Extending the Pioneer “Excusable Neglect” Standard to Criminal Rule 45 Motions: A Commentary on United States v. Beaufils

I. Introduction

The Eleventh Circuit’s published decision in United States v. Sherley L. Beaufils, No. 22‑13292 (11th Cir. Nov. 25, 2025), arises out of a large-scale Medicare fraud investigation known as “Operation Brace Yourself.” The defendant, a nurse practitioner, was convicted by a jury of sixteen counts connected to a telemedicine-based durable medical equipment (“DME”) scheme involving thousands of fraudulent prescriptions for orthopedic braces.

On appeal, Beaufils challenged:

• the sufficiency of the evidence on the “knowing” and “willful” mental-state elements of all counts;
• the district court’s failure to give a jointly requested “deliberate ignorance” (or “ostrich”) jury instruction;
• the court’s denial of her untimely Rule 33 motion for a new trial; and
• a two-level sentencing enhancement for obstruction of justice based on perjury.

The panel (Judges Rosenbaum, Newsom, and Abudu; opinion by Judge Abudu) affirmed both the convictions and the 87‑month sentence. Doctrinally, the most consequential aspect of the decision is its express adoption of the Pioneer/Cheney/Riney “excusable neglect” framework for extensions of time under Federal Rule of Criminal Procedure 45(b)(1)(B), and the clarification that an attorney’s considered decision not to file a Rule 33 motion, or a misunderstanding of clear law, does not constitute “excusable neglect.”

The case also reinforces existing law on:

• how juries may infer knowledge and intent in complex Medicare-fraud schemes;
• the harmlessness of a missing deliberate-ignorance instruction where the jury is properly instructed on actual knowledge; and
• the evidentiary basis needed for a perjury-based obstruction-of-justice enhancement under U.S.S.G. § 3C1.1.

II. Summary of the Opinion

A. Holdings in Brief

1. Sufficiency of the evidence – Under the demanding “manifest miscarriage of justice” standard (because the Rule 29 motion was not renewed), the court held that ample circumstantial and direct evidence showed that Beaufils knowingly and willfully engaged in health care fraud, made false statements, committed aggravated identity theft, and joined a conspiracy to receive kickbacks and make false statements.
2. Deliberate ignorance instruction / Rule 30(b) – The district court plainly erred by failing to tell the parties it would not give the requested deliberate-ignorance instruction, contrary to Rule 30(b)’s command. But under the “substantial compliance” and plain-error frameworks, the error was not prejudicial: the jury was correctly instructed on actual knowledge and the burden of proof, and omitting a deliberate-ignorance instruction arguably harmed the government, not the defendant.
3. Obstruction of justice & perjury (U.S.S.G. § 3C1.1) – The district court did not clearly err in finding that Beaufils “simply lied to the jury” in material ways (e.g., about whether she contacted patients or understood her role) and thus committed perjury. A general finding of wholesale perjury, read in context, sufficed under Eleventh Circuit precedent.
4. Excusable neglect & untimely Rule 33 motion – The panel explicitly applied the Supreme Court’s Pioneer “excusable neglect” framework (as adopted in Cheney and Riney) to Criminal Rule 45(b)(1)(B). It held that trial counsel’s deliberate assessment that there were no grounds for a new-trial motion, and any misunderstanding of the law, did not amount to excusable neglect. The district court therefore did not abuse its discretion in refusing to entertain a late Rule 33 motion.

B. Doctrinal Significance

The decision’s most notable new legal principle is the formal extension of the Pioneer-derived “excusable neglect” test to criminal extensions of time under Rule 45. This doctrinal move has significant consequences for defendants who miss post-verdict deadlines due to counsel’s choices or mistakes: barring extraordinary circumstances, those failures cannot be undone via Rule 45; the proper vehicle is an ineffective-assistance claim, typically in a § 2255 proceeding.

III. Factual and Legal Background

A. The Telemedicine DME Scheme

Beginning in 2018, while working as a nurse practitioner at a Georgia hospital, Sherley Beaufils took on part-time “telemedicine” work through Royal Physicians Network (RPN) and later EnVision IT Perfect (EIP). Through the DMERx internet portal, she was assigned patient “charts” and paid roughly $25 per chart.

