Background
Dr. David Young worked for purported telehealth companies that used prescriptions for durable medical equipment and genetic tests to bill Medicare. Evidence at his eight-day trial showed that Young signed prescriptions at unusually high speeds and volumes, shared login credentials that allowed nonmedical employees to pre-fill prescriptions, and prescribed items or tests without adequate patient examinations. Medicare was billed $34.5 million for 44,476 items of durable medical equipment and $37.2 million for 3,954 genetic tests attributable to his prescriptions.
A jury convicted Young of conspiracy to commit health care fraud and three counts of making false statements relating to health care matters. The district court sentenced him to 120 months in prison and ordered $26,622,522.82 in restitution. On appeal, Young challenged the sufficiency of the evidence, venue, the admission of testimony from two other doctors, the refusal to give a multiple-conspiracies instruction, and the loss amount used under the Sentencing Guidelines.
The Court’s Holding
The Fifth Circuit affirmed the convictions. It held that the prescription volume, Young’s sharing of credentials, departures from ordinary medical practice, promotion of genetic testing after a law-enforcement raid, substantial compensation, and continued prescribing despite fraud warnings permitted the jury to infer that he knowingly joined the scheme. Evidence also supported the false-statement counts because the signed records represented that Young had spoken with and evaluated patients whom he admitted he had not contacted.
The court held that Young waived his venue challenge by failing to raise it before trial or in a timely motion for acquittal. It found no reversible evidentiary error, concluding that testimony from doctors about fraud indicators they encountered at one telehealth company was permissible and, in any event, harmless given the other evidence. A jury could find one overarching conspiracy with Young as the link among the participating companies, and any error in omitting a multiple-conspiracies instruction was harmless. The district court also did not clearly err by using amounts billed to Medicare as intended loss because those billings were reasonably foreseeable acts of Young’s coconspirators and he offered no evidence establishing a lower intended loss.
Key Takeaways
- A defendant’s knowing participation in health care fraud may be inferred from circumstantial evidence, including extraordinary prescription volume, inadequate medical review, shared credentials, financial payments, and ignored warning signs.
- A defendant who knows the facts supporting a venue objection must raise it before trial; proposing a venue jury instruction does not preserve the objection.
- Amounts fraudulently billed to Medicare may serve as prima facie evidence of intended loss even when the defendant did not personally submit or know the precise amount of the bills.
Why It Matters
The decision illustrates the breadth of circumstantial evidence that can sustain a health care fraud conspiracy conviction when a physician claims reliance on information supplied by telehealth intermediaries. A doctor cannot avoid responsibility merely by asserting ignorance of inaccurate patient data when the doctor knowingly certifies examinations or conversations that never occurred and other circumstances support fraudulent intent.
The opinion also underscores two procedural points for criminal practitioners: venue objections must be asserted promptly, and defendants seeking a loss calculation below the amount billed must offer evidence addressing intended loss rather than relying only on ignorance of billing details or Medicare’s fixed reimbursement schedules.