Case Explained: 26a0171p.06

Court: United States Court of Appeals for the Sixth Circuit Filed: 2026-06-16 The Sixth Circuit affirmed the convictions and sentences of Evann Herrell, Mark Grenkoski, and Keri McFarlane for conspiracy to distribute controlled substances, healthcare fraud, and money laundering arising from their operation of “Express Health Care,” a clinic that functioned as a “pill mill.” The court held that the evidence was sufficient to support the verdicts under the standard established in *United States v. Ruan*, 597 U.S. 450 (2022), which requires proof that the defendants subjectively knew their prescriptions were not issued for a legitimate medical purpose or in the usual course of professional practice. The court found ample evidence, including testimony regarding abnormal prescribing doses, lack of patient examinations, and the defendants’ awareness of drug diversion, satisfied this subjective mens rea requirement beyond a reasonable doubt. Regarding evidentiary challenges, the court applied an abuse of discretion standard to rulings on the admissibility of the repealed X-waiver rule, speculative lay witness testimony, hearsay statements offered to show effect on the listener, text messages regarding clinic security, and references to patient deaths. The court determined that the district court did not abuse its discretion in excluding or admitting these items, noting that any potential errors were harmless given the overwhelming evidence of guilt. Specifically, the court found that evidence of the X-waiver rule’s repeal was too temporally distant to be relevant to the defendants’ state of mind during the conspiracy, and hearsay regarding patient diversion was admissible to show notice to the doctors rather than for the truth of the matter asserted. The court also rejected McFarlane’s motion to sever, finding she failed to demonstrate the “compelling, specific, and actual prejudice” required under Federal Rule of Criminal Procedure 14 to justify a separate trial. The court further ruled that the jury instructions regarding mens rea and deliberate ignorance were legally accurate and did not misstate the law following *Ruan*. Finally, the court rejected Grenkoski’s motion to correct or reduce his sentence under Federal Rule of Criminal Procedure 35, holding that the district court correctly dismissed the motion as untimely because it was filed after the 14-day jurisdictional deadline had expired. As a practical consequence, the defendants’ convictions and prison sentences remain in effect, and no new trial or resentencing will occur. Do It For The Case Law is a news reporting service. Nothing in this episode constitutes legal advice.