United States v. Srivastava

UNPUBLISHED

UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT

No. 10-4142

UNITED STATES OF AMERICA,

Plaintiff - Appellee,

v.

PRADEEP SRIVASTAVA,

Defendant - Appellant.

No. 10-4600

UNITED STATES OF AMERICA,

Plaintiff - Appellee,

v.

PRADEEP SRIVASTAVA,

Defendant - Appellant.

No. 10-4720

UNITED STATES OF AMERICA,

Plaintiff - Appellee,

v.
PRADEEP SRIVASTAVA,

Defendant - Appellant.

Appeals from the United States District Court for the District
of Maryland, at Greenbelt. Roger W. Titus, District Judge.
(8:05-cr-00482-RWT-1)

Argued: December 10, 2010 Decided: February 18, 2011

Before NIEMEYER and KING, Circuit Judges, and Patrick Michael
DUFFY, Senior United States District Judge for the District of
South Carolina, sitting by designation.

Affirmed by unpublished per curiam opinion.

ARGUED: Kannon Kumar Shanmugam, WILLIAMS & CONNOLLY, LLP,
Washington, D.C., for Appellant. Stuart A. Berman, OFFICE OF
THE UNITED STATES ATTORNEY, Greenbelt, Maryland, for Appellee.
ON BRIEF: Paula M. Junghans, ZUCKERMAN SPAEDER LLP, Washington,
D.C.; James A. Bruton, Amy R. Davis, WILLIAMS & CONNOLLY, LLP,
Washington, D.C., for Appellant. Rod J. Rosenstein, United
States Attorney, Baltimore, Maryland, for Appellee.

Unpublished opinions are not binding precedent in this circuit.

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PER CURIAM:

This appeal raises the question of whether Pradeep

Srivastava (“Srivastava”) made the “substantial preliminary

showing” under Franks v. Delaware, 438 U.S. 154 (1978), that is

required for him to be entitled to an evidentiary hearing

challenging the integrity of an affidavit submitted to support

the issuance of a search warrant. This appeal also raises the

question of whether the district court properly excluded

testimony of Srivastava as hearsay.

We hold that Srivastava did not make the “substantial

preliminary showing” required by Franks and, therefore, affirm

the district court’s ruling on the Franks issue. Furthermore,

we hold that the district court properly excluded Srivastava’s

hearsay testimony. Finally, we find that any issues Srivastava

raises as to the interpretation and execution of the March 2003

search warrants will not be revisited by this Court as we have

already analyzed these issues in United States v. Srivastava,

540 F.3d 277 (4th Cir. 2008)(“Srivastava I”), cert. denied, 129

S. Ct. 2826 (2009).

I.

In early 2003, a criminal investigation was initiated by

the Department of Health and Human Services (the “DHHS”), the

Federal Bureau of Investigation (the “FBI”), and the

3
government's Office of Personnel Management (the “OPM”), into an

alleged health care fraud scheme involving Srivastava, a

licensed cardiologist practicing with two associates in

Maryland. The federal authorities suspected that Srivastava and

his associates were involved in the submission of false claims

to various health care benefit programs, in violation of 18

U.S.C. § 1347. As a result, the authorities commenced an

investigation into Srivastava's billing practices.

On March 20, 2003, Special Agent Jason Marrero (“Marrero”

or “Agent Marrero”) of the DHHS Office of Inspector General

applied to the United States District Court for the District of

Maryland for three search warrants for evidence of federal

health care fraud. United States Magistrate Judge William

Connelly approved the warrants, which covered Srivastava’s two

medical offices and his residence. In support of its warrant

application, the government submitted an affidavit by Agent

Marrero that summarized evidence obtained by the Office of

Inspector General, the FBI, and the OPM concerning “allegations

that Srivastava’s medical group . . . submits false claims to

health care benefit programs.” The Affidavit asserted that

there was probable cause to believe that criminal fraud had been

committed by Srivastava’s medical group based upon five

categories of “[t]he evidence gathered to date [which] shows

that Srivastava’s medical office has defrauded health care

4
benefit programs. . . .” The warrants authorized agents to

search for “the following records, including, but not limited

to, financial, business, patient, insurance, and other records

related to the business of Dr. Pradeep Srivastava . . . which

may constitute evidence of violations of [medical fraud].” The

warrants proceeded to authorize the seizure of various specific

categories of records, including, “financial records, including

but not limited to accounting records, tax records, accounts

receivable logs and ledgers, banking records, and other records

reflecting the income and expenditures of the business.”

On March 21, 2003, agents executed the search warrants. In

the wake of the searches, the government abandoned its pursuit

of any criminal charges against Srivastava for health-care

fraud. Without conceding any wrongdoing, however, Srivastava

did enter into a civil settlement with the government involving

similar allegations. Based on records seized that indicated

that Srivastava had conducted financial transactions with the

Bank of India, the government suspected that Srivastava had

failed to file a report on a foreign bank account. The

government then launched a two-year investigation into

Srivastava’s tax returns, which uncovered evidence that, in tax

years 1998 and 1999, Srivastava had omitted certain capital

gains from personal stock-trading activity from his tax returns.

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 On October 12, 2005, the government obtained an indictment

from a grand jury in the District of Maryland charging

Srivastava with two counts of attempting to evade taxes and one

count of making false statements on a tax return.

