Emma Poroger sentencing memo

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Dr. Emma Poroger could face between 37 and 46 months in federal prison after pleading guilty to taking part in a Medicare fraud scheme. Her defense attorneys are asking she receive probation.

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Case 1:11-cr-00742-DLI Document 117 Filed 04/11/15 Page 1 of 27 PageID #: 591

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF NEW YORK
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UNITED STATES OF AMERICA,

:
:

- against EMMA POROGER
Defendant

11-CR-742 (DLI)
:
:
:

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MEMORANDUM IN AID OF SENTENCING

CREIZMAN PLLC
Eric M. Creizman
Melissa Madrigal
565 Fifth Avenue, 7th Floor
New York, New York 10017
Telephone: (212) 972-0200
Facsimile: (646) 200-5022
Attorneys for Emma Poroger
April 10, 2015

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TABLE OF CONTENTS
Page
PRELIMINARY STATEMENT ....................................................................................... 1
PERSONAL BACKGROUND ......................................................................................... 3
I. Childhood…………............................................................................................ 3
II. Devotion to Family and Friends......................................................................... 4
III. Medical Training............................................................................................... 7
IV. Devotion to Patients.......................................................................................... 8
V. Severe Health Problems..................................................................................... 9
VI. Fall From Grace ............................................................................................... 10
THE OFFENSE CONDUCT……………………………………………………………. 12
THE GUIDELINES CALCULATION………………………………………………….. 13
ANALYSIS OF AN APPROPRIATE SENTENCE UNDER 18 U.S.C. §
3553(A)………………....................................................................................................... 18
CONCLUSION…………………………………………………………………………... 25

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We respectfully submit this memorandum on behalf of Dr. Emma Poroger in connection
with her sentencing before Your Honor scheduled for Tuesday, April 21, 2015, at 10 a.m. Dr.
Poroger entered a guilty plea to a single-count superseding information charging her with
conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1347, pursuant to a plea
agreement almost three years ago, on May 2, 2012.
PRELIMINARY STATEMENT
Emma Poroger stands before this Court for sentencing as a broken woman, who, at the
relatively young age of 59, believes that she has little to enjoy or strive for and that her future is
bleak. In a period of just over three-and-a-half years, this criminal prosecution has sapped her of
her savings, stripped her of a career in medicine, divested her of her home, and constrained her
liberty, including her freedom to travel. The stress and remorse that Dr. Poroger has experienced
as a result of this case have taken their toll on her physical and psychological health. As detailed
in the reports prepared by the Probation Department, Dr. Poroger struggles with hypertension
and multiple cardiac conditions, physical disabilities due to lower back and pelvic pain, vision
impairments, and chronic vertigo, among other conditions. She often relies on a cane to walk,
and takes numerous medications on a daily basis. Dr. Poroger also suffers from severe
depression and anxiety, has experienced suicidal ideation, and has been hospitalized for suicidal
behaviors. Her declining physical and mental health led to the deterioration of a committed
relationship with her lover. The impact of this criminal case has had such a devastating impact
on Dr. Poroger’s life that a sentence of imprisonment is simply unnecessary for any deterrent
purposes or punishment. The objectives of federal sentencing have already been satisfied during
the three-and-a-half years Dr. Poroger has served under pretrial supervision.

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A non-custodial sentence is warranted not only because of the negative consequences Dr.
Poroger has endured as a result of her wrongdoing, but also, if not more so, because of her
affirmative efforts to accept responsibility for her wrongdoing and to cooperate with the
government in its investigation. Her conduct in this regard is detailed in the government’s letters
to the Court dated August 15, 2012, September 28, 2012, and April 3, 2015, which were
submitted under seal in support of the government’s motion in connection with Dr. Poroger’s
sentencing, as well as in status updates to the Court in letters dated November 7, 2013, February
24, 2014, October 28, 2014, January 30, 2015, and February 20, 2015. Dr. Poroger has
demonstrated, through her actions, her substantial remorse for her participation in the offense,
and her commitment to redress the harms caused by the members of the health care fraud
conspiracy. Her lengthy, spotless record of compliance with all of the conditions of her pretrial
release, also establishes that she presents no risk of recidivism and that she will continue to be a
law-abiding, productive member of society as she has been over the vast majority of her life.
Given Dr. Poroger’s constructive behavior since her arrest, and the serious consequences
she has faced as a result of this prosecution, the mitigating factors concerning Dr. Poroger’s
relative culpability in the offense also compel the conclusion that a non-custodial sentence is
“sufficient, but not greater than necessary” to achieve the goals of sentencing. Specifically, there
is no dispute that while working at the North Austin clinic, Dr. Poroger sincerely cared for her
patients, performed procedures that she believed were medically necessary, regularly worked
twelve to fourteen hour days, and honestly reported the treatments she provided to her office
management and the billing company. She never sought to bill Medicare for treatments that
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were unnecessary or for treatments that were not performed, and was unaware of the massive
scope of the fraudulent billing to Medicare until after she began cooperating with the
government. She did not plan the fraudulent scheme, did not support it, and did not seek to
profit from it. What Dr. Poroger admittedly did wrong, is that, in September 2008, less than six
months before she left the North Austin practice, she discovered that office management and the
billing company had submitted a fraudulent bill for a test that had not been performed. At that
point, she was on notice that fraudulent bills were likely being submitted under her name and
nevertheless continued to treat patients at the North Austin Facility, and never reported the
fraudulent billing to Medicare or law enforcement. Nor did she undertake any investigation to
determine the extent of the fraudulent billing or take sufficient action to prevent further
fraudulent billing. Dr. Poroger’s severe lapse in judgment constitutes a significant offense, but
in light of her productive conduct since her arrest and the severe price she has paid for her
wrongdoing, we respectfully submit that a non-custodial sentence is warranted here.
PERSONAL BACKGROUND
I.

Childhood
Dr. Poroger, who is 59 years old, was born and raised in Chernovtsy, Ukraine. Her

father, Nusim, was a hat-maker, and her mother, Khayka, now deceased, a military sales woman.
(PSR ¶ 23). As a child, Dr. Poroger was raised in a middle-income household. (PSR ¶ 24).
Although all of her economic needs were met while growing up in the former Soviet Union, Dr.
Poroger was the victim of religious persecution because of her Jewish faith. Id. Other children
beat and abused Dr. Poroger as punishment for her religious identity. Id.
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II.

Devotion to Family and Friends
Dr. Poroger has one son, Feliks Koyfman, a 37 year-old physician who resides in

Mineola, New York. (PSR ¶ 25). Feliks was born in Chernovtsy, Ukraine to the marital union
of Dr. Poroger and Aleksandr Koyfman. Dr. Poroger and Dr. Koyfman divorced but they
continue to share a friendly relationship. Id. On December 22, 1992, Dr. Poroger and Feliks,
then 14 years old, emigrated from Ukraine as religious refugees and legally entered the United
States where they settled in Brooklyn, New York. (PSR ¶ 27).
As described by one of the many letters submitted by Dr. Poroger’s supporters to the
Court, Dr. Poroger’s “life story is not unlike many other immigrants. She came to this country in
refuge of a bright future for her son.” (Ex. A). After arriving in the United States, Dr. Poroger
worked cleaning houses in Brooklyn for approximately 9 months to provide for her family. (PSR
¶ 51). Dr. Poroger’s “goal was to do everything possible to help her son to achieve and excel”
(Ex. B) which Feliks clearly accomplished as evidenced by the fact that he followed his mother’s
positive influence and became a physician. “My Mother is directly responsible for my
success…she instilled in me from an early age that hard work, integrity, perseverance, and
honesty are the keys to a full life and successful career.” (Ex. C).
Emma Poroger’s mother, Khayka, died at the age of 60 from psoriasis of the liver. (PSR
¶ 23). Khayka lived through Nazi occupation and concentration camps in the difficult post war
Russian system and was infected with a virus while working at a labor camp. “Emma’s goal in
life was to help her mother…She did become a doctor but too late to help her mom.” (Ex. D).

