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20 

DUBIN v. UNITED STATES 

Opinion of the Court 

the conduct criminal.  To be clear, being at the crux of the
criminality requires more than a causal relationship, such
as “ ‘facilitation’ ” of the offense or being a but-for cause of 
its  “success.”  Post,  at  3,  5–6  (GORSUCH,  J.,  concurring  in
judgment).  Instead, with fraud or deceit crimes like the one
in this case, the means of identification specifically must be
used  in  a  manner  that  is  fraudulent  or  deceptive.    Such 
fraud or deceit going to identity can often be succinctly sum-
marized as going to “who” is involved.10 

Here, petitioner’s use of the patient’s name was not at the 
crux  of  what  made  the  underlying  overbilling  fraudulent. 
The crux of the healthcare fraud was a misrepresentation 
about the qualifications of petitioner’s employee.  The pa-
tient’s name was an ancillary feature of the billing method 
employed.  The Sixth Circuit’s more colloquial formulation 
is a helpful guide, though like any rule of thumb it will have 
its limits.  Here, however, it neatly captures the thrust of 
the analysis, as petitioner’s fraud was in misrepresenting 
how and when services were provided to a patient, not who 
received the services. 

—————— 

10 Adrift in a blizzard of its own hypotheticals, the concurrence believes 
that it is too difficult to discern when a means of identification is at the 
crux of the underlying criminality.  Post, at 4.  The concurrence’s bewil-
derment is not, fortunately, the standard for striking down an Act of Con-
gress as unconstitutionally vague.  There will be close cases, certainly, 
but that is commonplace in criminal law.  Equally commonplace are re-
quirements  that  something  play  a  specific  role  in  an  offense,  whether 
that role is articulated as a “nexus,” Marinello v. United States, 584 U. S. 
___, ___ (2018) (slip op., at 10), a “locus,” Jones v. United States, 529 U. S. 
848, 855–856 (2000), or “proximate cause,” Robers v. United States, 572 
U. S. 639, 645 (2014).  Such requirements are not always simple to apply. 
Yet resolving hard cases is part of the judicial job description.  Hastily 
resorting to vagueness doctrine, in contrast, would hobble legislatures’ 
ability to draw nuanced lines to address a complex world.  Such an ap-
proach would also leave victims of actual aggravated identity theft, a se-
rious offense, without the added protection of §1028A(a)(1).