Government’s Notice of Intent to Introduce Inextricably Intertwined Evidence or Evidence pursuant to Fed. R. Evid. 404(b) — No. 1:24-cr-20155 (Dkt. 154, S.D. Fla.)

Summary

Government notice, entered 01/17/2025, of intent to introduce inextricably intertwined or Rule 404(b) evidence against Enrique Perez-Paris, Gregory Charles Milo Caskey, Omar Palacios, Nadir Perez and a fifth co-defendant. An 11-Count Superseding Indictment returned June 24, 2024 charges health care fraud, wire fraud, kickback and money laundering offenses over an alleged $65 million effort to bill payors for medically unnecessary COVID-19 and genetic tests through Innovative Genomics, LLC. Prosecutors say IGX's owners billed respiratory pathogen panel tests as add-ons to COVID-19 tests and used Medicare beneficiaries' information for telemarketing over-the-counter COVID-19 tests. Several defendants had recruited patients for laboratories charged in the 2019 Operation Double Helix. The charges are allegations.

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“Government’s Notice of Intent to Introduce Inextricably Intertwined Evidence or Evidence pursuant to Fed. R. Evid. 404(b) — No. 1:24-cr-20155 (Dkt. 154, S.D. Fla.).” Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/government-s-notice-of-intent-to-introduce-inextricably-intertwined-ev-55e99094c5/, SHA-256 ca402bd1225d430a6d86e7bdf61479fbe1c31e93c8596ea26d48809fd7a2830a.

Full text

Case 1:24-cr-20155-RAR Document 154 Entered on FLSD Docket 01/17/2025 Page 1 of 16

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF FLORIDA
Case No. 24-CR-20155-RAR

UNITED STATES OF AMERICA

vs.

ENRIQUE PEREZ-PARIS,
DIEGO SANUDO SANCHEZ CHOCRON,
GREGORY CHARLES MILO CASKEY,
OMAR PALACIOS, and
NADIR PEREZ,

Defendants.
/

GOVERNMENT’S NOTICE OF INTENT TO INTRODUCE
INEXTRICABLY INTERTWINED EVIDENCE
OR EVIDENCE PURSUANT TO FED. R. EVID. 404(b)

Pursuant to Federal Rule of Evidence 404(b)(2)-(3) and Local Rule 88.10(h), the United

States of America, through undersigned counsel hereby informs Defendants of its intent to

introduce evidence at trial of the following:

A. Innovative Genomics, LLC (“IGX”) employed the same scheme and people to generate

orders for laboratory testing as Defendants Perez-Paris, Caskey, Palacios and Co-

Conspirator Hermesman did for other laboratories.

B. IGX’s Owners (Perez-Paris, Sanchez, Caskey, and Hermesman) billed for medically

unnecessary respiratory pathogen panel tests (“RPP tests”) as add-ons to COVID-19

tests.

C. IGX’s Owners used Medicare beneficiaries’ personal identifying information obtained

from prior claims IGX billed to target them in telemarketing campaigns for over-the-

counter COVID-19 tests that they did not want or need.
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D. Other crimes Defendants engaged in to carry out the scheme and generate proceeds

from the scheme.

E. Probes and audits of IGX by Government and private entities.

Much of the evidence is either direct evidence of the charged conduct or is inextricably

intertwined with the charges. However, in an abundance of caution and in the interest of full

disclosure, the Government notices this evidence under Rule 404(b)(2) to prove knowledge, intent,

motive, and absence of mistake.

BACKGROUND

On June 24, 2024, a grand jury in the Southern District of Florida returned an 11-Count

Superseding Indictment in this matter charging Defendants with health care fraud, wire fraud,

kickback, and money laundering offenses for their respective roles in an approximately $65 million

scheme to bill Government and private payors for medically unnecessary and non-reimbursable

COVID-19 and genetic tests. Defendants Perez-Paris, Sanchez, Caskey, and Co-Conspirator

Hermesman owned IGX (“IGX’s Owners”). Defendant Palacios was among IGX’s most

productive patient recruiters.