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Dr. Poroger is the principal caretaker of her father who is 93 years old. (PSR ¶ 23).
Nusim, her father, suffers from a myriad of health problems associated with his advanced age.
Dr. Poroger provides a significant amount of medical care and assistance to her elderly father on
a daily basis. Id. Similarly, Dr. Poroger helps care for Riva, her stepmother, who is 86 years of
age and also suffers from a myriad of health ailments associated with her advanced age. Id.
Because Dr. Poroger is the principal provider to Nusim and Riva, no one else can quite fill her
shoes in this regard if she is sentenced to prison.
In his letter to the Court, Nusim writes, “she has practically returned me from the other
side several times. I have been battling bladder cancer and going through chemotherapy. And
only Emma’s patience and dedication to my treatment helped me stay alive.” (Ex. E). Nusim
describes how Dr. Poroger visits him daily to check his vital signs, cook for him, and take him to
his appointments. Nusim felt compelled to tell the Court “I survived the Holocaust, but lost
almost my entire family. [My daughter] is my family and my life; please don’t take her away
from me.” Id.
In their letters to the Court, family members express grave concerns for Emma’s father if
Dr. Poroger is unable to care for him. (Ex. F); (Ex. G); (Ex. H) (“[Nusim] has suffered several
falls in this past year, and after each one Emma would rush to his side, caring for him, cooking
his favorite meals, and tending to his injuries. With Emma in prison, I am very concerned for
my grandfather’s welfare since my father and I live in Toronto.”) Dr. Poroger’s nephew, Igor
Poroger, who is a barrister in Ontario, tells the Court “[Emma] has consistently aided [my]

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elderly grandfather with [his] medical needs throughout the years. Without Emma around, it is
uncertain how my 93 year old grandfather will manage on a day to day basis.” (Ex. I).
Almost all of the letters to the Court use the world “selfless” to describe Emma Poroger.
(Ex. J). Monika Paroder recounts when her father, who is Dr. Poroger’s cousin, was diagnosed
with cancer: “The following months were a tumultuous whirlwind of fear, hope, anger, and
pain…during this time, Emma was the voice of optimism; Emma was the voice of knowledge;
Emma was the voice of hope. She was a solid stone for us to lean against.” (Ex. A). Similarly,
Aleksandr Koyfman, Dr. Poroger’s ex-husband, who has battled 3 forms of cancer describes
“Emma was there for me during those tough times, frequently visiting me in the hospital and
helping me [get] through chemo and radiation treatments.” (Ex. K). When family friend Lyuba
Lebedeva’s mother was diagnosed with stage 4 pancreatic cancer, Dr. Poroger was one of the
first people to reach out to Lyuba with words of support and advice. (Ex. L).
Sema Krichman describes how Emma Poroger routinely finds time to check in and give
necessary advice to Sema regarding her 92 year old mother. (Ex. M). Dr. Poroger helps those in
need: (i) driving a friend to do groceries after Hurricane Sandy hit—otherwise Alla would not
have had any means to get the products home (Ex. N); (ii) driving pregnant friend Irina to her
doctors’ appointments (Ex. O); (iii) indefinitely opening her home during Hurricane Irene to the
Ozeryan family who did not have a safe place to stay—Dr. Poroger drove from Staten Island to
Coney Island to pick them up (Ex. P); (iv) traveling a long distance to friend Elena’s house on a
late Friday afternoon to give Elena’s son an injection to treat poison ivy (Ex. Q).

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III.

Medical Training
While living in Ukraine, Dr. Poroger attended Chernovtsy Medical School and graduated

in 1978 as a qualified medical doctor. (PSR ¶ 39). Anatoly Goldenfeld recalls the
discrimination against Jewish people in terms of admission to medical school, but describes how
Dr. Poroger not only successfully completed medical school but did so as one of the best
students at Chernovtsy. (Ex. R). Dr. Poroger worked as a physician in Ukraine from 1978 to
1992: (i) chief of the emergency division of Storozhynets Hospital (1978-1982) (PSR ¶ 52); and
(ii) internal medicine physician for the Chernovtsy District Psychiatric Hospital (1982-1992)
(PSR ¶ 53). At the age of 42, and less than 5 years after emigrating from Ukraine with her
young son, Dr. Poroger attended medical school once more, this time at the New York College
of Osteopathic Medicine in Old Westbury, New York. (PSR ¶ 27). As Dr. Poroger’s nephew,
Igor, observed “Emma’s ethos for hard work and determination has been an inspiration to those
around her. She put herself through medical school, well into her middle age, and never asked
for any help from anyone.” (Ex. I). Emma attended English classes when she first moved to the
United States and as family friend, Denis Shtabel recalls, “During the late 90’s when I would
visit her home, I would see stacks of medical books, notes, diagrams, and English/Russian
dictionaries opened and being used in every room and on every desk/table of her house. She was
immersed in studying.” (Ex. S). In 2000, Dr. Poroger completed medical school and undertook a
medical internship and residency in New Jersey. (PSR ¶ 27). Dr. Poroger secured licenses to
practice medicine in New York, New Jersey, and Florida and also achieved board certification by
the American Osteopathic Board of Family Medicine. (PSR ¶ 38).
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IV.

Devotion to Patients
Dr. Poroger’s patients admire and respect her, which is reflected by the many letters to

the Court from patients who have stood by Dr. Poroger during the last four years since her legal,
financial, and personal circumstances deteriorated. At the time of her arrest, Dr. Poroger ran a
private medical practice, Penfel Medical, PC, with two offices: (i) Jersey City, New Jersey; and
(ii) Staten Island, New York. (PSR ¶ 40). After her arrest, insurance companies began to steadily
drop Dr. Poroger as a covered medical provider and neither of her offices was able to earn a
profit. Dr. Poroger kept the offices open, albeit on a part-time basis, and operated at a loss
because she believed in serving her patients who relied on Dr. Poroger’s care. Id.
What really sets Dr. Poroger apart from the norm is her unparalleled compassion and
respect for her patients. Leonid Katsman, a longtime patient of Dr. Poroger, echoes these
sentiments. “Dr. Poroger has demonstrated the utmost respect for me as a patient” and “I have
on many occasions witness[ed] her compassion, care, and courtesy” in treating other patients.
(Ex. T). As Yaniris Candelaria, a medical assistance who worked with Dr. Poroger for many
years recounts, “The time I have spent in her office, I could understand why her patients loved
her so much. She was very attentive and concerned about not only their medical needs, but to
their needs as people.” (Ex. U).
Dr. Poroger made a difference in the lives of many patients. (Ex. V). Izabella Genin, a
patient of Dr. Poroger recounts how she met Dr. Poroger in a difficult time of her life. “It was
after a car accident with a drunk driver in which I sustained serious injuries that greatly affected
my personal and professional life. Under the devoted and exceptional care of Dr. Poroger, I was
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able to continue working until my retirement and be free from pain in my everyday activities.”
(Ex. W).
According to Tatyana Katsman, Doctor of Osteopathic Medicine, and colleague to Dr.
Poroger “over the years I have seen Dr. Poroger serve her patients to a degree that is compared to
none.” (Ex. X). Dr. Poroger is known to answer her patients’ calls to her cellular phone “24
hours a day, 7 days a week.” (Ex. Y); (Ex. Z).
V.

Severe Health Problems
Since her arrest, Dr. Poroger has suffered from a myriad of physical and mental health

problems, which are well documented in the PSR and the Addendums to the PSR. Beginning in
January 2011, Dr. Poroger fell into a severe depression and began to experience suicidal
thoughts. In March 2011, Dr. Poroger sought treatment for her depression attending regular
therapy sessions with a psychiatrist. In January 2013, Dr. Poroger was diagnosed with major
depressive disorder and anxiety disorder, with severe helplessness and hopelessness. (Second
PSR Addendum). As a result, Dr. Poroger takes multiple daily medications to treat her anxiety
and depression. Id. Dr. Poroger also attends biweekly psychotherapy sessions in addition to the
psychotropic medications she takes regularly. (Ex. AA). Dr. Poroger has expressed to her
pretrial services officer that “she will not survive if she has to go to prison” and doesn’t know
how she will “go on.” (Second PSR Addendum). Dr. Poroger’s son reported that prior to her
arrest, she did not suffer from any mental health or emotional problems. (PSR ¶ 31).
In addition to her mental health and emotional problems, Dr. Poroger has been diagnosed
with a number of conditions for which she takes a significant amount of prescription medication.
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(Second PSR Addendum). In 2011, Dr. Poroger underwent surgery as a preventative measure
due to the discovery of pre-cancerous cells. (PSR ¶ 33). In 2012, she was diagnosed with
multiple cardiac conditions, including hypertension and severe diastolic heart failure—conditions
which prevent her from working full time and which require regular medical care. (Second PSR
Addendum). In 2012, Dr. Poroger was also diagnosed with chronic severe low back pain and
pelvic pain due to lumbar-sacral spondylitis, which prevents Dr. Poroger from walking for more
than 20 minutes or sitting for more than 40 minutes. Id. She was also diagnosed in 2012 with
pituitary adenoma and chronic hypertensive vascular changes—which rendered her “functionally
significantly disabled” and “practically disable[d].” Id; (Ex. BB). Dr. Poroger receives
acupuncture treatments regularly to combat migraine headaches, dizziness, vertigo, insomnia,
anxiety, depression, constipation, incontinence, tinnitus, pain in the neck, lower back, shoulders,
knees, legs and feet. (Ex. CC). Due to Dr. Poroger’s severe medical problems and resulting
disability, she stopped working in December 2012 and began to draw disability payments from
her life insurance company. (Second PSR Addendum).
VI.

