“Where testimonial evidence is at issue, however, the Sixth Amendment demands what the common law required: unavailability and a prior opportunity for cross-examination.”
How later courts described this case
- “Where testimonial evidence is at issue, however, the Sixth Amendment demands what the common law required: unavailability and a prior opportunity for cross-examination.”
Written by the judges who cited it.
The opinion
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FILED
FOR THE ELEVENTH CIRCUIT U.S. COURT OF APPEALS
________________________ ELEVENTH CIRCUIT
MARCH 29, 2007
No. 06-12385 THOMAS K. KAHN
Non-Argument Calendar CLERK
________________________
D. C. Docket No. 04-00185-CR-T-24-TBM
UNITED STATES OF AMERICA,
Plaintiff-Appellee,
versus
ZANDRINA ALEXANDER,
Defendant-Appellant.
________________________
Appeal from the United States District Court
for the Middle District of Florida
_________________________
(March 29, 2007)
Before BIRCH, WILSON and PRYOR, Circuit Judges.
PER CURIAM:
Zandrina Alexander, following a jury trial, appeals her conviction of
presenting false claims against the government in violation of 18 U.S.C. § 287.
She argues that numerous evidentiary errors occurred during her trial, and require
reversal. Because we find no error, we AFFIRM her conviction.
I. BACKGROUND
In 1998, the Department of Health and Human Services (“HHS”) received a
tip from a whistleblower that Delellis Promotions, Inc. (“DPI”), and its owner,
Christine Delellis, were engaged in Medicare fraud. DPI’s business involved
supplying durable medical equipment (“DME”) to Medicare patients, and
submitting claims for reimbursement through the Medicare program. The whistle
blower alleged, among other things, that DPI and Delellis submitted fraudulent
requests for reimbursement and paid illegal monetary kickbacks for Medicare
patient referrals.
In response to the allegations, HHS began an investigation of DPI and
Delellis. In connection therewith, another DME supplier who was acquainted with
Delellis, Faith Fairbrother volunteered to act as an informant. Fairbrother agreed
to have recording devices installed on her home telephone and to meet with
Delellis while wearing a body wire. During the in-person meeting with Delellis,
Fairbrother was accompanied by Angela David, a government investigator posing
as a discharge case manager for a hospital, going by the name Angela Renea.
2
Fairbrother and David were also assisted by Kyle Ford, a special agent with HHS.
The investigation began with Fairbrother alerting Delellis that David had a
Medicare patient named Paul Watson who was set to be released from the hospital
and was in need of a mechanized wheelchair, but his physician was reluctant to
prescribe one. In fact, Watson was a fictitious beneficiary created by HHS. In
support of the investigation, HHS issued Medicare documentation in Watson’s
name.
According to tape recorded conversations, Delellis told Fairbrother that she
should talk to Watson’s doctor, but if he continued to refuse to prescribe Watson a
mechanical wheelchair, Delellis could arrange to have a doctor sign for one. In a
later conversation, after Fairbrother told Delellis that Watson’s doctor would not
cooperate, Delellis said, “I can get the CMN signed, that’s not a problem . . . I’ll
just . . . have the doc sign it and give her a couple bucks.” R4 at 249. When asked
who the prescribing doctor would be, Delellis indicated that she would probably
ask Alexander, a female internist. Delellis later informed Fairbrother that the
doctor had agreed to sign for a motorized wheelchair and that Delellis would
compensate her for the signature. After the wheelchair was delivered, Delellis
informed Fairbrother that she had paid the doctor and that she would file the claim
with Medicare because she had obtained the doctor’s signature. DPI subsequently
3
submitted an electronic CMN for reimbursement for the Watson wheelchair,
identifying Alexander as the referring physician.
After DPI filed for reimbursement for the wheelchair, the government
obtained and executed a search warrant on DPI, recovering numerous CMNs from
DPI’s files. Ford testified that while conducting the search, Delellis informed him
that she had improperly completed portions of the CMN and acknowledged that
she had never met Watson. Ford also later interviewed Alexander, and testified
that Alexander stated “yes, that is my signature” in reference to the Watson CMN.
R6 at 272.
