FECA as a “Healthcare Benefit Program” and Full-Account Forfeiture When Commingling Conceals Fraud Proceeds

Introduction

In United States v. Nourian (5th Cir. June 10, 2026) (per curiam) (not designated for publication), the Fifth Circuit affirmed the convictions and sentences of Dehshid Nourian and Christopher Rydberg for roles in a healthcare fraud and money laundering scheme centered on compounded medications. The scheme allegedly recruited doctors to prescribe drugs to patients in exchange for a share of insurance reimbursements, with a focus on federal employees receiving workers’ compensation benefits because the government paid unusually high amounts for compounded drugs.

The appeals raised recurring issues in federal fraud prosecutions: (1) whether the evidence was sufficient across multiple counts, (2) whether a challenged portion of the government’s closing argument warranted a new trial, (3) whether a “10 or more victims” enhancement could rely on Guidelines commentary, and (4) whether forfeiture may reach an entire investment account that contains commingled proceeds. A threshold legal contention was that the Federal Employees’ Compensation Act (FECA) is not a “healthcare benefit program” for purposes of 18 U.S.C. §§ 24(b), 1347, and 1349.

Summary of the Opinion

The court affirmed in full. It held that:

  • The evidence was sufficient to support the healthcare fraud conspiracy, substantive healthcare fraud (as to Nourian), money laundering, and conspiracy to defraud the United States convictions.
  • The contention that FECA is not a “healthcare benefit program” failed given the Fifth Circuit’s broad interpretation of that term and its prior references to FECA among federal healthcare programs; in any event, the conspiracy also targeted Blue Cross Blue Shield (BCBS), which defendants did not dispute was a federal healthcare benefit program.
  • Any impropriety in closing argument did not warrant a new trial because the defendants could not show an effect on substantial rights, particularly in light of curative and mens rea instructions and the presumption that juries follow them.
  • The district court properly applied the USSG § 2B1.1(b)(2)(A)(i) two-level enhancement for “10 or more victims,” relying on the definition in Application Note 4(E), which the panel treated as authoritative under United States v. Stinson.
  • The district court did not abuse its discretion at sentencing regarding alleged consideration of lack of remorse, and it imposed a below-Guidelines sentence.
  • The district court did not err by ordering forfeiture of Nourian’s entire TD Ameritrade account where the evidence showed most funds were fraud proceeds and commingling was used to conceal the illegal source.
  • Nourian’s constitutional challenge to judge-found restitution (not submitted to a jury) was foreclosed by circuit precedent.