Fall From Grace
Since her arrest in the instant offense, Dr. Poroger has suffered debilitating loss in

multiple aspects of her life: health wise—mentally, emotionally, and physically; financially; and
professionally. According to Dr. Poroger’s psychiatrist, Dr. Isakov, Dr. Poroger “fears to be left
alone,” has become “isolative and withdrawn” since her legal issues began, and she has “lost
interest in life [] frequently expressing her desire to end her life and end her suffering.” (Ex.
AA).
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For example, in his letter to the Court, Bezenchuk, Dr. Poroger’s stepbrother, writes
“You cannot imagine [Emma’s] sadness and remorse in her lapse in not following [her] values.”
(Ex. F). “Your Honor, it is hard for me to explain how much she has already been punished.
Emma’s health has deteriorated significantly over the past years. She is filled with anxiety and
depression which has exacerbated her chronic medical conditions.” (Ex. G). Koyfman similarly
observed “Knowing Emma as well as I do, I can see the toll this ordeal has taken on her. She
was a woman who was capable of working 80-100 hours a week; now she can barely walk
without a cane. However, the physical ailments are nothing in comparison to the mental anguish
she is experiencing.” (Ex. K).
Dr. Isakov expressed that Dr. Poroger’s main source of support is her son who visits her
frequently and assures Dr. Poroger that she is safe. Id. The instant case has taken a significant
toll on Dr. Poroger. “My mother was a vibrant and energetic woman, but in the last 3.5 years,
her health has significantly deteriorated…Her mental health is also in serious decline.” (Ex. C);
(Ex. DD). Putting aside the onset of multiple crippling health issues, the fallout from her
criminal case resulted in the loss of Dr. Poroger’s medical practice and her means of financial
independence. “The fact that she will never again practice medicine has been an enormous
emotional burden for Emma.” (Ex. DD).
A condition of Dr. Poroger’s plea agreement was that she forfeit her home located at 97
Giffords Lane in Staten Island (PSR ¶ 57). Additionally, Dr. Poroger was left in financial ruin
and with no choice but to file for Bankruptcy. (Second PSR Addendum). Dr. Poroger has lost
everything.
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Your Honor, I can tell you firsthand the shame, remorse and guilt my mother feels on [a]
daily basis for what she has done. She lives in misery and pain everyday, and she has
spent many sleepless nights agonizing over how this will impact the future of her family.
She knows she made a mistake and is extremely regretful for what she has done. She will
never forget what happened, and she strives every day to live a moral and honest life.
(Ex. C).
THE OFFENSE CONDUCT
From November 2006 through March 2009, Dr. Poroger served as the medical director
for North Austin Medical, P.C., a medical clinic located in Forest Hills, Queens. Poroger was
hired as medical director by the co-owner of a billing company called Claim Torrent, Inc. The
North Austin office was managed by Queens North, Inc. During Dr. Poroger’s tenure at North
Austin, approximately $13 million was billed in claims to Medicare under her Medicare provider
number, of which approximately $4 million was paid. A Significant portion of the $13 million
billed to Medicare was resubmissions of claims previously denied. Although Dr. Poroger signed
an enrollment application that was submitted to Medicare in which she certified that all claims
submitted under her provider number would be true, accurate, and medically necessary, Dr.
Poroger left the task of submitting bills to Queens North and Claim Torrent.
Nevertheless, Dr. Poroger would provide Queens North and Claim Torrent with an
accurate statement of the treatments she provided with accurate coding. There is no dispute that
Dr. Poroger honestly treated her patients to the best of her ability, performed services that she
believed to be medically necessary, and never submitted fraudulent accounts of her treatments to
patients. She relied on the assurances of Queens North and Claim Torrent that the bills that

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would be submitted to Medicare would accurately reflect the services she provided and the codes
that she assigned to those services.
In September 2008, only about six months before she left North Austin, Dr. Poroger
discovered that an electrocardiogram test was ordered for a patient without her knowledge or
approval. She also noticed that around that time period, revenues increased significantly without
any noticeable change in the number of patients she treated or the number of hours that she
worked. At that point, Dr. Poroger became aware of circumstances that strongly indicated that
her office manager and billing company were engaged in fraudulent billing. Although Dr.
Poroger chastised her office manager for ordering and billing for the unnecessary test, she did
not investigate whether fraudulent billing continued. She took no corrective measures to prevent
fraudulent billing and did not inform law enforcement or Medicare of her discoveries. It was
only after her arrest, when she began cooperating with the government, that she learned of the
substantial scope of the fraudulent scheme.
THE GUIDELINES CALCULATION
A district court should begin all sentencing proceedings by correctly calculating the
applicable Sentencing Guidelines. See United States v. Crosby, 397 F. 3d 103, 112-13 (2d Cir.
2005). The defense agrees with the government and the Probation Department that the
applicable Guidelines Manual in effect is the 2009 Guidelines. See PSR ¶10. Furthermore, the

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defense agrees that the base offense level applicable to the offense is 6 and that a two-level
enhancement for abuse of a position of trust is warranted under Section 3B1.3.1 The defense,
however, strongly disputes the government and Probation’s calculation of “loss” under Section
2B1.1, which asserts that a 20-level enhancement is warranted for a loss of over $13 million. See
U.S.S.G. § 2B1.1(b)(1)(K).
It is well established that loss under the Guidelines need not be established with
precision, and the Court, in determining the loss, “need only make a reasonable estimate of the
loss, given the available information.” United States v. Uddin, 551 F.3d 176, 180 (2d Cir. 2009).
Nevertheless, a “reasonable estimate” may not be based on “pure speculation.” United States v,
Deutsch, 987 F.2d 878, 886 (2d Cr. 1993). Nor can a flawed methodology that is the basis of an
asserted loss amount satisfy the “reasonable estimate” standard. See United States v. Cuti, 2011
WL 3585988, at *6 (S.D.N.Y. July 29, 2011) (holding that government failed to meet its burden
in establishing loss because it refused to consider other relevant data and methodologies in
arriving at its loss figure). Indeed, a loss calculation must be based on clearly articulable
conclusions and assumptions based upon evidence in the record and subject to evaluation by the

1 The parties previously have submitted substantial briefing on the calculation of loss and on the

potential enhancement for abuse of trust. See Dkt. ## 63, 64, 65, 68, 74, 76, and 77. In reviewing
the Guidelines submissions, current counsel departs from the position of previous defense counsel as
to the applicability of the two-level enhancement for abuse of trust under Section 3B1.3. We
concede that decisional authority supports the position of the government and Probation that the
enhancement is warranted under the facts and circumstances of this case. However, we dispute the
government and Probation’s calculation of loss under Section 2B1.1 for the reasons set forth herein.

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defendant. See, e.g., United States v. Hartstein, 500 F.3d 790, 796 (8th Cir. 2007) (vacating
sentence and remanding where government presented summary tables regarding an accounting
of the fraudulent loans at issue in the case, but the tables were based on evidence that was neither
before the court nor available to the defense to evaluate).
The loss calculation advanced by the government and Probation of $13 million lacks a
coherent methodology with respect to Dr. Poroger and is fundamentally flawed. First, the $13
million figure is based on the total amount billed by North Austin to Medicare from October
2006 through March 2009. See PSR ¶ 5; Dkt. ## 64, 73. This calculation improperly assumes
that all billing was fraudulent, notwithstanding that even the government must concede that
legitimate services were performed for patients at North Austin. Thus, the government’s loss
calculation ignores that a significant portion of the amount billed to Medicare was for legitimate
services.
Second, the government does not dispute that Dr. Poroger first discovered fraudulent
billing to Medicare in September 2008. At that time, she learned that an electrocardiogram was
ordered and billed without her authorization. The government does not contend that Dr. Poroger
knew at the time that the managers of the North Austin clinic and the billing company had been
altering her accurate reports of the treatments she provided, and submitted bills to Medicare that
overstated the extent of the services performed and included services that were never performed.
In these circumstances, Dr. Poroger cannot, for Guidelines purposes, be held accountable for
fraudulent billing pre-dating September 2008 because the scope of the fraudulent billing
committed by her co-conspirators was not reasonably foreseeable to her. See, e.g., Familglietti v.
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United States, 2010 WL 996004, *2 (S.D.N.Y. Mar. 12, 2010) (“A defendant convicted of
conspiracy is properly held liable for all of the victim’s reasonably foreseeable losses”); United
States v. O’Campo, 973 F.2d 1015, 1024 (1st Cir. 1992) (“[T]he concept of foreseeability (a
forward looking concept) must be turned around 180 degrees [to] be applied to the conduct of
co-conspirators occurring before the entry of a particular defendant into the conspiracy.”);
Bryant v. Mattel, Inc., 2010 WL 3705668 (C.D. Cal. Aug. 2, 2010) (“[A] conspirator cannot
reasonably foresee his co-conspirators’ commission of overt acts prior to his entry into the
unlawful agreement.”).
In these circumstances, the appropriate time period to evaluate the loss properly
attributable to Dr. Poroger under the Guidelines is September 2008 through March 2009. During
that time period, $2,458,440.91 was billed to Medicare under Dr. Poroger’s Medicare PIN that
was associated with North Austin. See Dkt. #73 at 1. That loss figure should be reduced by the
amounts billed for legitimate services performed, and further by the $25,000 that Dr. Poroger
voluntarily returned to Medicare during its audit of North Austin, prior to her indictment. See
Dkt. #74 at 5-8. Assuming, however, the offsets do not bring the loss figure below $1,000,000,
the appropriate loss calculation, even using the total amount billed from September 2008 through
March 2009 is less than $2.5 million, and thus, only a 16-level enhancement is warranted under
Section 2B1.1. See U.S.S.G. § 2B1.1(b)(1)(I).
Accordingly, the appropriate Guidelines calculation is a level 21, which is premised on a
base offense level of 6, a loss enhancement of 16 levels, a two-level adjustment for abuse of
trust, and a three-level reduction for acceptance of responsibility. The advisory Guidelines
16