At trial, Ford testified regarding DPI’s bank records and discussed two
specific transactions. Video footage confirmed that in the course of one of the in-
person meetings between Fairbrother, David, and Delellis, Delellis paid $100 in
cash to David for referring a patient. Bank records indicated that a withdrawal of a
similar amount was made from DPI’s account in temporal and physical proximity
to the meeting at a restaurant. Ford also testified that on the same day in which tape
recordings captured Delellis informing Fairbrother that she had paid the doctor, a
withdrawal was made from DPI’s bank account at an ATM near Alexander’s
office.
After hearing from all its witnesses at trial, the government recalled Ford to
4
summarize the evidence and introduced two summary exhibits. At sidebar,
Alexander’s counsel objected that the diagram drew an inference that Delellis had
paid Alexander and asked “for a – some type of instruction that it’s being entered .
. . based on . . . the government’s theory.” R7 at 184. Alexander also objected
before the jury that the diagram “shows that Dr. Alexander actually received the
money and, uh, I think that is a question for the jury.” Id. at 186. The court
overruled her objections and notified the jury that it “might have an instruction for
the jury at some point.” Id. After the second summary exhibit was admitted, and
again during final instructions, the court informed the jury that it had received the
exhibits into evidence as summaries of voluminous writings, documents, and
records and the summaries would be available during deliberation.
During its closing remarks, the government made statements to the jury that
Alexander now argues were improper. Alexander contends that the government
made direct appeals to the passions of the jury, and improperly attempted to shift
the burden of proof to the defendant.
On appeal, Alexander raises the following issues: (1) the court improperly
admitted into evidence tape recordings of out-of-court statements made by Delellis,
and publication of the statements to the jury violated Alexander’s rights under the
Confrontation and Due Process Clauses, (2) out-of-court statements made by
5
Delellis to Ford were improperly admitted into evidence and publication of the
statements to the jury violated Alexander’s rights under the Confrontation and Due
Process Clauses, (3) the court improperly admitted into evidence the summary
diagram prepared by Ford, (5) the government made improper closing arguments,
and (5) cumulative error requires that the verdict be set aside.
II. DISCUSSION
We review evidentiary rulings for an abuse of discretion. United States v.
Baker, 432 F.3d 1189, 1202 (11th Cir. 2005), cert. denied, __ U.S. __, 126 S. Ct.
1809 (2006). A district court commits an abuse of discretion where its “decision
rests upon a clearly erroneous finding of fact, an errant conclusion of law, or an
improper application of law to fact.” Id. Further, we review preserved evidentiary
objections under the harmless error standard, while we review evidentiary
objections raised for the first time on appeal for plain error only. Id. Under the
plain error standard of review, we may not correct an error not raised at trial unless
there is “(1) error, (2) that is plain, and (3) that affects substantial rights. If all
three conditions are met, an appellate court may then exercise its discretion to
notice a forfeited error, but only if (4) the error seriously affects the fairness,
integrity, or public reputation of judicial proceedings.” Id. at 1202-03. After
examining the individual allegations of evidentiary errors, we must review the
6
errors in the aggregate, and should “reverse if the cumulative effect of the errors is
prejudicial, even if the prejudice caused by each individual error was harmless.”
Id. at 1203.
A. Tape Recorded Statements
Alexander argues that the court erred by admitting tape recordings under
Federal Rule of Evidence 801(d)(2)(E), the co-conspirator exception to the hearsay
rule. She contends that the government did not meet its burden of proving by a
preponderance of the evidence that the underlying factual predicates of Rule
801(d)(2)(E) were present. See United States v. Underwood, 446 F.3d 1340, 1345-
46 (11th Cir.), cert. denied, __ U.S. __, 127 S. Ct. 225 (2006) (citation omitted).
She further argues that, even if the requirements of Rule 801(d)(2)(E) were met,
admission of the statements violated her constitutional rights under the Due
Process and Confrontation Clauses. Alexander also urges us to hold that the
application of Rule 801(d)(2)(E) turns on the existence of an agency relationship
between the declarant and the defendant, and that because such a relationship was
absent here, the admission of Delellis’s statements was improper. Finally,
Alexander contests the admission of the tapes in their entirety on the ground that
the tapes included prejudicial statements irrelevant to her case. We address these
arguments in turn.
