United States v. Sardar Ashrafkhan, 964 F.3d 574

Sardar Ashrafkhan owned Compassionate Doctors, a Detroit-area clinic the government alleged was a "pill mill" where doctors wrote opioid prescriptions for fake patients recruited by paid "marketers."
From 2007–2013 Compassionate filed 65,649 Medicare Part B claims (> $10 million claimed; > $6.5 million paid) and its prescriptions allegedly produced ~500,000 doses that reached the illegal market.
Ashrafkhan personally benefited (over $2 million transferred to his personal accounts); over $1 million in assets were seized at arrest.
Charged in 2013 with conspiracy to distribute controlled substances, healthcare-fraud conspiracy, and two counts of money laundering; convicted on all counts at trial.
Sentenced to an aggregate 276 months (23 years); appealed raising multiple issues—this published opinion addresses only the jury instruction on reasonable doubt; other issues disposed of in an unpublished appendix.
The instructional issue was reviewed for abuse of discretion because Ashrafkhan preserved his objection at trial.

Issue	Ashrafkhan's Argument	United States' Argument	Held
Constitutionality of the reasonable-doubt instruction	Omission of the Sixth Circuit model phrase ("proof … so convincing that you would not hesitate to rely and act on it") failed to convey the heightened criminal standard and risked jurors using a lower (civil-like) standard	The court’s alternative instruction made clear doubts must be "fair," "honest," and based on the evidence; model language is not mandatory and the instruction adequately conveyed the high burden	Instruction upheld; omission of the model "would not hesitate" language was not reversible error; conviction and sentence affirmed
Whether the instruction created a reasonable likelihood the jury could convict on insufficient proof	The given wording could permit conviction on proof less than Winship requires	Instruction emphasized evidence-based doubts, rejected speculative or sympathy-based doubts, and tracked prior accepted formulations	Applying Victor/Cage, the court found no reasonable likelihood of juror confusion and concluded the instruction did not permit conviction on insufficient proof

In re Winship, 397 U.S. 358 (U.S. 1970) (Due Process requires proof beyond a reasonable doubt)
Victor v. Nebraska, 511 U.S. 1 (U.S. 1994) (Constitution does not require specific wording; review asks whether instruction reasonably likely to permit conviction on insufficient proof)
Cage v. Louisiana, 498 U.S. 39 (U.S. 1990) (Invalidated an instruction that could lower the Winship standard by using confusing terms like "grave uncertainty")
Jackson v. Virginia, 443 U.S. 307 (U.S. 1979) (Reasonable-doubt standard requires factfinder reach near certitude of guilt)
Holland v. United States, 348 U.S. 121 (U.S. 1954) (Attempts to define "reasonable doubt" often produce confusion)
Binder v. Stegall, 198 F.3d 177 (6th Cir. 1999) (6th Cir. upheld a substantially similar reasonable-doubt instruction and rejected a requirement to include the "would not hesitate" language)