics submitted patients’ urine samples for testing that was, in part, medically unnecessary. R. 210 (Trial Tr. Vol. III at 19–20, 84–86) (Page ID #7986–87, 8051–53); R.211 (Trial Tr. Vol. IV at 135) (Page ID #8214); R. 212 (Trial Tr. Vol. VI at 91–92) (Page ID #8328–29). Patino and the companies involved in performing the diagnostic testing shared the funds that Medicare ultimately paid for the unnecessary testing. R. 207 (Trial Tr. Vol. II at 23–26) (Page ID #7907–10); R. 210 (Trial Tr. Vol. III at 19–20) (Page ID #7986– 87).

Over the course of the charged period, Patino’s clinic submitted more than $108 million in claims to Medicare, for which Medicare paid $31.4 million. R. 221 (Trial Tr. Vol. VIII at 69–71) (Page ID #8789–91). Patino then spent this money on luxury goods, personal travel expenses, and promotion of his diet program. R. 212 (Trial Tr. Vol. VI at 74–75) (Page ID #8311–12); R. 221 (Trial Tr. Vol. VIII at 15–17, 41–46, 92–105) (Page ID #8735–37, 8761–66, 8812–25).

On September 22, 2021, the jury found Patino guilty on all six counts. R. 218 (Jury Verdict at 1–7) (Page ID #8702–08). Shortly thereafter, Patino’s trial counsel filed a motion to withdraw

because there was “a breakdown in the attorney-client relationship.” R. 222 (Mot. to Withdraw at 1–2) (Page ID #8909–10). Patino also submitted a pro se request for new counsel, stating that he “lost confidence” in trial counsel “due to ‘ineffective Assistance of Counsel.’” R. 227 (Mot. for Counsel at 1) (Page ID #9183). After holding a hearing, the district court granted the motion for trial counsel to withdraw and appointed Patino new counsel. R. 230 (Dec. 3, 2021 Dist. Ct. Order at 1–2) (Page ID #9196–97).

On July 7, 2022, new counsel filed an emergency motion to extend the deadline for filing “post-trial motions” and to continue the sentencing date. R. 246 (Emergency Mot. to Cont. at 1) (Page ID #9467). The district court granted the motion and extended the deadline to file “Post- Trial Motions.” R. 248 (July 14, 2022 Dist. Ct. Order). On August 11, 2022, the district court entered an order accepting a joint stipulation signed by Patino and the government that extended the deadline for Patino to file a “Motion for an Evidentiary Hearing and a New Trial Pursuant to Federal Rule 33(b)(1).” R. 249 (Stip. & Dist. Ct. Order at 1–2) (Page ID #9475–76).

On August 16, 2022, Patino moved for an evidentiary hearing and for a new trial under Rule 33(b)(1). R. 251 (Rule 33 Mot. at 1–3) (Page ID #9547–49). Patino argued that trial counsel was ineffective because he did not object to certain portions of each government witness’s testimony, and he did not cross examine these witnesses based on information that Patino provided. R. 251 (Br. in Supp. of Rule 33 Mot. at 1–29) (Page ID #9550–78). Patino also argued that trial counsel was ineffective because he did not call as a witness Deborah Gamble, the office manager for one of the clinics, and trial counsel did not adequately communicate with Patino before and during the trial. Id. at 2, 29–31 (Page ID #9551, 9578–80).

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