Opinion ID: 2994331
Heading Depth: 2
Heading Rank: 6

Heading: 3d 913, 919 (7th Cir. 1994). However, the

Text: determination that Vivit occupied a position of trust is a finding of fact, which we review only for clear error. See United States v. Boyle, 10 F.3d 485, 489 (7th Cir. 1993). The determination whether a court has engaged in impermissible double counting is a question of law, which we review de novo. See United States v. Compton, 82 F.3d 179, 183 (7th Cir. 1996) (citation omitted). Guidelines sec. 3B1.3 requires courts to increase the total offense level of a defendant by two levels [i]f the defendant abused a position of public or private trust . . . in a manner that significantly facilitated the commission or concealment of the offense. U.S.S.G. sec. 3B1.3. The district court felt that the insurance companies to whom Vivit submitted claims trusted the doctor, and increased accordingly on this ground. However, Vivit claims that because his relationship with these insurance companies was commercial rather than fiduciary, the enhancement is not applicable. We recently disposed of this argument in United States v. Hoogenboom, 209 F.3d 665, 671 (7th Cir. 2000), when we noted that [m]edical service providers occupy positions of trust with respect to private or public insurers (such as Medicare) within the meaning of guideline sec. 3B1.3. Id. (citations omitted). We explained that [m]edical providers . . . enjoy significant discretion and consequently a lack of supervision in determining the type and quality of services that are necessary and appropriate for their patients. This forces [the insurer] to depend, to a significant extent, on a presumption of honesty when dealing with statements received from medical professionals. Id. Although in Hoogenboom, we were faced with fraud committed against a public insurer, Medicare, rather than against private insurers, we made no distinction between the two in determining whether the enhancement was applicable, and we believe that no distinction exists. For this reason, the facts presented by Vivit cannot be distinguished from those presented in Hoogenboom, and we find the logic in that case controlling. Vivit also claims that enhancement under sec. 3B1.3 constitutes impermissible double counting, because it punished him for both acting as a leader and abusing a special skill. Guidelines sec. 3B1.3 prohibits the enhancement under sec. 3B1.3 for use of a special skill in addition to enhancement under sec. 3B1.1 for a leadership role in the offense, but permits the enhancement for an abuse of trust in addition to a sec. 3B1.1 enhancement. U.S.S.G. sec. 3B1.3. The district court enhanced Vivit’s sentence under both sec.sec. 3B1.1 and 3B1.3, but the court’s articulated basis for the sec. 3B1.3 enhancement was that it is fair to say that he counted upon that the insurance companies would extend trust to him, and certainly after a period of time doing this it is quite clear that he understood that they did trust him; so that he did abuse his trust relative to the insurance companies. Therefore, the court based its enhancement on abuse of trust, not on use of a special skill. There is no impermissible double counting to enhance under both sec.sec. 3B1.1 and 3B1.3 in these circumstances.