Opinion ID: 2796615
Heading Depth: 2
Heading Rank: 3

Heading: Tran’s Sentence

Text: Finally, Tran challenges the calculation of her guidelines range. She contends that the government failed to prove several facts underpinning the district court’s drug-quantity and amount-of-loss findings. Specifically, Tran disputes that every unit of hydrocodone she prescribed during the conspiracy was unlawfully distributed and that every prescription filled at -8- Case No. 14-1092 United States v. Tran Highland Park constituted loss to the defrauded insurers. We conclude that any error by the district court proved harmless. We review drug-quantity findings for clear error. United States v. Swanberg, 370 F.3d 622, 625 (6th Cir. 2004); see also U.S.S.G. § 2D1.1, cmt. n.5. The government bears the burden of proving the quantity of illegally dispensed drugs attributable to the defendant’s conduct by a preponderance of the evidence. Swanberg, 370 F.3d at 625. Courts may draw all reasonable inferences from the evidence—or lack thereof—presented. See United States v. Huffman, 529 F. App’x 426, 431 (6th Cir.) (“[I]t was not inappropriate for the court to consider the lack of evidence that some of the prescriptions were legitimate.”), cert. denied, 134 S. Ct. 320 (2013); United States v. Leal, 75 F.3d 219, 229 (6th Cir. 1996) (“[T]he district court could have drawn certain inferences, [even though they were] not explicitly set forth during sentencing.”), abrogated on other grounds by United States v. Ellerbee, 73 F.3d 105, 107 (6th Cir. 1996); cf. Swanberg, 370 F.3d at 625 (“Although Swanberg objected to the Presentence Report’s calculation of the drug quantity attributable to him, he produced no contradictory evidence at the hearing.”). Although Tran acknowledges prescribing all 213,548 units of hydrocodone found by the district court, she maintains that “the record does not even come close to demonstrating an across-the-board lack of medical necessity” for them. But to show prejudicial error in her guidelines range, Tran would need to prove that more than half—or 113,548 units—of the district court’s drug-quantity finding is erroneous. See U.S.S.G. § 2D1.1(c)(7) (2013) (dictating a sixteen-point base offense level for an amount between 100,000 and 400,000 units); Leal, 75 F.3d at 229 (upholding drug-quantity finding where the defendant needed to show clear error with respect to over a thousand kilograms of controlled narcotics and the record showed, at best, -9- Case No. 14-1092 United States v. Tran de minimis error). She directs us to nothing in the record that supports such a dramatic reduction. The government’s statistical evidence showed that Tran prescribed twice as much hydrocodone to her Medicare patients as the second-ranking podiatrist in Michigan, her partner Dr. Meghan Lee. Lee refused to participate in Patel’s conspiracy. Although she served the same community of patients, her hydrocodone prescriptions totaled half of Tran’s, and these numbers include the prescriptions Lee renewed when covering Tran’s patients. This evidence suggests that the difference in hydrocodone prescriptions between the doctors resulted from Tran’s participation in the conspiracy. Furthermore, the government proved that the bulk of Tran’s prescriptions followed a specific pattern: a controlled pain killer—usually hydrocodone—combined with a bundle of eight to twelve expensive, non-controlled drugs. Drake testified that these prescription combinations would raise “red flags,” and the Highland Park pharmacists admitted to shorting the non-controlled drugs in prescriptions that fit this pattern. Through reasonable extrapolation, then, the conspiracy motivated at least half of all Tran’s hydrocodone prescriptions. See United States v. Rodriguez-Iznaga, 575 F. App’x 583, 588 (6th Cir. 2014) (allowing for the extrapolation of evidence on reasoned, factually supported grounds), cert. denied, 135 S. Ct. 1167 (2015). Thus, the district court committed no clear error in finding at least 106,774 units unlawfully dispensed. And because any figure over 100,000 units returns the same adjusted offense level, we need not consider whether the district court erred in counting the rest. The same is true for the district court’s loss calculation of $4,475,193.40. So long as the record supports a finding of at least $1 million, Tran’s combined offense level remains unchanged. See U.S.S.G. §§ 2B1.1(b)(1)(I), 3D1.4(a). District courts need provide only a - 10 - Case No. 14-1092 United States v. Tran reasonable estimate of loss, which we review for clear error. Id. § 2B1.1, cmt. n.3(C); United States v. Poulsen, 655 F.3d 492, 512 (6th Cir. 2011). Accordingly, Tran “must carry the burden of demonstrating that the court’s evaluation of the loss was not only inexact but outside the universe of acceptable computations.” United States v. Martinez, 588 F.3d 301, 326 (6th Cir. 2009) (quoting United States v. Raithatha, 385 F.3d 1013, 1024 (6th Cir. 2004)) (internal quotation marks omitted). As the government pressed at oral argument, the district court reasonably counted as loss at least eighty-five percent of Tran’s Medicare prescriptions—a measure worth $1,711,499.65. As discussed above, each prescription in this subset included a controlled substance like hydrocodone, and therefore fit the fraudulent pattern identified by the government’s witnesses. As further support for Tran’s offense level, her patients cost Medicare $1,069,644.42 more than Lee’s patients in prescription-drug costs from May 2010 to August 2011. Once again, the cost of Tran’s prescriptions surpassed all other podiatrists in Michigan during this period, with Lee coming in a distant second. The documented period also accounts for less than half the time Tran participated in the conspiracy. Combined with Tran’s apparent disregard for drug-seeking behavior in her patients receiving controlled substances, this evidence supports the finding that she wrote at least eighty-five percent of her Medicare prescriptions in furtherance of the conspiracy. And Tran offers nothing to show the medical necessity of any drug included in these prescriptions. See U.S.S.G. § 2B1.1, cmt. n.3(E) (allowing defendants to reduce the amount of loss by the fair market value of services actually rendered); id. § 2B1.1, cmt. n.3 (F)(viii) (stating that fraudulent healthcare bills constitute prima facie evidence of intended loss); United States v. Washington, 715 F.3d 975, 984–85 (6th Cir. 2013) (holding that defendants bear the burden of proving what part of a fraudulent bill represents services rendered). - 11 - Case No. 14-1092 United States v. Tran With no clear error evident in at least $1,711,499.65 of the district court’s loss finding, Tran would have received at least a sixteen-point enhancement on the fraud count, leaving her total offense level and guidelines range unaltered. Thus, any error in calculating the remainder was harmless.