Before trial, Srivastava moved for an evidentiary hearing

pursuant to Franks, 438 U.S. 154, contending that Agent

Marrero’s affidavit contained several omissions that were

intentionally and materially misleading and that had Agent

Marrero included the material information on the affidavit, the

affidavit would not sufficiently establish probable cause.

Srivastava also moved to suppress the tax-related documents

seized during the searches on the grounds that they fell outside

the scope of the warrants and that, even assuming they fell

within the scope of the warrants, they should be suppressed

under the “flagrant disregard” doctrine, which mandates blanket

suppression when officers act with flagrant disregard for a

warrant’s terms.

United States District Judge Roger W. Titus held hearings

on Srivastava’s motion to suppress evidence on March 27, 2006

and June 9, 2006. At the first hearing, the district court

denied Srivastava’s motion for a hearing under Franks. The

district court took evidence at the second hearing.

On August 4, 2006, the district court issued a memorandum

opinion and order suppressing evidence. United States v.

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Srivastava, 444 F. Supp. 2d 385 (D. Md. 2006), reconsideration

denied, 476 F. Supp. 2d 509 (D. Md. 2007). The United States

appealed pursuant to 18 U.S.C. § 3731. On September 3, 2008,

this Court reversed the district court’s order, finding no

Fourth Amendment violation and no grounds to suppress any of the

government’s evidence. Srivastava I, 540 F.3d 277.

When the case returned to the district court in 2009,

Srivastava moved for reconsideration of the March 2006 order

denying his motion for a Franks hearing. The district court

denied the motion. A jury convicted Srivastava of all three

charged crimes. In a post-trial motion, Srivastava again sought

a Franks hearing. The district court denied the motion. The

court imposed concurrent sentences of 46 months of imprisonment

on counts one and two and 36 months on count three; three years

supervised release, including a special condition of release

requiring payment of $16,110,160 in restitution to the IRS; and

a $300 special assessment. This appeal followed.

II.

A.

We first address the district court’s refusal to grant

Srivastava a Franks hearing. In Franks, the Supreme Court held

that Srivastava may challenge affidavits upon which search

warrants are based under the Fourth and Fourteenth Amendments,

7
and that properly challenged warrants may be voided. 438 U.S.

154. To entitle a Srivastava to a Franks hearing, he must make

a substantial preliminary showing that a warrant was procured

through false statements intentionally or recklessly made, and

that such statements were necessary for establishing probable

cause. In other words, in regards to an alleged omission,

Srivastava has to make a preliminary showing (1) that the

affiant omitted facts with the intent to make, or in reckless

disregard of whether they thereby made, the affidavit misleading

and (2) that the affidavit if supplemented by the omitted

information would not have been sufficient to support a finding

of probable cause. Because other pre-trial mechanisms exist to

protect innocent citizens, Srivastava’s burden in establishing

the need for a Franks hearing, based on either false statements

or material omissions, is a heavy one. See United States v.

Jeffus, 22 F.3d 554, 558 (4th Cir. 1994)(citing Franks, 438 U.S.

at 171-72). Srivastava’s showing must be more than conclusory

and requires a “detailed offer of proof,” United States v.

Colkey, 899 F.2d 297, 300 (4th Cir. 1990), and “allegations of

negligence or innocent mistake are insufficient,” Franks, 438

U.S. at 171.

False statements include information intentionally or

recklessly omitted; however, “the affirmative inclusion of false

information in an affidavit is more likely to present a question

8
of impermissible official conduct than a failure to include a

matter that might be construed as exculpatory.” Colkey, 899

F.2d at 301-02. Failure to include a matter “potentially opens

officers to endless conjecture about investigative leads,

fragments of information, or other matter that might, if

included, have redounded to Srivastava’s benefit. The potential

for endless rounds of Franks hearings to contest facially

sufficient warrants is readily apparent.” Id. Accordingly,

merely showing an intentional omission of a fact from a warrant

affidavit does not fulfill Franks’ requirements. United States

v. Tate, 524 F.3d 449, 455 (4th Cir. 2008). “To satisfy the

Franks intentional or reckless falsity requirement for an

omission, Srivastava must show that facts were omitted “with the

intent to make, or in reckless disregard of whether they thereby

made, the affidavit misleading.” Id. “Stated otherwise, the

omission must be “designed to mislead” or must be made “in

reckless disregard of whether [it] would mislead.” Id.

In order to show that the omitted material was “necessary

to the finding of probable cause,” id., Srivastava must show

that the inclusion in the affidavit of the omitted material

would defeat probable cause. Colkey, 899 F.2d at 301. Omitted

information that is potentially relevant but not dispositive is

not enough to warrant a Franks hearings. Id. For an omission

to serve as the basis for a hearing under Franks, it must be

9
such that its inclusion in the affidavit would defeat probable

cause. Id. Upon making this two-part preliminary showing,

Srivastava is entitled to a hearing, at which he bears the

burden of proving the allegations by a preponderance of the

evidence. See Franks, 438 U.S. at 156. If a Franks hearing is

appropriate and an affiant’s material perjury or recklessness is

established by a preponderance of the evidence, the warrant

“must be voided” and evidence or testimony gathered pursuant to

it must be excluded. Id. A warrant that violated Franks is not

subject to the good-faith exception to the exclusionary rule.