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sentence, given Dr. Poroger’s lack of any prior convictions, is therefore 37-46 months
imprisonment. For the reasons set forth in this memorandum, a downward departure under the
Guidelines is warranted because with respect to relative culpability in the offense, the loss
“overstates the seriousness of the offense” as to Dr. Poroger. See U.S.S.G. § 2B1.1, cmt. n.
19(c). Thus, the Guidelines themselves provide a basis for a sentence below the advisory
Guidelines range. See United States v. Emmenegger, 329 F. Supp. 2d 416, 422 (S.D.N.Y. 2004)
(“While some members of Congress and journalists occasionally seem to misunderstand the
concept, a sentencing departure does not constitute a subversion of the Sentencing Reform Act or
of the guidelines system. In fact, notwithstanding the shorthand terminology sometimes applied,
a departure is not a departure ‘from the guidelines’; it is a departure from the otherwise
applicable guideline range.”) (emphasis in original).
Judge Rakoff’s observation in imposing a below-Guidelines sentence in a recent case,
finding that the loss amount was disproportionate to the offense is particularly apt here:
Imposing a sentence on a fellow human being is a formidable responsibility. It requires a
court to consider, with great care and sensitivity, a large complex of facts and factors.
The notion that this complicated analysis, and moral responsibility, can be reduced to the
mechanical adding-up of a small set of numbers artificially assigned to a few arbitrarily
selected variables wars with common sense. Whereas apples and oranges may have but a
few salient qualities, human beings in their interactions with society are too complicated
to be treated like commodities, and the attempt to do so can only lead to bizarre results.
United States v. Gupta, 904 F. Supp. 2d 349, 350 (S.D.N.Y. 2012). See also, e.g., United States
v. Adelson, 441 F.Supp. 2nd 506 (S.D.N.Y. 2006), aff’d, 301 Fed. Appx. 93 (2d. Cir. 2008) (the
“Sentencing Guidelines . . . in an effort to appear ‘objective,’ tend to place great weight on
putatively measurable quantities, such as . . . the amount of financial loss in fraud cases, without
17

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however, explaining why it is appropriate to accord such huge weight to such factors.”); United
States v. Corsey, 723 F.3d 366, 380 (2d Cir. 2013) (“The history of bracket inflation directed by
Congress renders the loss guideline fundamentally flawed, especially as loss amounts climb.
The higher the loss amount, the more distorted the guideline’s advice to sentencing judges.”).
ANALYSIS OF AN APPROPRIATE SENTENCE UNDER 18 U.S.C. § 3553(a)
We respectfully submit that a sentence of probation is warranted here under the factors
set forth in 18 U.S.C. § 3553(a) in order to impose a sentence “sufficient but not greater than
necessary” to satisfy the objectives of federal sentencing. See Rita v. United States, 551 U.S.
338, 348 (2007) (quoting 18 U.S.C. § 3553(a)). Under Section 3553(a), a district court must
consider “the nature and circumstances of the offense and the history and characteristics of the
defendant.” Id. § 3553(a)(1). Moreover, the court must impose a sentence that is “sufficient, but
not greater than necessary” to, in pertinent part: (i) “reflect the seriousness of the offense,
promote respect for the law, and to provide just punishment for the offense.” (Id. §
3553(a)(2)(A)); (ii) “afford adequate deterrence to criminal conduct” (Id. § 3553 (a)(2)(B));
“protect the public from further crimes of the defendant” (Id. 3553(a)(2)(C)); and (iv) “provide
the defendant with needed educational or vocational training, medical care, or other correctional
treatment in the most effective manner.” (Id. § 3553(a)(2)(D)). In conducting this analysis, the
district court “may not presume that the Guidelines range is reasonable.” Gall v. United States,
552 U.S. 38, 50 (2007). Rather, “it must instead conduct its own independent review of the
sentencing factors, aided by the argument of the prosecution and the defense.” United States v.
Cavera, 550 F.3d 180, 189 (2d Cir. 2007). The “sentencing judge has a very wide latitude to
18

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decide the proper degree of punishment for an individual offender and a particular crime.” Id. at
188.
First, a non-custodial sentence is warranted based on the nature and circumstances of the
offense and Dr. Poroger’s personal characteristics. As set forth in the government’s submissions
to the Court, Dr. Poroger deserves consideration for the substantial assistance that she provided
in the investigation and prosecution of the offense. Furthermore, it is undisputed that Dr.
Poroger was a hard-working, devoted physician who never sought to steal from Medicare. Her
sole purpose was to treat patients. She did not plan the offense or actively participate in it.
Instead, she closed her eyes to the fraudulent scheme and did not take measures to investigate or
stop the fraud when she was put on unquestionable notice that wrongdoing was afoot.
Nevertheless, Dr. Poroger did not enjoy the profits of the fraud. She worked 12-14 hour
days and took a reasonable salary. Dr. Poroger lived comfortably in a home that she owned
(with a mortgage), but hardly lived a lavish lifestyle. She lived modestly and focused her free
time on caring for her parents and spending time with her son. Dr. Poroger was at most a
reluctant participant in the fraudulent scheme and her failure to take action to stop the fraud
represents a lapse in judgment over a short period in an otherwise exemplary life. Here, the
Court should exercise its substantial discretion and impose a non-Guidelines, non-custodial
sentence because the “defendant’s commission of the instant offense[] was aberrant behavior”,
although perhaps “not aberrant as defined by the U.S. Sentencing Guidelines, but rather as
defined by Merriam Webster: . . . atypical.” Gupta, 904 F. Supp. 2d at 354.

19

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Second, a non-custodial sentence is “sufficient, but not greater than necessary,” to
“reflect the seriousness of the offense . . . promote respect for the law, and . . . provide just
punishment.” 18 U.S.C. § 3553(a)(2)(A). The offense for which Dr. Poroger was convicted is
undoubtedly serious. However, as discussed in this memorandum, Dr. Poroger ultimately
suffered horrific personal, financial, and legal consequences as a result of her offense, and gained
nothing. Her culpability in the offense, for the reasons stated above, is much lower than that of
her coconspirators. Finally, in the over three years since her arrest, and the six years since the
offense, Dr. Poroger has a demonstrated a track record of following the law and abiding by all
the terms of her pretrial release.
In these circumstances, a non-custodial sentence is warranted. See, e.g., United States v.
Paul, 2007 WL 2384234 (9th Cir. Aug. 17, 2007) (within guideline sentence of 16 months (high
end) for taking government money was unreasonably high in part because Paul was “a first-time
offender with absolutely no criminal record whatsoever”); United States v. Edwards, 595 F.3d
1004 (9th Cir. 2010) (where defendant convicted of bankruptcy fraud and on probation for prior
state conviction for fraud, and where guidelines range 27-33 months, sentence of probation,
seven months of which was to be served under house arrest, and $5,000 fine, was not an abuse of
discretion in part because proper for judge to consider that “by the time of the 2008 resentencing, the offenses had been committed nine years previously and that Edwards had left the
stress of his earlier job in the construction business that led him to become involved in the
financial fraud scheme, and completed without incident three and one half years of probation.”).

20

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Third, a non-custodial sentence “afford[s] adequate deterrence to criminal conduct.” 18
U.S.C. § 3553(a)(2)(B). As a result of Dr. Poroger’s alleged offense: (i) she will never again be
licensed to practice medicine, (ii) her finances were devastated, (iii) her house was forfeited by
the government; (iv) her physical and mental health have substantially deteriorated; and (v) she
has spent approximately three-and-a-half year under pretrial supervision, which has involved
significant restrictions on her ability to travel. In these circumstances, one “need only consider
what happened to [Dr. Poroger] in order to reconsider [committing a similar offense]; thus,
general deterrence [is] served. United States v. Redemann, 295 F. Supp. 2d 887, 897 (E.D. Wis.
2003). See also, e.g., United States v. Gaind, 829 F. Supp. 669 (S.D.N.Y. 1993) (the destruction
of a defendant's only business, involving testing material for the EPA, warranted a downward
departure in false statement case because elimination of the defendant's inability to engage in
similar or related activities and the substantial loss of assets and income were a source of
individual and general deterrence); United States v. Anderson, 533 F.3d 623 (8th Cir. 2008)
(district court’s below-Guidelines sentence was not unreasonable in part because of collateral
consequences where district court “specifically addressed other ways in which the defendant had
suffered atypical punishment such as the loss of his reputation and his company, the ongoing
case against him from the Securities and Exchange Commission and the harm visited upon him
as a result of the fact that his actions brought his wife and friends into the criminal justice
system.”).