The overall scheme, uncovered in a nationwide investigation (“Operation Brace Yourself”) by the FBI and HHS, functioned as follows:

• Telemarketers obtained Medicare beneficiaries’ personal and medical information.
• Brokers purchased this data and funneled it to telemedicine companies.
• Telemedicine entities had licensed providers (or those presented as providers) generate brace prescriptions and supporting “exam” notes through DMERx.
• Brokers sold the package (patient data + prescription + documentation) to DME suppliers.
• Suppliers billed Medicare, often in violation of anti-kickback laws and Medicare’s coverage rules.

Critically, Medicare only pays for DME such as braces if:

• a licensed practitioner appropriate to the treatment has actually evaluated the patient;
• the encounter (including telemedicine) meets regulatory requirements (rural/underserved location, live interaction); and
• the treating provider’s orders and clinical rationale are documented in the medical record.

Nurse practitioners must likewise comply with scope-of-practice rules, including working under a supervising or collaborating physician and practicing only within that physician’s specialty. See 42 C.F.R. § 410.75; O.C.G.A. § 43‑34‑25.

B. Evidence Against Beaufils

The government’s proof was layered:

• Volume and pattern of orders – A fraud investigator found that:
  • She handled 942 patient charts and ordered approximately 3,800 orthotic devices (roughly four braces per patient).
  • These orders were directed to 57 suppliers, generating about $3.1 million in supplier bills and $1.6 million in Medicare reimbursements.
  • She almost always ordered the same model of each type of brace, suggesting a non-individualized, “template” approach.
  • Orders were placed in “clusters” – multiple multi-page orders, with purported exams and test results, signed within minutes of each other.
• Inherently implausible prescriptions – Examples included:
  • Prescribing a knee brace to a patient whose leg had been amputated below the knee months earlier.
  • Maximal “Iron Man” bracing (one back, two knee, one shoulder, one wrist brace) for a bedridden patient on her “deathbed.”
  • Ordering an extra-large brace for a patient who weighed under 100 pounds.
  • Signing an order for a hospice patient (Jessie Kimbrough) after the patient had already died earlier that same day.
• False attestations in chart notes – The DMERx records, bearing her name and NPI, contained attestations stating:
  • “Based on my discussion with [patient] and evaluation of her condition, I am ordering the following item.”
  • “I have personally performed the assessment of the patient for the prescribed treatment and device and verify that it is medically necessary.”
  Yet she admitted at trial she never examined or spoke with these patients.
• Scope-of-practice and credentialing – Her collaborative practice agreement limited her NP practice to emergency medicine at a specific hospital. Wellstar’s records showed none of “her” brace patients were seen there. Her credentialing documents explicitly warned about the Anti-Kickback Statute and profiting from DME referrals; she signed those acknowledgments.
• Direct patient and caregiver testimony – Beneficiaries or caretakers testified that:
  • They had never seen or spoken with Beaufils.
  • They received braces in the mail that they did not order.
  • DMERx records describing their history, injuries, and activities (e.g., long-distance running, volleyball) were false.
• Co-conspirator testimony – A broker confirmed he paid a marketing company that, in turn, compensated providers including Beaufils for brace orders. RPN/EIP owner Charlene Frame admitted she paid providers (including Beaufils) to authorize orthotic orders, denied telling Beaufils that other providers had already examined the patients, and testified that her signature alone was sufficient to bill Medicare.
• Electronic and financial trail –
  • Emails showed her acknowledging she had “reviewed and signed the prescriptions” and responding “Done” immediately after being prompted to clear backlog charts.
  • Browser history reflected views of YouTube videos titled “DMERx Knee Pain” and “DMERx Free Cash.”
  • Bank records showed regular payments from EIP roughly equaling $25 per brace ordered.

C. The Defense Theory

At trial, Beaufils testified that she believed:

• her role was limited to “quality control” – checking charts for consistency and grammar, not generating prescriptions;
• other physicians had already seen the patients and would provide the “final” attestation; and
• her signature was simply part of an internal record of everyone who had “touched” the chart.

She also claimed that when an insurer (Cigna) raised concerns about her being listed as sole provider, she queried RPN and was reassured. She asserted her failure to contact patients, despite telling the FBI earlier that she had called and conducted phone exams, was a misunderstanding: she said she only described hypothetically how such exams could be done.

