United States v. Roger Anderson, 67 F.4th 755

Background

Dr. Roger Anderson, an Ohio infectious-disease physician registered with the DEA, was investigated after pharmacists and the State Medical Board raised concerns about his opioid prescribing; a DEA confidential source recorded multiple visits.
DEA executed a search warrant at Anderson’s clinic; a grand jury indicted him on counts including conspiracy and unlawful distribution of controlled substances (21 U.S.C. § 841) and healthcare fraud (18 U.S.C. § 1347/1349).
At a Daubert hearing the government disclosed Dr. Timothy King, a pain-medicine expert, who reviewed 50 patient files and applied 15 standards of care (drawn from professional organizations) to opine that many prescriptions lacked a legitimate medical purpose.
Trial evidence included patient and employee testimony about cursory or absent exams, prescriptions given on request or by staff, pharmacists’ suspicious-activity reports, and expert testimony that many prescriptions were outside the usual course of practice.
The district court excluded Anderson’s proposed unqualified good-faith jury instruction (citing Godofsky), admitted King’s expert testimony, and submitted jury instructions emphasizing defendant knowledge/deliberate blindness; the jury convicted Anderson on ten counts.
On appeal the Sixth Circuit affirmed: it upheld the admission of King’s testimony, found the instructions adequately conveyed the mens rea required after Ruan, and found the evidence sufficient for the drug-distribution and healthcare-fraud convictions.

Issues

Issue	Plaintiff's Argument (Government)	Defendant's Argument (Anderson)	Held
Whether the district court abused its discretion by refusing Anderson’s requested good-faith jury instruction on § 841 counts	Godofsky supports denying an unqualified good-faith instruction; existing instructions conveyed the knowledge/deliberate-ignorance standard required by Ruan	Requested instruction misstated law or was necessary to convey Anderson’s good-faith defense (sought objective good faith)	Denial not an abuse: the court’s instructions on knowledge and deliberate blindness substantially covered the mens rea required by Ruan
Admissibility of Dr. King’s expert testimony under Daubert/Rule 702	King is qualified; his file-review methodology compared records to accepted standards and was reliable and relevant	Methodology was unsupported, not peer-reviewed, and amounted to speculation; court failed its gatekeeping duty	Admission affirmed: district court properly evaluated reliability; methodology rested on accepted professional standards and weight was for cross-examination
Sufficiency of evidence for conspiracy/distribution convictions under § 841	Patient testimony, staff witness statements, pharmacy reports, and King’s opinions showed prescriptions were issued without legitimate medical purpose and with defendant’s knowledge/deliberate blindness	At most sloppy practice or malpractice and poor documentation—insufficient to prove unlawful distribution or intent	Evidence sufficient: reasonable juror could find prescriptions were issued outside usual course of practice and that defendant acted knowingly or with deliberate ignorance
Sufficiency of evidence for healthcare fraud conviction under § 1347	Anderson’s prescribing caused claims to be submitted to Medicare/Medicaid; provider agreement and testimony tied program payments to prescriptions; intent may be inferred circumstantially	Pharmacies billed, not Anderson; he did not personally profit and lacked knowledge of payment; therefore no scheme or intent to defraud	Evidence sufficient: jury could infer Anderson caused unlawful claims and had intent to defraud from circumstantial evidence and knowledge of coverage patterns

Key Cases Cited

Moore v. United States, 423 U.S. 122 (1975) (discusses physician prescriptions "authorized" under CSA)
Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (1993) (trial courts’ gatekeeping duties for expert testimony)
Ruan v. United States, 142 S. Ct. 2370 (2022) (mens rea "knowingly or intentionally" applies to the "except as authorized" clause in § 841)
United States v. Godofsky, 943 F.3d 1011 (6th Cir. 2019) (addressed good-faith instruction for physician § 841 cases)
United States v. Chaney, 921 F.3d 572 (6th Cir. 2019) (upheld § 841 conviction where prescriptions were issued on request with minimal exams)
United States v. Johnson, 71 F.3d 539 (6th Cir. 1995) (elements required to convict a physician under § 841)
United States v. Bek, 493 F.3d 790 (7th Cir. 2007) (affirming § 841 conviction where physician ignored signs of abuse and performed superficial exams)
United States v. Azmat, 805 F.3d 1018 (11th Cir. 2015) (upheld expert methodology based on Federation of State Medical Boards guidance)
United States v. Persaud, 866 F.3d 371 (6th Cir. 2017) (circumstantial evidence can supply intent for healthcare fraud)
United States v. Hunt, 521 F.3d 636 (6th Cir. 2008) (defendant can be liable under § 1347 for causing others to submit false claims)