The scheme at IGX was plain: pay patient recruiters to generate falsified orders for

laboratory tests. The patient recruiters bribed providers for these orders and even forged orders or

had subordinates do it for them. The Superseding Indictment focuses on COVID-19 and genetic

testing, IGX’s highest grossing tests. The evidence will show that IGX’s Owners selected which

types of tests and payors to target as well as the diagnosis and procedure codes that needed to be

in the orders so they would be reimbursed. They then directed the patient recruiters to obtain

orders pursuant to those codes regardless of whether they were medically necessary or

reimbursable. For example, because patient recruiters were bribing them, providers referred orders

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for genetic testing to IGX that patients did not need and for tests that IGX did not have the ability

to perform.

The alleged conspiracy began with generating orders for genetic testing and evolved into

COVID-19 testing, which quickly became the most lucrative for IGX. Defendants Perez-Paris,

Caskey, and Palacios served as patient recruiters with Co-Conspirator Hermesman for other

laboratories in a prior genetic testing scheme. Some of those laboratories’ owners and operators

were criminally charged in September 2019 in a large enforcement action called Operation Double

Helix. Once those laboratories shut down, Perez-Paris, Sanchez, Caskey, and Hermesman opened

IGX and effectively restarted the scheme – first with genetic testing and then, when the pandemic

began, with COVID-19 testing. The scheme continued to involve kickbacks to patient recruiters

to generate orders for laboratory testing regardless of medical necessity or other requirements for

reimbursement. Defendant Palacios was brought on as a proven patient recruiter.

Specifically, the Government will present evidence at trial showing that IGX’s Owners

entered into illegal volume-based agreements with patient recruiters, including Defendant

Palacios, to set up COVID-19 testing tents around the country to collect samples. COVID-19

polymerase chain reaction (“PCR”) tests require a physician’s order, had to be sent to a laboratory,

could take up to three days to generate results, and are more likely to detect the virus. COVID-19

antigen tests provide results in 15-30 minutes at the point of care. IGX gave the patient recruiters

direct access to its laboratory information system (“LIMS”) to create their own physicians’ orders

for COVID-19 PCR tests. Pay was directly tied to how many orders the patient recruiters created

on their own. The ordering providers were not at the testing sites and made no determination as

to the tests’ medical necessity. However, their signatures were pre-populated on the requisition

forms for the test. Because patient recruiters were paid for creating their own orders, this resulted

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in billing for tests that were never administered at all, billing for patients that were dead, and

patients being subject to repeated testing with no medical oversight or no need for them, all under

the guise that a physician had ordered the tests.

IGX’s Owners and the patient recruiters also made material misrepresentations regarding

IGX’s COVID-19 PCR testing to entice patients to take these tests and so that payors would

reimburse for them – particularly, that IGX administered tests that had U.S. Food & Drug

Administration emergency-use authorization (“FDA EUA”) and that IGX could provide 24-hour

COVID-19 PCR test results from anywhere in the country despite the tests having to be shipped

to the laboratory in San Antonio, Texas. IGX’s Owners knew these false representations were

being made.

From in or around November 2019 to in or around June 2023, as a result of the scheme,

IGX billed payors approximately $65,875,979, of which roughly $44,417,197 was paid.

Defendants are currently set to begin trial on March 3, 2025.

THE PROPOSED EVIDENCE

A. IGX employed the same scheme and people to generate orders for laboratory
testing as Defendants Perez-Paris, Caskey, Palacios, and Co-Conspirator
Hermesman did for other laboratories in a prior scheme.

The Government will seek to introduce evidence demonstrating that Co-Conspirator Nikita

Hermesman previously paid Defendants Perez-Paris, Caskey, and Palacios, Co-Conspirator Daryle

Fallings, and others as his downline patient recruiters on volume-based agreements he had with

laboratory owners charged in Operation Double Helix, including Khalid Satary and Ravitej

Reddy. 1 Hermesman paid them through shell companies, one of which he owned with his ex-

1
Daryle Fallings and Ravitej Reddy have also been convicted. See [ECF No. 42] United
States v. Fallings, No. 22-cr-00154 (C.D. Cal. Marc. 28, 2023); [ECF No. 78], United States v.
Reddy, No. 19-cr-00357 (W.D. Pa.).
4
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fiancé who was convicted of conspiracy to commit health care fraud. See [ECF No. 206] United

States v. Curran, No. 18-CR-80124-RUIZ (S.D. Fla. Feb. 20, 2020) (IGX_SD_000082359).

