United States v. Chhibber, 741 F.3d 852

Dr. Jaswinder R. Chhibber, an internist who owned diagnostic equipment, ran a walk-in clinic and ordered large numbers of specialized tests (echocardiograms, carotid/transcranial Dopplers, pulmonary function tests, nerve conduction studies, ECGs, abdominal ultrasounds).
Government alleged Chhibber submitted false diagnostic codes and fabricated symptoms/diagnoses in charts to obtain insurance and Medicare reimbursement for medically unnecessary tests.
Witnesses included former employees (who described orders placed without exams and minimal staff training), patients, and undercover agents who denied reporting the symptoms recorded in their charts.
The district court excluded the government’s peer-group comparison statistics but admitted summary exhibits showing percentages of Chhibber’s patients receiving particular tests/diagnoses under Fed. R. Evid. 1006; Chhibber objected as irrelevant and misleading.
An expert internist (Dr. Herdeman) testified regarding typical frequencies of such tests, that these specialized tests require symptoms and specialist review, and that Chhibber’s records lacked expected exam detail; corporate reps explained insurer definitions of medical necessity.
Jury convicted Chhibber on 4 counts under 18 U.S.C. § 1035 and 5 counts under 18 U.S.C. § 1347; Chhibber appealed evidentiary rulings and argued expert testimony was required to prove medical necessity.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Admissibility of summary charts (Rule 1006)	Gov: summaries accurately reflect voluminous billing/medical records and are admissible	Chhibber: charts irrelevant and prejudicial without peer comparison; per-patient basis misleading	Court: admissible; charts accurately summarized records and were contextualized by other evidence and expert testimony
Exclusion of peer-group comparison statistics	Gov: peer comparisons show testing frequency unusually high	Chhibber: peer group not comparable because equipment ownership/referrals differ	Court: district properly excluded peer-group but that did not render summaries inadmissible
Requirement of expert testimony to prove medical necessity	Chhibber: law should require expert to prove tests medically unnecessary	Gov: not strictly required; factual testimony may suffice	Court: did not decide rule generally because gov. presented expert (Dr. Herdeman); his testimony plus other evidence sufficed to prove medical necessity issues
Sufficiency of evidence for §1035 and §1347 convictions	Chhibber: convictions rested on statistics and lacked expert support, especially for Medicare counts	Gov: undercover/patient testimony, expert medical testimony, and insurer reps provided adequate proof	Court: evidence sufficient; jury could credit witnesses over medical records and convict

United States v. Simon, 727 F.3d 682 (7th Cir. 2013) (abuse of discretion standard for evidentiary rulings)
United States v. Thornton, 642 F.3d 599 (7th Cir. 2011) (review of evidentiary decisions)
United States v. Isaacs, 593 F.3d 517 (7th Cir. 2010) (Rule 1006 summary exhibits admissibility)
United States v. McIntosh, 702 F.3d 381 (7th Cir. 2012) (standard for sufficiency review)
United States v. Vaughn, 585 F.3d 1024 (7th Cir. 2009) (review standard for sufficiency of evidence)
United States v. Olson, 450 F.3d 655 (7th Cir. 2006) (sufficiency review and jury deference)
United States v. Natale, 719 F.3d 719 (7th Cir. 2013) (elements of §1035 false statements convictions)
United States v. Hunt, 521 F.3d 636 (6th Cir. 2008) (expert testimony supported health care fraud convictions where exams were not performed)
United States v. Morgan, 505 F.3d 332 (5th Cir. 2007) (conviction where provider billed Medicare without examining patients)
United States v. Wasson, 679 F.3d 938 (7th Cir. 2012) (appellate courts do not reweigh credibility)
United States v. Carraway, 612 F.3d 642 (7th Cir. 2010) (credibility and jury’s province)