United States v. Leon, 468 U.S. 897, 923 (1984).

B.

Srivastava alleges that Agent Marrero knowingly and

intentionally, or with reckless disregard, omitted material

information from his affidavit, and that had the affidavit

included such omitted information, it would not have supported a

finding of probable cause. Srivastava accuses Marrero of

mischaracterizing “a harmless discrepancy in diagnostic codes,”

“shad[ing] and distort[ing]” innocuous evidence “to make it

appear that it reflected nefarious conduct,” and swearing out an

affidavit that “was intentionally crafted” to mislead the

magistrate and contained “little if any” evidence that “was

untainted by the government’s pervasive omissions and spin.”

However, we find that a careful examination of the facts

10
demonstrates that Agent Marrero’s affidavit did not contain

knowing and intentional material omissions. Therefore, we find

that the district court properly denied Srivastava’s request for

a Franks hearing.

Agent Marrero submitted a 19-page affidavit that summarized

evidence concerning allegations that Srivastava’s medical

practice submitted false claims to health care benefit programs.

Agent Marrero established probable cause by setting forth five

categories of evidence: (1) billing for services not rendered;

(2) billing for duplicative services through two different

CareFirst plans; (3) listing inappropriate diagnosis codes on

claims; (4) billing for incidental services, which is charging

for services that are already included in the primary diagnostic

or treatment procedure billed; and (5) altering medical records.

We will discuss Srivastava’s allegations in relation to the five

categories of evidence set forth in the affidavit to establish

probable cause.

1. Billing for Services Not Rendered.

The affidavit outlined evidence that Srivastava was billing

for services not rendered. To examine Srivastava’s billings,

the government hired Dr. David A. Rawling, a consultant and

practicing cardiologist. In June 2001, Dr. Rawling reviewed

spreadsheets that described services and procedures that

Srivastava’s office billed for three CareFirst patients and

11
three Medicare patients. Dr. Rawling concluded (1) that

Srivastava’s billing of combined right and left heart

catheterizations covered by Current Procedural Technology

(“CPT”) code 93526 appeared to be excessive, because fewer than

ten percent of cases justify procedures that include a right

heart catheterization or combined left and right heart

catheterizations; (2) that Srivastava consistently billed for

services already included in the primary diagnostic procedure;

and (3) that Srivastava appeared to be adding procedures or

services to bills to maximize reimbursements.

In November 2002, Dr. Rawling examined hospital patient

records for nine of Srivastava’s Medicare patients, including

records concerning sixteen dates of service in 2000 for which

Srivastava’s office billed Medicare using CPT 93526—the billing

code for a combined right and left heart catheterization. In

fifteen of those sixteen instances, Dr. Rawling found that the

hospital records did not show any right heart catheterization

being performed, nor any change in right heart pressure that

would be associated with a right heart catheterization. Billing

for a combined right and left heart catheterization rather than

a left heart catheterization alone increased the Medicare

payment by $141.85. Dr. Rawling advised that he detected “a

consistent pattern of over-billing, billing for procedures not

performed, or billing inappropriate codes.”

12
 Dr. Rawling’s observations were corroborated by Dr. Bruce

Lloyd, another cardiologist who reviewed the medical records for

Srivastava’s treatment of a CareFirst member. Srivastava billed

CareFirst for a combined right and left heart catheterization,

but Dr. Lloyd concluded that “in each situation, only a left

heart procedure was done. No right heart study was done, but it

was billed. This is fraud.”

At the hearing on Srivastava’s initial motion for a Franks

hearing and on appeal, Srivastava claims that in this section,

Agent Marrero omitted information so as to make the evidence

appear more suspicious than it actually was. Srivastava claims

that Agent Marrero’s affidavit omitted information that in some

cases where Srivastava’s office billed for right and left heart

catheterizations, Srivastava had actually performed a left heart

catheterization and had “inserted a venous sheath into the

patient’s right heart.” Srivastava claims that Marrero failed to

tell the magistrate judge that Srivastava actually lost money by

billing for a combined right and left heart catheterization

rather than for two separate procedures of a left heart

catheterization and right heart venous sheath. Srivastava argues

that while “it was arguably incorrect to bill for the combined

procedure as a right and left heart catheterization,” Agent

Marrero still should have included information in his affidavit

that Srivastava had performed a right venous sheath in some

13
cases. Srivastava argues that “if Agent Marrero had disclosed to

the magistrate that the alleged miscoding identified in this

section of the affidavit often redounded to Srivastava’s

financial detriment, instead of his benefit, the magistrate

would presumably have determined that the allegations in this

section did not support the conclusion that Dr. Srivastava was

engaging in health care fraud.” Srivastava’s allegation is

based on entries in Dr. Rawling’s notes concerning his review of

Srivastava’s claims for combined right and left heart

catheterization. In two instances, Dr. Rawling wrote “no RHC

(right heart catheterization), just venous access.” In a third,

he wrote: “no RHC. Cath lab procedure report only indicates

venous sheath placed.” In other instances, he reviewed

laboratory records and simply wrote that “no RHC” had been

performed.