21

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Thus, in light of the adverse consequences Dr. Poroger suffered as a result of the alleged
offense, a non-custodial sentence is more than sufficient to deter others from committing the
same offense. As the Supreme Court observed in Gall v. United States, 552 U.S. 38, 48 (2007):
We recognize that custodial sentences are qualitatively more severe than probationary
sentences of equivalent terms. Offenders on probation are nonetheless subject to several
standard conditions that substantially restrict their liberty . . . Probationers may not leave
the judicial district, move, or change jobs without notifying, and in some cases, receiving
permission from, their probation officer or the court. They must report regularly to their
probation officer, permit unannounced visits to their homes, refrain from associating with
any person convicted of a felony, and refrain from excessive drinking. Most probationers
are also subject to individual “special conditions” imposed by the court.
Similarly, Judge Gleeson observed in a recent opinion “when a judge chooses between a
prison term and probation, she is not choosing between punishment and no punishment.
Probation is less severe than a prison term, but both are punishment. And as the Supreme Court
has recognized, probation is significant punishment.” United States v. Leitch, 2013 WL 753445,
at *12 (E.D.N.Y. Feb. 2, 2013) (emphasis in original). Indeed, special conditions of probation
may include significant restrictions on liberty such as home detention. See 18 U.S.C. §
3563(b)(19) (discretionary conditions of probation may include that the defendant “remain at his
place of residence during nonworking hours and, if the court finds it appropriate, that compliance
with this condition be monitored by telephonic or electronic signaling devices.”); United States
v. Coughlin, Crim. No-06-20005, 2008 WL 313099, at *5 (W.D. Ark. Feb. 1, 2009) (“Home
detention and probation can be severe punishments, hugely restrictive of liberty, highly effective
in the determent of crime and amply retributive.”).

22

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Here, Dr. Poroger has experienced the equivalent of three-and-a-half years of Probation
by remaining under relatively restrictive conditions of pretrial supervision, especially for a
person without significant assets, without overseas or unaccounted-for assets, without foreign
ties, but with very strong ties to the community, and who has cooperated with the government.
Fourth, for the same reasons a sentence of probation is sufficient to achieve general
deterrence, it is also sufficient to “protect the public from further crimes of the defendant.”
Indeed, the “personal, business and family consequences [Dr. Poroger has] experienced will
likely deter [her] from future misconduct.” Redemann, 295 F. Supp. 2d at 897; United States v.
Mizrahi, 2008 WL 3009983, at *2 (E.D.N.Y. 1993) (where defendant loses his or her livelihood
and is thus prevented from engaging in similar crimes, “the necessity for achieving the purposes
of sentencing through sentencing itself has been reduced.”). In addition, because Dr. Poroger
will never be able to practice medicine again, she will never again be in a position to commit a
similar offense. See United States v. Speed Joyeros, 204 F. Supp. 2d 412, 440 (E.D.N.Y. 2002)
(departure appropriate where “defendant is barred by the destruction of business from
committing similar future criminal acts”); Gaind, 829 F. Supp. At 671 (where the defendant
loses his or her livelihood and is thus prevented from engaging in similar crimes, “the necessity
for achieving the purposes of sentencing through sentencing itself has been reduced.”).
Fifth, a non-custodial sentence is warranted in order “to provide the defendant with
needed . . . medical care, or other correctional treatment in the most effective manner. 18 U.S.C.
§ 3553(a)(2)(D). Dr. Poroger currently suffers from severe physical and psychiatric
impairments. Most seriously, she suffers from major cardiac conditions, impaired vision,
23

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impaired movement, severe depression, severe anxiety, and suicidal ideation. She is prescribed
over 18 medications and requires frequent visits to her medical providers, who are fully familiar
with her myriad conditions and have treated her for several years. If Dr. Poroger is incarcerated,
it is substantially unlikely that Dr. Poroger will receive the health care she desperately needs for
her chronic physical and psychological conditions.

24

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CONCLUSION
Accordingly, a non-Guidelines, non-custodial sentence is sufficient, but not greater than
necessary to satisfy the objectives of federal sentencing set forth in 18 U.S.C. §3553(a). For the
foregoing reasons, we respectfully request that the Court impose a non-custodial sentence.
Dated:

New York, New York
April 10, 2015
Respectfully submitted,
/s/ Eric M. Creizman
Eric M. Creizman
Melissa Madrigal
CREIZMAN PLLC
565 Fifth Avenue, 7th Floor
New York, New York 10017
Phone: (212) 972-0200
Fax: (646) 200-5022
[email protected]
Attorneys for Emma Poroger

25

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March 30, 2015.
The Honorable Dora L Irizarry
United States District Court Judge
United States District Court
Eastern District of New York
225 Cadman Plaza East
Brooklyn, New York 11201
Dear Honorable Judge Irizarry,
My name is Monika Paroder and I am a resident physician at New York Presbyterian- Columbia University
Medical Center, mother of two baby boys, and Emma’s niece. Thus needless to explain, I have known
Emma my entire life. I would like to share with you some insight into Emma’s character – a selfless
dedicated woman of incredible strength, kindness, and compassion.
Almost five years ago, my life, my family’s life and the world as I knew it had changed forever. My dad was
diagnosed with cancer. The following months were a tumultuous whirlwind of fear, hope, anger, and pain;
moments that will forever be vividly ingrained in my memory. During this time, Emma was the voice of
optimism; Emma was the voice of knowledge; Emma was the voice of hope; Emma was the voice of reality.
She was a solid stone for us to lean against, yet I know it was unimaginably difficult for her. Emma too lost
her mother when she was in her 20s.
Emma is my dad’s cousin, my aunt. In reality though, she was like his sister and more that that, she is my
mom’s dear friend. Her life story is not unlike many other immigrants’. She came to this country in refuge of
a bright future for her son and her family. Her decision to enter the highly regarded field of medicine was
driven by the selfless, fervent desire to help people, even at her own expense. As a foreigner, she was
faced with a new culture, a new language, the challenge of starting a new life. She succeeded, like she
always did. She was a role model for me – a woman with a career, a family, friends who love her.
There is one quality I love about Emma most. Emma always believes; she has faith. She sees the good in
anyone, even that bum on the corner begging for money for a family he doesn’t have. She trusts people; she
is all about second chances. She doesn’t question whether people have ulterior motives. She is honest and
she thinks the world is too. It is rare to encounter people of this character these days.
Emma has always been an honest woman with immense perseverance and incredibly high values. While I
know it sounds like a cliché, it is in the nature of human beings to make mistakes. I truly do believe Emma
acted very much out of her character. As the Roman Philosopher Lucius Annaeus Seneca once said,
“There is no person so severely punished, as those who subject themselves to the whip of their own
remorse.” To say that Emma is punished by her remorse for her actions would be an understatement.
Emma is the only remaining family from my dad’s side that my family and I have left here in the US. Today,
your honor, I am terribly fearful that Emma may be taken away from those that love her and depend on her
and that my two little boys may not have the opportunity to get to know her and their roots. “Love and
compassion are necessities, not luxuries. Without them humanity cannot survive,” said the Dalai Lama. I
hope that you will show my aunt, Emma Paroger, compassion, as she has always shown to everyone in her
life, even those who don’t deserve it.
I plead for you to be kind to our family and allow her to remain with us.

Respectfully,
Monika Paroder-Belenitsky, MD, PhD

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March 17,2015
The Honorable Dora L.lrizarry
United States District Court Judge
United States District Court
Eastern District of New York
225 Cadman Plaza East
Brooklyn, New York 11201
Dear Judge lrizarry:
My name is Matvey Nikhamin. I currently work as Senior Application Analyst at
Partners HealthCare in Boston area.
I am aware that Emma has been convicted of a crime and that you are going to
be sentencing her in connection with this crime. I would like to request as much

Ieniency as possible in Emma's sentencing.
I have met Emma about 22 years ago, soon after she and her family immigrated
to the United States. Ever since then, I have known her as a great friend to my
family and also as a mother of one of my best friends. My family and I have gone
through many of the same life-changing experiences as our families immigrated
to the United States around the same time and endured many of the same
difficulties and challenges in order to settle here. Emma and her husband, same
as my parents, had to uproot their whole lives, careers in order to come here.
Decade's worth of memories, possessions, connections and relationships were
left behind, suspended - in order to bring kids to better and safer future.

