United States Court of Appeals

For the First Circuit

No. 21-1583

UNITED STATES OF AMERICA,

Appellee,

v.

ABDIRASHID AHMED,

Defendant, Appellant.

APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF MAINE

[Hon. Jon D. Levy, U.S. District Judge]

Before

Barron, Chief Judge,

Lynch and Gelpí, Circuit Judges.

Daniel Dube, with whom Peter E. Rodway was on brief, for 

appellant.

Lindsay B. Feinberg, Assistant United States Attorney, with 

whom Darcie N. McElwee, United States Attorney, was on brief, for 

appellee.

October 12, 2022
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LYNCH, Circuit Judge. Abdirashid Ahmed pleaded guilty 

to health care fraud in connection with a multiyear scheme to 

defraud MaineCare, the state run program that administers Medicaid 

benefits in Maine and reimburses health care providers for 

MaineCare services. See 18 U.S.C. § 1347; see also Me. Rev. Stat. 

Ann. tit. 22, § 3173 (establishing MaineCare). The district court 

sentenced him to twenty-four months' imprisonment. His appeal

challenges the procedural and substantive reasonableness of that 

sentence. We affirm.

I.

A.

Because this appeal follows a guilty plea, "we draw the 

facts from the plea colloquy, the unchallenged portions of the 

presentence investigation report [(PSR)], . . . the transcript of 

the sentencing hearing," and the parties' sentencing memoranda and 

exhibits. United States v. De la Cruz, 998 F.3d 508, 509 (1st

Cir. 2021) (quoting United States v. Padilla-Colón, 578 F.3d 23, 

25 (1st Cir. 2009)); see United States v. Lee, 892 F.3d 488, 490 

n.1 (1st Cir. 2018).

MaineCare reimburses approved providers for covered 

health care services for MaineCare clients. See Me. Rev. Stat. 

Ann. tit. 22, § 3173; 10-144 Me. Code R. ch. 101, ch. I, § 1.06. 

Part of the reimbursement to providers is for the costs of 

interpreter services "necessary and reasonable to communicate 
- 3 -

effectively with [MaineCare] members regarding health needs." 10-

144 Me. Code R. ch. 101, ch. I, § 1.06-2(A). All claims must be 

submitted by the provider, who then compensates the interpreter. 

See id. § 1.06-2(A), (D), (F). MaineCare rules forbid false or 

fraudulent reimbursement claims. See id. § 1.20-1. MaineCare 

providers typically track time in fifteen-minute "unit[s]." See

id. § 1.03-8(M)(2).

Ahmed, a naturalized U.S. citizen born in Somalia, 

became a certified Somali-English translator in 2014. From late 

2014 to approximately April 2018, Ahmed, as an interpreter with 

various mental health counseling providers, defrauded MaineCare 

through fraudulent reimbursement claims made for mental health 

treatment and interpreter services. Ahmed (and another Somali 

interpreter, Garat Osman, who joined the conspiracy in 2016) would 

purport to bring the provider Somali MaineCare beneficiaries. The 

provider then submitted to MaineCare inflated or otherwise 

falsified reimbursement requests -- including claims for 

interpreter services -- involving the beneficiaries and paid Ahmed

(and Osman) for the interpreter services supposedly provided.

One MaineCare provider with whom Ahmed admitted to

conspiring, Elizabeth Daigle, began submitting fraudulent claims 

in late 2014.1 Each claim sought reimbursement for a client visit 

1 Daigle cooperated with the investigation into Ahmed's 

conduct. The record does not disclose whether she was ever charged 
- 4 -

that purportedly employed Ahmed's interpretive services and lasted

2.5 hours, when in fact the visits were far shorter in length. 

This activity continued until Daigle went on maternity leave in 

December 2014. 

While Daigle was on maternity leave, another MaineCare 

provider, Heather Borst, filled in at her practice. From January 

2015 until June 2017, Borst continued the overbilling, submitting 

almost exclusively claims for 2.5-hour visits, 80% of which

purportedly required interpreter services.2 Borst frequently 

submitted claims, including inflated claims for Ahmed's 

interpretive services, for over 10 hours of service per day, and 

on at least one occasion billed for over 24 hours in a single day. 

When approached by investigators in June 2017, Borst admitted to 

frequently falsifying claims, including for visits that never 

happened or that were much shorter than her reimbursement claims 

showed. She told investigators that Ahmed had instructed her 

always to bill for 2.5 hours. With Borst's cooperation, 

investigators recorded a conversation among Borst, Ahmed, and

Osman in which Ahmed agreed to bring Somali patients to Borst for 

short visits (lasting about 15 minutes) that Borst would 

with or convicted of a crime related to her participation in the 

conspiracy.

2 Borst later pleaded guilty to one count of conspiring to 

defraud a health care program, see 18 U.S.C. §§ 1347, 1349, and 

cooperated with the investigation of Ahmed.
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nonetheless claim in reimbursements to have lasted 1.75 hours. 

Ahmed and Osman followed through on this agreement in the following 

few days by bringing Somali clients to Borst's office for brief 

visits; Borst then billed MaineCare for 1.75-hour sessions and 

paid Ahmed and Osman with law enforcement funds.

A third provider, a behavioral health agency named

Facing Change, P.A., also worked with Ahmed to defraud MaineCare.3

From February 2015 until approximately May 2016, the agency paid 

Ahmed a 10% premium above his hourly rate in exchange for referring 

his Somali clients to Facing Change. Beginning in late 2015, 

Facing Change staff also began submitting false claims to MaineCare

for patient visits -- in which Ahmed purportedly served as an 

interpreter -- that did not occur, were of shorter duration than 

reported, or involved falsified patient diagnoses. This activity 

continued until roughly April 2018.

In total, the providers billed -- and MaineCare paid --

over $1.8 million in connection with the fraudulent claims. Ahmed 

3 Facing Change's owner, Nancy Ludwig, was indicted as 

Ahmed's codefendant and ultimately convicted after a jury trial of 

one count of conspiracy to commit health care fraud, see 18 U.S.C. 

§§ 1347, 1349; one count of conspiracy to receive and pay health 

care kickbacks, see id. § 371; 42 U.S.C. § 1320a-7b(b); five counts 

of offering/paying health care kickbacks, see 42 U.S.C. § 1320a7b(b)(2); one count of false statements relating to a health care 

benefit program, see 18 U.S.C. § 1035; and one count of obstruction 

of a federal audit, see id. § 1516. Multiple other Facing Change 

employees pleaded guilty to various charges related to the 

conspiracy and cooperated with the investigation.
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acknowledges that throughout the conspiracy "he often pressed 

[providers] to overbill for translation services," and he does not 

dispute that "his gross proceeds over time were larger than the 

other participants[']."