7
1. Requirements of Federal Rule of Evidence 801(d)(2)(E)
In order to introduce the tape recordings of Delellis as co-conspirator
statements, the government was first required “to prove by a preponderance of the
evidence that (1) a conspiracy existed, (2) the conspiracy included the declarant
and the defendant against whom the statement [was] offered, and (3) the statement
was made during the course of and in furtherance of the conspiracy.” Id. (citation
omitted). We review for clear error the district court’s determination that these
factual requirements were satisfied. United States v. Matthews, 431 F.3d 1296,
1308 (11th Cir.) (per curiam), cert. denied, __ U.S. __, 127 S. Ct. 46 (2006).1
Alexander argues that the government failed to adduce sufficient evidence to
prove the existence of a conspiracy by a preponderance of the evidence. We
disagree. In assessing whether the government has shown the existence of a
conspiracy, the contents of the statement at issue are not alone sufficient to prove
the existence of a conspiracy, but are to be considered by the district court. Fed R.
Evid. 801(d)(2)(E); see also United States v. Diaz, 248 F.3d 1065, 1087 n.22 (11th
Cir. 2001). Here, the disputed tape recordings contained statements by Delellis
that Alexander was “a friend of [hers]” who would be willing to sign a CMN for a
1
Although the district court did not make explicit findings on this threshold issue, by
admitting the controverted statements, the court implicitly found that the statements had been
made “in the course of, and in furtherance of, a conspiracy.” See United States v. Miles, 290
F.3d 1341, 1352 (11th Cir. 2002) (per curiam).
8
patient without first treating that patient. R4 at 259. The recordings also contain
statements by Delellis that Alexander was “fantastic,” had been “very good to
[Delellis],” and was “one of [Delellis’s] biggest referral sources.” Id. at 267-68.
The district court properly considered this evidence in determining whether the
government proved a conspiracy.
Moreover, evidence independent of the disputed recordings included an
electronic claim form for a wheelchair for the fictitious patient Paul Watson,
submitted by DPI, and identifying Alexander as the referring physician. The
evidence also included a hard copy of the CMN for Paul Watson, containing
Delellis’s handwriting in Section B and Alexander’s signature, as well as Ford’s
testimony that Alexander stated “yes, that is my signature,” when shown Watson’s
CMN. R6 at 272. The district court did not clearly err in finding this evidence
sufficient to establish the existence of a conspiracy by a preponderance of the
evidence.
Alexander also argues that, at best, the government established the existence
of two separate conspiracies, and that Delellis’s recorded statements to Fairbrother
were in furtherance of a conspiracy in which Alexander did not take part.
Alexander contends that if she was involved in a conspiracy at all, the conspiracy
was only between Alexander and Delellis, and involved Alexander signing CMNs
9
for patients she had not treated. Meanwhile, she contends that Delellis was
engaged in a separate conspiracy with Fairbrother and David, whereby Alexander
would pay Fairbrother and David kickbacks for patient referrals. Alexander claims
she was unaware of the kickback scheme among Delellis, Fairbrother, and David,
and that statements made in furtherance of that separate conspiracy could not
properly be introduced against Alexander under Rule 801(d)(2)(E).
The district court did not clearly err in finding that Alexander, Delellis,
Fairbrother, and David were involved in a single conspiracy. Alexander could not
have signed CMNs for Watson and other fictitious patients had Fairbrother and
David not referred those patients to Delellis. Likewise, the patient referrals
Delellis received from Fairbrother and David were worthless without a physician
who was willing to sign CMNs. “Because [Alexander’s] acts facilitated the entire
scheme, a single conspiracy was shown.” See United States v. Woodward, 459
F.3d 1078, 1085 (11th Cir. 2006) (per curiam). Thus, at least with respect to the
portions of the recordings played in court, the requirements of Rule 801(d)(2)(E)
were satisfied.2
2. Due Process and Confrontation Clauses
Alexander argues that, even if the requirements of Rule 801(d)(2)(E) were
2
We address subsequently the portions of the recordings not played in court, but made
available to the jury.
10
met, admission of Delellis’s tape-recorded statements violated her rights under the
due process and confrontation clauses of the constitution. Alexander contends that
Delellis’s statements were testimonial evidence, and because Delellis had not been
subjected to cross-examination, and was not unavailable to testify, the statements
were inadmissible. See Crawford v. Washington, 541 U.S. 36, 68, 124 S. Ct. 1354,
1374 (2004) (“Where testimonial evidence is at issue, however, the Sixth
Amendment demands what the common law required: unavailability and a prior
opportunity for cross-examination.”). She further argues that, even if the
statements were not testimonial in nature, they were nonetheless so unreliable as to
violate her due process and confrontation rights. These arguments fail.
