U.S. v. Gumila

Dist. Ct. did not err in sentencing defendant to 72-month term of incarceration on several counts of healthcare fraud and making false statements in connection with healthcare matter that was based, in part, on finding that Medicare suffered losses totaling $2.375 million for unnecessary and upcoded home visits, $9.45 million for skilled-nursing services that were either unnecessary or did not meet Medicare’s requirement, and $3.779 million in claims for care-plan oversight services that did not qualify for payment or were never performed. Ct. rejected defendant’s argument that Dist. Ct. should have limited loss calculation to $14,449 that arose from eight patients specifically mentioned in indictment. Moreover, record showed that all of Dist. Ct. calculations were conservative with respect to what govt. had alleged that defendant had upcoded or fraudulently billed. Ct. also rejected defendant’s claim that her sentence was substantively unreasonable, after noting that said sentence was less than half of low end of applicable guideline range.