United States v. Robert Read, 2012 U.S. App. LEXIS 22617

Defs Read were convicted on one count conspiracy to commit health care fraud and twenty counts of mail fraud; they appeal the convictions, sentences, and restitution orders.
Superseding indictment added counts of conspiracy to commit health care fraud, health care fraud, mail fraud, and aggravated identity theft; included a criminal forfeiture notice for proceeds.
Reads owned Priority One, an ambulance service for dialysis patients; government alleges they fraudulently claimed ambulance transport to Medicare, Medicaid, and BCBS from 2004–2007.
Medicare rules require medical necessity and a CMN; defendants allegedly instructed staff to omit information on run sheets to induce payment; some EMTs testified about alterations and front-seat transportation for nonessential cases.
Jury found conspiracy and most mail counts; district court calculated forfeiture at roughly $93k and restitution at about $1.77 million; trial included testimony on doctors signing CMNs and various patient cases where transport was not medically necessary.
On appeal, the court affirms the judgments, addressing evidentiary sufficiency, loss and restitution calculations, and the position-of-trust enhancement.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Were the conspiracy and mail fraud convictions supported by sufficient evidence?	Reads: sufficient evidence of unlawful agreement and overt acts.	Reads: challenged sufficiency of overt acts and intent.	Convictions affirmed; sufficient evidence supported a rational jury's verdict.
Was the loss amount used for Guidelines calculation correct?	Government proposed full billed amount as intended loss; district court used actual/forfeitable loss.	Reads: should use lesser loss amount corresponding to forfeiture or trial findings.	Loss determined as actual loss ($1,766,681.31) for guidelines purposes; Booker-based challenges rejected.
Is restitution properly ordered in light of forfeiture findings?	Restitution aligns with victims' loss from the scheme.	Restitution cannot exceed or conflict with jury’s forfeiture verdict.	Restitution affirmed; may exceed forfeiture amount where legally permissible under statute.
Was the two-level position of trust enhancement properly applied?	Medicare/Medicaid enrollment and discretion granted substantial supervisory freedom; enhancement appropriate.	The enhancement is vague/overbroad as applied to commercial billing.	enhancement affirmed; district court properly found substantial discretion and minimal supervision.

United States v. Coleman, 609 F.3d 699 (5th Cir. 2010) (elements of conspiracy require agreement, knowledge, and overt act)
United States v. Moser, 123 F.3d 813 (5th Cir. 1997) (evidentiary standard for reviewing sufficiency of evidence)
United States v. Jara-Favela, 686 F.3d 289 (5th Cir. 2012) (Jackson v. Virginia standard for sufficiency)
Jackson v. Virginia, 443 U.S. 307 (U.S. 1979) (sufficiency standard: rational trier of fact)
United States v. Ragsdale, 426 F.3d 765 (5th Cir. 2005) (overt act requirement and conspiracy proof)
United States v. El-Mezain, 664 F.3d 467 (5th Cir. 2011) (overt act and conspiracy scope interpretation)
United States v. Phipps, 595 F.3d 243 (5th Cir. 2010) (fraudulent scheme elements and knowledge of false representations)
United States v. Ratcliff, 488 F.3d 639 (5th Cir. 2007) (mails usage and proof of fraudulent claims)
United States v. Dillman, 15 F.3d 384 (5th Cir. 1994) (material falsity and recklessness in false representations)
United States v. Ollison, 555 F.3d 152 (5th Cir. 2009) (loss calculation and guideline application)
Skilling v. United States, 130 S. Ct. 2896 (2010) (limits on broad or vague interpretations of aiding false services)
United States v. Isiwele, 635 F.3d 196 (5th Cir. 2011) (position-of-trust enhancement for Medicare/Medicaid providers)
United States v. Miller, 607 F.3d 144 (5th Cir. 2010) (application of 3B1.3 enhancement factors)