Analysis

Precedents Cited

  • United States v. Scott, 892 F.3d 791 (5th Cir. 2018): Cited for the standard of review—sufficiency challenges are reviewed de novo. This frames the panel’s approach: it independently assesses legal sufficiency, while still viewing evidence through the lens mandated by Jackson.
  • United States v. Anderson, 980 F.3d 423 (5th Cir. 2020): Used to support a broad interpretation of the statutory term “healthcare benefit program.” This citation is central to rejecting the defendants’ attempt to carve FECA out of 18 U.S.C. §§ 24(b), 1347, and 1349.
  • United States v. Shah, 95 F.4th 328 (5th Cir. 2024): The panel relied on this decision’s inclusion of FECA in a list describing federal healthcare programs. While not necessarily a holding that “FECA always qualifies,” it functions as persuasive circuit confirmation that FECA fits comfortably within the Fifth Circuit’s understanding of covered federal healthcare benefit structures.
  • Jackson v. Virginia, 443 U.S. 307 (1979): Supplies the governing sufficiency test: whether, viewing the evidence in the light most favorable to the prosecution, any rational jury could find the elements beyond a reasonable doubt. The panel repeatedly invokes this standard to reject knowledge-based challenges.
  • United States v. Sanders, 952 F.3d 263 (5th Cir. 2020): Quoted for the proposition that the same evidence often supports both conspiracy and aiding-and-abetting convictions, which the panel uses to reinforce the sufficiency of evidence for Nourian’s substantive healthcare fraud counts once the conspiracy evidence is credited.
  • United States v. Barnes, 979 F.3d 283 (5th Cir. 2020): Cited for the “substantial rights” inquiry when evaluating whether alleged prosecutorial misconduct in closing argument warrants relief. The panel’s conclusion turns on lack of prejudice rather than categorizing the review standard.
  • Zafiro v. United States, 506 U.S. 534 (1993): Cited for the presumption that juries follow instructions. This underwrites the panel’s reliance on the district court’s curative instruction and explicit mens rea instructions to neutralize any arguable closing-argument misstep.
  • United States v. Bourrage, 138 F.4th 327 (5th Cir. 2025): Provides the appellate review framework for Guidelines issues: de novo review of interpretation and application, and clear-error review of factual findings. This is the lens through which the panel evaluates the “10 or more victims” enhancement.
  • United States v. Stinson, 508 U.S. 36 (1993): The cornerstone for treating Sentencing Guidelines commentary as authoritative unless it violates the Constitution or a federal statute, or is inconsistent with, or a plainly erroneous reading of, the guideline. The panel uses Stinson to uphold reliance on Application Note 4(E)’s definition of “victim.”
  • Gall v. United States, 552 U.S. 38 (2007): Cited for abuse-of-discretion review of sentencing decisions. The panel uses Gall to frame review of Nourian’s claim that the district court improperly considered lack of remorse.
  • United States v. Simpson, 796 F.3d 548 (5th Cir. 2015): Cited for the presumption of reasonableness for within- or below-Guidelines sentences, which bolsters affirmance where the district court varied downward.
  • United States v. Dennis, 41 F.4th 732 (5th Cir. 2022): Supplies the standard of review for forfeiture orders: legal conclusions de novo, factual findings for clear error, and the ultimate legal propriety of forfeiture de novo. The panel uses this framework to uphold forfeiture of the entire Ameritrade account.
  • United States v. Real Prop. Located at 1407 N. Collins St., Arlington, Tex., 901 F.3d 268 (5th Cir. 2018): Provides the critical substantive rule for commingling: pooling tainted and untainted funds does not automatically subject the entire account to forfeiture, but untainted funds become forfeitable if commingled to disguise the nature and source of the scheme. The panel applies this rule to sustain full-account forfeiture based on concealment-focused commingling.
  • United States v. Luna Caudillo, 110 F.4th 808 (5th Cir. 2024): Forecloses Nourian’s argument that restitution must be submitted to a jury, allowing the panel to reject the claim without extended analysis.

Legal Reasoning

1) Sufficiency of the evidence and FECA as a “healthcare benefit program”

The defendants’ principal legal sufficiency argument attacked the applicability of the healthcare fraud statutes by asserting that FECA is not a “healthcare benefit program” under 18 U.S.C. §§ 24(b), 1347, and 1349. The panel rejected this for two independent reasons:

  1. Broad statutory interpretation: Relying on United States v. Anderson, the panel emphasized that the term “healthcare benefit program” is interpreted broadly in the Fifth Circuit, making categorical exclusions disfavored where the program functions to provide or pay for healthcare-related benefits.
  2. Alternative program victim (BCBS): Even if FECA were debated, the conspiracy also involved defrauding BCBS, and defendants did not contest that BCBS is a federal healthcare benefit program. Thus, the sufficiency challenge could not defeat the conspiracy conviction where evidence allowed the jury to find a scheme to defraud both payors.

On the facts, the panel applied Jackson v. Virginia and credited evidence of operational involvement—Nourian’s management of multiple pharmacies, recruiting assistance (including Nicolas Aguilar), and receipt of substantial profits, along with evidence both defendants supplied pre-filled prescription pads—supporting knowledge and participation.