As Alexander acknowledges in her brief, we held in Underwood that
statements made to an undercover informant in the course of an investigation are
non-testimonial, because the statements “clearly were not made under
circumstances which would have led [the declarant] to believe that his statement
would be available for use at a later trial.” 446 F.3d at 1347. Delellis’s statements
that were introduced at trial were made to an undercover informant, Fairbrother,
and an investigator, David. As such, pursuant to our holding in Underwood, those
statements were not testimonial. See id. Because the statements were non-
testimonial and satisfied the requirements for admissibility of co-conspirator
11
statements they were properly admitted. See id. at 1347-48.
Alexander points out that the government characterized Delellis as
“deceptive” and “not credible,” R7 at 18-19, and argues that Delellis believed she
could mitigate her own potential liability by implicating Alexander, rendering her
statements inherently unreliable. The Supreme Court, however, has stated that “the
co-conspirator exception to the hearsay rule is firmly enough rooted in our
jurisprudence that . . . a court need not independently inquire into the reliability of
such statements.” Bourjaily v. United States, 483 U.S. 171, 183, 107 S. Ct. 2775,
2782 (1987) (citation omitted). Because the statements at issue qualify as co-
conspirator statements, we hold that their admission did not violate Alexander’s
rights under the due process and confrontation clauses.
3. Lack of Agency Relationship
Alexander also argues that Delellis’s out-of-court statements should not have
been admitted because Delellis was not speaking as an agent or representative of
Alexander, and because Delellis’s interests did not coincide with Alexander’s
interests. Alexander cites no case in which we have held that the co-conspirator
exception turns on the existence of an agency relationship between the declarant
and the defendant, and we decline to create such a rule. Accordingly, we reject this
argument.
12
4. Admission of Tapes in Their Entirety
We next turn to Alexander’s argument that the district court erred in
admitting in their entirety the government’s undercover recordings of Delellis.
Alexander identifies several portions of the tapes that she believes were both
irrelevant and prejudicial. Specifically, she contests the admission of portions of
the tapes in which Delellis is heard discussing dealings with doctors other than
Alexander involving unrelated conduct, describing a scheme wherein Delellis
would buy back equipment and then sell it for a profit, and explaining how she had
lied in order to help a friend get a job. Alexander argues that these statements were
not in furtherance of the conspiracy at issue, and were prejudicial in that they
showed Alexander’s association with a “bad woman.”
We first note that under circuit precedent, these statements may qualify as
co-conspirator statements. Even if the conduct discussed was not directly related
to the conduct in which Alexander was involved, the statements may have been in
furtherance of the conspiracy if they were “used to obtain the confidence or to allay
the suspicions of a co-conspirator.” See United States v. Santiago, 837 F.2d 1545,
1549 (11th Cir. 1988). We need not decide whether they were in furtherance of the
conspiracy, however, because even if the contested statements were erroneously
admitted, they would not warrant reversal. See United States v. Arbolaez, 450
13
F.3d 1283, 1290 (11th Cir. 2006) (per curiam) (“To require a new trial a significant
possibility must exist that, considering the other evidence presented by both the
prosecution and the defense, the statement had a substantial impact upon the
verdict of the jury.”) (citation, quotation, and formatting omitted). We believe that
any error in admitting the disputed portions of the tapes was harmless, and did not
have a substantial influence on the outcome of the trial.
The evidence Alexander complains of showed that Delellis participated in
similar schemes with numerous doctors, and that she was a dishonest person. Yet
the properly admitted evidence of the conspiracy involving Alexander
demonstrates those same qualities in Delellis. Thus, we do not find the admission
of the complained-of statements prejudicial.
5. Reliability of Recordings
Alexander also argues that the tapes and transcripts failed to meet the
standards for authenticity because portions of the tapes were unintelligible and the
transcripts contained errors or inaccuracies. We have stated that “[i]t is well settled
law that the party introducing a tape into evidence has the burden of going forward
with sufficient evidence to show that the recording is an accurate reproduction of
the conversation recorded.” United States v. Sarro, 742 F.2d 1286, 1292 (11th Cir.
1984). A tape recorded in poor quality or containing inaudible or unintelligible
14
portions is admissible unless the trial judge, in his sound discretion, determines
that “the inaudible or unintelligible portions ‘are so substantial as to render the
recording as a whole untrustworthy.’” United States v. Pope, 132 F.3d 684, 688
(11th Cir. 1998) (citation omitted). As for the transcripts prepared from the
recording, we have held that “[a] district court need not find that the transcript is
perfectly accurate prior to its admission, and a defendant’s remedy for alleged
inaccuracies is to offer his own transcript with proof as to why it is a better one.”
