Health Law Daily Wrap Up, FRAUD AND ABUSE—6th Cir.: Clinic duo’s convictions affirmed for mail fraud, wire fraud, healthcare fraud, and conspiracy, (Oct 24, 2025)

By Justin Marcus Smith, J.D.

The husband and wife did not make adequate insufficiency-of-evidence or jury instruction arguments to overturn their convictions.

The United States Court of Appeals for the Sixth Circuit affirmed the convictions of a clinician and his uncredentialed wife on charges of mail fraud, wire fraud, healthcare fraud, and conspiracy to commit those same offenses, in an unpublished opinion. The Sixth Circuit held a rational jury could have found the couple (1) worked together to conceal the nature of the wife’s unlicensed practice of medicine because the couple knew it was unlawful; and (2) agreed to commit at least one of the three types of fraud charged. The husband’s statements to the clinic about the operation, within the clinic, of their putative Cognitive Center, the wife’s credentials, and the scope of her practice, not only did not exonerate the husband, the statements suggested knowledge of illegality. Jury instructions tracked Sixth Circuit model jury instructions. Government closing argument references to possible unindicted co-conspirators did not negate the couple’s presentation of a good-faith defense. The district court did not abuse its discretion in declining to admit cumulative and confusing evidence pertinent to that good-faith defense. The couple failed to preserve objections at various junctures, and compliance officer and attorney testimony also tended to contradict their good-faith defense (U.S. v. Jenkins, No. 23-3820/3821 (6th Cir. Oct. 17, 2025)).

Background. In 2014, an ear, nose, and throat (ENT) physician with a physician-owned Ohio clinic convinced clinic officials to open a Cognitive Center that he would oversee and that would employ his wife. The wife had a Ph.D. in neuroscience, but she did not have any clinical experience, nor did she have a National Provider Identifier (NPI) for billing because she was not credentialed. According to the court’s review of the record, the wife ended up billing under the ENT’s NPI. The clinic later fired the wife and shuttered the Cognitive Center after it allegedly received complaints from patients about treatment and billing practices.

In 2020, a grand jury indicted the ENT and his wife on charges of mail fraud, wire fraud, healthcare fraud, and conspiracy to commit those offenses. In 2023, the government obtained guilty verdicts for both on all counts. The district court sentenced the ENT to 41 months in prison and the wife to 71 months in prison.

On appeal, the couple argued (1) the jury did not have enough evidence to find agreement to conspire; (2) given good-faith reliance on advice from clinic employees, there was not enough evidence to convict them on any count; (3) the district court improperly instructed the jury; (4) the district court erred in admitting only excerpts from a clinic employee’s research in to proper billing practices, rather than the entire document.

Evidentiary sufficiency. Applying de novo review, the Sixth Circuit rejected the couple’s insufficiency-of-the-evidence argument on the conspiracy charge. The court concluded it could not say that no rational juror could have found the couple guilty of conspiracy. The trial evidence was enough for the jury to reject the couples’ claim that the husband hid nothing. On review of the record, the court stated that the husband misrepresented the nature of the wife’s practice and credentials to key clinic leadership. The couple did not identify any clinic leader who approved the Cognitive Center while knowing the wife was unlicensed while she nonetheless diagnosed patients and ordered laboratory and radiology work. The clinic director of compliance testified that even under her mistaken interpretation of the applicable regulations, she did not understand the general-supervision rule to permit the wife to diagnose patients or order brain PET scans. Importantly, when an insurer raised questions, the husband challenged the insurer’s authority to raise such issues and instructed the compliance manager to misrepresent that the Cognitive Center was a fictitious division within the husband’s otolaryngology department. Patients testified they would not have sought treatment from the wife had they known she was unlicensed.

The court found a reasonable juror could have concluded that the husband’s statements to the clinic about the operation of the Cognitive Center, the wife’s credentials, and the scope of her practice not only did not exonerate him but actually suggested knowledge of illegality. The compliance officer’s advice to the couple did not undermine the jury’s determination of guilt because she did not advise the couple that the wife could diagnose patients or order brain PET scans under general supervision. The couple’s responses to inquiries about the propriety of their conduct were troubling and could imply knowledge of illegality. That a jury might have found otherwise was not the standard of review. Circumstantial evidence alone can sustain a guilty verdict.

As for good-faith reliance on advice received from the compliance officer and the sole in-house attorney, the court concluded it could not say that no rational juror could have rejected the couple’s good-faith defense and convicted them of the four charged counts. The couple said their reliance negated the required intent for healthcare fraud, mail fraud, and wire fraud, but again, there could be no misunderstanding of what kind of supervision might have been permitted. The compliance officer testified she did not understand the rules to permit the wife to diagnose patients or order brain PET scans. She also testified she did not lead the couple to believe they could provide the services, despite being unlicensed, by billing under the husband’s NPI. As for in-house counsel advice, her testimony indicated the couple did not disclose all pertinent facts. She said she did not review the husband’s presentation in full and understood the husband or a referring physician would diagnose, not the wife. For these reasons, the court said it could not conclude that no rational juror would have rejected the couple’s good faith defense on the four charged counts.

