N O T FO R PUB L ICAT IO N

UNITED STATES C OUR T OF APPEALS

FOR THE NINTH C IR C UIT

UNITED STATES OF AM ER IC A,

Pla intiff - Appe lle e ,

v.

HAKOP GAM B AR

YAN,

De fe nda

nt - Appe lla

nt. No. 15-50258

D.C . No. 2:14-c r-00249-ODW -1

M EM O R ANDUM *

Appe a l from

the Unite d

Sta t e s Distric t C ourt for the C e ntra l Distric t of C a lifornia Otis D. W

right, II, Distric t Judge , Pre siding
Argue d a nd Subm itte d June 9, 2016 Pa sa de n a , C a l ifornia

B e fore : R EINHAR

DT a nd W AR DLA W, Ci rc uit Judge s, a nd KOR M AN, ** Distric t Judge

.
Ha kop Ga m

ba ry a n (“ Ga m

ba ry a n ” ) wa s c onvic t e d a fte r tria l of billing M e dic a re

for powe r whe e lc h a irs he provided to Med i c a re b e ne fic ia

rie s for whom t

he de vic e s

we re not m e dic a lly n e c e ssa ry , in viola

tion o f 18 U.S.C

. § 1347(a ). At se nte nc ing, the



# FIL ED

JUL 05 2016

M OLLY C. DW Y ER, CLERK U

. S

. CO URT O F APPEALS

* This disposition is not a ppropria te for public a t ion a

nd is not pre c e de nt

e xc e pt a s provide d

by 9th C ir. R . 36-3.

** The Honora

ble Edwa rd R . Korm a n, Se n i or Distric t Judge for the U.S. Distric t C ourt for the Ea s te rn Distric t of Ne w York, sitting by de signa tion.distric t judge found tha t ove r $2.5 m i llion of Ga m ba ry a n’ s tota l M e d ic a re billings

we re fra udule nt. T h e applic a tion of the the n-a pplic a ble Se n te nc ing Guide line s for

c a se s in w h i c h the inte nde d loss e xc e e ds $2.5 m illion, U.S.S.G. § 2B 1.1(b)(1)(J)
(2014), a long w i t h an a dditiona l e nha nc e m e nt w e disc uss be low, id. § 2B 1.1(b)(7),

re sulte d in a Guide l ine s ra nge of sixty -thre e to se ve nty -e ight m onths.

The distric t judge im

p o se d a se nte nc e of e ighty -four m onths, a fte r c onside ring

the fa c t ors se t out i n 18 U

. S

. C. § 3553(a ) a nd “ e va lua t[ing] the va rious kinds of

se nte nc e s a va ila

ble a s we ll a s t

he Guide line s se nte nc in g r an ge .” W hile Ga m ba ry a n

doe s not c ha lle n ge the substa ntive re a sona

b l e ne s s of the se nte n c e , he doe s a rgue tha t

the distric t judge e rre d in c a lc ula ting the a p p ropria te Guide l in es r a nge

. B e c a use the

Guide line s m

ust be c orre c tly c a lc ula t e d— if the y a re to be ta k e n into a c c ount, a s the y

m ust be , in de ter m i n i ng a n a p p ropria te se nte nc e unde r § 3553(a )— a nd be c a use we

hold tha t the distric t judge did not do so, w e v acat e the se nte nc e a nd re m a nd for

re se nte nc ing on a

n ope n re c ord.

1. Ga m ba ry a n ar g ue s tha t the e nha nc e m e nt wa s not supporte d by c le a r a n d

c onvinc i ng e vide nc e of the a m ount of loss. C onside ring only the loss re la ting to the

insta nc e s of fra ud for whic h Ga m ba ry a n wa s c onvic te d would ha ve le d to a Guide line s

ra nge of six to twe lve m onths. Se e U.S.S.G. § 2B 1.1(b)(1)(C ) (2014). The dispute d

se nte nc ing e nha

nc e m e nts inc re a se d this ra nge to sixty -thre e to se ve nty -e ight m onths.