United States v. Hogan, 986 F.2d 1364, 1376 (11th Cir. 1993).
The government met its burden of authenticity. Prior to the government
introducing the tapes into evidence, Fairbrother, a participant in all recorded
conversations, testified that they were the same tapes she had listened to in their
entirety, that she recognized the voices on the tapes, and that the tapes accurately
depicted what transpired during the conversations. The government later elicited
similar testimony from Ford with respect to the conversations involving him. The
district court, in its discretion, determined that the inaudible or unintelligible
portions were not “so substantial as to render the recording as a whole
untrustworthy.” See Pope, 132 F.3d at 688 (citation omitted). Though Alexander
identifies several portions of the transcripts marked “unintelligible,” the majority
of the excerpts of the tapes played at trial appear from the record to have been
15
intelligible, and the district court did not abuse its discretion by admitting the
recordings. Moreover, Alexander did not contest the accuracy or provide an
alternate version of the transcripts at trial, and, therefore, cannot now challenge
their reliability.
B. Delellis’s Statements to Agent Ford
When Ford executed the search warrant at DPI, Ford questioned Delellis
about CMNs that he found on the premises. In response, Delellis stated that she
had completed Section B of the CMN for Watson’s wheelchair, and that she knew
what she had done was wrong, because she did not know Watson. She also stated
that she could not identify some of the handwriting on the CMN. Alexander
contends, and the government concedes, that the district court erred in admitting
these statements at trial. The government, however, argues that the error was
harmless.3
We agree with the government that the admission of Delellis’s statements to
Ford was, at most, harmless error. As the government points out, the jury heard
testimony from Angeline Rober, Delellis’s office manger, that Delellis had
completed Section B of CMNs that bore Alexander’s signature, including the
3
The government further argues that, because Alexander only raised a hearsay objection
at trial, we must apply the plain-error standard of review to Alexander’s claims of constitutional
error. We need not address the issue, however, because even under harmless error analysis,
Alexander’s argument fails.
16
Watson CMN. Indeed, the key evidence as to the count of conviction consisted of
the Watson CMN, apparently signed by Alexander, and properly admitted
testimony that Alexander acknowledged the signature as her own. Delellis’s
statements to Ford added nothing to this crucial evidence, and accordingly, did not
have a substantial influence on the jury’s verdict. See United States v. Williams,
445 F.3d 1302, 1307 n.4 (11th Cir. 2006) (finding that any error in admitting
evidence was harmless, as the properly admitted evidence “provided ample support
for every crime of which [the defendant] was convicted”).
C. The Diagram
The district court admitted into evidence a diagram, prepared by the
government, that purported to summarize the evidence relating to Count V, the
only count of which Alexander was ultimately convicted. The diagram contained a
chart that, in part, showed a CMN for Watson flowing from Alexander to Delellis,
and $150 flowing from Delellis to Alexander. Alexander argues that the chart was
inadmissible under Federal Rule of Evidence 1006, and moreover, that it was
prejudicial, in that it merely depicted the government’s theory of the case, and, by
showing Alexander receiving a monetary kickback, assumed Alexander’s guilt.
We need not decide whether the diagram was admitted in error, because to
the extent it was, that error was harmless. Alexander was convicted of presenting
17
false claims against the government under 18 U.S.C. § 287, and the receipt of a
kickback is not an element of that offense. Thus, the diagram’s depiction of
Alexander accepting payment from Delellis was not relevant to her conviction.
Indeed, the evidence that Alexander signed the Watson CMN without treating the
patient was sufficient to support her conviction. In any event, the record contained
ample evidence from which the jury could have inferred that Delellis paid
Alexander. For example, the evidence included recorded statements made by
DeLellis that she had paid Alexander to sign the Watson CMN. Additionally, on
the date that Delellis told Fairbrother that she had paid Alexander to sign the CMN,
a withdrawal was made from DPI’s account in the vicinity of Alexander’s office.
Accordingly, the admission of the diagram was at most harmless error, and does
not warrant reversal.