2) Money laundering counts: knowledge of unlawful proceeds

The defendants argued that money laundering convictions cannot stand absent proof they knew the funds were criminal proceeds. The panel’s reasoning was straightforward: because the jury could find underlying healthcare fraud participation and knowledge, and because the record contained “extensive evidence” the defendants understood the funds were fraud proceeds and were not processed for legitimate purposes, the mens rea element for money laundering could be satisfied. The sufficiency analysis again relies on Jackson’s deferential view of the evidence in favor of the verdict.

3) Conspiracy to defraud the United States: “intimate involvement” as proof of knowledge

The panel treated the conspiracy-to-defraud-the-United-States count as turning largely on proof of knowledgeable participation in fraudulent financial transactions. It held the government’s detailed evidence of defendants’ intimate involvement supported the jury’s finding of the essential elements beyond a reasonable doubt, expressly quoting Jackson.

4) Closing argument challenge: no prejudice in light of instructions

Without resolving a dispute about the precise standard of review, the panel held the claim failed under any standard because the challenged argument did not affect substantial rights, invoking United States v. Barnes. The dispositive reasoning was institutional: the district court issued a curative instruction and emphasized that knowledge was required for guilt; under Zafiro v. United States, juries are presumed to follow instructions. This is a common Fifth Circuit pathway for disposing of alleged improper argument: even if error is assumed, relief is denied absent demonstrable prejudice.

5) “10 or more victims” enhancement and commentary deference

Nourian and Rydberg challenged the two-level enhancement under USSG § 2B1.1(b)(2)(A)(i), focusing on the district court’s use of Application Note 4(E) to define “victim.” Applying United States v. Bourrage, the panel reviewed guideline interpretation de novo. It then invoked United States v. Stinson to treat the commentary as authoritative absent inconsistency or invalidity. On that basis, the panel concluded the district court “correctly relied” on Application Note 4(E).

The practical import is that, at least in this case, the Fifth Circuit treated the “victim” definition dispute as settled by Stinson-style deference, rather than entertaining a narrower reading of the guideline’s text that would exclude the commentary’s reach.

6) Lack of remorse at sentencing

Nourian argued the district court erred by considering lack of remorse. Under Gall v. United States, the panel reviewed for abuse of discretion. It found no indication lack of remorse was used as a § 3553(a) factor, and it stressed the court varied downward. Under United States v. Simpson, a below-Guidelines sentence is presumed reasonable, and Nourian failed to rebut that presumption.

7) Forfeiture of the TD Ameritrade account: commingling plus concealment

The forfeiture holding is one of the opinion’s clearest operational rules. The panel acknowledged the limiting principle from United States v. Real Prop. Located at 1407 N. Collins St., Arlington, Tex.: simple commingling does not automatically make an entire account forfeitable. But it emphasized the same decision’s carve-in: untainted funds are forfeitable if commingled with tainted funds to disguise the scheme’s nature and source.

Applying the review structure from United States v. Dennis, the panel upheld full forfeiture because the government presented evidence (i) most funds were direct fraud proceeds and (ii) Nourian moved tainted funds through multiple accounts before commingling in Ameritrade, supporting an inference of concealment facilitation. Those facts supported the legal conclusion that the account facilitated money laundering, justifying forfeiture “in its entirety.”

8) Restitution and the jury-trial argument

Nourian’s constitutional challenge to restitution not being submitted to a jury was rejected as “squarely foreclosed” by United States v. Luna Caudillo. The panel treated this as a binding circuit rule, leaving any change to en banc review or the Supreme Court.