Roughly two months after Operation Double Helix was announced, Defendants Perez-

Paris, Sanchez, Caskey, and Co-Conspirator Hermesman officially launched IGX. They

immediately started using some of the same providers that Perez-Paris, Caskey, Hermesman, and

others bribed for the previous laboratories to refer the same types of tests to IGX. They also

continued referring orders to other laboratories the same way. Defendant Sanchez agreed to join

as he was Perez-Paris’ childhood friend and was interested in instantly generating profit from the

built-in referrals. Perez-Paris, Caskey, and Hermesman brought in Sanchez as IGX’s Chief

Financial Officer because of his experience in finance and investing in cryptocurrency arbitrages,

as they wanted to invest the laboratory’s revenue in cryptocurrency. Indeed, despite being

geographically dispersed (Sanchez in Los Angeles, Perez-Paris and Hermesman in Miami, and

Caskey in San Antonio), they chose to open IGX in San Antonio, Texas. This is because, through

Perez-Paris, Caskey, and Hermesman’s experience recruiting at other laboratories, they believed

that the Medicare Administrative Contractor that covered Texas for laboratory testing was the

easiest to target for fraud, and Caskey already had a stable of doctors there that he was bribing for

referrals. They then enlisted several other patient recruiters that Perez-Paris, Caskey, and

Hermesman worked with at the previous laboratories to join IGX, including Palacios, and Fallings.

They continued to build out IGX’s patient recruiter ranks with others, including Defendant Perez.

The evidence to be introduced will be potential testimony from Hermesman, Reddy, and Fallings

and documents including the following: 2

2
These witnesses and documents have been disclosed to Defendants in discovery and the
Government’s Preliminary Witness and Exhibit Lists
5
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• Co-Conspirator Hermesman’s contracts with Satary listing the amounts to be paid

per laboratory test he referred to Satary’s laboratories.

• The invoices that Hermesman, Palacios, Perez-Paris, and Fallings sent to Satary’s

laboratories that were used as templates for invoices IGX used.

• The “new account” enrollment forms Caskey, Hermesman, and Perez-Paris used to

enroll some of the physicians with the previous laboratories.

• Banking records reflecting payments from Hermesman to Caskey, Palacios,

Fallings, and others for patient referrals sent to laboratories.

• Documents and communications showing that Defendants knew others were

arrested and convicted for the same conduct in which Defendants were engaging.

• Documents showing that Perez-Paris converted the human resources software and

website of the company he used to receive his share of the payments from the

previous laboratories into IGX.

B. IGX’s Owners, through IGX, billed for false and fraudulent orders for
respiratory pathogen panels as add-ons to COVID-19 tests.

The Government will seek to introduce evidence that Defendants Perez-Paris, Sanchez,

Caskey, and Co-Conspirator Hermesman, through IGX, billed health care benefit programs for

medically unnecessary respiratory pathogen panels that were automatically added onto COVID-

19 tests from the same swab. This evidence will consist of billing data reflecting IGX’s

submissions of RPP tests, testimony from Co-Conspirator Hermesman, and communications

among Perez-Paris, Sanchez, Caskey, and Co-Conspirator Hermesman discussing the decision to

do so and knowledge that it was illegal. This evidence has also been included on the Government’s

Preliminary Exhibit List.

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C. IGX’s Owners used Medicare beneficiaries’ personal identifying information
obtained from prior claims IGX billed to target them in telemarketing campaigns
for over-the-counter COVID-19 tests that they did not want or need.

The Government will seek to introduce evidence that Defendants Perez-Paris, Sanchez,

Caskey, and Co-Conspirator Hermesman, through IGX, used Medicare beneficiaries’ information

previously received for other tests to target them in telemarketing campaigns for over-the-counter

(“OTC”) COVID-19 tests. IGX sent these tests to beneficiaries regardless of if they wanted or

needed them so that IGX could bill Medicare. This evidence will consist of testimony from

Hermesman and communications showing knowledge of complaints regarding the tests, also on

the Government’s Preliminary Exhibit List.