At the district court hearing, Srivastava offered no

evidence that Agent Marrero knew Srivastava had placed a “venous

sheath” in or near the right heart or knew, believed, or

deliberately omitted information that such an action was

medically equivalent to performing a right heart catheterization

or could be billed as such. As a result the district court

rejected Srivastava’s argument.

We agree with the district court that while Srivastava

claims that Agent Marrero should have disclosed that Srivastava

14
could have billed separately for the venous sheath procedure and

that had he done so he would have actually billed more for the

procedure, the record is devoid of any evidence (1) that Marrero

knew that Srivastava had conducted any venous sheath procedures,

(2) that he was aware that Srivastava could have billed more for

a left heart catheterization and a right venous sheath than for

a combined right and left heart catheterization, or (3) that he

intentionally omitted such information from his affidavit.

Srivastava points to Dr. Rawlings notes and Dr. Rawling’s

memorandum summarizing his findings as evidence that Agent

Marrero knew that Srivastava conducted venous sheath insertions

for which he did not bill. However, a review of Dr. Rawling’s

notes and memorandum indicates that Agent Marrero could not have

inferred from Dr. Rawlings findings that Srivastava performed a

venous sheath, which could have been billed for separately, and

that billing for a right and left heart catheterization

together, while erroneous, actually resulted in a lower amount

paid to Srivastava. Additionally, Dr. Rawling’s notes

indicating that a venous sheath was performed in some of the

instances does not explain the remaining instances where

Srivastava billed for a right and left heart catheterization and

did not perform a right catheterization or a venous sheath. The

district court correctly concluded that Srivastava failed to

make a preliminary showing that Agent Marrero omitted facts with

15
the intent to make, or in reckless disregard of whether they

thereby made, the affidavit misleading with respect to this

section on Billing for Services Not Rendered. The information

that Agent Marrero included in his affidavit accurately depicted

the overall findings of Dr. Rawling’s as to Srivastava’s billing

for services that he did not render.

2. Billing for Duplicate Services.

The affidavit also outlined evidence that Srivastava

submitted duplicate bills for the same services to two different

CareFirst entities. As background, Agent Marrero described how,

in May 1997, BlueCross BlueShield National Capital Area

(“BCBSNCA”) placed Srivastava on “pre-payment review” because of

concern about possibly fraudulent or inappropriate benefits, and

required Srivastava to submit supporting medical documentation

for it to examine prior to deciding whether to pay or reject

Srivastava’s claims.

The affidavit described that in the case of CareFirst

subscriber G.B., Srivastava submitted claims to BCBSNCA, dated

February 26, 1999, for eight procedures or services allegedly

performed on January 14, 1999. Payment for five of the eight

procedures was rejected for lack of documentation. Srivastava

then submitted claims dated December 8, 1999 to Blue Cross Blue

Shield Maryland (“BCBSM”) for seven procedures or services

16
performed on January 14, 1999. All seven procedures or services

had been part of the previously billed February 26, 1999 claims.

In the case of subscriber S.B., Srivastava submitted claims

to BCBSNCA and BCBSM, respectively, on August 20, 1998 and

November 23, 1999, which both billed for six identical

procedures or services that were allegedly provided on August

18, 1998.

In the case of patient, A.F., Srivastava submitted claims

to BCBSNCA and BCBSM, respectively, dated March 3, 1999, and

December 7, 1999, for four identical procedures or services that

were allegedly provided on March 2, 1999.

At the March 27, 2006 hearing, Srivastava barely challenged

this section of the affidavit. Srivastava suggested innocent

explanations for sending the same bill to two separate CareFirst

entities and contended that the affidavit should have included

exculpatory information that a longtime employee of his medical

office had told investigators that she was not aware of any

billing fraud.

The district court made short shrift of this argument,

pointing out that Franks and this Court’s Franks cases did not

require that every conceivable thing that is said by a person

being interviewed must find its way into the affidavit if it’s

exculpatory in nature. See Colkley, 899 F.2d at 301.

17
 On Appeal, Srivastava claims that the heading, “Billing for

Duplicate Services,” is misleading. Srivastava claims that

Agent Marrero described Srivastava’s resubmission of denied

claims from CareFirst’s National Capital Area plan to its

Maryland counterpart and implied—via the section heading—that

the resubmission was duplicative and therefore fraudulent.

Srivastava argues that this implication was misleading because

Dr. Srivastava did not attempt to be paid twice for the same

procedures but instead merely resubmitted denied claims in

accordance with CareFirst’s written procedures.

We find that the district court properly concluded that

Srivastava failed to make a preliminary showing that Agent

Marrero omitted “with the intent to make, or in reckless

disregard of whether they thereby made, the affidavit

misleading” with respect to this section of the affidavit.

Srivastava has failed to make a preliminary showing that the

omission was “designed to mislead” or was made “in reckless

disregard of whether [it] would mislead.” Tate, 524 F.3d at

455. Rather, in this section of the affidavit, Agent Marrero

recounts the exact facts of how Srivastava billed two separate

providers for the same service. While Srivastava argues that

the heading is misleading, when we read the entire affidavit,

including a summary of the headings which says “(2) billing for

duplicate services through two different CareFirst plans,” we

18
find that the district court was correct in finding that

Srivastava has failed to make a preliminary showing that Agent

Marrero intended to mislead the Magistrate Judge in this

section.