The jury acquitted her of one conspiracy-to-commit-health-care-fraud count but convicted on all remaining counts: health care fraud, false statements relating to health care, aggravated identity theft, conspiracy under 18 U.S.C. § 371 (kickbacks and false statements), and making false statements to a federal agency.

IV. Analysis

A. Precedents and Doctrinal Context

1. Sufficiency-of-the-evidence standards

Because Beaufils moved for a Rule 29 judgment of acquittal at the close of the government’s case but did not renew after presenting her own evidence, the panel applied the stringent “manifest miscarriage of justice” standard drawn from United States v. Fries, 725 F.3d 1286 (11th Cir. 2013) and United States v. Milkintas, 470 F.3d 1339 (11th Cir. 2006):

A reversal is warranted only when the record is devoid of evidence on an essential element, or the evidence on a key element is so tenuous that upholding the conviction would be “shocking.”

The court, consistent with Milkintas, viewed all evidence in the light most favorable to the government and accepted all reasonable inferences and credibility determinations supporting the verdict.

2. Mental state: “Knowingly” and “willfully”

The court’s discussion of mental state draws on:

• United States v. Henderson, 893 F.3d 1338 (11th Cir. 2018) – defining “willfully” as acting with knowledge that the conduct is unlawful, and “knowingly” as awareness of the facts constituting the offense.
• Longstanding jurisprudence (also reflected in Henderson) allowing knowledge and intent to be proven by circumstantial evidence.

The panel accepted that in a Medicare-fraud context, knowledge can be inferred from patterns of billing, scope-of-practice violations, and implausible clinical documentation.

3. Substantive fraud and related offenses

• Health care fraud – 18 U.S.C. § 1347 – The court relied on its recent articulation of the elements in United States v. Scott, 61 F.4th 860, 863–64 (11th Cir. 2023): a knowing and willful scheme to defraud a health care benefit program or obtain program funds by false pretenses, materiality, and a connection to the delivery or payment of health care items/services.
• False statements related to health care – 18 U.S.C. § 1035(a)(2) – The panel applied a straightforward reading: knowingly and willfully making or using any materially false writing in connection with payment for health care items/services.
• Aggravated identity theft – 18 U.S.C. § 1028A – Following United States v. Barrington, 648 F.3d 1178 (11th Cir. 2011), the panel treated the § 1035 offenses as predicate felonies and held that using real beneficiaries’ identifying information in false medical records “during and in relation to” the fraud satisfied § 1028A.
• Conspiracy – 18 U.S.C. § 371 – The court applied the standard from United States v. Sosa, 777 F.3d 1279, 1290 (11th Cir. 2015) (existence of conspiracy, knowledge, and voluntary participation), with the familiar rule from United States v. Duldulao, 87 F.4th 1239 (11th Cir. 2023) that circumstantial evidence suffices, and from United States v. Nerey, 877 F.3d 956 (11th Cir. 2017) that co-conspirator testimony alone may sustain a conviction.

4. Jury-instruction error and Rule 30(b)

On the jury-instruction issue the panel drew from:

• United States v. Lopez, 590 F.3d 1238 (11th Cir. 2009); United States v. Descent, 292 F.3d 703 (11th Cir. 2002); and United States v. Clark, 732 F.2d 1536 (11th Cir. 1984) – which require only “substantial compliance” with Rule 30(b) and impose a prejudice requirement for reversal.
• United States v. Beasley, 72 F.3d 1518 (11th Cir. 1996) – noting that an error benefiting the defendant (making acquittal more likely) is generally not prejudicial.
• United States v. Stone, 9 F.3d 934 (11th Cir. 1993) – clarifying deliberate-ignorance doctrine and reiterating that jurors are presumed to follow instructions correctly stating the law.

5. Obstruction of justice and perjury

For the § 3C1.1 enhancement, the panel invoked:

• United States v. Dunnigan, 507 U.S. 87 (1993) – defining perjury for guidelines purposes and approving perjury-based enhancements; and
• Eleventh Circuit authorities including United States v. Singh, 291 F.3d 756 (11th Cir. 2002); United States v. Singer, 963 F.3d 1144 (11th Cir. 2020); United States v. Arguedas, 86 F.3d 1054 (11th Cir. 1996); and United States v. Lewis, 115 F.3d 1531 (11th Cir. 1997) – emphasizing:
  • elements of perjury: sworn, false, material, and willfully false;
  • deference to district courts’ credibility findings; and
  • acceptance of “global” findings of perjury where all predicate facts are encompassed.