D. Other crimes Defendants engaged in to carry out the scheme and generate
proceeds from the scheme.

The Government will seek to introduce evidence that Defendants committed a host of other

serious crimes in furtherance of the scheme. IGX’s Owners conspired to distribute the COVID-

19 PCR tests, in vitro diagnostic medical devices, that they knew were not authorized or approved

by the FDA. See 21 U.S.C. §§ 331 and 333; see [ECF No. 46 at 18]. They also conspired to

commit bank fraud in obtaining loans to finance IGX by misrepresenting that they were following

applicable laws and regulations while they knew that they were committing fraud and using the

proceeds to repay the loans. See 18 U.S.C. § 1344. Defendants Perez-Paris, Sanchez, Caskey, and

Co-Conspirator Hermesman were signatories on these loans. Additionally, Defendants conspired

to engage and engaged in aggravated identity theft by using patients’ and medical professionals’

information without their consent and to obtain proceeds from the scheme. See 18 U.S.C. § 1028A;

see [ECF No. 46 at 17-18]. IGX’s volume-based contracts applied to claims reimbursed by private

payors as well which is also a violation of the Eliminating Kickbacks in Recovery Act (“EKRA”),

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see 18 U.S.C. § 220. IGX’s owners instructed the patient recruiters to apply the same scheme to

whatever payor was presented to them. See [ECF No. 46 at 18]. The direct evidence in this case

also establishes these offenses. They simply have not been charged at this time.

E. Probes and audits of IGX by Government and private entities.

The Government will seek to introduce evidence of probes and audits of IGX conducted

by entities such as Medicare, the FDA, and private payors during and after the time frame alleged

in the Superseding Indictment. Some audits began after the conspiracy ended but for claims billed

during the conspiracy. All of these audits are intrinsic evidence to the charged conduct.

Nonetheless, in an abundance of caution, notice is hereby provided that the Government intends

to introduce testimony from the payors and Co-Conspirator Hermesman, and documents related

thereto.

LEGAL STANDARD

Evidence of prior bad acts is not extrinsic under Rule 404(b) if it: (1) arose out of the same

transaction as the charged offense; (2) is necessary to complete the story of the crime; or (3) is

inextricably linked with the charged offense. United States v. Ellisor, 522 F.3d 1255, 1269 (11th

Cir. 2008) (affirming mail fraud conviction). It is settled law that “[e]vidence, not part of the crime

charged but pertaining to the chain of events explaining the context, motive and set-up of the crime,

is properly admitted if it is linked in time and circumstances with the charged crime, or forms an

integral and natural part of an account of the crime, or is necessary to complete the story of the

crime for the jury.” United States v. McClean, 138 F.3d 1398, 1403 (11th Cir. 1998) (quoting

United States v. Williford, 764 F.2d 1493, 1499 (11th Cir. 1985)); see also United States v.

Edouard, 485 F.3d 1324, 1344 (11th Cir. 2007) (holding that “evidence is inextricably intertwined

with the evidence regarding the charged offense if it forms an ‘integral and natural part of the

8
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witness’s accounts of the circumstances surrounding the offenses to which the defendant was

indicted.’”) (quoting United States v. Foster, 889 F.2d 1049, 1053 (11th Cir. 1989)).

In contrast, Rule 404(b)(2) permits the introduction of evidence to prove “motive,

opportunity, intent, preparation, plan, knowledge, identity, absence of mistake, or lack of

accident.” Courts in this Circuit apply a three-prong test to assess the admissibility of extrinsic

evidence under Rule 404(b):

First, the evidence must be relevant to an issue other than the
defendant’s character. Second, as part of the relevance analysis,
there must be sufficient proof so that a jury could find that the
defendant committed the extrinsic act. Third, the evidence must
possess probative value that is not substantially outweighed by its
undue prejudice, and the evidence must meet the other requirements
of Rule 403.

United States v. Jernigan, 341 F.3d 1273, 1280 (11th Cir. 2003) (upholding district court’s

admission of evidence of defendant’s prior crimes). 3 “A defendant who enters a not guilty plea

makes intent a material issue which imposes a substantial burden on the government to prove

intent, which it may prove by qualifying Rule 404(b) evidence absent affirmative steps by the

defendant to remove intent as an issue.” United States v. Zapata, 139 F.3d 1355, 1358 (11th Cir.

