United States v. Adebola Adefunke Adebimpe, 819 F.3d 1212

Patrick Sogbein (owner of Debs) and Adebola Adebimpe (owner of Dignity) ran a scheme supplying unnecessary power wheelchairs to Medicare beneficiaries and billing Medicare through an intermediary (Noridian).
Suppliers enrolled in Medicare and certified compliance; Medicare’s electronic system used modifiers (notably KX) to auto-process claims based on supplier certification rather than routine document review.
Physicians (notably Dr. Calaustro) provided prescriptions without proper face-to-face exams; suppliers delivered chairs without adequate home assessments.
Trial evidence showed suppliers have responsibilities to verify medical records, perform home assessments, recommend appropriate equipment, and choose claim modifiers; some suppliers (Sogbein and Adebimpe) nonetheless submitted fraudulent claims.
Jury convicted both defendants of health-care fraud/conspiracy; district court applied a two-level Sentencing Guidelines §3B1.3 abuse-of-trust enhancement.
Ninth Circuit majority affirmed: DME suppliers can occupy a position of trust when they exercise professional/managerial discretion in determining equipment need and personally certify claims; dissent argued supplier duties are largely ministerial under the LCD framework.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether DME suppliers occupy a position of public or private trust (U.S.S.G. §3B1.3)	Gov't: Suppliers exercise professional/managerial discretion (select equipment, perform home assessments, decide KX modifier) and thus held a trust position vis-à-vis Medicare	Defs: Supplier duties are ministerial—verify physician’s 7-element order and checklist under LCDs; substantive medical determinations rest with physicians	Court: Held yes — suppliers may have requisite discretion where they determine appropriateness, perform/verify home assessments, and personally certify claims, so §3B1.3 applies
Whether abuse of that trust significantly facilitated or concealed the offense (requirement for the 2-level enhancement)	Gov't: Suppliers’ certifications and use of Medicare’s honor-system reimbursement (KX) enabled massive, automated payments and thus materially facilitated fraud	Defs: Any failure to follow procedures was simply part of the underlying fraud, not evidence of a distinct facilitation by a trust role	Court: Held no clear error — defendants’ roles and certifications allowed automatic reimbursement and substantially facilitated the fraud

United States v. Aubrey, 800 F.3d 1115 (9th Cir. 2015) (abuse-of-trust analysis: first decide trust status de novo, then clear-error review of facilitation)
United States v. Laurienti, 731 F.3d 967 (9th Cir. 2013) (professional or managerial discretion is dispositive for §3B1.3)
United States v. Rutgard, 116 F.3d 1270 (9th Cir. 1997) (physician convicted of Medicare fraud occupies position of trust)
United States v. Contreras, 581 F.3d 1163 (9th Cir. 2009) (post-commentary emphasis on substantial professional/managerial discretion; mere ability to commit hard-to-detect wrongdoing is insufficient)
United States v. Willett, 751 F.3d 335 (5th Cir. 2014) (upholding §3B1.3 for DME owner; Medicare relies on suppliers’ honesty)
United States v. Garrison, 133 F.3d 831 (11th Cir. 1998) (rejecting §3B1.3 for health-care executive where intermediary/fiscal agent reviewed claims and defendant lacked direct discretion)
Broderson v. United States, 67 F.3d 452 (2d Cir. 1995) (statutory reporting duties and certification obligations alone do not necessarily create a §3B1.3 trust position)