United States v. Georvanys Rodriguez Pineda

CourtCourt of Appeals for the Eleventh Circuit
DecidedJanuary 20, 2021
Docket19-14556
StatusUnpublished

This text of United States v. Georvanys Rodriguez Pineda (United States v. Georvanys Rodriguez Pineda) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States v. Georvanys Rodriguez Pineda, (11th Cir. 2021).

Opinion

USCA11 Case: 19-14556 Date Filed: 01/20/2021 Page: 1 of 19

[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT ________________________

No. 19-14556 Non-Argument Calendar ________________________

D.C. Docket No. 1:18-cr-20426-RAR-1

UNITED STATES OF AMERICA,

Plaintiff-Appellee,

versus

GEORVANYS RODRIGUEZ PINEDA,

Defendant-Appellant.

________________________

Appeal from the United States District Court for the Southern District of Florida ________________________

(January 20, 2021) USCA11 Case: 19-14556 Date Filed: 01/20/2021 Page: 2 of 19

Before LUCK, LAGOA, and BRASHER, Circuit Judges.

PER CURIAM:

Georvanys Rodriguez Pineda appeals his convictions for healthcare fraud and

conspiracy to commit healthcare and wire fraud. Pineda argues that the district court

erred by giving a deliberate ignorance jury instruction and by admitting Federal Rule

of Evidence 404(b) evidence of Pineda’s relationship with an unrelated healthcare

fraudster. We affirm.

FACTUAL BACKGROUND AND PROCEDURAL HISTORY

Pineda was indicted for health care fraud, in violation of 18 U.S.C.

section 1347, and conspiracy to commit healthcare and wire fraud, in violation of 18

U.S.C. section 1349. The indictment alleged that Pineda defrauded Medicare’s

Limited Income Newly Eligible Transition program. The LINET program is a

“safety net” that provides temporary coverage to Medicaid-eligible beneficiaries

who are newly eligible for Medicare Part D but haven’t yet enrolled in a Part D plan.

This ensures that beneficiaries can receive their medications without interruption

until they transition into a Part D plan.

The Fraud at Urantia Pharmacy

The pharmacy fraud at the heart of this case was the brainchild of Pablo Garcia

Menendez. At the time of Pineda’s trial, Menendez was on the lam facing charges

in two separate healthcare fraud cases (both involving pharmacy fraud). Pineda was

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Menendez’s handyman. According to Maria Estrada, Menendez’s ex-wife, Pineda

also ran “errands” for Menendez, including cashing checks to launder the proceeds

of illegal prescription drug sales.

Menendez had previously served time in prison for healthcare fraud involving

durable medical equipment. He returned to healthcare fraud when he was released,

this time involving pharmacies. But Menendez couldn’t operate a pharmacy in his

own name because of his prior conviction for healthcare fraud. Estrada testified that

Menendez recruited other people to become the registered owners of his fraudulent

pharmacies in exchange for a cut of the profits.

The fraud at Urantia Pharmacy began after Menendez discovered that the

LINET program was especially vulnerable to fraud. He learned that he didn’t need

a patient’s name or a prescription to submit claims to the program. All he needed

was a beneficiary’s identification number and a doctor’s name. Menendez’s

coconspirators in the Urantia Pharmacy fraud scheme included Pineda, Estrada

(Menendez’s ex-wife), and Juan Carmenate, a pharmacy technician who helped

Menendez with the technical aspects of pharmacy fraud.

Estrada testified that Pineda agreed to become the nominal owner of Urantia

Pharmacy in exchange for Menendez paying him $8,000 a month. Estrada prepared

the bill of sale for Pineda’s purchase of Urantia Pharmacy. Pineda enrolled with the

Florida Department of Health as Urantia Pharmacy’s owner and transferred the

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pharmacy’s National Provider Identifier number to his name. Estrada testified that

Pineda willingly did these acts “[w]ith full knowledge” that Urantia Pharmacy was

a fraud. He did so, Estrada explained, “[t]o make money.” Estrada testified that

Menendez paid Pineda for his role with Urantia Pharmacy in cash because it wasn’t

traceable.

Carmenate confirmed that Pineda agreed to become Urantia Pharmacy’s

owner “for the money.” Carmenate testified that he discussed the Urantia Pharmacy

fraud with Menendez in Pineda’s presence.

Urantia Pharmacy used software called Abacus to submit its LINET claims to

Medicare. Pineda’s name and phone number were on Urantia Pharmacy’s

application to obtain the Abacus software, and his daughter signed the application

on his behalf. Pineda paid for Abacus on a monthly basis through his personal bank

account. Abacus’s contract with Urantia Pharmacy became effective on June 10,

2015.

Urantia Pharmacy was a “phantom pharmacy” under Pineda’s ownership. It

didn’t purchase medication, it didn’t have customers, and its shelves were empty.

Urantia Pharmacy’s prescription department was never open because it didn’t

employ a pharmacist. No legitimate pharmacy operations ever took place at Urantia

Pharmacy. The only person working in the pharmacy was Pineda’s daughter who,

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Estrada explained, “was just there waiting” every day in case the government came

by to inspect the pharmacy.

But Urantia Pharmacy still managed to rake in plenty of money. Pineda

owned Urantia Pharmacy from June 15, 2015 until August 20, 2015. From June 11,

2015 through August 1, 2015, Urantia Pharmacy submitted over $1,111,000 worth

of claims to Medicare and received over $310,000 in reimbursements. Carmenate

submitted Urantia Pharmacy’s first billing on June 11 using a list of drugs, doctors,

and patient identification numbers that Menendez gave him.

On June 30, Pineda opened an account for Urantia Pharmacy at a check

cashing store. This account allowed him—but no one else—to cash checks on the

pharmacy’s behalf. That same day, a Medicare reimbursement check worth

$41,485.23 made out to Urantia Pharmacy was cashed at the store. This check was

for the claims Urantia Pharmacy submitted on June 11. Pineda endorsed the check

and his thumbprint was on it.

There were several unusual things about Urantia Pharmacy’s billing practices

under Pineda’s ownership. The pharmacy only billed Medicare through the LINET

program, only billed for uncommon and “very expensive” drugs, and only had “a

few beneficiaries”—almost all of them from out of state—billing “for all of these

medications.” Because these red flags were “consistent with fraud,” Medicare

investigators zeroed in on Urantia Pharmacy. In August 2015, Medicare halted

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further payments to Urantia Pharmacy after it had already paid over $310,000. On

August 20, 2015, Pineda stepped down as the pharmacy’s owner and someone else

took over. The Urantia Pharmacy fraud ended that same month.

The Rule 404(b) Evidence About Andy Armas

The government put Pineda on notice prior to trial that it intended to introduce

rule 404(b) evidence about his role in a money laundering operation involving his

coconspirators from the Urantia Pharmacy scheme. Pineda objected to this proffered

evidence. The district court ruled that the government’s rule 404(b) evidence was

admissible.

Special Agent Eddie Calienes, a healthcare fraud investigator with the

Department of Health and Human Services, testified at trial that Pineda was involved

in a multimillion-dollar money laundering scheme involving check cashing stores

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