1998) (“The relevance of other crimes evidence to intent is determined by comparing the

defendant’s state of mind in committing both the extrinsic and charged offenses.”). 4

3
As with any evidence, “the probative value of proffered 404(b) evidence must not be
substantially outweighed by unfair prejudice.” Jernigan, 341 F.3d at 1282 (internal quotations
omitted). “This determination lies within the sound discretion of the district judge and calls for a
common sense assessment of all the circumstances surrounding the extrinsic offense, including
prosecutorial need, overall similarity between the extrinsic act and the charged offense, as well as
temporal remoteness.” Id.
4
The Eleventh Circuit has recognized that Rule 404(b) is “a rule of inclusion, and . . .
accordingly ‘404(b) evidence, like other relevant evidence, should not lightly be excluded when it
is central to the prosecution’s case.’” Id. (quoting United States v. Perez-Tosta, 36 F.3d 1552,
1562 (11th Cir. 1994)) (accord United States v. Stephens, 365 F.3d 967, 975 (11th Cir. 2004)).

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ARGUMENT

I. MUCH OF THE PROPOSED EVIDENCE INVOLVES ACTS IN FURTHERANCE
OF THE CHARGED CONSPIRACY OR IS INEXTRICABLY INTERTWINED
WITH THE CHARGES.

The proposed evidence directly inculpates Defendants in the charged scheme to pay and

receive bribes for obtaining falsified orders for laboratory tests. In United States v. Nerey, the

Eleventh Circuit agreed with the district court in admitting “[e]vidence of Nerey’s involvement

with other home health care agencies . . . was inextricably intertwined with, and probative of, how

Nerey became involved with the home health care agencies in this case and why they trusted him

as a patient recruiter.” 877 F.3d 956, 975 (11th Cir. 2017). Similarly, in United States v.

Benevides, the Eleventh Circuit found no error in the district court admitting testimony of the

defendant’s “participation in a scheme involving the same manner of fraud (submitting false

Medicare claims), using the same type of company . . . , hiring the same intermediaries to bill the

claims and launder the money (All-Med and Cashflow), and involving the same main players

(Guerra and Benevides).” 470 F. App’x 782, 788 (11th Cir. 2012). Likewise, in United States v.

Ruiz, 698 F. App’x 978 (11th Cir. 2017), the Eleventh Circuit agreed that evidence of kickback

transactions was admissible in a case where defendant was charged with health care fraud, but not

kickbacks. The defendant was charged with “fabricating and falsifying medical records to reflect

treatment services which were not provided.” Id., 698 F. App’x at 989. Evidence that the

defendant admitted patients to the treatment facility “so that she would receive a kickback [was]

‘inextricably intertwined’ with the charged health care fraud conspiracy.”

Rule 404(b) is a rule “of inclusion which allows [extrinsic] evidence unless it tends to only prove
criminal propensity. The list provided by the rule is not exhaustive and the range of relevancy
outside the ban is almost infinite.” Stephens, 365 F.3d at 975 (quoting United States v. Cohen, 888
F.2d 770, 776 (11th Cir. 1989) (internal quotations omitted)).

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Here, evidence that the charged scheme evolved out of a prior laboratory fraud scheme

involving many of the Defendants is inextricably intertwined with the charged conduct. The

Defendants created IGX in response to the arrest and dismantling of a prior laboratory scheme,

used many of the same conspirators, and operated in the same manner. They used similar volume-

based contracts to generate revenue and, in some instances, the same sham invoices to disguise the

kickbacks. This evidence tells the story, motive, and set-up of the crime, and is an “integral and

natural part” of the genesis of IGX. See McClean, 138 F.3d at 1403; Edouard, 485 F.3d at 1344;

[ECF No. 141], United States v. Perez-Paris et al., No. 24-cr-20155 (S.D. Fla. Dec. 20, 2024)

(paperless order denying Defendant Sanchez’s motion to sever citing McClean). Specifically, it

explains how and why a geographically dispersed group joined to form and operate IGX from

South Florida. Perez-Paris, Caskey, Hermesman, Palacios, and others knew who to bribe so that

IGX could generate revenue immediately. Sanchez had experience in accounting and

cryptocurrency arbitrages – one of the manners in which they intended to launder IGX’s proceeds.

