United States v. Arun Sharma, 703 F.3d 318

Arun and Kiran Sharma pleaded guilty to conspiring to defraud health-care insurers by billing for injections never administered; restitution to 32 victims totaled $43,318,170.93.
Probation PSRs calculated actual insurer losses at $43,318,170.93 and recommended that restitution amount; Sharmas argued for credits and exclusions for non-injection payments and unrelated treatments.
Sharmas proposed an alternative loss figure of $21,028,963.61 after excluding non-injection payments and applying credits for medically necessary injections.
District court adopted the PSR figure and denied objections, ordering restitution in the full $43,318,170.93 and maintaining forfeiture provisions.
On appeal, Arun contends the government breached the plea agreement and challenges restitution/forfeiture calculations.
Court vacates restitution and remands for recalculation consistent with the opinion, noting no breach of the plea agreement.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether restitution under MVRA must equal actual losses caused by the offenses	Sharmas argue only losses from 1998–2009 injections and related upcoding should be included.	Government contends the district court properly included all losses caused by the charged scheme.	Abuse of discretion; must remand to recalculate based on actual losses.
Whether insurers’ payments for legitimate injections should be credited against restitution	Sharmas seek a credit for injections that would have been reimbursed absent fraud.	Government asserts no credit because fraud undermined insurer payments; Jones/ Klein distinctions discussed.	No credit for medically unnecessary injections; court declined to apply a restitution credit.
Whether the government breached the plea agreement	Arun claims the government acted inconsistently with the plea terms regarding forfeiture and credits.	Government contends no breach; plea agreement lacked specific restitution/credit calculations and limited forfeiture scope.	No breach; plea agreement not violated.

United States v. Klein, 543 F.3d 206 (5th Cir. 2008) (credit for value of meds when insurer would pay absent fraud)
United States v. Jones, 664 F.3d 966 (5th Cir. 2011) (no credit for services actually provided if insurer would not have paid absent fraud)
Arledge, 553 F.3d 881 (5th Cir. 2008) (remand for recalculation of actual loss based on record evidence)
Beydoun, 469 F.3d 102 (5th Cir. 2006) (remand to reanalyze government’s evidence for restitution)
Hinojosa, 484 F.3d 337 (5th Cir. 2007) (vacate restitution including uncharged/fraud beyond indictment)