3. Listing Inappropriate Codes on Claims.

The affidavit outlined evidence obtained when the FBI sent

three male undercover agents, using fictitious names, to receive

treatment at Srivastava’s medical practice. Before each agent

went to Srivastava’s office, Dr. Lloyd, a cardiologist and

consultant, checked his blood pressure, checked his height and

weight, and performed an electrocardiogram. In each case, Dr.

Lloyd advised the agent that the blood pressure, weight, and EKG

results were normal. After each agent visited Srivastava, Dr.

Rawling reviewed the claim forms and the agents’ summaries

describing visits to Dr. Lloyd and to Srivastava’s practice,

including information about the date they were seen by the

doctors, what services they recalled receiving and by whom, and

what if any complaints were noted.

The affidavit recited that after the agents visited

Srivastava’s practice, the office submitted claim forms

containing diagnostic codes for Agent Flores (hypertensive heart

disorder; tachycardia, unspecified; secondary cardiomyopathy,

unspecified; and other and unspecified hyperlipidemia); Agent

Yerdon (two diagnostic codes, including hypertensive heart

19
disorder); and Agent Striebich (two diagnostic codes, including

other and unspecified hyperlipidemia). Dr. Rawling reviewed the

available records; the claim forms and the agents’ summaries

describing visits to Dr. Lloyd and to Srivastava’s practice.

Based on this information, Dr. Rawling found no basis for the

diagnoses indicated by the billing codes used by Srivastava’s

medical practice.

At the 2006 hearing, Srivastava contended that three active

FBI agents were not considered to be normal in any time frame

that was remotely the same as when they were being seen by

Srivastava. This contention was based on brief passages in two

FBI form 302 memoranda relating to the agents’ visits with Dr.

Lloyd. The memoranda indicated that Dr. Lloyd had found EKG

results, weight and blood pressure to be in the normal range and

had so advised Agent Flores, Yerdon, and Striebich,

respectively. But one memorandum indicated that after Dr. Lloyd

told Agent Flores that his condition was normal, the agent

received a form listing services provided which contained a

diagnostic description of “401.1:L Essential hypertension,

benign.” A second memorandum indicated that documents given to

Agent Yerdon contained the same language. No such reference

appeared in the memorandum for Agent Striebich. The memoranda

did not indicate that Dr. Lloyd told any agent that he suffered

from hypertension, and Srivastava presented no evidence that

20
either Dr. Rawling or Agent Marrero was told anything about the

phrase “401.1: Essential hypertension, benign.” Nevertheless,

Srivastava claims these brief references to hypertension on

billing forms demand a conclusion that Agent Marrero made

knowing false representations about the agents’ condition.

The district court rejected this argument. The memorandum

for Agent Yerdon listed a blood pressure of 114/74, and the

district judge observed that hypertension is not diagnosed

“until you get to 140/90 or more.” The district court

speculated that “maybe this is a case of bad codes, but maybe

Dr. Lloyd simply coded the visit as being an evaluation of that

possible condition.” The district court later ruled:

Now, much is made by the defense of the fact that at
the end of the agent’s report of his visit to see Dr.
Lloyd, a diagnosis description was put down “essential
hypertension benign,” and it indicates that
notwithstanding everything the agent was told in
English, that this coding on a billing sheet indicates
that these agents, or at least two of these three
agents, had “essential hypertension benign.”

My understanding of what “essential hypertension
benign” means is that the cause of the hypertension is
not known, but there is hypertension. I have no idea
why Dr. Lloyd would have put that on his billing
records. It may be more of the extraordinary world we
live in with medical records that code has to be put
down for something. And if a person comes in to see a
physician and the physician puts down something is
wrong, that they won’t get compensated, so they have
to put down what the suspected diagnosis is . . . . I
don’t see anything here that indicates to me that
these agents reported to Agent Marrero that they had
“Essential hypertension benign.” They simply gave him
what the records said of the diagnosis code.

21
 I would assume from the context of these, that if
these agents really did have blood pressure readings
taken that were within normal range, that they were in
fact told they were normal. So that from the
perspective of Agent Marrero, who’s trying to portray
accurately for Magistrate Connelly the circumstances
of these three agents, it is that these are three
agents who saw a cardiologist at Georgetown University
Hospital; and all three were told they were normal,
and they then decided to test what would happen when
they went to see Srivastava’s medical practice.

So I don’t find anything . . . that comes close to
meeting the Franks standard on the basis of the
statement allegedly made with reckless disregard of
the truth here. The highest level I could get this to
would be negligent. And even there, if he put down,
by the way the, diagnosis code when I left on a sheet
of paper was “essential hypertension benign,” I don’t
know that even if that had been intentionally and
recklessly made that that would gut this affidavit of
sufficient information to negate a finding by the
magistrate of probable cause.

Joint Appendix at 602-04.