6. Excusable neglect framework – the doctrinal pivot

The key doctrinal move appears in the section on Rule 45(b)(1)(B). The court:

• identified Cheney v. Anchor Glass Container Corp., 71 F.3d 848 (11th Cir. 1996) (interpreting Civil Rule 60(b)), and Advanced Estimating Sys., Inc. v. Riney, 77 F.3d 1322 (11th Cir. 1996) (interpreting Appellate Rule 4(a)(5)), both of which adopted the Supreme Court’s Pioneer Investment Services Co. v. Brunswick Associates, 507 U.S. 380 (1993) test for “excusable neglect.”
• noted that Riney applied a uniform understanding of “excusable neglect” across Bankruptcy Rule 9006(b)(1), Civil Rule 60(b), and Appellate Rule 4(a)(5).
• relied on United States v. Snipes, 611 F.3d 855 (11th Cir. 2010), and United States v. Davenport, 668 F.3d 1316 (11th Cir. 2012) for the proposition that counsel’s misunderstanding of clear law or deadlines, standing alone, is not “excusable neglect.”

The panel then extended this established civil/appellate framework to Criminal Rule 45(b), holding there is “no reason” for the phrase “excusable neglect” to mean something different in the criminal context.

B. The Court’s Legal Reasoning

1. Knowledge and intent in a complex medical-fraud context

The panel methodically rejected the defense theory that Beaufils was an unwitting “quality control” contractor:

• Contradictions with documentary evidence – DMERx files repeatedly listed “Provider Sherley L. Beaufils” and contained first-person exam notes and attestations that she herself had examined, counseled, and prescribed. Her trial claim that she thought others would later add their own attestations was undermined by Frame’s testimony that no additional provider signature was required for Medicare billing and that she never told Beaufils otherwise.
• Scope-of-practice warnings – Her collaborative agreement and Georgia credentialing documents (including express Anti-Kickback warnings) put her on notice that:
  • She could not function as a stand-alone provider for Medicare patients outside her emergency-medicine scope.
  • Receiving remuneration tied to DME referrals was a criminal risk.
  Continuing to accept per-brace payments while signing brace prescriptions for non-emergency patients scattered hundreds of miles from her practice therefore supported an inference of willful blindness at best and actual knowledge at worst.
• Inherent implausibility of chart narratives – The sheer absurdity of some records (braces for amputated limbs, for dying hospice patients, grossly inaccurate weight and activity histories) made it reasonable for the jury to infer that no reasonable practitioner carefully reading these charts could believe them, yet she certified them as accurate and medically necessary.
• Electronic behavior consistent with knowing participation – Clusters of signatures following “charts ready/overdue” emails, followed by immediate “Done” responses, belied the notion that she was carefully reviewing and questioning dubious material. Her viewing of videos such as “DMERx Free Cash” further suggested awareness of the profit motive and scheme-like nature of the operation.

Collectively, these facts easily met the “manifest miscarriage of justice” standard for all substantive and conspiracy counts.

2. False statements and aggravated identity theft

For the § 1035 counts, the court focused on the falsity and materiality of Beaufils’s attestations:

• She certified that she had engaged in patient “discussion,” performed “examinations,” and determined medical necessity.
• Her own testimony conceded she had done none of these things.
• The statements were “material” because they went directly to the prerequisites Medicare relies on when deciding whether to pay for DME.

Once those underlying false-statement convictions were upheld, the aggravated identity theft counts under § 1028A followed largely as a matter of course: she had used real beneficiaries’ identifying information in those false records “during and in relation to” the health-care fraud felonies.

3. Conspiracy under § 371

The conspiracy analysis combined co-conspirator testimony and circumstantial proof:

• Frame admitted she paid providers, including Beaufils, to authorize brace orders, and that the DMERx platform did not require any other provider’s involvement.
• Brokers testified that they purchased brace prescriptions from entities paying Beaufils via intermediaries.
• Beaufils knew from her contract that accepting compensation tied to DME referrals could violate the Anti-Kickback Statute.
• She continued signing orders after being alerted by Cigna that she was improperly listed as sole provider.