Emma, who was a doctor back in Ukraine, was determined to become a doctor
here as well. She knew how challenging and demanding the path to becoming a
doctor was. For Emma it meant going back to school, it meant learning English
and mastering it as quickly as possible in order to succeed. Any one of these is a
great challenge to an individual, but for Emma this was a challenge worth facing
and overcoming. Emma had a plan and she put forth extraordinary amount of
effort to follow through on it.
At the same time as Emma started on a path to become a doctor again, she and
her husband had to quickly learn, understand and organize future of their 15 year
old son. They were under a lot of pressure to make the best possible choices for
their son. They had to digest a lot of new and important information to make
decisions as their son entered school mid-sophomore year and he was going to
be applying to Colleges and Universities very soon. Emma, as most immigrant

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parents, had a vision of better and brighter future for her son, when she made a
decision to come to the United States. Emma's goal was to do everything
possible to help her son to achieve and excel in the new country, new city, new
school, new environment.
Besides, having gone through immigration and settling, there was another life
event in Emma's life that was very close to what my family has gone through.
Emma went through divorce, just like my parents did. However, unlike my
parents Emma and her husband made sure that the divorce had as little affect on
her son as possible. Emma and her husband had strong commitment to support
their son even after separation. They collaborated together to attend his
birthdays, graduations, and a wedding. They worked together to provide him any
support he needed while he was nearby in medical school and after from a far
with frequent visits and phone calls. Being one of his best friends, I can candidly
say that his hard work, ethics, integrity are reflection of Emma's strong values.
Furthermore, over the past 22 plus years Emma has also been one of my
mother's closest friends here in United States. Emma has been a shoulder to
lean on for my mother numerous times over the years. While in the beginning
there was a lot of common challenges to overcome, over time Emma and my
mother were on different paths. A lot had to do with my mother's persistent health
issues and bitter divorce, but no matter what Emma was always there for her.
Even during these hard times after her arrest and plea, Emma always found time
to reach to my mother and check in on her to make sure she was ok. Whenever
Emma could not reach my mother after numerous calls, she would call me to find
out if I talked to her and she was ok.
For me, growing from a teenage boy, to a parent myself in the country that is my
second home I can really appreciate the effort and strength it took for Emma to
accomplish as much as she did under such trying circumstances. Emma and my
parents made this once in a lifetime decision to come to this country. ln the last
few years I have continuously tried to measure myself against my own parents
and parents of my friends - Am I courageous enough? Am I determined enough?
Do I have strength to start everything over? Do I have what it takes? - To even
entertain such decision. Emma with her husband and my parents went far
beyond just thinking about it. They did it. And, I have always felt that our parents
sacrificed some of the best years of their lives to get us here and to watch us
grow and succeed. We are forever indebted to them for it. Seeing us and our
children develop and establish ourselves is the best gift we can give them at this
time. And, for Emma who is going to become a grandmother this June - it would
be such a huge triumph to meet her future grandson, To be there when he is
born, to be there to see his first smile, to be there when he starts lifting his head,

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and to be there seeing how a giant step taken some 20 odd years ago led to first
tiny baby steps - propelling new life to better and brighter future.

firmly believe in Emma's strength, integrity, perseverance, and determination to
overcome many challenges. I have seen it over the years, as I have seen Emma
rise to the occasion to accomplish and achieve things that seemed unimaginable.
She has always done it with dignity, grace and sincerity. I hope with all my heart
that Emma can avoid any jail sentence and can continue in her role as mother,
grandmother and a friend for everyone that's close.
I

Respectfully yours,

Matvey Nikhamin

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Igor
 Poroger
 
22
 Market
 Road,
 Flat
 7
 
 London,
 United
 Kingdom
 
 N7
 9GS
 
Phone:
 +44
 7449929691
 
 E-­‐Mail:
 [email protected]
 

 

March
 18,
 2015
 

 
The
 Honorable
 Dora
 L.
 Irizarry
 
United
 States
 District
 Court
 Judge
 
United
 States
 District
 Court
 
Eastern
 District
 of
 New
 York
 
225
 Cadman
 Plaza
 East
 
Brooklyn,
 New
 York
 11201
 

 

 
Dear
 Judge
 Irizarry,
 
Please
 accept
 this
 letter
 in
 support
 of
 my
 aunt
 Dr.
 Emma
 Poroger.
 I
 can
 appreciate
 that
 an
 
endorsement
 letter
 from
 a
 family
 member
 may
 not
 be
 very
 convincing
 to
 you,
 given
 the
 
inherent
 bias.
 For
 this
 reason,
 I
 write
 this
 letter
 as
 both
 a
 concerned
 family
 member
 and
 as
 a
 
fellow
 officer
 of
 the
 court.
 With
 the
 utmost
 respect
 for
 the
 justice
 system,
 I
 implore
 you,
 in
 
your
 deliberations
 regarding
 Emma’s
 sentencing,
 to
 please
 consider
 her
 good
 character
 
before
 coming
 to
 your
 decision,
 and
 that
 incarceration
 does
 not
 form
 part
 of
 her
 sentence.
 
 
Emma
 is
 the
 type
 of
 person
 who
 will
 rarely
 say
 “no”
 when
 someone
 is
 in
 need.
 She
 will
 go
 
above
 and
 beyond,
 though
 in
 her
 eyes
 I
 think
 she
 is
 merely
 being
 herself.
 
 I
 know
 this
 
because
 she
 has
 consistently
 aided
 both
 my
 parents
 and
 elderly
 grandfather
 with
 their
 
medical
 needs
 throughout
 the
 years.
 Without
 Emma
 around,
 it
 is
 uncertain
 how
 my
 93
 year
 
old
 grandfather
 will
 manage
 on
 a
 day
 to
 day
 basis.
 
 
Emma’s
 biggest
 flaw
 is
 that
 she
 forgets
 to
 think
 about
 herself
 when
 the
 interests
 of
 others
 
are
 at
 stake.
 Quite
 recently,
 Emma
 went
 out
 of
 her
 way
 for
 me,
 gathering
 my
 grandfather’s
 
naturalization
 documents,
 as
 I
 required
 these
 for
 a
 personal
 immigration
 matter
 while
 
living
 abroad.
 This
 was
 no
 easy
 feat,
 as
 Emma
 had
 to
 personally
 escort
 my
 grandfather
 (who
 
had
 not
 left
 Brooklyn
 in
 several
 years)
 to
 Manhattan,
 translate
 various
 documents
 for
 
government
 clerks,
 and
 coordinate
 a
 complicated
 over-­‐legalization
 process
 to
 validate
 the
 
documents
 for
 foreign
 use.
 Without
 Emma’s
 help,
 my
 immigration
 situation
 would
 have
 
stalled,
 but
 I
 was
 never
 concerned,
 because
 knowing
 the
 kind
 of
 person
 my
 aunt
 is,
 a
 selfless
 
and
 dedicated
 individual,
 there
 was
 never
 a
 reason
 to
 doubt
 that
 she
 wouldn’t
 come
 
through,
 or
 that
 she
 would
 not
 be
 willing
 to
 help.
 
Emma’s
 ethos
 for
 hard
 work
 and
 determination
 has
 been
 an
 inspiration
 to
 those
 around
 
her.
 
 She
 put
 herself
 through
 medical
 school,
 well
 into
 her
 middle
 age,
 and
 never
 asked
 for
 
any
 help
 from
 anyone.
 Her
 proud
 nature
 does
 not
 allow
 her
 to
 fall
 down
 or
 pity
 herself,
 even
 

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throughout
 this
 tumultuous
 ordeal.
 It
 would
 be
 a
 travesty
 is
 she
 was
 to
 be
 prevented,
 even
 
temporarily,
 from
 inspiring
 others
 with
 her
 strength.
 
 

 I
 know
 that
 Emma
 is
 truly
 repentant
 for
 her
 error
 in
 judgement,
 and
 only
 wants
 the
 
opportunity
 to
 care
 for
 her
 family
 and
 make
 a
 positive
 contribution
 to
 her
 community.
 I
 ask
 
you
 to
 please
 consider
 the
 benefits
 to
 be
 derived
 from
 allowing
 Emma
 to
 continue
 serving
 
her
 family
 and
 community,
 and
 reflect
 on
 what
 little
 could
 be
 gained
 from
 incarcerating
 
Emma,
 other
 than
 depriving
 the
 freedom
 of
 a
 good,
 hard
 working
 and
 penitent
 woman.
 

 
Respectfully,
 
 

Igor
 Poroger,
 B.E.S.,
 J.D.
 
Barrister
 and
 Solicitor
 (Called
 to
 the
 Bar
 of
 Ontario,
 Canada)
 

 

 

2
 

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Elena
 Bronstein
 
60
 Holiday
 Ct
 
River
 Vale,
 NJ
 07675
 

 

 
Dear
 Judge
 Irizarry:
 
I
 have
 known
 Emma
 Poroger
 for
 12
 years
 and
 during
 that
 time
 span
 have
 become
 good
 friends
 with
 her.
 
First
 of
 all,
 I
 would
 like
 to
 thank
 fate
 that
 I
 met
 this
 person.
 From
 the
 first
 moment
 we
 met,
 I
 understood
 
that
 she
 was
 a
 person
 I
 could
 put
 my
 trust
 in.
 
