United States v. Alexander Popov
742 F.3d 911
| 9th Cir. | 2014Background
- Defendants-Appellants Ramanathan Prakash and Alexander Popov were convicted of conspiracy to commit health care fraud and health care fraud counts following a jury trial.
- The district court sentenced Popov and Prakash with guideline calculations using the total amount billed as intended loss and imposed restitution.
- The government sought loss calculations based on Medicare billing; Popov and Prakash argued loss should be limited to amounts actually paid by Medicare.
- Trial evidence showed the Sacramento clinic billed Medicare for over two million dollars, with Medicare paid amounts substantially lower than billed.
- 2011 amendments to the Guidelines and application notes instruct that billed amounts may be prima facie evidence of intended loss in government health care program cases; on appeal the court vacated and remanded for resentencing on the loss issue.
- The court also addressed foreseeability of Popov’s and Prakash’s liability for claims under their co-defendant’s provider numbers and affirmed some accountability findings while vacating on the loss question.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is intended loss the billed amount or the Medicare-paid amount? | Gov’t: billed amount should establish intended loss as prima facie. | Popov/Prakash: use Medicare-paid amounts; billed overstates intent. | Remand for resentencing; reliance on billed amounts as prima facie evidence with rebuttal allowed; clarify standard. |
| Foreseeability of Popov/Prakash for co-defendant’s Medicare claims? | N/A (Gov’t argues accountability under conspiracy scope). | Prakash: not foreseeable that Popov would bill Medicare under his number. | Finding not clearly erroneous; liability for foreseeable conduct sustained; remand on loss issue remains. |
Key Cases Cited
- United States v. Miller, 316 F.3d 495 (4th Cir. 2003) (prima facie evidence that billed amounts reflect intended loss; not conclusive)
- United States v. Isiwele, 635 F.3d 196 (5th Cir. 2011) (adopts burden-shifting approach to loss in health care fraud)
- United States v. Singh, 390 F.3d 168 (2d Cir. 2004) (allows rebuttal to billed loss in health care fraud sentencing)
- Stinson v. United States, 508 U.S. 36 (1993) (guideline commentary authoritative unless unconstitutional or incoherent)
- Gall v. United States, 552 U.S. 38 (2007) (establishes standard for de novo review and sentencing framework)