B.

On April 27, 2018, a federal grand jury indicted Ahmed 

and Osman on one count of conspiracy to commit health care fraud, 

see 18 U.S.C. §§ 1347, 1349; one count of conspiracy to defraud 

the United States and to pay and receive health care kickbacks, 

see id. § 371; 42 U.S.C. § 1320a-7b(b)(1); and six counts of 

receiving health care kickbacks, see 42 U.S.C. § 1320a-7b(b)(1). 

On November 16, 2018, a grand jury returned a superseding 

indictment, which added a codefendant -- Nancy Ludwig, the owner 

of Facing Change -- and charged Ahmed with eighteen total counts:

one count of health care fraud, see 18 U.S.C. § 1347; three counts 

of conspiracy to commit health care fraud, see id. §§ 1347, 1349; 

two counts of conspiracy to receive and pay health care kickbacks, 

see id. § 371; 42 U.S.C. § 1320a-7b(b); and twelve counts of 

receiving health care kickbacks, see 42 U.S.C. § 1320a-7b(b)(1).

After initially pleading not guilty on all counts, 

Ahmed, during a May 24, 2019 change of plea hearing, pleaded guilty 

to the first count of the superseding indictment.4 Although 

4 The first count of the superseding indictment charged 

Ahmed with health care fraud in violation of 18 U.S.C. § 1347. As 
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Ahmed's guilty plea was not pursuant to a written plea agreement, 

the government orally agreed to dismiss the remaining counts at 

sentencing in exchange for Ahmed's plea.

On October 17, 2019, the probation officer issued an 

initial PSR. The initial PSR determined that the total loss amount 

attributable to Ahmed was $1,020,073.79. This loss amount resulted 

in an increase of 16 levels in Ahmed's Total Offense Level: 14 

levels for a loss amount over $550,000 but not more than $1.5 

million, and 2 additional levels because Ahmed was convicted of a 

federal health care offense involving a federal health care program 

with a loss amount over $1 million. See U.S. Sent'g Guidelines

Manual § 2B1.1(b)(1)(I), (b)(7) (U.S. Sent'g Comm'n 2018)

[hereinafter U.S.S.G.]. The report also recommended a four-level 

role enhancement because Ahmed "was a leader or organizer of a 

criminal activity that involved five or more participants." See

the government notes in a footnote in its brief, however, the 

judgment ultimately issued by the district court and the revised 

PSR developed by the probation officer "indicate that Ahmed 

[pleaded] guilty to conspiracy to commit healthcare fraud," rather 

than "a substantive count of health care fraud." The government 

requests "a limited remand to permit the district court to correct 

the clerical error in the judgment." The record suggests that the 

government is correct that a clerical error occurred. Under 

Federal Rule of Criminal Procedure 36, "the [district] court may 

at any time correct a clerical error in the judgment," and the 

parties may move it to do so. See United States v. Claudio, 44 

F.3d 10, 16-17 (1st Cir. 1995); see also, e.g., United States v. 

Davis, 841 F.3d 1253, 1265 (11th Cir. 2016) (affirming correction 

of offense listed in judgment under Rule 36). We remand to permit 

the parties to address the district court on this issue.
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id. § 3B1.1(a). Based on these calculations, the initial PSR 

recommended a Total Offense Level of 23, which, given Ahmed's 

Criminal History Category of I, corresponded to a Guidelines 

sentencing range (GSR) of 46 to 57 months.

Both the government and Ahmed filed objections to the

initial PSR. Based on a new assessment by a loss analyst, the 

government asserted that a higher loss amount applied. The 

defense, conversely, argued both that the loss amount was too high 

and that the role enhancement was inappropriate. In particular, 

the defense contended that the loss amount should be offset by the 

value of any interpreter services Ahmed actually provided and that 

it should not include the sums MaineCare paid for provider 

services, rather than interpreter services.

In response to these objections, the probation officer 

issued a revised PSR on November 12, 2019. The revised report 

adopted the government's updated loss amount by changing the total 

to $1,267,309.33,5 but -- beyond adding some clarifying 

language -- rejected Ahmed's objections. The revisions did not 

affect the Total Offense Level or GSR, which remained 23 and 46 to 

57 months, respectively.

5 In briefing both before the district court and on appeal, 

the government contends that the revised PSR did not accurately

adopt the government's proposed loss amount and that the 

government's figure was higher than the $1,267,309.33 given in the 

revised report.
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Following the revised PSR's issuance, the parties 

continued to litigate the loss amount and role enhancement issues

through multiple rounds of briefing and a series of hearings. 

During this process, both parties submitted evidence, including 

provider billing records; materials generated by law enforcement 

during the investigation of the conspiracy; reports from law 

enforcement interviews with the providers with whom Ahmed 

conspired; and transcripts of grand jury and trial testimony from 

the government's prosecution of Ahmed's coconspirator, Ludwig. 

The substance of this evidence is discussed in more detail below.

The government maintained that the four-level role 

enhancement was warranted and that the loss amount should include 

the amounts fraudulently billed by providers for their own services 

as part of the conspiracy in addition to the amount billed for 

Ahmed's interpreter services. The government also contended that 

Ahmed was not entitled to offset the loss amount by the value of 

interpreter services actually delivered, as he had failed to show 

that he provided legitimate interpreter services in connection 

with MaineCare reimbursable treatment. The exact loss amount 

proposed by the government varied over time; at sentencing, the 

government submitted a figure of $1,863,264.85, which, together 

with the four-level role enhancement, corresponded to a Total 

Offense Level of 25.
- 10 -

Ahmed argued for a lower loss amount and against the 

application of a leader/organizer role enhancement. On loss 

amount, he asserted that he should receive credit for interpreter

services actually provided and that he should not be held 

responsible for overbilling by providers for their own services 

(as opposed to his interpreter work), because that overbilling was 

not foreseeable to him. After discounting for the amount of 

interpreter services he estimated himself to have provided and 

excluding charges for the providers' services, Ahmed proposed a 

loss amount of $436,195. Regarding the role enhancement, Ahmed 

asserted that he lacked the necessary control over the 

providers -- whom he characterized as "gatekeepers" without whose 

cooperation he could not independently bill MaineCare for 

interpreter services -- to qualify as a leader or organizer. His 

counsel did acknowledge, however, that this "argument [was] less 

forceful about whether [Ahmed] was a manager/supervisor" for whom 

a three-level enhancement under U.S.S.G. § 3B1.1(b) would be 

appropriate, because "it did appear that [Ahmed] . . . was a 

manager or supervisor of . . . Osman." Ahmed's proposed Guidelines 

calculations would have resulted in a Total Offense Level of 15.