She
 did
 a
 lot
 of
 good
 things
 for
 me
 that
 she
 did
 not
 have
 to
 do.
 First,
 she
 helped
 me
 get
 a
 good
 job
 at
 a
 
difficult
 time
 in
 my
 life.
 She
 recommended
 me
 as
 a
 medical
 biller
 to
 her
 boss.
 Because
 of
 her
 
recommendation
 he
 offered
 me
 a
 position
 in
 his
 office
 which
 improved
 my
 career
 prospects.
 It
 was
 very
 
fortunate
 for
 me
 back
 then
 because
 I
 recently
 came
 to
 United
 States
 and
 did
 not
 know
 many
 people
 in
 
the
 medical
 field
 that
 would
 put
 their
 trust
 in
 me.
 
In
 2006,
 my
 son
 got
 a
 severe
 case
 of
 Poison
 Ivy.
 It
 was
 Friday
 late
 afternoon
 and
 I
 called
 Emma
 for
 
advice.
 She
 did
 not
 even
 hesitate
 for
 a
 second
 and
 personally
 came
 to
 my
 house
 to
 give
 my
 son
 an
 
injection
 despite
 having
 to
 travel
 a
 long
 distance.
 
We
 worked
 together
 in
 VitaMed
 Family
 Practice
 for
 3
 years
 and
 later
 I
 did
 medical
 billing
 for
 her
 practice
 
and
 not
 once
 has
 she
 requested
 to
 over
 code.
 Now
 being
 an
 experienced
 medical
 biller
 and
 being
 
around
 the
 medical
 billing
 industry
 I
 can
 say
 that
 Emma
 Poroger
 was
 an
 honest
 doctor
 for
 whom
 the
 
main
 goal
 was
 to
 give
 a
 good
 care
 and
 a
 proper
 medical
 treatment
 to
 the
 patients.
 
I
 understand
 that
 in
 this
 case
 Dr.
 Poroger
 did
 not
 use
 her
 best
 judgment
 and
 she
 has
 lost
 a
 lot
 because
 of
 
this
 situation.
 But
 I
 really
 believe
 that
 this
 case
 is
 not
 a
 reflection
 of
 Dr.
 Poroger's
 character.
 She
 is
 a
 very
 
good
 person
 who
 has
 helped
 not
 only
 me
 but
 other
 people
 that
 she
 has
 come
 in
 contact
 with.
 
 
Your
 honor,
 I
 would
 like
 to
 ask
 you
 to
 be
 lenient
 with
 Emma
 Poroger.
 
 
Respectfully
 yours,
 
Elena
 Bronstein
 

 

 

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Case 1:11-cr-00742-DLI Document 117-19 Filed 04/11/15 Page 1 of 1 PageID #: 644

The
 Honorable
 Dora
 L.
 Irizarry
 
United
 States
 District
 Court
 Judge
 
United
 States
 District
 Court
 
Eastern
 District
 of
 New
 York
 
225
 Cadman
 Plaza
 East
 
Brooklyn,
 New
 York
 11201
 

 
Dear
 Judge
 Irizarry:
 
My
 name
 is
 Denis
 Shtabel.
 I
 am
 a
 Sr.
 QA
 and
 production
 support
 IT
 Manager
 at
 Aetna.
 I
 have
 
been
 working
 at
 Aetna
 for
 the
 past
 14
 years.
 
 I
 have
 known
 Emma
 Poroger
 for
 22
 years.
 
 Her
 son
 Feliks
 
and
 I
 have
 been
 best
 friends
 since
 high
 school.
 
In
 early
 90’s
 Emma
 made
 a
 decision
 to
 immigrate
 to
 US,
 hoping
 for
 a
 better
 life
 and
 a
 brighter
 
future
 for
 her
 son
 and
 her
 family.
 It
 was
 a
 difficult
 decision,
 one
 that
 would
 require
 Emma
 to
 sacrifice
 
her
 own
 successful
 medical
 career
 in
 Ukraine
 for
 the
 better
 of
 her
 loved
 ones.
 

 Once
 family
 settled
 in
 Brooklyn
 and
 Feliks
 started
 to
 attend
 high
 school,
 Emma
 went
 back
 to
 
school
 herself.
 She
 started
 with
 English
 classes
 and
 then
 applied
 for
 medical
 school.
 

 It
 was
 a
 difficult
 task
 to
 start
 all
 over
 again,
 but
 Emma
 was
 not
 intimidated
 by
 it.
 
During
 late
 90’s
 when
 I
 would
 visit
 her
 home,
 I
 would
 see
 stacks
 of
 medical
 books,
 notes,
 diagrams
 and
 
English/Russian
 dictionaries
 opened
 and
 being
 used
 in
 every
 room
 and
 on
 every
 desk/table
 of
 her
 
house.
 
 She
 was
 immersed
 in
 studying.
 

 
 
For
 Emma
 to
 go
 back
 to
 school
 at
 age
 40
 and
 to
 graduate
 with
 a
 medical
 degree
 from
 New
 York
 
College
 of
 Osteopathic
 Medicine
 in
 2000,
 speaks
 volumes
 about
 Emma’s
 tenacity,
 character
 and
 
courage.
 Years
 of
 grueling
 medical
 school
 and
 residency,
 didn’t
 break
 her
 down
 but
 instead
 made
 her
 
appreciate
 her
 family
 and
 her
 future
 profession
 even
 more.
 
She
 taught
 her
 son,
 through
 her
 own
 actions,
 that
 nothing
 comes
 easy
 in
 life,
 yet
 if
 you
 put
 your
 
mind
 and
 effort
 to
 it,
 you
 can
 achieve
 your
 goals
 and
 dreams.
 
Emma’s
 innate
 passion
 for
 medicine
 and
 her
 natural
 calling
 to
 help
 people
 is
 what
 motivated
 her
 
to
 start
 her
 medical
 career
 once
 again
 from
 the
 ground
 up.
 
 During
 Emma’s
 years
 of
 practicing
 medicine,
 
she
 has
 many
 patients
 who
 are
 thankful
 to
 her
 for
 her
 knowledge,
 her
 professionalism,
 and
 her
 ability
 to
 
listen
 and
 resolve
 their
 medical
 issues.
 

 
I
 can
 continue
 on
 and
 on
 writing
 about
 how
 much
 Emma
 means
 to
 her
 family
 and
 how
 much
 her
 
family
 means
 to
 Emma.
 I
 can
 talk
 about
 her
 life
 long
 struggle
 and
 success,
 but
 what
 I
 want
 to
 finish
 this
 
letter
 with
 is
 by
 writing
 about
 Emma’s
 positive
 impact
 on
 those
 who
 she
 comes
 in
 contact
 with.
 
 She
 
would
 always
 help
 one
 in
 need.
 
 It
 can
 be
 a
 relative,
 a
 friend
 or
 patient
 of
 hers.
 
 She
 does
 not
 
discriminate.
 
 
 I
 can
 honestly
 say
 that,
 without
 knowing
 it,
 Emma
 made
 positive
 impact
 on
 decisions
 that
 
I
 made
 in
 my
 life.
 
 
 She
 has
 a
 big
 heart
 and
 that
 heart
 is
 full
 of
 love
 and
 compassion
 for
 others.
 
 
 
 

 
 
In
 a
 couple
 of
 months
 Emma
 is
 going
 to
 become
 a
 grandma
 for
 the
 first
 time
 in
 her
 life.
 
 
I
 can
 only
 imagine
 how
 happy
 and
 excited
 Emma
 will
 be
 when
 she
 gets
 to
 see
 her
 grandson
 the
 day
 he
 is
 
born.
 And
 I
 can
 also
 imagine
 how
 devastating
 it
 would
 be
 for
 her
 and
 for
 her
 family
 to
 know
 that
 she
 
won’t
 be
 able
 to
 hold
 him
 and
 help
 taking
 care
 of
 him
 if
 she
 were
 to
 be
 sentenced
 to
 serve
 time
 in
 
prison.
 
I
 understand
 that
 Emma
 has
 pleaded
 guilty
 to
 a
 federal
 crime
 and
 awaits
 sentencing.
 I
 
understand
 that
 she
 made
 a
 mistake
 in
 judgement.
 
 Nevertheless,
 I
 believe
 that
 she
 is
 no
 threat
 to
 
society
 and
 I
 respectfully
 ask
 the
 court
 to
 be
 lenient
 and
 not
 to
 sentence
 her
 to
 jail
 time.
 

 
Respectfully,
 
 
Denis
 Shtabel.
 

