United States v. Ankita Singh, 147 F.4th 652

Dr. Ankita Singh, a physician, was convicted on six counts of healthcare fraud (18 U.S.C. § 1347) stemming from her work reviewing and approving durable medical equipment (DME) orders through telehealth companies.
Singh performed “chart reviews” for Real Time Physicians and Expansion Medical, believing that she was reviewing records for patients already evaluated by another provider.
These telehealth companies were running a Medicare fraud scheme, using physicians’ signatures to place fraudulent DME orders billed to Medicare.
At trial, the government focused on Singh’s lack of personal examination of patients, the number and speed of approvals, and argued she should have known her actions were wrong.
Singh’s defense emphasized her good faith belief in the lawfulness of her conduct and lack of knowledge that her actions were unlawful.
The district court made multiple evidentiary and instructional rulings that became the focal points on appeal.

Issue	Singh's Argument	Government's Argument	Held
Definition of "willfully" in jury instructions	The court failed to instruct the jury that she had to know her conduct was unlawful.	Jury instructions as a whole conveyed the correct standard.	For Singh; instructions were deficient—jury must be told defendant must know conduct is unlawful.
Exclusion of Singh's statements to insurance investigator	Her statements to the investigator showed good faith and should be admissible under Rule 803(3).	The statements were not contemporaneous to the conduct and thus inadmissible.	For Singh; statements were admissible as evidence of contemporaneous state of mind.
Admission of lay witnesses on medical necessity	Testimony that a physician must personally examine a patient to determine medical necessity requires expert, not lay, opinion.	Lay testimony was sufficient and appropriate.	For Singh; determining medical necessity requires expert testimony, not lay.

Bryan v. United States, 524 U.S. 184 (1998) (distinguishes between "knowingly" and "willfully" in criminal statutes—willfulness requires knowledge that conduct is unlawful)
United States v. Roth, 628 F.3d 827 (6th Cir. 2011) (applies Bryan to require knowledge of unlawfulness for willful violations)
United States v. Emmons, 8 F.4th 454 (6th Cir. 2021) (discusses Bryan’s application to other criminal statutes)
United States v. Lang, 717 F. App’x 523 (6th Cir. 2017) (lay witnesses cannot provide opinion on medical necessity)
United States v. Hunt, 521 F.3d 636 (6th Cir. 2008) (expert testimony is used to establish medical necessity in fraud cases)