At Ahmed's sentencing hearing, conducted on July 16, 

2021, the district court adopted the government's loss amount of 

$1,863,264.85 and found that the four-level leader/organizer 

enhancement was appropriate. In addressing loss amount, the court 
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rejected Ahmed's offset and foreseeability arguments. Regarding 

offset, the court reasoned that Ahmed bore the burden of producing 

"evidence to show . . . what amounts represent[ed] legitimate 

claims," see United States v. Alphas, 785 F.3d 775, 784 (1st Cir. 

2015), and concluded that Ahmed had not supported his assertion 

that he performed any reimbursable interpreter services in 

connection with covered MaineCare services. Regarding 

foreseeability, the court found that Ahmed "knew or should have 

known that the providers could only seek reimbursement for 

interpreter services in the same units of time as they sought 

reimbursement for the counseling services," and that "it was 

entirely foreseeable that the providers' records . . . would not 

be accurate," so "the amounts paid with respect to [the providers'] 

claims [were] fairly attributable to . . . Ahmed."

In applying the leader/organizer enhancement, the court 

found that "Ahmed was the common denominator as between the three 

counseling practices that participated in fraudulent billing";

"was involved from the very beginning" of the fraud; "was a 

critically important driving force" in the conspiracy, even if 

"not the sole driving force"; "cajoled, encouraged, and pressured 

others to participate in the scheme"; "influence[d] the amounts 

that were billed" through "his control over the clients and his 

demands regarding the number of units that had to be billed"; and 

"personally received the largest share of the crime proceeds."
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The court also noted that "there certainly [was] evidence 

that . . . Osman was in some respects subservient to . . . Ahmed."

Based on those rulings, the court determined that 

Ahmed's Total Offense Level was 25, with a corresponding GSR of 57 

to 71 months.

The court then turned to imposing Ahmed's sentence. It 

announced that it had "considered all [the 18 U.S.C. § 3553(a)

sentencing] factors," and gave detailed descriptions of its 

reasoning with respect to several of those factors. It highlighted 

the "very serious" nature of the crime, which involved a "longstanding, carefully planned and executed, flagrant scheme to 

defraud the government motivated by greed." It also discussed the 

need for the sentence "to afford adequate deterrence from criminal 

conduct, both by . . . Ahmed [and] by the general public," which 

the court felt was "quite important" because "[t]he fraud in this 

case lasted years and perhaps expose[d] . . . the weaknesses of 

the MaineCare system or its exposure to fraud going undetected." 

In addition, the court acknowledged Ahmed's personal 

circumstances -- particularly his "parental responsibilities" as 

the father of "seven minor children," one of whom "requires an 

adult to care for him every waking moment" due to "autism spectrum 

disorder and anxiety." The court reasoned that these personal 

circumstances "supported" a downward variance from the GSR. It
- 13 -

concluded that twenty-four months' imprisonment was "a just and 

fair sentence."

After announcing this sentence, the district court 

further stated:

I want the record to reflect that I have 

carefully weighed all the defendant's 

arguments regarding the [G]uidelines as they 

affect his total offense level and criminal 

history category. I want it to be clear that 

even if I had accepted any of the objections 

or arguments that I have rejected, the 

sentence I have announced today would be the 

same untethered from the [G]uidelines. That 

is, based on the [§] 3553(a) sentencing 

factors, I would impose the same sentence, 

even if the [GSR] had been reduced by my 

acceptance of an argument that I have not 

accepted.

Ahmed timely appealed.

II.

Ahmed challenges the procedural and substantive 

reasonableness of his sentence. "Where challenges are to the 

procedural and substantive reasonableness of a sentence, '[o]ur 

review process is bifurcated: we first determine whether the 

sentence imposed is procedurally reasonable and then determine 

whether it is substantively reasonable.'" United States v. 

Flores-Quiñones, 985 F.3d 128, 133 (1st Cir. 2021) (quoting United 

States v. Reyes-Torres, 979 F.3d 1, 6-7 (1st Cir. 2020) (alteration 

in original) (internal quotation marks omitted)). "In the 

sentencing context, we evaluate claims of unreasonableness in 
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light of the totality of the circumstances." Id. (quoting United 

States v. Flores-Machicote, 706 F.3d 16, 20 (1st Cir. 2013)).

A.

Ahmed asserts that the district court erred procedurally 

both in imposing the four-level leader/organizer role enhancement, 

see U.S.S.G. § 3B1.1(a), and in calculating the loss amount 

attributable to Ahmed, see id. § 2B1.1. He argues that no role 

enhancement was warranted and that the court should have (1) 

excluded the providers' overbilling for noninterpreter services

from Ahmed's loss amount and (2) reduced the loss amount to give 

credit for interpreter services he provided. Ahmed contends that 

correcting these alleged errors produces a Total Offense Level of 

15, which, with his Criminal History Category of I, would result 

in a GSR of 18 to 24 months, as opposed to the Total Offense Level 

of 25 and GSR of 57 to 71 months adopted by the district court.6 

See id. ch. 5, pt. A.

"When mulling the procedural reasonableness of a 

sentence, we afford de novo review to the sentencing court's 

6 At one point in his brief, Ahmed also references a loss 

amount of $558,390.14 -- between his preferred figure of 

$436,195.00 and the $1,863,264.85 calculated by the district 

court -- that he says would result if we accepted only one of his 

two arguments on loss amount. Because we ultimately conclude that 

any alleged procedural error by the district court was harmless 

even assuming, favorably to Ahmed, that all of Ahmed's Guidelines 

arguments are correct on their merits, we need not separately 

consider this compromise position.
- 15 -

interpretation and application of the [Guidelines], assay the 

court's factfinding for clear error, and evaluate its judgment 

calls for abuse of discretion." United States v. Ouellette, 985 

F.3d 107, 110 (1st Cir. 2021) (quoting United States v. 

Ruiz-Huertas, 792 F.3d 223, 226 (1st Cir. 2015)). 