2Se e id. § 2 B1

. 1(b)(1)(J). W e ha ve he ld tha t “ fa c ts found in support of Guide line s

e nha nc e m e nts t

ha t turn out to ha ve a disproportiona te im pa c t on the ultim a te se nte nc e

im pose d [ m u s t] be e sta

blishe d by c le a r a nd c onvinc ing e vide nc e ,” ra the r tha n the

othe rwise a

pplic a ble pre p onde ra nc e of the e vide nc e sta nda rd. U nite d Sta te s v. Sta te n,

466 F.3d 708, 720 (9th C ir. 2006). Inde e d, “ whe re a se ve re se nte nc ing e n ha nc e m e nt

is im p ose d on the ba sis of unc ha rge d or a c qu i t t ed conduc t, due proc e ss m a y re quire

c le a r a nd c o nvinc ing e v ide nc e o f tha t c onduc t.” Unite d Sta te s v. Tre a dwe ll, 593 F.3d

990, 1 000 (9th C ir. 2 010). B a se d on this c onside ra tion a nd othe rs a pplic a b l e in the se

c irc um s ta nc e s , se e id., we hold t

ha t the loss e nha

nc e m e nt wa s re quire d to re st on c le a r

a nd c onvinc ing e v ide nc e

.
This sta nda rd h a s not be e n m e t. First, a lthough Ga m ba ry a n bille d M e dic a re for
$3,370,200, only $2,541,805 of those c la im s wer e for powe r whe e lc ha irs.

Ne ve rthe le ss, the re c ord is unc le a r a s to the m a nne r in whic h t he distric t judge a rrive d

a t the lo s s c a lc ula tion of ove r $2.5 m illion. Inde e d, the PSR c a lc ula te d the loss a s

be twe e n $1 m illion a nd $2.5 m illion a nd, w he n gra nting ba il pe nding ap peal , t he

distric t j udge obse rve d tha t he wa s unde rsta nda bly t rouble d by the fa c t tha t “ we c ould
[not] qua ntif y how m a n y of the tota l c la im s subm itte d we re fra u d ule nt.” The re wa s

a n e xc e e dingly na

rrow m ar g i n dividing a s e nte nc ing e nha nc e m e nt for inte nde d loss

e xc e e ding $1 m illion a nd the e nha nc e m e nt for loss e x c e ed i ng $ 2

. 5 m illion. The

3$41,805 diffe re nc e works out to b e a bout e ight or n ine whe e lc hairs out of

a pproxim a te l y

300, or a bout thre e pe rc e nt of the powe r whe e lc ha ir c la im s.

M ore signific a ntly , the e vide nc e a t tria l wa s not s uf f i cie ntly c l e a r a

n d

c onvinc i ng to j ustify the a ssum ption tha t n e a

rl y the e ntire a m ount bille d for powe r

whe e lc ha irs wa s fra udule nt. To c ite j ust one of a num be r of e x a m

ple s, o f the 123

doc tors whose pre sc riptions for powe r whe e lc h a irs Ga m ba ry a n fille d, only thirty -four

we re liste d in a M e d ic a re d a ta ba se a s ha ving be e n c om

prom ise d—

m e a ning tha t the y

we re “ ide ntifie d a s

. . . fra u d u l en t p r o v i d er s

. . . [for] billing a busive ly or ha ving

re porte d tha t the ir [Na tiona l Provide r Ide ntific a tion] n um be rs we re s tole n.” W hile t his

e vide nc e m a y h a ve be e n suffic ie nt to support the infe re nc e t ha t a ll of the p re sc riptions

writte n by the se thirty -four c om prom i se d doc t ors we re fra u d u l en t, the re wa s

c onc e de dly no evide nc e tha t a ny of t he othe r e ighty -nine pre sc ribing doc tors we re

c om prom ise d. Signific a n tly , e ve n a s to the c o m prom ise d d oc tors, the re c o rd doe s not

re ve a l the num

b er o f powe r whe e lc ha i r c la im s tha t we re pre dic a te d o n p re sc riptions

writte n by the se doc tors.

Nor doe s our holding in Unite d Sta te s v. Popov, 742 F.3d 911 (9th C ir. 2014),

c om pe l a c ontra

ry re sult. The re , it wa s a s s um e d tha t a ll of the c la im s subm itte d to

M e d ic a re we re fra udule nt. The de fe nda nts a rgue d, howe ve r, tha t, “ [b] e c a u se it is we l l

known tha t M e dic a re routine ly pa y s m uc h l e ss tha

n the bille d a m ount,

. . . the distric t

4c ourt should h a ve c a lc ula te d the inte nde d loss b a s e d on the a m ounts a c t ua lly pa id by

M e d ic a re .” Id. a t 915. W e re j e c te d this a

rgum e nt for re a sons upon whic h we ne e d not

dwe ll he re

. Id. a t 915–16. Unlike Popov, in t his c a se the thre shold issue is whe the r

a ll o f the c la im s subm itte d to M e dic a re for powe r whe e lc ha irs we re fra ud u l en t , a

n d

not whe the r, if the y we re fra u dule nt, the i nte nde d loss w a s the a m ount M e d ic a re pa id.