On Appeal, Srivastava claims Agent Marrero intentionally

misled the magistrate about the results of the undercover

investigation in the way that he described the results of the

investigation. Srivastava argues that “the government undertook

its undercover investigation for the specific purpose of

catching Dr. Srivastava in the act of committing health-care

fraud. . . . However, when it became clear that Dr. Srivastava

had not committed fraud because he had performed and billed for

altogether appropriate procedures for the three undercover

agents, the government went to elaborate lengths to generate

22
evidence suggestive of wrongdoing.” First, Srivastava claims

that agent Marrero entirely excluded from the affidavit the most

relevant results of the undercover investigation: “namely, that

the investigation produced no direct evidence of health-care

fraud, because Dr. Srivastava billed only for procedures that he

appropriately performed on the undercover agents.” Second,

Srivastava claims that Agent Marrero “drew the magistrate’s

attention to the discrepancy in diagnostic coded that Dr.

Rawling eventually identified without explaining the

significance of the diagnosis codes or revealing that Dr.

Rawling was not provided with the medical records that would

have allowed him to determine if there was a basis for the

diagnosis or not.” According to Srivastava, “the overall effect

of Agent Marrero’s statements concerning the undercover

investigation, then, was to leave the magistrate with the

impression that the investigation had succeeded when it had in

reality completely failed.”

We find that Srivastava’s attack on the undercover

investigation section of the affidavit presented nothing that

comes close to meeting the Franks standard on the basis of

statement or omissions allegedly made with reckless disregard of

the truth. In his affidavit, Agent Marrero described how Dr.

Lloyd checked the undercover agents’ blood pressure, checked

their height and weight, performed an EKG, and advised them that

23
the results were normal. When the agents visited Srivastava’s

practice, the office submitted claim forms containing ominous

diagnostic codes for Agent Flores (hypertensive heart disorder;

tachycardia, unspecified; secondary cardiomyopathy, unspecified;

and other and unspecified hyperlipidemia), Agent Yerdon (two

diagnosis codes, including hypertensive heart disorder), and

Agent Striebich (two diagnostic codes, including other and

unspecified hyperlipidemia). Dr. Rawling reviewed the available

records—the claim forms and the agents’ summaries describing

visits to Dr. Lloyd and to Srivastava’s practice. Based on this

information, Dr. Rawling found no basis for the diagnoses

indicated by the billing codes used by Srivastava’s medical

practice. This is exactly what happened according to the

record, and Agent Marrero accurately described for the

Magistrate Judge the results of the investigation.

Srivastava claims that Agent Marrero “excluded” evidence

that “Dr. Srivastava billed only for procedures that he

appropriately performed on the undercover agents.” However,

Srivastava is making a conclusory statement that Dr.

Srivastava’s procedures were appropriate. All Agent Marrero

knew when he wrote the affidavit was that Srivastava billed for

a variety of diagnostic codes that were inconsistent with Dr.

Lloyd’s diagnoses of three healthy FBI agents. Second,

Srivastava claims that Agent Marrero excluded information that

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Dr. Rawlings made his opinion without being provided with the

medical records that would have allowed him to determine if

there was a basis for the diagnoses or not. However, given that

the affidavit was submitted in support of applications for

search warrants to obtain Srivastava’s medical records, Agent

Marrero hardly concealed the fact that Dr. Rawling had not been

provided with Srivastava’s medical records. Therefore, we

affirm the district court’s finding that nothing Agent Marrero

included or failed to include in his affidavit comes close to

meeting the Franks standard for statements or omissions

“designed to mislead” or made “in reckless disregard of whether

[it] would mislead.” Tate, 524 F.3d at 455.

4. Billing for Incidental Services.

The affidavit also contained evidence of a form of double-

billing. Agent Marrero explained that descriptions of

procedures as defined by the CPT Code Book included all services

necessary to accomplish the primary diagnostic or treatment

procedure, even if an independent CPT code covers the specific

service. For the relevant time period, the CPT Code Book

definition of cardiac catheterization included, among other

things, the introduction, positioning, and repositioning of

catheters.

In the case of patient A.B., however, Srivastava’s office

submitted one claim to Medicare for a combined right and left

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catheterization (CPT 93526) on March 8, 2000, and also billed

for ten other procedures, including the introduction of the

catheter into the aorta (CPT 36200). Introducing the catheter

into the aorta is an included service in the primary diagnostic

procedure CPT code 93526. The same form of double-billing

occurred with respect to service provided to patient J.W. on

July 20, 1999, and patient L.S. on September 14, 2000.

In response to the results in these cases, Agent Marrero

recited that E.S., a former employee of Srivastava’s, told an

FBI agent that Srivastava used multiple billing codes and billed

for duplicative services, such as an electrocardiogram and its

interpretation. E.S. reported that she had worked for another

doctor who only billed one code for an EKG.

Srivastava’s primary criticism of this section of the

affidavit was that Agent Marrero should not have relied on

information from E.S. because her former employer was a

gynecologist, not a cardiologist. Srivastava also claimed that

Agent Marrero’s affidavit mischaracterized E.S.’s statements,

when in fact the affidavit closely tracked the interview memo.

The district court found no problem with this portion of the

affidavit, and Srivastava abandoned this issue in his motion for

reconsideration and in his post-trial motion.

On appeal, Srivastava does not allege that Agent Marrero

made any misleading statements or omissions in regard to this

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section. Therefore, we adopt the district court’s finding that

the Affidavit did not contain intentional, material false

statements or omissions relating to billing for services not

rendered.