In this case, however, "we may bypass the substance" of 

Ahmed's arguments because "any [procedural] error that the 

[d]istrict [c]ourt may have made . . . was harmless." United 

States v. Ayala, 991 F.3d 323, 326 (1st Cir. 2021). "[W]e have 

consistently held that when a sentencing court makes clear that it 

would have entered the same sentence regardless of the Guidelines, 

any error in the court's Guidelines calculation is harmless." 

Ouellette, 985 F.3d at 110; see, e.g., Ayala, 991 F.3d at 326-27; 

United States v. Graham, 976 F.3d 59, 62-63 (1st Cir. 2020). In 

Ouellette, for example, we concluded that any error in the district 

court's Guidelines calculations was harmless because the court had 

announced during sentencing that the sentence it imposed was 

"untethered from the [G]uidelines" and that it "would impose 

precisely the same sentence even if the applicable [GSR] would 

have been reduced by any or all of the objections made [by the 

parties]." 985 F.3d at 109-10. The district court in this case 

used strikingly similar language in stating that Ahmed's sentence 

was "untethered from the [G]uidelines" and that the court "would 

impose the same sentence, even if the [GSR] had been reduced by 
- 16 -

[its] acceptance of an argument that [it] ha[d] not accepted." As 

in Ouellette, "[b]ecause the district court made clear that it 

would have imposed the same sentence regardless of the Guidelines, 

any alleged error in calculating [Ahmed's GSR] is harmless." Id.

at 110. 

Ahmed argues that the alleged errors were not harmless 

because the district court "found that a variance from the low end 

of the [GSR] was warranted," and so "if . . . the case is remanded 

to the [district court] for resentencing, the sentence could be 

lower." But this optimistic view is impossible to square with the 

district court's unqualified statement that it "would impose the 

same sentence, even if the [GSR] had been reduced by [its]

acceptance of an argument that [it] ha[d] not accepted." For 

remand to be appropriate, there must be "at least a possibility 

that the [district] court would have imposed an even more lenient 

sentence had it started with a lower GSR." Alphas, 785 F.3d at

780 (declining to hold any error harmless where the district court 

said it was "unlikely," but not impossible, that a lower GSR would 

result in a lower sentence). The record "does not admit of such 

a possibility" here. Ayala, 991 F.3d at 327. There was no 

reversible procedural error.

B.

Ahmed also challenges the substantive reasonableness of 

his sentence, arguing that if his Guidelines arguments regarding 
- 17 -

loss amount and the leader/organizer enhancement are correct, "his 

sentence was substantively unreasonable," but acknowledging that 

if we affirm the district court's Guidelines calculations, his 

substantive unreasonableness claim "is weak at best." Because we 

decline to address the merits of Ahmed's Guidelines arguments in 

the context of his procedural reasonableness claim, and because 

his substantive reasonableness claim turns on those arguments, we 

assume, favorably to Ahmed, that he can raise those arguments in 

the substantive reasonableness context. Cf. Ouellette, 985 F.3d 

at 111 ("[E]ven if we are satisfied that [a procedural] error did 

not affect the district court's determination of the sentence, we 

still must review the sentence for substantive reasonableness."

(quoting United States v. Tavares, 705 F.3d 4, 27 (1st Cir. 

2013))). We determine that there was no Guidelines error and 

conclude that his sentence is substantively reasonable.

1.

Ahmed's first Guidelines claim contests the district 

court's conclusion regarding loss amount; he argues that the court 

erred both in holding him responsible for amounts billed by 

providers for their own services and in declining to credit him 

for interpreter services he purportedly provided. "We review the 

[d]istrict [c]ourt's 'interpretation and application of the

[Guidelines]' de novo, and factual findings, including the 

[d]istrict [c]ourt's 'calculation of the amount of loss, for clear 
- 18 -

error.'" United States v. Cadden, 965 F.3d 1, 31 (1st Cir. 2020) 

(citations omitted) (first quoting Flores-Machicote, 706 F.3d at

20; and then quoting United States v. Ihenacho, 716 F.3d 266, 276 

(1st Cir. 2013)). "A defendant 'dissatisfied with the sentencing 

court's quantification of the amount of loss in a particular case 

must go a long way to demonstrate that the finding is clearly 

erroneous.'" United States v. Curran, 525 F.3d 74, 79 (1st Cir. 

2008) (quoting United States v. Rostoff, 53 F.3d 398, 407 (1st 

Cir. 1995)). We conclude that Ahmed's arguments are without merit.

a.

Ahmed first challenges the district court's inclusion of 

the amounts billed by coconspirator providers for clinical 

services -- rather than interpreter services -- in his loss amount. 

"Defendants who engage in a 'jointly undertaken criminal activity' 

are responsible for . . . losses that result from 'reasonably 

foreseeable acts committed by others in furtherance of the jointly 

undertaken criminal activity.'" United States v. Delima, 886 F.3d 

64, 72 (1st Cir. 2018) (quoting United States v. Pizarro-Berríos, 

448 F.3d 1, 8 (1st Cir. 2006)); see U.S.S.G. § 1B1.3(a)(1)(B). A 

"sentencing court must [(1)] 'ascertain what activity fell within 

the scope of the specific conduct and objectives embraced by the 

defendant's agreement,' and [(2)] then 'determine to what extent 

others' acts and omissions that were in furtherance of jointly 

undertaken criminal activity likely would have been foreseeable by 
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a reasonable person in [the] defendant's shoes at the time of his 

or her agreement.'" Delima, 886 F.3d at 72-73 (quoting United 

States v. LaCroix, 28 F.3d 223, 227 (1st Cir. 1994)). We review 

each of these "fact-bound determination[s]" for clear error. 

United States v. Sandoval, 6 F.4th 63, 106 (1st Cir. 2021); see

United States v. Carrozza, 4 F.3d 70, 76 (1st Cir. 1993) ("Such 

determinations are, of course, all inherently fact-bound.").

Ahmed challenges the district court's compliance with 

both prongs. With respect to the first inquiry, he asserts both 

that the district court failed to "make particularized findings 

concerning . . . the scope of Ahmed's agreement and whether the 

conduct of the individual counseling providers exceeded the scope 

of his agreement" and that "the evidence was insufficient to show 

that Ahmed's agreement in any way encompassed the fraud that was 

being committed by the counseling providers." With respect to the 

second prong, he argues that "there was insufficient evidence from 

which to conclude that it was foreseeable that the providers would 

overbill for their own services in addition to overbilling for 

translation services." We find no error in the district court's 

reasoning.