They chose to open IGX in San Antonio, Texas because, through Perez-Paris, Caskey, and

Hermesman’s experience recruiting at other laboratories, they knew that the Medicare

Administrative Contractor that covered Texas for laboratory testing was a ripe target for fraud.

Particularly, it reimbursed for expensive “Tier 2” codes that other jurisdictions did not. These

codes were frequent targets for fraud as they were the most expensive but pertained to testing rare

genes that applied to an extremely small fraction of the population. From there, they simply built

the patient recruiter ranks at IGX with people they knew like Defendant Palacios, and anyone else

who wanted to make money even if they had no medical background. Thus “[e]vidence of

[Defendants’] involvement with other [laboratories] . . . [is] inextricably intertwined with, and

probative of, how [they] became involved with . . . [IGX] . . . and why they trusted [each other] as

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a patient recruiter[s].” Nerey, 877 F.3d at 975. This resulted in the “same manner of fraud . . .

using the same type of company [a laboratory] . . . [and] hiring the same intermediaries to bill

claims . . . .” Benevides, 470 F. App’x at 788.

Evidence of uncharged crimes Defendants committed in furtherance of the charged scheme

are also admissible as inextricably intertwined. See Ruiz, 698 F. App’x at 989 (Evidence that the

defendant admitted patients to the treatment facility “so that she would receive a kickback [was]

‘inextricably intertwined’ with the charged health care fraud conspiracy.”). As noted above, IGX’s

Owners knew that they were administering COVID-19 PCR tests that were not FDA authorized.

See 21 U.S.C. §§ 331 and 333. These tests were significantly cheaper than those that were FDA

authorized and thus IGX’s Owners increased their profit margins by misrepresenting what was

administered. IGX’s Owners also knew that they misrepresented to financial institutions,

including Bank 1, that they were following applicable laws and regulations in running IGX so that

they could obtain funds to finance the scheme. See 18 U.S.C. §1344. Defendants also knew that

patients’ identities were being stolen to bill because of the frequent complaints. See 18 U.S.C. §

1028A. Using the patients’ information to bill directly supported the underlying scheme to

generate falsified orders for laboratory tests. See Dubin v. United States, 599 U.S. 110, 114 (2023).

Also, for the volume-based contracts for the COVID-19 tests, the patient recruiters were paid

kickbacks for antigen and PCR tests regardless of the payor, and they were instructed to collect

whatever insurance information they received. Kickbacks paid for reimbursements of referrals

made to private payors violate 18 U.S.C. § 220. IGX’s Owners also knew that billing for RPP

panels from the same swabs collected for COVID-19 was illegal as they subscribed to publications

informing them of this, but they did it anyway to increase their profits. They also used the same

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information collected from Medicare beneficiaries to target them for COVID-19 tests they did not

request or need as they received complaints stating this.

Evidence stemming from payors’ audits that put IGX’s Owners on notice of the lack of

medical necessity of its tests and indicia of overutilization is evidence of their knowledge that their

business model was illegal. See United States v. Bek, 493 F.3d 790 (7th Cir. 2007) (affirming

health care fraud conviction supported by evidence that a pharmacy benefit company sent

defendant a letter informing him that company had paid to fill some of the prescriptions he had

issued and that “there is potential over-utilization for controlled substances.”). IGX’s Owners

participated in these audits. For example, Medicare audited IGX’s genetic testing claims and the

patient files supporting the claims and communicated to them that the tests lacked medical

necessity and that they were violating the Shell Laboratory Rule. Physicians that Defendant

Caskey was paying for the referrals ordered the tests. Private payors conducted investigations and

made law enforcement referrals regarding IGX’s billing practices. Particularly, that IGX’s billing

patterns indicated overutilization and fraud. The FDA also suspected IGX of offering non-FDA

authorized COVID-19 tests, and directly contacted IGX about it. These audits contained

information about regulations relevant to the tests at issue in this case. They are, as such,

intrinsically intertwined with the charged offenses. They also demonstrate knowledge of the

pertinent laws and that IGX’s Owners were not following them. United States v. Stokes, 392 F.

