In United States v. Gevorgyan, 886 F.3d 450 (5th Cir. 2018), the court of appeals affirmed convictions of a defendant charged with committing healthcare fraud and violating the AKS. The defendant served as an "operations person" of a clinic, and he personally paid a marketer to bring patients into the clinic. The marketer then provided money to prospective patients. The defendant challenged his convictions for conspiracy to violate, and substantive violation of, the AKS and his convictions for conspiracy to commit, and substantive commission of, healthcare fraud.

The court found that the defendant's interactions with the clinic's receptionist, whereby he trained the receptionist to keep a ledger tallying the number of incoming patients and such ledger contained total figures written by the defendant that directly mirrored figures on payments that the defendant paid to the marketer — along with the defendant's ownership of the corporation that acted as the source of payments to the marketer — was sufficient evidence to meet the mens rea element under AKS. The court also ruled that this evidence sufficiently supported the finding that the defendant voluntarily participated in the conspiracy to violate AKS.

The defendant also targeted the mens rea element of the healthcare fraud convictions. However, the court was not swayed by the defendant's arguments that he was too young and inexperienced in the medical field to have knowledge of the clinic's healthcare fraud. The court held that sufficient evidence supported the jury's determination that the defendant knew of the healthcare fraud and was aware of the conspiracy's purpose. The court relied on the facts that the defendant trained and supervised others regarding patient intake, played a central role in the scheme and served as an owner, a director and an officer of the corporation issuing payments to the marketers.