5. Altering Medical Records.

Finally, the affidavit contained evidence of altered

medical records. For example, Srivastava’s office billed

CareFirst twice for six laboratory procedures or services

provided to patient S.H. The dates of service were allegedly

November 2 and 3, 1998, but the affidavit stated that “the

documentation provided for the November 3rd date of service

appears to be altered because a ‘3’ is handwritten over where

the typewritten ‘2’ appears to be in the date ‘11/02/1998.’” In

the case of patient O.B., Srivastava’s office billed CareFirst

for four procedures (CPT 93307, 03320, and 93325) allegedly

provided on November 24, 1997, and for six procedures (including

the same three CPT codes) allegedly provided on November 26,

1997. The office submitted two EKG reports as supporting

documentation for both alleged dates of service, but the

affidavit stated that “the documentation provided for the

November 24th date of service appears to be altered because a

‘4’ is handwritten over where the typewritten ‘6’ appears to be

in the date ‘11/26/1997,” The two Echocardiography Reports

27
appear to be identical with the exception of the handwritten

‘4.’”

At the 2006 hearing, Srivastava did not contend that this

section of the affidavit was false. Instead, Srivastava claimed

that Agent Marrero failed to include exculpatory information

provided by Srivastava’s longtime billing manager, who denied

any improprieties. The billing manager insisted that “Dr.

Srivastava had never asked [her] to do anything improper about

the billing,” and expressed the view that the alterations were

“mistakes and corrections.” Srivastava also claimed that at

least one set of documentation revealed that Dr. Srivastava had

in fact performed two different tests that yielded different

results. Srivastava claimed that these omissions were intended

to mislead the magistrate into viewing these altered records as

attempts at double billing for the same procedure.

The district court found that the affidavit was accurate

because the records were altered and found that this section of

the affidavit was included to show alteration, not to

demonstrate double-billing. The court did not find anything

that is misleading or comes close to the reckless disregard for

the truth standard under Franks with regard to the reference to

the altered medical records. The district court found that it

certainly appeared that these records were altered.

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 In his motion for reconsideration, Srivastava claimed that

Agent Marrero had an obligation to disclose exculpatory

assertions by the billing manager. Srivastava further claimed

that the November 3, 1998 results were different from the

November 2, 1998 results, proving that two sets of tests had

been performed. Because this evidence did not negate the

essential point made by this section of the affidavit—that the

dates on records had been altered, providing additional evidence

that the medical practice was engaged in fraud—the district

court denied the motion.

On appeal, Srivastava acknowledges that this section of the

affidavit accurately recites that his office billed CareFirst

twice for procedures or services for patients S.H. (alleged

dates of service November 2 and 3, 1998) and O.B. (alleged dates

of service November 24 and 26, 1997), and that in each instance,

the second claim contained a handwritten alteration of the date

on a medical record. The affidavit included these two paragraphs

as a fifth and final category of evidence that Srivastava’s

medical office was engaged in fraud. However, Srivastava argues

that Marrero implied that the changes had been made so as to

permit submission of two claims for only one set of underlying

services, and then argues that Marrero intentionally omitted,

with the intent to mislead, records indicating that two sets of

procedures were conducted with respect to S.H., as well as

29
exculpatory information provided by Srivastava’s longtime

billing assistant. Srivastava argues that without those pieces

of omitted information the Affidavit leaves a reviewing judge

with the misleading impression that the alterations were

suspicious.

We find that, with respect to this part of the affidavit,

Srivastava failed to make a preliminary showing that Agent

Marrero omitted information “with the intent to make, or in

reckless disregard of whether they thereby made, the affidavit

misleading.” Stated otherwise, Srivastava has failed to make a

preliminary showing that the omission was “designed to mislead”

or was made “in reckless disregard of whether [it] would

mislead.” Rather, in this section of the affidavit, Agent

Marrero accurately recounts the facts of how Srivastava’s office

altered medical records by changing the dates on the records.

Srivastava claims that this section is misleading because it

implies double-billing without providing an exculpatory

statement by Srivastava’s employee and without providing records

that, in fact, two procedures were performed on patient S.H.

However, nothing in the affidavit states that the altered

medical records are evidence of double-billing. Additionally,

this Court’s rulings in Colkley and Jeffus make clear that not

all information which might constitute Brady material at a later

30
stage of the criminal process needs to be included in a search

warrant affidavit.

Therefore, after reviewing all sections of Agent Marrero’s

affidavit, we find that the district court properly denied a

Franks hearing. As explained in detail above, the district

court correctly found Srivastava failed to make a preliminary

showing that there were false statements or omissions in the

affidavit that were made by Agent Marrero with the intent to

mislead the magistrate. Additionally, even if we were to find

some of the various omissions mentioned above to have been made

intentionally or in reckless disregard for the truth, the

excision of one or even two of them under the circumstances of

this case would not undermine the finding of probable cause from

this affidavit, considered as a whole.

III.

The District Court initially granted Srivastava suppression

of the evidence seized pursuant to the search warrants on the

ground that the officers acted with “flagrant disregard” for the

terms of the warrants in executing them. On the government’s

earlier interlocutory appeal, however, a panel of this Court

reversed the district court’s decision, holding that the

“flagrant disregard” doctrine was inapplicable. Srivastava I,

540 F.3d 277. Srivastava again raises this issue in this appeal;

31
however, under the law-of-the-case doctrine, we are foreclosed

from revisiting the earlier panel’s holding. See United States

v. Aramony, 166 F.3d 655, 661 (4th Cir. 1999)(rulings that

constitutes law of the case “should continue to govern the same

issues in subsequent stages in the same case”).