The transcript of Ahmed's sentencing hearing undercuts 

his first argument: During the proceeding, the district court made 

explicit findings about the nature and scope of Ahmed's agreements 

with the counselors involved. The court found, for example, that 
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Ahmed "conspired with mental health counselors to fraudulently 

bill MaineCare for mental health counseling services and 

accompanying translation services provided to Somali clients";

that he "knew that the records being submitted to MaineCare were 

not accurate"; and that submission of such fraudulent claims "was, 

in essence, the whole point of the[] scheme."

And contrary to Ahmed's second argument, the evidence 

supports the district court's findings. In determining relevant 

conduct, a sentencing court "may consider any explicit agreement 

or implicit agreement fairly inferred from the conduct of the 

defendant and others." U.S.S.G. § 1B1.3 cmt. n.3(B). The 

sentencing record showed that Ahmed at least implicitly agreed to 

the providers' overbilling for clinical services. Multiple 

providers described Ahmed's pressuring them to inflate the number 

of units for which they billed. The district court noted that 

Daigle, for example, "explained that she [was] . . . pressured by 

[Ahmed] . . . to bill for services not provided." Common sense 

dictates that, to avoid claims' appearing obviously fraudulent, 

providers would need to overbill for clinical services to 

correspond to the units billed for interpreter services. Cf. 10-

144 Me. Code R. ch. 101, ch. I, § 1.06-2(A) ("Interpreter services 

can only be covered in conjunction with another covered MaineCare 

service or medically necessary follow-up visit(s) to the initial 

covered service."). The district court did not err in concluding 
- 21 -

that the providers' overbilling for clinical services fell within 

the scope of Ahmed's agreement.

The district court did not err in concluding that the 

providers' overbilling was foreseeable to Ahmed. As the district 

court recognized, Ahmed "knew or should have known that the 

providers could only seek reimbursement for interpreter services 

in the same units of time as they sought reimbursement for the

counseling services." A reasonable person in his position would 

have foreseen that the providers would overbill for clinical 

services in addition to interpreter services.

b.

Ahmed next objects to the district court's refusal to 

credit him for interpreter services he purportedly provided in the 

course of the scheme. 

The Guidelines provide that a defendant's loss amount 

"shall be reduced by . . . the fair market value of . . . the 

services rendered . . . by the defendant." U.S.S.G. § 2B1.1 cmt. 

n.3(E)(i). But "in a case . . . where a defendant's claims were 

demonstrably rife with fraud[,] . . . a sentencing court may use 

the face value of the claims as a starting point in computing 

loss." Alphas, 785 F.3d at 784; see United States v. Iwuala, 789 

F.3d 1, 14 (1st Cir. 2015) (applying this framework in a Medicare 

fraud case). "'[T]he burden of production will then shift to the 

defendant, who must offer evidence to show' why the loss figure 
- 22 -

should be set at a lower amount." Iwuala, 789 F.3d at 14 (quoting 

Alphas, 785 F.3d at 784). "After the record is fully formed, the 

sentencing court must determine the amount of loss that the 

government (which retains the burden of proof) is able to 

establish." Id. (quoting Alphas, 785 F.3d at 784). The district 

court concluded -- and Ahmed does not dispute on appeal -- that 

this "case is rife with fraud." The Alphas burden-shifting 

framework applies, and Ahmed bore the burden of producing evidence 

justifying a reduction in his loss amount from the initial figure 

proven by the government.7 We review the district court's findings 

regarding loss amount for clear error. See, e.g., Cadden, 965 

F.3d at 31.

In the district court, Ahmed sought to meet his 

evidentiary burden in two ways. First, based on statements by 

Daigle, Borst, and a counselor at Facing Change, he purported to 

calculate "rudimentary" ratios representing the degree to which 

Ahmed's loss amount related to each practice should be reduced. 

For example, Ahmed argued that, because Daigle indicated in a law 

enforcement interview that "anything over [five units in a given 

7 We note that, although the Alphas burden-shifting 

framework allows the government to use "the face value of the 

claims as a starting point" for the loss calculation, 785 F.3d at 

784, the government in this case chose "for efficiency purposes" 

to instead use "the amount[] actually paid by MaineCare, which is 

roughly $250,000 less than the amount billed." This choice worked 

to Ahmed's benefit, and he unsurprisingly does not question it on 

appeal. 
- 23 -

session] was an overbilling" and because Daigle generally billed 

for ten units per session, Ahmed's loss amount related to Daigle's 

practice should be reduced by 50%. Second, he submitted records 

purporting to show that some of the patients involved in the 

conspiracy received mental health care paid for by MaineCare before 

and/or after interacting with the conspiracy. We conclude that 

the district court did not clearly err in finding that neither 

submission warranted a reduction in Ahmed's loss amount.

We first consider Ahmed's proposed offset ratios. The 

evidence offered by Ahmed in support of his calculations suffered 

from a number of obvious defects. With respect to Daigle, Ahmed's 

proposed ratio relied on a report describing an interview with law 

enforcement in which Daigle "estimated that anything billed over 

5 units was fraudulent." The report does not state that Daigle 

was certain that the first five units of each session were 

legitimate -- only that anything beyond that was not -- and 

characterizes her five-unit figure as an "estimate[]" based on 

"preliminary calculations."

With respect to Borst, Ahmed's proposed ratio rested on 

the assertion that "Borst told investigators that the typical 

session was thirty minutes," or two units. Borst did state in an 

interview that in "basically every patient session [Ahmed] 

interpreted for, [he] would get up after about thirty minutes and 

just leave with the patient." But she did not state that those 
- 24 -

thirty minutes were spent on legitimate counseling; on the 

contrary, she later described many visits as "pretty much 

just . . . check-in[s]." Moreover, her description of most 

sessions as lasting thirty minutes was contradicted by other record 

evidence: Borst testified to the Ludwig grand jury that some visits 

never actually took place; that she could not tell from her records 

whether any particular visit occurred; and that typical visits 

with Somali clients, at least early in the conspiracy, lasted only 

"10 or 15 minutes." Further, as the district court noted, 

"[g]overnment surveillance of the Borst practice for 13 days 

observed that on six of those days Borst saw no patients but 

submitted claims for 10 to 12-1/2 hours of service," and "[o]n 

other days agents saw patients come into the office for no longer 

than 16 minutes, yet Borst submitted claims for every patient for 

two and a half hours."

