United States v. Charles DeHaan, 896 F.3d 798

Background

Dr. Charles DeHaan, a Medicare-enrolled physician and medical director for home-health providers, ran a scheme (2009–2014) involving: (1) overbilling for in‑home visits he either performed only perfunctorily or did not perform, and (2) certifying patients as "homebound" when he knew or did not know they met Medicare criteria.
DeHaan pled guilty to two counts involving overbilling; the scheme’s fraudulent-certification component was charged as relevant conduct for sentencing.
At sentencing the district court held an evidentiary hearing to estimate loss under U.S.S.G. § 2B1.1, finding $478,520.29 loss from overbilling (not disputed) and attributing $2,787,054.58 in Medicare Part A payments to 305 patients fraudulently certified by DeHaan, for a total loss of $3,265,574.87.
The court inferred fraud for the 305 patients (Exhibit 94C) because there was no record of DeHaan providing billable services to them (other than the certifications), and some had no other physician certifications; DeHaan had acknowledged certifying patients he knew did not qualify.
The district court imposed a within-Guidelines 108‑month sentence and ordered restitution of $2,787,054.58. DeHaan appealed only the loss/restitution attributable to the fraudulent-certification component.

Issues

Issue	DeHaan’s Argument	Government’s/Respondent’s Argument	Held
Whether the district court legally erred by treating certifications as fraudulent because there was no evidence DeHaan had face‑to‑face encounters with the 305 patients	Face‑to‑face encounters (or encounters by supervised non‑physician practitioners) were required only after 2011; absence of DeHaan’s in‑person visits does not prove fraud	The court did not rely on a face‑to‑face theory; it relied on absence of any evidence that the patients were under DeHaan’s care (no billings by him), a reasonable inference of fraud	Held: No error — court permissibly inferred fraud from lack of evidence that patients were under DeHaan’s care
Whether the district court erred by using the total Medicare payments to home‑health agencies for those patients as the loss amount without proving each patient was ineligible	Loss must reflect proximate cause; agencies’ independent billing decisions and the possibility some patients were actually homebound mean the full payments should not be treated as loss attributable to DeHaan	Certifying physician is the gatekeeper; DeHaan’s fraudulent or reckless certifications foreseeably enabled agencies to bill Medicare; absent proper certification patients were ineligible under Medicare regardless of actual condition	Held: No plain error — the total payments were a reasonable and conservative approximation of the loss attributable to DeHaan’s fraud
Whether the district court’s restitution order (equal to the $2,787,054.58) was plain error	Restitution should be reduced if loss calculation was improper or agencies’ independent acts break causation	Restitution matched the court’s loss estimate; payments were direct, foreseeable consequence of DeHaan’s fraudulent certifications	Held: No plain error — restitution order affirmed
Burden of proof and reasonableness of district court’s methodology for estimating loss	DeHaan argued the government did not establish each element of entitlement to treat payments as loss	Government presented evidence and a conservative methodology; defendant had the opportunity to rebut and did not	Held: Government met its burden to make a reasonable loss estimate; defendant failed to counter it

Key Cases Cited

United States v. Hebron, 684 F.3d 554 (5th Cir.) (discussing burden and presumption issues in fraud loss calculations)
United States v. Williams, 892 F.3d 242 (7th Cir.) (government bears burden to prove loss at sentencing)
United States v. Patel, 778 F.3d 607 (7th Cir.) (certifying physician as gatekeeper; physician culpability in Medicare fraud)
United States v. Jones, 664 F.3d 966 (5th Cir.) (treating full payments as loss where services were of no value under program rules)
United States v. Triana, 468 F.3d 308 (6th Cir.) (full Medicare payments properly treated as loss when defendant caused ineligibility)
Puckett v. United States, 556 U.S. 129 (plain‑error standard)