IV.

Lastly, we address Srivastava’s contention that the

district court improperly excluded Srivastava’s proffered

testimony as to the issue of intent in the tax evasion case. As

part of the tax evasion case presented at trial, the Government

had to show that Srivastava acted willfully when he allegedly

failed to disclose certain capital gains on his tax returns. As

part of proving that willfulness, the Government presented

evidence that Srivastava made multiple transfers to bank

accounts in India. Specifically, on July 16 and 21, 1999, with

his broker Sohan Aggarwal’s assistance, Srivastava sent outgoing

wire transfers of $440,000 and $465,000 from Bentley-Lawrence

accounts for deposit in his accounts in India. In December 1999

and January 2000, Srivastava sent four wire transfers from the

U.S. to India.

In regard to the evidence of wired transfers to India,

Srivastava wished to introduce testimony from his broker,

Aggarwal, that Srivastava told him “during the period of the

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rising market in 1998 and 1999” that he “went to India and then

he said, hey, guys, look, why—I have decided to build a charity

hospital. Okay, fine. Where is the money? Well, you tell me

when you want to send the money, I’ll send the money.” Joint

Appendix 1961. Srivastava wished to introduce this testimony to

controvert the Government’s argument that Srivastava was

transferring money to India to purposefully evade taxes.

The district court excluded this testimony because it found

that it was hearsay not subject to an exception. Srivastava

argues that the district court erred by not applying Rule

803(3), a hearsay exception, in order to allow the testimony.

We review decisions to admit or exclude evidence for abuse

of discretion. United States v. Forrest, 429 F.3d 73, 79 (4th

Cir. 2005). Under that standard, we may not substitute our

judgment for that of the district court; rather, we must

determine whether the district court’s exercise of discretion,

considering the law and facts, was arbitrary or capricious.

United States v. Mason, 52 F.3d 1286, 1289 (4th Cir. 1995).

Whether reviewed only for abuse of discretion or de novo, any

error in the admission or exclusion of evidence is subject to

the harmless error test. See Delaware v. Van Arsdall, 475 U.S.

673, 680-84 (1983).

Rule 803(3) provides an exception for hearsay statements

when the statement represents “a statement of the declarant’s

33
then existing state of mind, emotion, sensation, or physical

condition (such as intent, plan, motive, design, mental feeling,

pain and bodily health).” Fed. R. Evid. 803(3). The threshold

requirements for invoking this hearsay exception are that (1)

the statement must be contemporaneous with the mental state

sought to be proven; (2) there must be no suspicious

circumstances suggesting a motive for the declarant to fabricate

or misrepresent his or her thoughts; and (3) the declarant’s

state of mind must be relevant to an issue in the case. United

States v. Neely, 980 F.2d 1074, 1083 (7th Cir. 1992); United

States v. Faust, 850 F.2d 575, 585 (9th Cir. 1988). On the

question of relevance, “the declarant’s statement of mind must

be relevant to some issue in the case before such testimony can

be admitted under Rule 803(3).” United States v. Veltmann, 6

F.3d 1483 (11th Cir. 1993). “Where state of mind itself is in

issue [as intent was in this case], the court must determine if

the declarant’s state of mind at the time of the declaration is

relevant to the declarant’s state of mind at the time at issue.”

United States v. Ponticelli, 622 F.2d 985, 991 (9th Cir. 1980)

(emphasis added).

The district court excluded the proffered testimony on

three grounds: (1) failure to satisfy the requirement of

contemporaneousness, because Srivastava’s statement to Aggarwal

preceded the largest transfers to India and the filing of the

34
1998 tax return by months and preceded the filing of the 1999

and 2000 tax returns by years; (2) irrelevance of the evidence

to the intent issues in a tax evasion case; and (3) pursuant to

the balancing test of Rule 403.

We find that district court properly concluded that the

statement was irrelevant to the core issue in the case—whether

Srivastava willfully evaded income taxes on $40 million of

capital gains. As stated by the United States in its brief

“[t]he intended end use of the $5 million in untaxed income once

it reached India, however, had no bearing on Srivastava’s

specific intent to commit tax crimes. A person who is required

by law to accurately declare his income and pay taxes cannot

evade that requirement by promising to use the fruits of tax

evasion for a good cause. It made no difference whether

Srivastava transmitted funds to India with the intent to open a

hospital, build a vacation home, or finance a software company.

Srivastava’s claim that his stated intent to build a hospital

‘rebutted the government’s contention that the purpose was

instead to hide the transferred funds from the IRS’ is simply

without merit.” Because we find the statements to be irrelevant

to the intent issue in the tax evasion case, the testimony does

not meet the requirements for a hearsay exception under Rule

803(3). Therefore, we affirm the district court’s exclusion of

this testimony.

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 V.

For the foregoing reasons, we affirm the district court’s

denial to conduct a Franks hearing; refuse to reconsider any

arguments about the previously appealed motion to suppress under

the law-of-the-case doctrine; and affirm the district court’s

exclusion of proffered hearsay testimony.

AFFIRMED

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