United States v. Sokolow

Court of Appeals for the Third Circuit·Decided April 18, 1996·No. 95-1292,95-1367·Unknown

Opinion

Opinions of the United

1996 Decisions States Court of Appeals for the Third Circuit

4-18-1996

United States v. Sokolow Precedential or Non-Precedential:

Docket 95-1292,95-1367

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Recommended Citation "United States v. Sokolow" (1996). 1996 Decisions. Paper 201. http://digitalcommons.law.villanova.edu/thirdcircuit_1996/201

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UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT

Nos. 95-1292/1367

UNITED STATES OF AMERICA

vs.

CRAIG B. SOKOLOW,

Appellant

Appeal from the United States District Court for the Eastern District of Pennsylvania (D.C. Crim. No. 93-cr-00394)

Argued

January 22, 1996

BEFORE: MANSMANN and SCIRICA, Circuit Judges,

0

and RESTANI, Judge, Court of International Trade.

(Filed April 18, 1996)

John Rogers Carroll Johanna E. Markind Carroll & Carroll 400 Market Street, Suite 850 Philadelphia, PA 19106

Peter Goldberger (Argued) Anna M. Durbin Pamela A. Wilk 50 Rittenhouse Place Ardmore, PA 19003-2276

COUNSEL FOR APPELLANT

Michael R. Stiles United States Attorney Walter S. Batty, Jr.

0 * Honorable Jane A. Restani, Judge, United States Court of International Trade, sitting by designation.

Chief of Appeals Joseph T. LaBrum, III (Argued) Maryanne Donaghy Sarah L. Grieb Assistant United States Attorneys 615 Chestnut Street, Suite 1250 Philadelphia, PA 19106-4476

COUNSEL FOR APPELLEE

OPINION OF THE COURT

RESTANI, Judge.

Defendant Craig B. Sokolow ("Sokolow") appeals from his

conviction in the United States District Court for the Eastern District of Pennsylvania following a two month jury trial. On March 18, 1994, Sokolow was convicted of 107 counts of mail fraud in violation of 18 U.S.C. § 1341 (1988), 17 counts of money laundering in violation of 18 U.S.C. § 1957 (1988), and one count of criminal forfeiture in violation of 18 U.S.C. § 982 (1988). Following several sentencing hearings, the district judge sentenced Sokolow to 92 months in prison, to be followed by three years supervised release, and ordered a $50,000 fine, $6200 in special assessments, $690,246.34 in restitution, and the forfeiture of $2.1 million. On appeal, defendant challenges both his conviction and sentencing. For the reasons stated herein, we will affirm the conviction, sentencing, and the order of forfeiture, but remand for reconsideration of the restitution order.

I. BACKGROUND

The events leading to Sokolow's indictment and subsequent conviction occurred between May 1, 1987 and July 23, 1990. Sokolow, an attorney and licensed insurance agent, offered health benefits plans to the public in Pennsylvania and several other states through a series of corporations that he established and controlled, but primarily through the National Independent Business Association, Inc. ("NIBA").0 The plans were marketed to small business employers, their employees, and their families. Association Insurance Marketing, Inc. ("AIM"), a corporation established and controlled by Sokolow, served as the primary marketing arm of NIBA. Through AIM, Sokolow received commissions on all premiums received for the sale of NIBA policies.

Prior to May 1987, NIBA members were fully insured by NIBA's group insurance contract with World Life and Health Insurance Company ("World Company"). On May 1, 1987, Sokolow replaced World Life with Independence Blue Cross and Pennsylvania Blue Shield to administer and process NIBA's health care claims. Sokolow purchased stop-loss coverage from Blue Cross, whereby NIBA assumed responsibility for the payment of NIBA members' medical care claims up to the first $25,000. Blue Cross would pay any remaining claims in excess of $25,000. The indictment charged that Sokolow falsely represented to the public that NIBA

0 In 1984, Sokolow began offering his health benefits plan through the Pennsylvania Independent Business Association, Inc. ("PIBA"). NIBA was established as a successor to PIBA in 1987. In 1988, NIBA was succeeded by the American Independent Business Alliance, Inc. ("AIBA"), the association existing until the time of liquidation on February 15, 1990. For convenience, "NIBA" will be used throughout the opinion to refer to the various corporations.

was fully-insured by Blue Cross, when, in fact, it was a self- funded plan, thus defrauding members of their premiums. In addition, Sokolow allegedly used the Blue Cross logo on marketing and billing materials, in violation of NIBA's agreement with Blue Cross, to foster the impression that NIBA was the equivalent of a Blue Cross fully-insured health benefits plan.

On June 30, 1988, Blue Cross terminated its service plan with NIBA when Sokolow failed to pay approximately $2 million in claims for which Blue Cross sought reimbursement. Sokolow then contracted with another company for higher stop-loss coverage that required NIBA to pay the first $50,000 of a member's medical care claims. The indictment alleged that Sokolow again misrepresented that NIBA was fully insured by the new coverage, when, in fact, it was self-funded.

After receiving complaints concerning NIBA's claims administration in late 1988, the Pennsylvania Insurance Department (the "Department") began to investigate NIBA's operations. The Department determined that Sokolow had been operating NIBA as an illegal, unlicensed insurer in Pennsylvania. Sokolow objected to the Department's inquiries on the basis that NIBA was a Multi-Employer Welfare Arrangement ("MEWA") that could file a benefits plan under ERISA and, thus, was not subject to state regulation.0 The Department disagreed with Sokolow's

0 Although Sokolow represented to the Department that he could have filed the NIBA plan under ERISA, the evidence at trial indicated that Sokolow represented to Virginia and Maryland insurance regulators that the NIBA health plan was, in fact, filed as an ERISA plan with the United States Department of Labor, and, thus, not subject to state regulation. Trial

contentions and, on May 2, 1989, suspended NIBA's operations. On August 31, 1989, the Commonwealth Court of Pennsylvania ruled that NIBA did not constitute a valid MEWA plan, but was a commercial enterprise "marketing insurance, without the benefit of a licensed company status, while purporting to be a valid ERISA plan, such that state licensing would not be necessary."0 Appellant's App. [hereinafter "App."] at 1193. Consequently, NIBA was ordered liquidated by the commonwealth court on February 15, 1990.

Sokolow collected more than $34 million in premiums from NIBA plan members who were allegedly defrauded by Sokolow during the period covered by the indictment. The indictment alleged that Sokolow converted approximately $4 million of the premiums for his personal benefit. He received $2,239,575.67 in commissions through AIM and two other related insurance companies0 ($1,837,152.30 of those commissions went to AIM) and $1,806,259.23 in salary, officer's loans, and other disbursements. These monies were deposited into AIM and NIBA accounts. The indictment alleged that Sokolow laundered these

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