 

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Izabella Genin
43 Sunset Lane
Staten Island, NY 10307
[email protected]
(347) 331-9795
March 27th, 2015
The Honorable Dora L. Irizarry
United States District Court Judge
United State District Court
Eastern District of New York
225 Cadman Plaza East
Brooklyn, NY 11201
Dear Judge Irizarry,
I am asking you to accept this letter in support of Dr. Emma Poroger. I thankfully appreciate
your time and willingness to consider this letter in your decision. This letter is about one medical
professional who is asking the court to be lenient in imposing the sentence of another medical
professional.
I was a nurse from Memorial Sloan Kettering Cancer Center who devoted the last decade of her
professional life and retired from this hospital last year. I met Dr. Emma Poroger in a very
difficult time in my life. It was after a car accident with a drunk driver in which I sustained
serious injuries that greatly affected my personal and professional life. Under the devoted and
exceptional care of Dr. Poroger, I was able to continue working until my retirement time and be
free from pain in my everyday activities.
In the medical profession, we are dealing with extreme physical and emotional pain. From my
working experience, emotional pain is equally and even greater than physical pain. This pain not
only is affecting Dr. Poroger, but also her family and friends who she takes great care of. When
dealing with emotional pain you can only overcome and care with kindness, compassion, and
dignity.
Your Honor, in my 65 years of life I have seen a lot of doctors and I can assure you that the
words "devoted, humane, passionate, kind and not one to harm" are all applied to
Dr. Poroger. We all make mistakes, but not all have the decency to admit it and sincerely
apologize. I know that Dr. Poroger is truly repentant for her mistake and is deeply in pain. Her
mistake was the result of poor judgment by letting people take advantage of her good will and
unspoiled nature.
I am confident in my pleading to you Judge Irizarry for your compassion, fairness, and wisdom.
"I have always found that mercy bears richer fruits than strict justice" – Abraham Lincoln
Respectfully yours,

Izabella Genin

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March
 27,
 2015
 

 
The
 Honorable
 Dora
 L.
 Irizarry
 
 
United
 States
 District
 Court
 Judge
 
 
United
 States
 District
 Court
 
 
Eastern
 District
 of
 New
 York
 
 
225
 Cadman
 Plaza
 East
 
 
Brooklyn,
 New
 York
 11201
 

 
Dear
 Judge
 Irizarry,
 
My
 name
 is
 Julianna
 Shtabel
 and
 I’ve
 been
 employed
 by
 Insurity
 as
 a
 Manager
 of
 Software
 Engineering
 
in
 Hartford,
 CT
 since
 2001.
 I
 am
 writing
 this
 letter
 on
 behalf
 of
 Emma
 Poroger.
 
 
I
 was
 introduced
 to
 Emma
 Poroger
 through
 my
 husband
 and
 his
 best
 friend
 Feliks
 Koyfman,
 Emma’s
 son.
 
 
This
 was
 back
 in
 2000
 when
 my
 husband
 (boyfriend
 at
 the
 time)
 and
 I
 were
 visiting
 my
 mother-­‐in-­‐law
 in
 
New
 York
 and
 met
 Feliks
 and
 Emma
 at
 a
 quite
 restaurant
 in
 Brooklyn
 for
 lunch.
 
 She
 talked
 a
 lot
 about
 
Feliks,
 his
 accomplishments
 at
 school
 and
 his
 future
 plans.
 
 I
 could
 tell
 that
 she
 is
 very
 much
 devoted
 to
 
her
 family.
 
 She
 provided
 emotional
 support
 to
 her
 son
 during
 his
 medical
 school
 years.
 
 She
 kept
 his
 
spirits
 up
 during
 difficult
 times
 and
 gave
 valuable
 advice
 when
 he
 was
 at
 crossroads
 in
 his
 life.
 
Even
 though
 these
 days
 I
 don’t
 have
 the
 pleasure
 of
 spending
 a
 lot
 of
 time
 with
 Emma,
 I
 hear
 many
 
stories
 about
 Emma
 from
 Feliks.
 
 
 Emma
 is
 always
 there
 for
 him
 and
 his
 wife.
 
 They
 are
 both
 
professionals
 with
 demanding
 jobs
 and
 Emma
 helps
 them
 with
 keeping
 up
 their
 household
 for
 which
 
they
 are
 very
 grateful
 to
 her.
 
Emma
 is
 a
 very
 positive
 and
 energizing
 person.
 
 When
 I
 think
 back
 to
 all
 the
 times
 I
 have
 been
 in
 her
 
company,
 she
 always
 had
 a
 smile
 on
 her
 face
 and
 found
 a
 way
 of
 making
 everyone
 around
 her
 laugh.
 
 
Even
 in
 dark
 times,
 she
 always
 kept
 positive.
 
Emma
 is
 expecting
 her
 first
 grandchild
 in
 June.
 
 She
 is
 very
 excited
 about
 it
 as
 she
 has
 been
 patiently
 
waiting
 to
 become
 a
 grandmother
 ever
 since
 her
 son
 was
 married.
 
 This
 is
 the
 time
 when
 Emma’s
 
involvement
 and
 help
 will
 be
 invaluable
 to
 her
 son
 and
 her
 daughter-­‐in-­‐law.
 
 Being
 deprived
 of
 ability
 to
 
see
 her
 family
 frequently
 and
 from
 being
 involved
 in
 her
 grandson’s
 life
 due
 to
 imprisonment
 will
 be
 
devastating
 for
 Emma
 and
 her
 family.
 
I
 understand
 that
 Emma
 has
 pleaded
 guilty
 to
 a
 federal
 crime
 and
 awaits
 sentencing.
 
 I
 believe
 Emma’s
 
time
 will
 be
 more
 valued
 with
 her
 family
 as
 it
 continues
 to
 grow.
 
 I
 respectfully
 ask
 that
 she
 be
 spared
 
imprisonment.
 

 
Respectfully,
 
Julianna
 Shtabel
 

Case 1:11-cr-00742-DLI Document 117-40 Filed 04/11/15 Page 1 of 2 PageID #: 673

March 25, 2015
The Honorable Dora L. Irizarry
United States District Court Judge
United States District Court
Eastern District of New York
225 Cadman Plaza East
Brooklyn, New York 11201
Dear Judge Irizarry:
My name is Viktoriya Paroder and Emma Poroger is my aunt. I am an academic
radiologist and a scientist. I know that my aunt has been convicted of a crime and
that you will be sentencing her in connection with this crime. I am writing this
letter in hope that ask for your leniency in deciding on the sentence. I am asking
you to spare my aunt, Emma Poroger, of any sentence of imprisonment. I can
state with confidence that if Emma Poroger has made any mistake in judgment, it
doesn’t at all reflect who she really is as a person and as a professional.
I have known Emma since I was a little girl. She is a very caring, warm, honest
and kind person. As I grew up I have come to realize that she is just as caring,
warm and knowledgeable physician. She has always strived to help people
irrespective of their background or social status. For her patients, there was no
time of the day when she was not reachable; always ready to listen, support and
help.
Emma has worked very hard ever since she arrived to this country. Needless to
say, she has accomplished a nearly impossible task of finishing medical school for
the second time at already not so young age in a foreign language. This is
something not very many physicians from foreign countries are able to achieve.
Having gone through many years of undergraduate and graduate training in this
country myself, I admire Emma for her perseverance, dedication, hard work and
strong work ethic.
For her immediate and extended family she has always been a source of endless
support, encouragement and pride. She has raised a son who is an excellent
physician. She is the primary caretaker of her elderly father. To the rest of us she
is just as kind, warm and caring aunt as she has always been. We can always turn
to Emma for advice, help and support, knowing that we will always get an honest,
sincere opinion on any issue.

Case 1:11-cr-00742-DLI Document 117-40 Filed 04/11/15 Page 2 of 2 PageID #: 674

Again, I am asking for your leniency in deciding Emma Poroger’s sentence to
spare her of any imprisonment.
I thank you for your time and attention to my letter.
Respectfully,

Viktoriya Paroder MD PhD


 

Case 1:11-cr-00742-DLI Document 117-41 Filed 04/11/15 Page 1 of 1 PageID #: 675

Dear Judge Irizarry,
March 31, 2015
My name is Dr. Samuel Vasershteyn and I am a retired Dentist. I have known Dr.
Emma Poroger since she was a medical student in the Ukraine and remained good friends
with her during our difficult immigrations. Emma is a remarkable physician who I
consult when any member of my family has any sort of illness. When my father was
hospitalized a few years ago she was the first person I contacted for consultation. Dr.
Poroger immediately contacted the attending physician and helped identify an alternative
diagnosis which dictated my father’s course of treatment and helped eliminate
unnecessary testing and discomfort for my father. I credit her for minimizing my father’s
hospital stay and greatly improving his outpatient treatment plan.
Emma is an astute clinician with amazing empathy which she has demonstrated to
me when answering my clinical questions and helping me make an informed health
decision. I have remained close friends with Emma as she has struggled with the terms of
the recent conviction. She feels a void in her life without the relationships and daily
interactions she had with her patients. Emma still remains a reliable and available
resource for former patients, family, and friends when it comes to health care questions.
My family and I consider Emma a member of our family. She is a benevolent soul
and a person of high integrity and morale. She has paid for her mistakes dearly and would
like to move forward and continue contributing to her close circles and community. I
plead that you spare Emma jail time and instead allow her a more constructive approach
to correct her mistakes and rebuild her life. Emma has expressed her deep regret for her
mistakes and is actively working to make amends in her life.
Respectfully,
Dr. Samuel Vasershteyn

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