In sum , we ha ve he ld tha t a d istric t judge “ n eed n ot m a ke [his or h e r] loss

c a lc ula t ion with a

bsolute pre c ision [a

nd] ne e d o nly m a ke a re a sona b le e stim a te of the

loss ba se d o n the a va ila

b l e inform a tion.” Unite d Sta te s v

. Z o l p , 4 7 9 F.3d 715, 719
(9th C ir. 2 0 0 7 ) (c iting U.S.S.G. § 2B 1.1 c m t. n.3(C )). Ne ve rthe le ss, whe re the

diffe re nc e be t

w e e n a se nte nc ing e n ha

nc e m e nt re sts on $41,805 out of $2,541,805 in

tota l c la im s (o r ap p r ox i m a te ly e ight or nine whe e lc ha irs), a nd whe re the a va ila ble

inform a t ion in the re c ord is insuffic ie nt to e sta blish t ha t a l l (or a lm ost a ll) the c la im s

file d we re fra u dulen t , we a re una ble to c onc lude tha t the e stim a te d loss wa s

re a s ona ble

. W e re m a nd o n a n ope n re c ord so tha t, if the De pa rtm e nt of Justic e wishe s

to pre s s for the highe r e nha nc e m e nt ba s e d on a loss of ove r $2.5 m illion— ra the r tha n

a n e nha nc e m e nt ba se d on loss e xc e e ding $1 m i llion, whic h the tria l record

supports— i t will ha ve the opportunity t o c om e forwa rd with a dd i t i ona l e vide nc e ,

pe rha p s by fina l l y o pening t

he boxe s of file s Ga m

b a ry a n produc e d pursua

nt to a
subpoe na on the first d a y of t ria l. M ore ove r, c ontra

ry to Ga m ba ry a n’ s sugge stion, the

5distric t judg e is not lim ite d to the c ounts of c onvic tion. Nor d o w e sugge st tha t the

fa c t ors s e t o ut in 18 U.S.C

. § 3553(a ), upon w hic h the distric t judge pre viously re lie d,

w o u l d n ot wa rra nt a se nte nc e gre a te r tha n the a pplic a ble G uide line s ra nge.

Ne ve rthe le ss, be fore suc h a se nte nc e c a n b e i m pose d, the a

pplic a b le Guide line s ra n ge

m ust be a c c ura te ly

c a lc ula te d.

2. Ga m ba ry a n a lso a rgue s tha t i nc re a sing his Guide line s ra n ge for de fra uding

a fe de ra l he a lth c a re progra m m ore t ha n $1 m illion viola

te d the Ex Post Fa c to C la

use

.
Ga m ba ry a n’ s ba se offe n se le ve l wa s inc reas ed by two ste ps pursua nt to

U.S.S.G. § 2B 1.1(b)(7) (2014). This spe c ific offe nse c ha ra c t e ristic wa s a dde d to the

Se nte n c i ng Guidel i nes in Nove m be r 2011, a fte r Ga m

b a ry a n c om

m itte d t he offe nse s

c ha rge d in t he indic tm e nt. Se e U.S.S.G. a pp. C v o l. III a m e nd. 749 (2011). W e a gre e

with the De pa

rtm e nt of Justic e tha t this r eq ui r es t h e se nte nc e to be v a c a t e d. Se e

Pe ugh v. Unite d Stat es , 1 3 3 S. C t. 2072, 2084 (2013). Ne ve rthe l e ss, Ga m ba ry a n’ s

suc c e ss on this issue m a y possibly b e c a nc e le d out by Unite d Sta te s v. A de bim pe , 819

F.3d 1212 (9th C i r. 2016), whic h wa s de c ide d while this ap p eal wa s pe nding a n d

whic h he ld tha t a two-ste p inc re a se for a busing a position of trust c ould a pply in the se

c irc um s ta nc e s , id. a t 1214— a n inc re a se the distric t judge initia lly re je c te d.

V ACAT E D AND RE M ANDE D.

6