From this, the panel held that a rational jury could find she knew of and voluntarily joined a scheme to receive kickbacks and make false health-care statements.

4. The missing deliberate-ignorance instruction and Rule 30(b)

The trial court initially told counsel it had largely adopted their joint instructions, but in the final charge it omitted the deliberate-ignorance instruction the parties had requested and failed to announce that decision before closing arguments, as required by Rule 30(b).

The Eleventh Circuit’s reasoning proceeded in steps:

1. Rule 30(b) violation and plain error – Rule 30(b) plainly states the court “must inform” parties before closing arguments how it intends to rule on requested instructions. Because this did not happen, and the instruction was not given, the court classified this as “plain” error in the Rule 30 sense.
2. Substantial compliance and no prejudice – Relying on Lopez, Descent, and Clark, the panel emphasized it requires only “substantial compliance” with Rule 30, and reversal requires a showing that the error affected the outcome.
   • The jury was explicitly instructed that only the judge states the law, that counsel’s arguments are not evidence or binding, and that the government bore the burden to prove all elements—including knowledge—beyond a reasonable doubt.
   • The court gave full and correct instructions on the mental-state requirements for each offense.
3. Effect of the omission – The panel made a subtle but important point: a deliberate-ignorance instruction is a tool that helps the government prove knowledge when direct proof is lacking. Withholding that tool did not expand the government’s proof options; if anything, it restricted them.
   • Thus, the omission could not have prejudiced the defendant by lowering the mental-state threshold. The jury had to (and presumptively did) base guilt on actual knowledge as defined in the main charge.
4. Closing argument “ostrish defense” remark – The prosecutor referred to deliberate ignorance as “sticking your head in the sand” (“ostrich defense”). The court held this did not misstate the law and, given the judge’s repeated instructions that arguments were not law, there was no realistic risk the jury substituted counsel’s phrasing for the legal standard.

In effect, the panel signals that even clear Rule 30(b) missteps rarely justify reversal absent a concrete showing that the change in (or omission of) an instruction undercut defense counsel’s argument or misled the jury on burden of proof or elements.

5. Obstruction of justice and perjury at sentencing

The district court found that:

“On the whole[,] Mrs. Beaufils simply lied to the jury.”

It noted that her testimony consisted of “specific and wholesale denial of the actual criminal acts,” later “incrementally modified, altered or withdrawn” when confronted with prior inconsistent statements. The court factored in her demeanor and the consistency of her testimony with the documentary and co-conspirator evidence.

On appeal, the Eleventh Circuit:

• confirmed that perjury is an enumerated basis for a § 3C1.1 enhancement;
• reaffirmed that a general finding of perjury is acceptable if it necessarily includes all factual predicates (sworn, false, material, and willful), citing Singh and Lewis;
• stressed that credibility determinations at sentencing receive “significant deference,” especially when aligned with the jury’s verdict, citing Singer.

The critical inconsistencies included:

• her statements to the FBI that she had contacted patients and conducted phone-based exams vs. trial testimony conceding she did not;
• her claim that she believed other providers had already examined the patients vs. Frame’s testimony that no such process existed and the DMERx forms were incomplete until she filled in and signed the “exam” sections.

These contradictions were material: if believed, her trial account would have undercut the knowledge and willfulness elements central to every fraud and false-statement charge. The panel therefore upheld the enhancement.

6. Excusable neglect and untimely Rule 33 motion

This is where the opinion makes its clearest doctrinal contribution.

Rule 33(b)(2) requires a new-trial motion (other than for newly discovered evidence) to be filed within 14 days after the verdict. Rule 45(b)(1)(B) allows the court to extend this deadline “after the time expires” if “the party failed to act because of excusable neglect.”

Beaufils conceded her motion was out of time, but argued:

• she had texted trial counsel within the 14-day window asking him to file such a motion based on “evidence not presented”;
• he disagreed there were grounds, declined to file, and did not explain deadlines or advise her to seek new counsel; and
• new appellate counsel, hired later, filed the motion as soon as practicable.