Finally, with respect to Facing Change, Ahmed's proposed 

ratio depended on his assertion that one counselor at the agency, 

Danielle Defosse-Strout, "told investigators that the typical 

session with Mr. Ahmed was 2 to 3-units, or 30 minutes to 45 

minutes." Defosse-Strout did say in one interview that "most 

visits involving [Ahmed] were 30-40 minutes in length." But she 

claimed in a different interview that a "typical visit with 

[Ahmed]" lasted fifteen minutes, and she stated that -- whatever 

the length of the visits that Ahmed in fact attended -- most
- 25 -

patient visits for which Ahmed purportedly provided interpreter 

services, and for which she billed MaineCare, did not actually 

occur: only one-third of billed visits involved client contact. 

Further, Defosse-Strout did not state that those visits that did 

take place involved legitimate services.

The district court also considered during sentencing the 

evidence that any sessions that did occur did not involve treatment 

for MaineCare eligible conditions. As the court recounted, Borst, 

for example, "explained that she didn't provide any counseling 

services to her Somali patients because her visits with them were 

so brief and disorganized." Defosse-Strout testified that she had 

had patients who did not require treatment whom Ahmed would resist 

discharging, and admitted to falsifying billing codes to obtain 

reimbursements for services not covered by MaineCare. Another 

Facing Change counselor, Brittany Harrington, described instances 

in which Ahmed would bring back former clients whom she did not 

believe needed treatment and whom she had recently discharged, 

with Ahmed claiming that the clients were experiencing symptoms 

they had never before reported.

As the district court also highlighted, testimony at 

Ludwig's trial by former Facing Change patients for whom Ahmed 

served as interpreter cast further doubt on the legitimacy of the 

services offered. One former patient testified that he did not 

know why he was brought to the agency and that he attempted to 
- 26 -

tell staff that he did not need any assistance. Another explained 

that he had hoped to receive treatment for asthma and a toothache, 

rather than for any mental health concerns.

Finally, the district court "note[d] that there was 

substantial testimony calling into question the legitimacy of the 

translation services that were provided by [Ahmed]." Harrington 

stated both in an interview with law enforcement and in testimony 

during Ludwig's trial that she doubted the accuracy of Ahmed's 

work. She explained that Ahmed used "clinical-based terms" that 

patients "would not know" or were unlikely to use, such as 

"flashbacks," and spoke for lengths of time that did not match the 

patients' speech -- including instances where he answered without 

the patients' having spoken at all. Defosse-Strout raised similar 

concerns that "what [Ahmed] was translating back to her wasn't 

what the client was actually saying," as his "translated 

responses . . . were all suspiciously identical."

On this record, it was not clearly erroneous for the 

district court to conclude that Ahmed's back of the envelope 

calculations based on a few provider estimates were insufficient 

evidence to show that a portion of the claims were legitimate. 

See United States v. Arif, 897 F.3d 1, 11 (1st Cir. 2018); see 

also, e.g., United States v. Mathew, 916 F.3d 510, 521-22 (5th 

Cir. 2019) (affirming district court's denial of loss amount credit 

to defendant despite his submission of "medical documents, patient 
- 27 -

interviews, and witness testimony" to show legitimacy of services 

because "government presented evidence that discredited [his] 

claims" and evidence); United States v. Bikundi, 926 F.3d 761, 798 

(D.C. Cir. 2019) (affirming denial of loss amount credit where 

defendants "did not produce evidence of [legitimate] services with 

any specificity").

The other evidence cited by the defense does not 

undermine this finding. As the district court pointed out, "even 

taking as true that several of the patients involved during the 

conspiracy received legitimate mental health diagnoses and

counseling before and/or after the fraudulent diagnoses and 

treatment, that does not mean that . . . the [providers] that 

[Ahmed] conspired with actually provided treatment for those 

conditions." This reasoning is not clearly erroneous.

Ahmed's remaining argument is also unpersuasive. He 

asserts that the district court should have credited him for any 

legitimate interpreter services he provided "regardless of the 

legitimacy of the [clinical] service" delivered by providers. In 

support of this contention, Ahmed cites United States v. Klein, 

543 F.3d 206 (5th Cir. 2008), in which the Fifth Circuit concluded 

that a physician convicted of defrauding insurance companies by 

billing for appointments that never happened was entitled to a 

credit against his loss amount for the value of medicine he gave 

to patients to self-administer. See id. at 208, 213-14. Ahmed 
- 28 -

characterizes the medication in Klein as a "connected service" 

analogous to the interpreter services he purportedly provided. 

Even assuming that Ahmed provided genuine interpreter services, 

this analogy does not withstand scrutiny: The government in Klein

did not dispute that "the patients needed th[e] drugs and that the 

insurers would have had to pay for the drugs had Klein merely 

written prescriptions." Id. at 213. Here, in contrast, 

interpreter services would be of value to and reimbursable by 

MaineCare only if "necessary and reasonable" for providing covered 

services to MaineCare beneficiaries. 10-144 Me. Code R. ch. 101, 

ch. I, § 1.06-2(A). The district court properly declined to credit 

Ahmed for interpreter services not associated with legitimate 

clinical services.8

We find no error in the district court's loss 

calculations.

2.

Ahmed also challenges the district court's imposition of 

a four-level leader/organizer enhancement. "We review the 

imposition of this particular sentencing enhancement, and any 

8 Ahmed protests that "the logical extreme [of this] 

reasoning . . . is that a perfectly legitimate, law-abiding 

ancillary service provider could be denied payment because of the 

misdeeds . . . of the primary service provider." But because our 

decision today addresses only sentencing, any ancillary service 

provider affected is necessarily not "law-abiding." Moreover, our 

interpretation of the Guidelines does not bear on an interpreter's 

right to payment by MaineCare or providers.
- 29 -

predicate factual findings, for clear error." United States v. 

Appolon, 695 F.3d 44, 70 (1st Cir. 2012); see also United States

v. May, 343 F.3d 1, 7 (1st Cir. 2003) (noting that "battles over 

a defendant's status . . . will almost always be won or lost in 

the district court" (omission in original) (quoting United States

v. Conley, 156 F.3d 78, 85 (1st Cir. 1998))). The Guidelines 

authorize this enhancement "[i]f the defendant was an organizer or 

leader of a criminal activity that involved five or more 

participants or was otherwise extensive." U.S.S.G. § 3B1.1(a). 

