United States v. Diana Gumila, 879 F.3d 831

Diana Gumila, head of clinical operations for Suburban Home Physicians (Doctor at Home), was convicted after trial of multiple counts of health-care fraud (18 U.S.C. § 1347) and false statements in a health-care matter (18 U.S.C. § 1035) for a scheme submitting fraudulent Medicare claims.
Evidence showed systemic practices she directed: instructing employees to upcode visits, claim non-homebound patients as homebound, process nursing orders without physician examination, and fabricate care-plan oversight billing.
The government and the PSR estimated total Medicare loss at about $15.6 million across three categories: upcoded/unnecessary home visits (~$2.375M), improper skilled-nursing services (~$9.35M), and fraudulent care-plan oversight services (~$3.779M).
The Sentencing Guidelines range based on that loss was 151–188 months; the district court found the PSR loss estimate reasonable, but imposed a below-guidelines sentence of 72 months imprisonment, 24 months supervised release, and $15.6M restitution.
On appeal Gumila challenged (1) the loss calculation, (2) substantive reasonableness of the 72-month sentence, and (3) procedural adequacy of the court’s explanation for supervised-release term/conditions.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Loss calculation (total loss)	Gumila: loss should be limited to Medicare payments for eight patients in the indictment (~$14,449)	Government: loss may be estimated by scaling representative proof to the scheme’s full scope; PSR = $15.6M	Court: affirmed loss estimate; district court did not clearly err in using a reasonable estimate based on systemic evidence
Home-visit upcoding amount	Gumila: payments should be discounted for fair market value of services rendered	Government: many visits were noncompensable or should have been billed at lower codes; PSR used conservative approach	Court: accepted judge’s method (difference between billed high codes and appropriate lower-code payments); no error
Skilled-nursing services loss	Gumila: challenge to % attributed to non-homebound patients	Government: relied on claims data and specific doctors’ patterns (Drs. Pauwaa and Newman) to estimate 40–43% nonqualifying	Court: judge reasonably limited estimate to those doctors and used conservative percentages; no clear error
Supervised-release explanation	Gumila: judge failed to explain term/conditions under §3553(a)	Government: PSR provided advance written notice and opportunity to object	Court: waiver — Gumila received PSR notice, did not object to supervised-release conditions at hearing; claim forfeited

United States v. Littrice, 666 F.3d 1053 (7th Cir. 2012) (appellate review of loss calculation is for clear error)
United States v. Schroeder, 536 F.3d 746 (7th Cir. 2008) (government may prove loss by preponderance; reasonable estimate suffices)
United States v. Natour, 700 F.3d 962 (7th Cir. 2012) (court may scale representative evidence to estimate total loss)
United States v. Mikos, 539 F.3d 706 (7th Cir. 2008) (loss need not be discounted for services that did not qualify for Medicare payment)
United States v. Sutton, 582 F.3d 781 (7th Cir. 2009) (indictment’s examples may be representative rather than limiting for loss calculation)
United States v. Annoreno, 713 F.3d 352 (7th Cir. 2013) (substantive-reasonableness review is abuse-of-discretion)
United States v. Wallace, 531 F.3d 504 (7th Cir. 2008) (below-range sentences have not been deemed unreasonably high)
United States v. Lewis, 823 F.3d 1075 (7th Cir. 2016) (advance PSR notice permits informed objections to supervised-release conditions)
United States v. Ranjel, 872 F.3d 815 (7th Cir. 2017) (failure to object to PSR’s supervised-release conditions can constitute waiver)