D. The Government’s Closing Statements
Alexander cites several statements that the government made in its closing
argument that, for the first time on appeal, she argues were improper. She
contends that the government attempted to appeal to the emotions of the jury by
arguing that this case was about protecting Medicare beneficiaries, that Alexander
had violated the trust given to her as a doctor in her role as “gate keeper” to the
Medicare system, and in doing so had acted “calloused” and may have harmed
18
patients. Alexander also contends that the government attempted to shift the
burden of proof when it argued that her closing statements attempted to create
reasonable doubt, were not supported by the evidence and did not contradict the
evidence adduced in the government’s case. Finally, Alexander states that the
government misused character evidence by arguing that, because Alexander had
allegedly accepted kickbacks before, the jury could infer that she had done so in
this case.
Because Alexander did not object to the government’s closing arguments at
trial, “relief is available to rectify only plain error that is so obvious that failure to
correct it would jeopardize the fairness and integrity of the trial.” See United
States v. Bailey, 123 F.3d 1381, 1400 (11th Cir. 1997) (citations omitted). We
have stated that “[a]lthough a prosecutor may not make an argument directed to
passions or prejudices of the jurors instead of an understanding of the facts and law
. . . , there is no prohibition on colorful and flamboyant remarks if they relate to the
evidence adduced at trial.” Id. (internal quotation and citation omitted). We have
also held that “a comment by the prosecutor on the failure by defense counsel, as
opposed to the defendant, to counter or explain evidence” does not amount to
improper burden-shifting. United States v. Hernandez, 145 F.3d 1433, 1439 (11th
Cir. 1998).
19
The remarks made by the government during closing did not “jeopardize the
fairness and integrity of the trial.” See Bailey, 123 F.3d at 1400. All of the
statements that Alexander contests related to the evidence presented at trial or were
permissible observations that Alexander’s defense did not contradict the evidence
the government offered. See Hernandez, 145 F.3d at 1439. Moreover, to the
extent the government violated Federal Rule of Evidence 404(b) by using evidence
of prior kickbacks to persuade the jury that Alexander accepted a kickback in this
case, the remarks did not rise to the level of plain error. As previously discussed,
there was sufficient circumstantial evidence in the record to support the inference
that Alexander accepted payment in exchange for signing CMNs. Cf. United
States v. Blakely, 14 F.3d 1557, 1560 (11th Cir. 1994) (prosecution’s reference,
during closing argument, to defendant as “professional criminal” was “clearly
improper” where it was “based on facts not admitted as evidence”). Thus,
Alexander is not entitled to relief on the basis of the prosecution’s closing remarks.
E. Cumulative Error
Lastly, we must determine whether the errors alleged, even if independently
harmless, cumulatively worked to deprive Alexander of a fair trial. We have
recognized that “the cumulative prejudicial effect of many errors may be greater
than the sum of the prejudice caused by each individual error.” Baker, 432 F.3d at
20
1223 (citation omitted). We determine the harmlessness of cumulative error by
“look[ing] to see whether the defendant’s substantial rights were affected.” Id.
(citation and quotation omitted).
At most, the erroneously admitted evidence in this case consisted of the
government’s summary exhibit and Delellis’s hearsay statement to Ford during the
execution of the search warrant. Despite any error with respect thereto, the jury
had before it sufficient evidence to convict Alexander for filing a false claim. The
evidence included a CMN for a wheelchair for Watson submitted by DPI for
reimbursement under the Medicare plan. Alexander was listed on Watson’s CMN
as the treating physician and her signature appeared on the form. Alexander never
treated Watson, however, because he was a fictitious person created by the
government. Ford testified that the signature on the CMN for Watson was similar
to signatures that appeared on CMNs filed by patients that Alexander had treated
and that Alexander admitted the signature on the Watson CMN was hers. The
evidence also included recorded conversations between Delellis and Fairbrother
during which Delellis indicated that she had an ongoing referral relationship with
Alexander and had paid Alexander to sign the CMN. The date on which DeLellis
told Fairbrother she had Alexander’s signature was the same date on which the
CMN for Watson was completed and the same date that DeLellis made a
21
withdrawal from an ATM in the vicinity of Alexander’s office. In light of this
evidence, and upon reviewing the record, we find that cumulative error did not
effect the outcome of the trial.
III. CONCLUSION
Alexander appealed her conviction of presenting false claims against the
government under 18 U.S.C. § 287. Because she has identified no reversible
evidentiary error, we AFFIRM her conviction.
22