The Eleventh Circuit resolved the issue in two key moves:

1. Formally applying the Pioneer excusable-neglect test to Criminal Rule 45(b)
   • Citing Cheney and Riney, the court noted that it had already adopted a unified understanding of “excusable neglect” across Civil Rule 60(b), Appellate Rule 4(a)(5), and Bankruptcy Rule 9006(b)(1).
   • In Riney, the court held there was “no reason” the phrase should have different meanings across those contexts. The panel extended that logic: there is likewise “no reason” to interpret “excusable neglect” differently in Criminal Rule 45(b)(1)(B).
   • Accordingly, the Pioneer factors govern:
     1. danger of prejudice to the non-movant;
     2. length of delay and its impact on proceedings;
     3. the reason for the delay, including whether it was within the movant’s reasonable control; and
     4. whether the movant acted in good faith.
2. Concluding that counsel’s deliberate choice and any legal mistake are not “excusable neglect”
   • The court stressed that under Pioneer, “neglect” typically means a simple or careless omission, not a deliberate decision about litigation strategy.
   • Here, trial counsel did not “forget” or misunderstand the deadline; he consciously chose not to file because he believed there was no merit. That is not “neglect” at all under Pioneer—it is a strategic judgment, for which the client is generally bound.
   • Even assuming some misinterpretation of law, Snipes and Davenport make clear that “counsel’s misunderstanding of the law” or failure to review clear law does not qualify as a “reason for delay” amounting to excusable neglect.
   • The panel also noted that Rule 33/45 is not the appropriate vehicle for litigating ineffective-assistance-of-counsel claims; those belong in collateral proceedings (e.g., § 2255 motions).

Because the district court applied the correct legal framework and its factual findings (that trial counsel’s inaction was deliberate, not neglectful) were not clearly erroneous, there was no abuse of discretion in denying relief.

C. Impact and Practical Implications

1. For criminal practitioners: deadlines and remedies

The extension of the Pioneer excusable-neglect framework to Rule 45(b) has concrete consequences:

• Missed post-verdict deadlines are hard to revive – Mere attorney oversight, miscalculation, or misjudgment rarely qualifies as “excusable neglect,” especially where the law is clear. A deliberate decision not to file never does, under this case’s reasoning.
• Strategic choices vs. procedural defaults – If counsel affirmatively decides not to file a Rule 33 motion—and later that judgment is questioned—the proper remedy is an ineffective-assistance claim, not a Rule 45 extension. Courts will not recast strategic choices as “neglect.”
• Client diligence cannot substitute for legal compliance – Even where a defendant can show she personally desired a motion and communicated that desire (e.g., via text), that fact alone does not render counsel’s non-filing “excusable neglect” under Rule 45.

2. For health-care professionals and telemedicine enterprises

The case delivers several cautionary lessons for clinicians and entities engaged in telehealth:

• Signing is ownership – A licensed practitioner who signs orders and attestations is treated as author and examiner. Claims of being a mere “reviewer” or “quality-control” agent will be scrutinized against documentary content and payment structure.
• Scope-of-practice is not just an administrative detail – Practicing outside the collaborative agreement or supervising physician’s specialty is not only a regulatory issue; it can be strong circumstantial evidence of fraudulent intent when combined with questionable billing patterns.
• Red flags matter – Implausible chart content (e.g., braces for amputated limbs, obviously false histories) supports an inference of actual knowledge or at least deliberate avoidance of the truth. Continuing to sign such documents after insurers raise concerns increases exposure.
• Telemedicine regulations are substantive elements of fraud cases – Compliance with 42 C.F.R. §§ 410.78 and 410.38 (rural/underserved requirement, live encounters) is not optional. Ignoring these constraints transforms administrative violations into criminal evidence.

3. For sentencing practice

On sentencing:

• Testifying defendants face real § 3C1.1 exposure – If a defendant takes the stand and gives a narrative flatly contradicted by documents, co-conspirators, and prior statements, a perjury enhancement is likely. Courts may make global findings that a defendant “simply lied” so long as the record shows which subjects were materially false.
• Jury verdict plus judicial credibility findings – The panel underscores that sentencing judges may consider the jury’s verdict as corroborative of their own credibility findings, while still making an independent assessment.

