United States v. Elekwachi Kalu, 936 F.3d 678

Elekwachi Kalu, owner/CEO of Rhythmic Home Health Care Services, pleaded guilty to conspiracy to commit health-care fraud for submitting fraudulent Medicare claims from Aug 2012–Jan 2017.
Rhythmic billed Medicare ~$3.19 million and received ~$2.88 million for services that were unnecessary or not provided; restitution ordered for $2,878,120.59.
PSR produced a total offense level of 27, criminal history category I, yielding a Guidelines range of 70–87 months; district court sentenced Kalu to 70 months (bottom of range) and three years supervised release.
On appeal Kalu challenged two Guidelines enhancements applied by the district court: (1) +2 under U.S.S.G. §2B1.1(b)(11)(C)(i) for using a means of identification to produce another means of identification, and (2) +2 under §2B1.1(b)(2)(A)(i) for offenses involving 10 or more victims.
Kalu argued Medicare claim numbers created by the billing process are not “other means of identification” (and that he lacked intent to produce such identifiers) and that only Medicare—rather than the beneficiaries—was a victim.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether use of beneficiaries’ Medicare information to submit false claims triggers the §2B1.1(b)(11)(C)(i) enhancement	Kalu: Medicare claim numbers generated by billing are not an "other means of identification"; he only sought payment and lacked intent to produce another identifier	Government/District Ct: Beneficiaries’ Medicare info is a means of identification and the unique Medicare claim numbers produced by the fraudulent submissions are a second means of identification	Court: Enhancement applies—fraudulent Medicare claim numbers are "means of identification" and analogous to bank‑account/loan number examples in commentary
Whether each Medicare beneficiary counts as a "victim" for the §2B1.1(b)(2)(A)(i) 10‑victim enhancement	Kalu: Beneficiaries weren’t victims; Medicare was the sole victim	Government/District Ct: Beneficiaries for whom false claims were made qualify as victims	Court: Affirmed—Barson controls; beneficiaries are victims under the Guidelines

Suchowolski v. United States, 838 F.3d 530 (5th Cir. 2016) (controls plain‑language Guideline interpretation and prior application of the means‑of‑identification enhancement)
Chavez‑Hernandez v. United States, 671 F.3d 494 (5th Cir. 2012) (discusses means‑of‑identification guidance)
United States v. Cooks, 589 F.3d 173 (5th Cir. 2009) (held mortgage loan numbers are unique identifiers qualifying for the enhancement)
United States v. Jackson, 549 F.3d 963 (5th Cir. 2008) (addresses scope of precedent and error review in similar contexts)
United States v. Barson, 845 F.3d 159 (5th Cir. 2016) (holds Medicare beneficiaries for whom conspirators falsely claimed benefits are "victims" under the Guidelines)
United States v. Vasquez, 673 F.3d 680 (7th Cir. 2012) (upheld means‑of‑identification enhancement in health‑care fraud context)
Sash v. United States, 396 F.3d 515 (2d Cir. 2005) (explains enhancement not limited to classic identity‑theft breeding schemes)