United States v. Tariq Mahmood, 820 F.3d 177

Background

Mahmood, a licensed physician and owner of multiple Texas hospitals, directed employees to resequence diagnosis codes on Medicare claim forms to increase reimbursements without reviewing patients’ medical records.
Key employees: Ruth Ann Crow (complied at Lake Whitney), Norma Longley (refused changes; originally coded claims), and Charlotte Wyatt (accessed and resequenced Longley’s entries per Mahmood’s instructions).
Government investigation identified 85 claims altered after Longley’s original coding; repricing showed Medicare overpaid $143,608 on those claims and would have paid $430,639 absent the resequencing.
Superseding indictment charged Mahmood with one count of conspiracy to commit health care fraud (18 U.S.C. § 1349), seven counts of health care fraud (18 U.S.C. § 1347), and seven counts of aggravated identity theft (18 U.S.C. § 1028A). Jury convicted on all counts.
District court denied a Rule 33 new-trial motion asserting ineffective assistance based on experts not called at trial, calculated loss/restitution at $599,128.02, and sentenced Mahmood to 135 months (concurrent and consecutive components). Appeals court affirmed convictions and denial of new trial but vacated sentence and restitution and remanded for resentencing.

Issues

Issue	Plaintiff's Argument (Government)	Defendant's Argument (Mahmood)	Held
Sufficiency of evidence for health care fraud	Evidence showed Mahmood directed scheme to change codes to inflate payments; intent to defraud proven	Mahmood argued claims weren’t proven false and resequencing might have been supported by records	Affirmed: jury could find Mahmood knowingly executed scheme to cheat Medicare (§ 1347(a)(1))
Sufficiency for aggravated identity theft (§ 1028A)	Use of patients’ identifying information without lawful authority supported convictions	Mahmood argued § 1028A requires actual theft/misappropriation; here patients consented to billing uses	Affirmed: § 1028A does not require actual theft; unlawful use beyond lawful authority suffices
Denial of motion for new trial (ineffective assistance)	Trial strategy reasonable; experts’ post-hoc opinions would not have exculpated Mahmood because he never reviewed records	Mahmood argued counsel was ineffective for not calling experts who would show coding was justified and resequencing not improper	Affirmed: district court did not abuse discretion; expert proffers were non-exculpatory or conclusory, no hearing required
Loss and restitution calculation at sentencing	Loss fixed at $599,128.02 (amount reimbursed) and restitution ordered accordingly	Mahmood sought credit for fair market value of legitimate services rendered (reducing loss to $143,608) relying on Government’s own repricing evidence	Vacated and remanded: district court erred by not crediting fair market value of services Medicare would have paid (per U.S.S.G. §2B1.1 comment and Klein)

Key Cases Cited

United States v. Haines, 803 F.3d 713 (5th Cir. 2015) (standard for reviewing facts in light most favorable to verdict)
United States v. Vasquez, 766 F.3d 373 (5th Cir. 2014) (manifest miscarriage of justice standard for unpreserved sufficiency claims)
United States v. Umawa Oke Imo, 739 F.3d 226 (5th Cir. 2014) (elements of health care fraud under § 1347)
United States v. Osuna-Alvarez, 788 F.3d 1183 (9th Cir. 2015) (§ 1028A does not require actual theft; unlawful use beyond authority suffices)
United States v. Spears, 729 F.3d 753 (7th Cir. 2013) (distinguishes identity fraud from identity theft; limited to meaning of "another person")
United States v. Kaluza, 780 F.3d 647 (5th Cir. 2015) (statutory interpretation principles)
United States v. Klein, 543 F.3d 206 (5th Cir. 2008) (credit for fair market value of services in loss calculation under §2B1.1 comment)
United States v. Jones, 664 F.3d 966 (5th Cir. 2011) (when services provide no value to Medicare, no fair-market credit)
Strickland v. Washington, 466 U.S. 668 (1984) (ineffective-assistance two-prong test)