V. Complex Concepts Simplified

1. “Deliberate ignorance” (the “ostrich” doctrine)

Deliberate ignorance (or willful blindness) describes a situation where:

• a defendant strongly suspects a fact (e.g., that a scheme is fraudulent); but
• purposefully avoids confirming it (e.g., by not asking obvious questions), in order to later claim lack of knowledge.

Courts sometimes allow jurors to treat this deliberate avoidance as equivalent to actual knowledge. However:

• mere negligence or carelessness is not enough; and
• in Beaufils, the jury had to find actual knowledge, because the deliberate-ignorance instruction was never given.

2. “Manifest miscarriage of justice”

When a defendant fails to properly preserve a sufficiency-of-the-evidence challenge (for example, by not renewing a Rule 29 motion after presenting her own defense), the appellate court applies an exceptionally deferential standard:

• Reversal occurs only if the record is virtually devoid of evidence on a key element, or the evidence is so weak that a conviction would be “shocking.”
• All evidence is viewed in the light most favorable to the government.

Under this standard, even fairly marginal government evidence will typically suffice; in Beaufils, the evidence was far from marginal.

3. The “Pioneer” excusable-neglect test

“Excusable neglect” is a flexible, equitable concept used to decide whether a missed deadline can be forgiven. The Supreme Court in Pioneer set out four non-exclusive factors:

1. Prejudice to the opposing party;
2. Length of delay and its impact on the proceedings;
3. Reason for the delay, including whether it was within the movant’s control; and
4. Whether the movant acted in good faith.

In Beaufils, the third factor—reason for the delay—was decisive. A lawyer’s strategic decision not to file a motion, or failure to consult clear law, is almost never “excusable.”

4. Aggravated identity theft in fraud schemes

Under 18 U.S.C. § 1028A, a defendant commits aggravated identity theft if:

• in the course of committing certain predicate felonies (such as health care fraud or false statements about health care);
• she knowingly uses, transfers, or possesses someone else’s identifying information (such as name, date of birth, or Medicare number);
• without lawful authority.

The identity theft is “aggravated” because Congress mandates a separate, usually consecutive, two-year sentence for each count. In Beaufils, her use of real beneficiaries’ identifiers in false DMERx records tied directly to the health care fraud offenses.

5. Perjury-based obstruction of justice

Perjury, for guideline purposes, is:

• sworn testimony;
• that is false;
• about a material matter (something that could influence the case’s outcome);
• given with willful intent to mislead, not due to confusion or faulty memory.

If the judge finds perjury by a preponderance of the evidence, U.S.S.G. § 3C1.1 calls for a two-level increase in the offense level. This can significantly increase the advisory sentencing range.

VI. Conclusion

United States v. Beaufils is a multifaceted decision grounded in a relatively conventional fraud prosecution, but it has outsized doctrinal importance in two main respects.

First, it clarifies how robustly the Eleventh Circuit will treat circumstantial evidence of knowledge and intent in Medicare-related fraud, especially in telemedicine contexts. Scope-of-practice documents, anti-kickback warnings, implausible clinical narratives, and payment structures are all powerful evidence of willfulness. Health-care professionals engaging in remote or high-volume order generation should assume that signing an attestation is tantamount to owning the underlying exam and clinical judgment.

Second, and more distinctively, the opinion cements the Pioneer-based “excusable neglect” standard as the governing framework for extensions of time under Criminal Rule 45. By aligning criminal practice with civil, appellate, and bankruptcy rules, and by reiterating that attorney misjudgment or ignorance of clear law does not excuse missed deadlines, the court signals a strict approach to post-verdict time limits. Defendants who believe counsel failed to act on their directions must typically pursue relief via ineffective-assistance claims, not by asking district courts to reopen expired Rule 33 windows.

Finally, the court’s handling of the missing deliberate-ignorance instruction and the perjury-based obstruction enhancement reinforces two themes: appellate courts will presume juries follow correct instructions on actual knowledge, and sentencing judges are afforded broad discretion to draw credibility-based inferences when defendants testify in ways sharply contradicted by the evidentiary record and the jury’s verdict.

Collectively, Beaufils stands as a significant Eleventh Circuit authority at the intersection of health care fraud, criminal procedure, and sentencing, and it will likely be cited both in future telemedicine-fraud prosecutions and in disputes over late-filed criminal motions predicated on “excusable neglect.”