App’x 362 (6th Cir. 2010) (holding that evidence of corporate audits performed on defendant’s

medical practice was offered to show that defendant had knowledge of auditors’ warnings and

guidance). The probe and audits also provided IGX’s Owners with information regarding the types

of records they needed to have ready to try to justify their fraudulent claims.

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II. THE PROPOSED EVIDENCE IS ADMISSIBLE UNDER FEDERAL RULE OF
EVIDENCE RULE 404(B).

Alternatively, the same evidence is admissible under Rule 404(b) to prove Defendants’

knowledge, intent, motive, and absence of mistake. Defendants used some of the same people to

bribe the same physicians to order the same types of tests using the same method of pay and

invoices right after the Double Helix enforcement action. This speaks volumes about their

culpable mental state. See United States v. Ramirez, 426 F.3d 1344, 1354 (11th Cir. 2005) (“A

similarity between the other act and a charged offense will make the other offense highly probative

with regard to a defendant’s intent in the charged offense”); United States v. Hernandez, 896 F.2d

513, 521 (11th Cir. 1990) (indicating that when evaluating the probative value of an extrinsic

offense to establish intent, a court must “consider the similarity between the extrinsic and charged

offenses and the time gap between the two offenses”). Moreover, evidence of the additional

uncharged crimes leading up to and during the conspiracy is relevant to Defendants’ intent because

of the overlap in involvement and because the overarching objective was the same. See United

States v. Graham, 51 F.4th 67, 82 (2d Cir. 2022) (holding that the district did not err in admitting

evidence of uncharged crimes committing “at the same time as the charged conspiracy, with the

same coconspirators, and with the same hallmarks—“unconventional” . . . techniques used to

purportedly discharge debt[,]” was probative of fraudulent intent); United States v. Kolodesh, 787

F.3d 224, 236 (3d Cir. 2015) (affirming admission of evidence of uncharged fraudulent activity

occurring at a home health company where “it was offered as circumstantial evidence of [the

defendant’s] knowledge of the fraudulent activity. . .[,]” undermining defendant’s theory that he

“ran Community Home Health as a legal, legitimate business.”). Additionally, the audits

conducted on IGX, of which Perez-Paris, Sanchez, and Caskey were aware, are plain evidence of

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the knowledge that what they were doing was wrong. Fed. R. Evid. 404(b). This is not character

evidence, and its relevance is not substantially outweighed by any prejudice because it bears

directly on intent.

The Government expects Defendants to dispute their knowledge and intent by (i) shifting

blame on others, including third parties and subordinates; (ii) arguing that certain regulations were

in flux during the pandemic; and (iii) arguing that they believed patients needed the tests. The

proposed evidence described above contradicts these defenses.

CONCLUSION

The Government respectfully submits that the above-described evidence is properly

admitted as intrinsic or inextricably intertwined with the charged conduct and proof of knowledge,

intent, motive, and absence of mistake under Rule 404(b)(2). The evidence is not submitted to

prove Defendants’ character and any prejudice is far outweighed by its relevance.

Respectfully submitted,

MARKENZY LAPOINTE
UNITED STATES ATTORNEY

GLENN S. LEON, CHIEF
U.S. DEPARTMENT OF JUSTICE
CRIMINAL DIVISION, FRAUD SECTION

By: /s/ Reginald Cuyler Jr.
James V. Hayes
Florida Special Bar No. A5501717
Assistant Chief
Reginald Cuyler Jr.
Florida Bar No. 0114062
Matthew R. Belz
Florida Special Bar No. A5503303
Trial Attorneys
United States Department of Justice
Criminal Division, Fraud Section
1400 New York Avenue NW

15
Case 1:24-cr-20155-RAR Document 154 Entered on FLSD Docket 01/17/2025 Page 16 of 16

Washington, D.C. 20005
Tel: (202) 774-4276 (Hayes)
Tel: (202) 748-3024 (Cuyler)
Tel: (202) 579-4526 (Belz)
james.hayes@usdoj.gov
reginald.cuyler.jr@usdoj.gov
matthew.belz@usdoj.gov

CERTIFICATE OF SERVICE

I hereby certify that, on January 17, 2025, I served and filed the forgoing document with

the Clerk of the Court via ECF.

By: /s/ Reginald Cuyler Jr.
Reginald Cuyler Jr.
Trial Attorney

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