"Th[e] enhancement requires a district court to make 'both a status 

determination -- a finding that the defendant acted as an organizer 

or leader of the criminal activity -- and a scope 

determination -- a finding that the criminal activity met either 

the numerosity or the extensiveness benchmarks established by the 

[G]uideline[s].'" United States v. Hernández, 964 F.3d 95, 101 

(1st Cir. 2020) (quoting United States v. Tejada-Beltran, 50 F.3d 

105, 111 (1st Cir. 1995)). Ahmed concedes that the conspiracy met 

the Guidelines' numerosity requirement because it involved five or 

more participants, leaving only the district court's status 

determination at issue on appeal. Ahmed challenges this 

determination on various grounds, but none are persuasive.

Ahmed's first argument -- that the district court erred 

by failing to "specify in its findings the evidentiary basis for 

its ruling" -- is a nonstarter both legally and factually. 
- 30 -

Legally, Ahmed is mistaken in asserting that explicit factual 

findings are always required: on the contrary, "there is no 

requirement that the district court specifically find whom the 

defendant controlled or how he did so." United States v. Payne, 

881 F.3d 229, 231 (1st Cir. 2018); see also United States v. 

Morales-De Jesus, 896 F.3d 122, 125-26 (1st Cir. 2018) ("A district 

court need not make specific findings justifying its application 

of a role-in-the-offense-enhancement if 'the record clearly 

reflects the basis of the court's determination.'" (quoting United 

States v. Marrero-Ortiz, 160 F.3d 768, 779 (1st Cir. 1998))). In 

fact, the district court did make relevant findings in imposing 

the role enhancement. In particular, notwithstanding Ahmed's 

claim that the court made "no findings about which other 

participants Ahmed controlled," the court noted that "there 

certainly [was] evidence that . . . Osman was in some respects 

subservient to . . . Ahmed," and adopted the PSR's conclusion that 

Ahmed "appeared to have a leadership role over . . . Osman."

To the extent Ahmed argues that he did not have the 

requisite authority over at least one of his coconspirators, that 

argument, too, misses the mark. It is true that, for the 

enhancement to apply, Ahmed must have led or organized at least 

one other criminal actor -- and not just a criminal activity -- on 

at least one occasion. See United States v. García-Sierra, 994 

F.3d 17, 37 (1st Cir. 2021); see also United States v. McKinney, 
- 31 -

5 F.4th 104, 109 (1st Cir. 2021). But the record supports the 

district court's conclusion that, at minimum, Ahmed organized or 

led Osman. Defosse-Strout, for example, stated to investigators 

that on at least one occasion Ahmed "made [Osman] execute . . . 

interpreter sheets even though [Ahmed] was the interpreter for the 

actual visit." Cf. Hernández, 964 F.3d at 102-05 (concluding 

organizer enhancement warranted where defendant on one occasion 

gave coconspirator instruction intended to facilitate criminal 

activity). Both she and Harrington also testified at Ludwig's 

trial that they understood all of Facing Change's Somali patients, 

whether brought in by Ahmed or Osman, to be "[Ahmed's] clients." 

Cf. United States v. Carrero-Hernandez, 643 F.3d 344, 352 (1st 

Cir. 2011) (noting that defendant's referring to criminal 

enterprise as "'his' system" supported conclusion that he led or 

organized coconspirators). Facing Change's billing manager 

similarly testified that all the firms through which the agency 

employed Somali translators, including Osman, were "[Ahmed's] 

operations." Indeed, Ahmed's counsel conceded in the district 

court that "it did appear that . . . [Ahmed] was a manager or 

supervisor of . . . Osman." The district court did not clearly 

err in determining that, at minimum, Ahmed exercised the requisite 

authority over Osman for the enhancement to apply.

Ahmed next contends that the facts in the record do not 

support the imposition of the enhancement. He relies on the 
- 32 -

factors set forth in an application note to Guidelines section 

3B1.1, which provides:

Factors the court should consider [in 

assessing a defendant's role in an offense] 

include the exercise of decision making 

authority, the nature of participation in the 

commission of the offense, the recruitment of 

accomplices, the claimed right to a larger 

share of the fruits of the crime, the degree 

of participation in planning or organizing the 

offense, the nature and scope of the illegal 

activity, and the degree of control and 

authority exercised over others.

U.S.S.G. § 3B1.1 cmt. n.4; see also Appolon, 695 F.3d at 70 

("[T]here need not be proof of each and every factor before a 

defendant can be termed an organizer or leader." (quoting 

Tejada-Beltran, 50 F.3d at 111)). Contrary to Ahmed's argument, 

the district court considered these factors and reasonably 

concluded that Ahmed qualified as a leader or organizer. 

The court's factual findings from the sentencing hearing 

track the Guidelines factors. The district court found that Ahmed 

influenced both the providers' schedules and their billing through 

"his control over the clients" -- which allowed him, and "not the 

clinicians," to "make the appointments for clients" -- and through 

"his demands regarding the number of units that had to be billed." 

These findings reflect Ahmed's "exercise of decision making 

authority," his significant "degree of participation in planning 

or organizing the offense," and his "degree of control and 

authority exercised over others." U.S.S.G. § 3B1.1 cmt. n.4. The 
- 33 -

district court also found that Ahmed "was a critically important 

driving force" in the conspiracy, "was involved from the very 

beginning . . . until the end," and "was the common denominator as 

between the three counseling practices that participated in

fraudulent billing." Those findings support the conclusion that 

Ahmed's "participation in the commission of the offense" was 

substantial, and illustrate the wide-reaching, multi-agency 

"nature and scope of [his] illegal activity." Id. Further, the 

district court plausibly found that Ahmed "proposed and influenced 

Daigle and Borst to participate in the scheme," demonstrating 

Ahmed's "recruitment of accomplices."9 Id. Finally, the district 

court determined that Ahmed "personally received the largest share 

of the crime proceeds."10 See id. (listing "the claimed right to 

a larger share of the fruits of the crime" as a relevant factor in 

the leader/organizer analysis).

9 In his brief, Ahmed asserts without citation that Daigle 

recruited Ahmed into the scheme, rather than the other way around. 

The record does not support this view; Daigle stated to 

investigators, without contradiction in the record, that the idea 

to overbill originated with Ahmed.

10 On appeal, Ahmed concedes that "his gross proceeds over 

time were larger than the other participants[']," but contends 

that this was the result of his "working with multiple providers," 

and that "his percentage share of the proceeds was not higher." 