Impact

  • FECA-based healthcare fraud prosecutions: The panel’s reasoning reinforces that FECA-related benefit payments can be treated as coming from a “healthcare benefit program” in Fifth Circuit healthcare fraud cases, especially when coupled with the circuit’s broad construction in United States v. Anderson and the supportive reference in United States v. Shah. Defendants seeking dismissal or reversal on the theory that FECA falls outside §§ 24(b), 1347, and 1349 face an uphill battle, particularly where the scheme also targets an additional covered payor (as here, BCBS).
  • Sufficiency challenges in complex schemes: The opinion illustrates how operational evidence—management roles, tools of the fraud (e.g., pre-filled prescription pads), profit flows, and transaction structuring—can satisfy knowledge and participation across fraud, laundering, and defraud-the-United-States conspiracies under Jackson.
  • Closing-argument claims: The decision underscores the practical importance of contemporaneous jury instructions. Even when arguable impropriety exists, curative and mens rea instructions—combined with the Zafiro presumption—often defeat prejudice-based relief.
  • Guidelines commentary reliance: By affirming use of Application Note 4(E) through Stinson, the panel signals continued comfort (in this context) with commentary-driven definitions for § 2B1.1 enhancements, affecting how victim counts may be litigated at sentencing.
  • Forfeiture exposure for commingled accounts: The forfeiture holding is a cautionary precedent for defendants: while commingling alone is not enough, evidence of routing funds through multiple accounts and commingling to conceal can justify forfeiture of an entire account, including arguably untainted amounts, under United States v. Real Prop. Located at 1407 N. Collins St., Arlington, Tex..
  • Restitution challenges: The summary rejection under United States v. Luna Caudillo indicates that, in the Fifth Circuit, Apprendi-style jury arguments against restitution remain unavailable absent higher-court change.

Complex Concepts Simplified

“Healthcare benefit program” (18 U.S.C. § 24(b))
A statutory term defining the kinds of plans or programs that provide or pay for healthcare benefits and therefore fall within federal healthcare fraud statutes. The Fifth Circuit treats the term broadly, making it easier for prosecutors to show that a particular payor or benefit structure qualifies.
Sufficiency of the evidence (Jackson v. Virginia)
The appellate court does not re-try the case. It asks whether a rational jury, viewing the evidence in the prosecution’s favor, could find the elements proven beyond a reasonable doubt. Conflicts in testimony and competing inferences are generally resolved in favor of the verdict.
Money laundering “knowledge”
For many laundering offenses, the government must prove the defendant knew the money involved came from some form of unlawful activity. Participation in the underlying fraud, awareness of suspicious payment flows, and evidence of concealment steps can support an inference of that knowledge.
“Substantial rights” in closing-argument challenges
Even if a prosecutor’s argument is improper, a conviction is not reversed unless the defendant shows the error likely mattered to the outcome. Curative instructions and clear jury instructions on required mental states frequently defeat such claims.
Guidelines “commentary” and Application Notes (United States v. Stinson)
The Sentencing Guidelines include interpretive notes. Under Stinson, those notes are generally treated as authoritative unless they conflict with the guideline text or higher law. Here that principle supported using Application Note 4(E)’s definition of “victim.”
Forfeiture and commingling
Putting “dirty” (tainted) and “clean” (untainted) money in one account does not automatically make everything forfeitable. But if commingling is done to hide where the dirty money came from—such as moving funds through multiple accounts before mixing—courts may allow forfeiture of the entire account because it facilitated concealment.
Restitution and the jury
Restitution is the amount a defendant must pay victims. Some defendants argue a jury must determine restitution amounts. The Fifth Circuit has precedent rejecting that argument, so district judges may order restitution without a jury finding in this circuit.

Conclusion

United States v. Nourian consolidates several Fifth Circuit themes in fraud and financial-crime litigation: a broad view of what qualifies as a “healthcare benefit program” (including FECA in this case’s analysis), deference to jury verdicts under Jackson v. Virginia when evidence supports knowledge and participation, skepticism toward closing-argument challenges in the face of strong instructions, continued reliance on Guidelines commentary under United States v. Stinson, and a practical forfeiture rule that allows full-account forfeiture where commingling is used to conceal fraud proceeds. Even as an unpublished per curiam decision, its reasoning provides a clear roadmap for how the Fifth Circuit will evaluate similar sufficiency, sentencing, and forfeiture arguments in healthcare fraud prosecutions.