In United States v. Ifediba, No. 20-13218 (Aug. 25, 2022) (Jill Pryor, Branch, Ed Carnes), the Court affirmed the defendants’ convictions and sentences.

Mr. Ifediba, a doctor, operated a clinic called CCMC, and employed his sister, Ms. Ozuligbo, as a nurse there.  Mr. Ifediba was alleged to have been running a “pill mill” to distribute controlled substances to patients who had no medical need for them, as well as running an allergy-fraud scheme.  Mr. Ifediba and Ms. Ozuligbo were indicted on substantive counts of health care fraud, conspiracy to commit health care fraud, money laundering of the clinic’s unlawful proceeds, and conspiracy to money launder.  Mr. Ifediba was also indicted for unlawfully distributing controlled substances for no legitimate medical purpose and for operating CCMC as a “pill mill.”

On appeal, Mr. Ifediba first challenged the district court’s exclusion of his evidence of good care he provided his patients to prove that his medical practice was legitimate.  The Court agreed with the district court that such evidence was improper character evidence because evidence of good conduct is not admissible to negate criminal intent.  The Court also held that the exclusion of such evidence did not violate Mr. Ifediba’s constitutional right to present a defense.

Next, he challenged the district court’s decision not to question all jurors individually after dismissing an alternate juror upon learning that the alternate had independently researched the case outside of court.  The Court found that the district court acted within its discretion in addressing the juror misconduct and then instructing the jury collectively.

Third, he challenged the sufficiency of the evidence supporting his substantive health care fraud convictions that were based upon evidence from medical records rather than patient testimony.  The Court held that patient records were sufficient to support Mr. Ifediba’s convictions for substantive health care fraud.  Documentary evidence alone can be sufficient to establish the elements of an offense.

Finally, he challenged his sentence by disputing the district court’s drug-quantity calculation on which the sentence was based.  The PSI calculated the quantity of illegal substances attributable to Mr. Ifediba to be between 30,000 and 90,000 kilograms.  The estimate came from an analysis of Alabama’s Prescription Drug Monitoring Program (“PDMP”) data spanning the charged conspiracy period.  Mr. Ifediba objected, arguing that the court should derive the drug quantity using only the prescriptions admitted into evidence at trial that the jury found to be unlawful–which would have totaled between 1,000 and 3,000 kilograms.  The Court disagreed with Mr. Ifediba and found his sentence to be procedurally reasonable.

Ms. Ozuligbo separately appealed the court’s exclusion of her cultural-defense evidence proffered to demonstrate that Nigerian cultural norms required her to obey her older brother.  The Court agreed with the district court that such evidence was irrelevant.