Even taking this claim as true, Ahmed does not explain why his 

greater gross income from the conspiracy would not be a relevant 

consideration in assessing his role.
- 34 -

The district court also found that Ahmed's "control over 

the clients" gave him the necessary leverage to influence the 

providers, who relied on his "ability . . . to provide Somali 

beneficiaries." The record supports this finding, as multiple 

providers described Ahmed's role in billing decisions; 

Defosse-Strout, for example, testified to the Ludwig grand jury 

that she and Ahmed would negotiate billing amounts and, on 

occasion, Ahmed would simply "direct[]" her on what claims to file. 

The district court reasonably concluded that Ahmed's inability to 

submit claims did not "in any way detract from the initiative and 

leadership that he displayed in making possible the fraud that the 

providers then committed." The district court did not clearly err 

in applying the leader/organizer enhancement. 

3.

We turn to Ahmed's substantive challenge and find no 

abuse of discretion. "We review a preserved challenge to the 

substantive reasonableness of a sentence under an abuse of 

discretion standard." Flores-Quiñones, 985 F.3d at 133 (quoting 

Reyes-Torres, 979 F.3d at 9). "[A] sentence will be deemed 

substantively reasonable as long as it rests on 'a plausible 

rationale and . . . represents a defensible result.'" United 

States v. Ortiz-Pérez, 30 F.4th 107, 113 (1st Cir. 2022) (omission 

in original) (quoting United States v. Rivera-Morales, 961 F.3d 1, 

21 (1st Cir. 2020)). "We rarely find a below-[G]uidelines sentence 
- 35 -

to be substantively unreasonable." United States v. 

Millán-Machuca, 991 F.3d 7, 32 (1st Cir. 2021).

Unsurprisingly, Ahmed's downward variant sentence 

readily satisfies the substantive reasonableness standard. The 

district court provided a plausible sentencing rationale. It 

discussed the § 3553(a) factors, placing particular emphasis on 

the need to deter future fraud, as Ahmed's activities had "perhaps 

expose[d] . . . the weaknesses of the MaineCare system," and on 

Ahmed's personal characteristics and history, including his 

parental responsibilities. The court's reasoning that a twentyfour-month sentence properly balanced these considerations is 

plausible.11

That result is also defensible: Even under Ahmed's

proposed Guidelines calculations (with a GSR of 18 to 24 months), 

his sentence would fall within the GSR and be "presumptively 

reasonable." Reyes-Torres, 979 F.3d at 9. Given our rejection of 

his Guidelines arguments, and the substantially higher applicable 

GSR of 57 to 71 months, we are still more unlikely to hold the 

sentence unreasonable. See Millán-Machuca, 991 F.3d at 32. In 

any event, considering that Ahmed admitted to participating in a 

11 We note that the district court's reasoning -- grounded 

in the § 3553(a) factors and untethered from the Guidelines --

would be equally sustainable even if we had accepted Ahmed's loss

amount and role enhancement arguments, which bear only on the 

Guidelines and do not address the district court's sentencing 

rationale.
- 36 -

multiyear scheme to defraud MaineCare in which even by his own 

calculations -- let alone those adopted by the district court --

he personally wrongfully received over $436,000, we cannot say 

that his twenty-four-month sentence is outside the "universe of 

reasonable sentences." United States v. Rivera-González, 776 F.3d 

45, 52 (1st Cir. 2015). Medicaid fraud like that committed by 

Ahmed "cause[s] significant harm" by corruptly commandeering funds 

"meant for the needy." Bikundi, 926 F.3d at 796. After all, every 

time Ahmed "fraudulently billed [MaineCare], the government lost 

funds that it otherwise could have used to provide medical care to 

eligible [Mainers]." United States v. Regueiro, 240 F.3d 1321, 

1324 (11th Cir. 2001). The district court did not abuse its 

discretion by responding to this serious offense with a twentyfour-month sentence.

Ahmed's last argument to the contrary is unpersuasive.12 

He contends that the disparity between his sentence and Osman's 

renders his sentence substantively unreasonable. It is true that 

a sentencing court must consider "the need to avoid unwarranted 

12 Ahmed's brief also posits that, if his Guidelines 

arguments carried the day, leaving his sentence at the high end of 

his preferred GSR of 18 to 24 months, his sentence would be 

substantively unreasonable because, since "the [district court] 

held that a downward variance was appropriate . . . , a sentence 

at the high end of the [GSR] [would not be] substantively 

reasonable." Because we reject Ahmed's Guidelines arguments, his 

sentence is below, rather than at the top of, the applicable GSR, 

mooting this argument.
- 37 -

sentence disparities among defendants with similar records who 

have been found guilty of similar conduct." 18 U.S.C. 

§ 3553(a)(6). But because § 3553(a) specifically addresses

"unwarranted sentence disparities among defendants with similar

records" convicted of "similar conduct," id. (emphasis added), a

defendant "must compare apples to apples" by pointing to sentencing 

disparities between "similarly situated" individuals, United 

States v. Candelario-Ramos, 45 F.4th 521, 526 (1st Cir. 2022) 

(first quoting United States v. González-Barbosa, 920 F.3d 125, 

131 (1st Cir. 2019); and then quoting United States v. Romero, 906 

F.3d 196, 211 (1st Cir. 2018)). Cases involving such apples to

apples comparisons "are unusual." United States v. Grullon, 996 

F.3d 21, 35-36 (1st Cir. 2021).

Ahmed's argument is easily rejected. He has not in the 

least shown that Osman was a relevant comparator for these 

purposes. Ahmed "is attempting to compare apples to kumquats." 

United States v. Gonzalez, 981 F.3d 11, 23 (1st Cir. 2020). For 

example, as the district court explained during Ahmed's sentencing 

hearing, "[t]he conspiracy . . . was begun by . . . Ahmed" "no 

later than early 2015," with Osman not joining until "sometime in 

2016"; Ahmed "personally received the largest share of the crime 

proceeds"; and "there certainly [was] evidence that . . . Osman 

was in some respects subservient to . . . Ahmed." Indeed, defense 

counsel acknowledged to the district court that "it did appear 
- 38 -

that [Ahmed] . . . was a manager or supervisor of . . . Osman." 

Cf. United States v. Floyd, 740 F.3d 22, 39 (1st Cir. 2014) ("[A]n 

offender who sits at the top of a criminal hierarchy is not 

similarly situated to his underlings."). Given Ahmed's and Osman's 

disparate situations, the difference in their sentences does not 

establish any abuse of discretion.

III.

We affirm Ahmed's sentence and remand for the limited 

purpose of addressing the issue identified in footnote 4.