Jury instructions. The couple’s argument that the district court improperly instructed the jury about deliberate ignorance failed under plain-error review. The couple argued the district court erred by filing to limit the jury instruction about voluntary agreement to conspire to only the aims of the alleged conspiracy. The government argued the couple waived their objection that the deliberate-ignorance instruction was inapplicable because their counsel in fact conceded the instruction was applicable to both conspiracy and healthcare fraud.

The government cannot prove voluntary agreement to conspire by deliberate ignorance because there must be intent to join a conspiracy. The district court instruction closely tracked the approved Sixth Circuit Pattern Jury Instruction 2.09. Further limiting language designed to exclude deliberate ignorance as a basis for conviction was unnecessary because the pattern instruction made it clear that the government must prove a defendant knew the main purpose of a conspiracy and voluntarily joined it, albeit deliberate ignorance can establish knowledge. At no point did the district court instruct the jury that deliberate ignorance could bear upon voluntary agreement to conspire. The instruction specified aims. There was no plain error here.

As for deliberate ignorance and the healthcare fraud charge, the couple argued the jury could have “back door[ed]” the deliberate-ignorance instruction for healthcare fraud to apply it to the mail- and wire-fraud counts. The latter charges required specific intent, but the court clarified these were substantive offenses that did not depend on violation of another statute, they did not turn on the healthcare fraud charge. The court said it did not have to speculate about back-door transfer of the healthcare fraud instructions because the district court separately stated to the jury that it was giving definitions that applied to the other counts. It gave discrete deliberate-ignorance jury instruction as applicable to the mail- and wire-fraud charges. Moreover, the couple’s counsel did not preserve an objection to the instructions with regard to the mail- and wire-fraud charges.

Turning to whether there was plain error for instructing a jury it may infer deliberate ignorance for crimes that require specific intent, there is no per se bar to such instruction. The Sixth Circuit has permitted the consideration of deliberate ignorance in mail- or wire-fraud cases. Here, the court instructed on intent to defraud as intent to deceive or cheat to cause financial loss or obtain financial gain. The face of the instructions made it clear that even if the jury found deliberate ignorance about false claims for reimbursement, it would not necessarily follow that the couple acted with specific intent to defraud. The district court instructed the jury it still needed to consider specific intent, and at no point did it equate deliberate ignorance of likely false claims with specific intent to defraud. There was no plain error here.

The couple next challenged the unindicted co-conspirator instruction. The Sixth Circuit applied abuse of discretion review here and plain error review to government closing argument mentioning possible unindicted co-conspirators. The couple argued, without legal analysis or citation, that the district court permitted the jury to believe the criminal agreement was with the compliance officer, thereby effectively blocking fair consideration of their good-faith defense. Again, the district court’s instruction and the government’s closing statement both tracked the Sixth Circuit Pattern Jury Instruction, in this instance, instruction 3.06. The court did not abuse its discretion. Defense counsel’s theory that others at the clinic were more responsible for wrongdoing than the couple clearly justified the instruction about unindicted co-conspirators. The Sixth Circuit concluded here it could not say that the instructions were confusing, misleading, or prejudicial.

The couple’s argument was more convincing with respect to the government’s mention of the compliance officer in closing, but the couple failed to preserve an objection. The Sixth Circuit also said it could not find plain-error because the government’s general characterization of the law was correct. It simply reiterated the district court’s appropriate jury instructions. Defense counsel may have attempted to shift the blame to clinic leadership rather than the compliance officer, but defense counsel also elicited that the FBI interviewed the compliance officer.

Perhaps most importantly, the couple did not explain how the government’s brief mention of the compliance officer in closing effectively blocked fair consideration of the good-faith defense. The government’s passing suggestion of possible unindicted co-conspirators did not nullify the body of evidence the couple presented for their putative good faith defense. The Sixth Circuit said the government made it clear that each defendant would have to knowingly join an agreement to conspire in order to convict. The court accordingly rejected the couple’s claim of error.

Compliance research. Last, the court did not find any abuse of discretion in the admission of only excerpts of the compliance officer’s research. Witnesses that included the compliance officer testified extensively about the steps they took to address the issue of the wife’s performing and billing for memory-testing services. They testified to their understanding of what the regulations permitted. Other witnesses testified about the correct interpretation of the rules. Admitting the entire research file would have been cumulative and potentially confusing. Last, as to whether the couple was able to present a complete defense, they were not entitled to offer cumulative or potentially confusing evidence under the standard rules of evidence.

The case is Nos. 23-3820/3821.

Judge: White, H.

Attorneys: Daniel R. Ranke, Office of the U.S. Attorney, for U.S. David Lawrence Doughten (Law Office David L. Doughten) for Oliver H. Jenkins.

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