United States v. John McLean
2013 U.S. App. LEXIS 8160
| 4th Cir. | 2013Background
- McLean, an interventional cardiologist in Salisbury, MD, held PRMC privileges to perform stent procedures.
- PRMC's quality review found inappropriate stenting in a substantial portion of cases; outside review confirmed many issues.
- McLean resigned; subsequent investigations included shredding subpoenaed records and continuing office practice.
- He was indicted on one health care fraud count and six false statement counts; Count 6 was dismissed.
- Jury convicted on all counts; district court imposed loss-based 16-level enhancement and forfeiture/restitution totaling over $579,000 plus $1.3 million hospital settlement.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Vagueness as applied to § 1347 | McLean argues lack of medical-necessity standard renders § 1347 vague. | McLean claims no government medical standard defined stenosis thresholds. | Statute not unconstitutionally vague as applied. |
| Sufficiency of evidence for health care fraud (Count 1) | Gov't showed a fraudulent scheme to defraud insurers. | McLean argues lack of proof of intent and reliance on subjective readings. | Substantial evidence supports conviction. |
| Sufficiency of evidence for false statements (Counts 2-5,7) | Misstatements about stenosis levels were material to reimbursement. | Claims could be explained by non-criminal misreads or subjectivity. | Substantial evidence supports false-statement convictions. |
| Rule 16 and Marmur testimony issues | Impeachment/disclosure failures affected trial fairness. | R16 violations remedied; Marmur testimony appropriately managed. | No reversible error; remedies and rulings upheld. |
| Sentence computation and loss amount | Loss calculated from stent-related reimbursements and hospital settlement. | Loss evidence unreliable or not causally linked to conduct. | No clear error; loss calculation supported imposition of enhancement. |
Key Cases Cited
- United States v. Williams, 364 F.3d 556 (4th Cir. 2004) (vagueness challenges reviewed de novo in criminal context)
- United States v. Passaro, 577 F.3d 207 (4th Cir. 2009) (vagueness and fair notice in health-care fraud context)
- United States v. Jaensch, 665 F.3d 83 (4th Cir. 2011) (scienter suffices to prove fraud; relief from vagueness concerns)
- United States v. Harvey, 532 F.3d 326 (4th Cir. 2008) (proof may be inferred from totality of circumstances in fraud cases)
- United States v. Barile, 286 F.3d 749 (4th Cir. 2002) (Rule 16 disclosure remedies and discretion of district court)
- United States v. Franklin-El, 554 F.3d 903 (10th Cir. 2009) (statutory fraud; Medicaid-like regulation not required for notice)