April 7, 2017
from the United States District Court for the Northern
District of Illinois, Eastern Division. No. 14 cr 411 -
Charles P. Kocoras, Judge.
Ripple, and Sykes, Circuit Judges.
Gumila ran a home-healthcare company that defrauded the
federal government of several million dollars. She was
convicted of multiple counts of healthcare fraud and making
false statements in connection with a healthcare matter. The
district judge imposed a below-guidelines prison sentence of
72 months followed by 24 months of supervised release.
appeals, raising several challenges to her sentence. She
first argues that the judge miscalculated the financial loss
attributable to her offenses. She also contends that the
72-month prison term is substantively unreasonable. Finally,
she claims that the judge did not adequately explain the term
and conditions of supervised release. The first two arguments
are meritless. The third is waived. We affirm.
Gumila was head of clinical operations for Suburban Home
Physicians, LLC, which did business under the name
"Doctor at Home." The company employed doctors and
other medical personnel to provide home medical care to the
elderly in and around Chicago. Gumila was indicted on 21
counts of healthcare fraud in violation of 18 U.S.C. §
1347 and three counts of making a false statement in a
healthcare matter in violation of 18 U.S.C. § 1035. The
indictment alleged that Doctor at Home (1) over billed
Medicare for medical home visits; (2) billed Medicare for
unwarranted skilled-nursing services; and (3) billed Medicare
for care-plan oversight services that were never provided.
trial the government introduced testimony from more than 20
witnesses and a trove of documentary evidence establishing
that Gumila played a central role in Doctor at Home's
scheme to defraud the government. The evidence showed that
she regularly overruled physicians who wanted to discharge
patients from their care. She instructed nonphy- sician
employees to bill medical services at unjustifiably high
rates (a practice known as "upcoding"). She
instructed employees to claim that patients were homebound
even when they weren't. And she instructed employees to
process orders authorizing skilled-nursing services even if
the attending doctor did not believe the patient qualified
for that service and even when no doctor had ever examined
the patient. A jury found her guilty on all counts.
the sentencing hearing, the government proposed figures for
three categories of financial loss suffered by Medicare: (1)
approximately $2, 375 million for unnecessary and upcoded
home visits; (2) at least $9.45 million for skilled-nursing
services that did not meet Medicare's requirements and
were unnecessary; and (3) $3, 779 million in claims for
care-plan oversight services that did not qualify for payment
or were never performed.
presentence report ("PSR"), the probation officer
substantiated those figures for the three categories of loss
and estimated the total financial loss stemming from
Gumila's unlawful conduct to be $15.6 million. The
corresponding guidelines range was 151 to 188 months in
prison. The probation officer recommended a below-guidelines
sentence of 84 months in prison and a 24-month term of
supervised release. The PSR also recommended 18 specific
conditions of supervision.
filed written objections to the PSR, challenging the loss
calculation and arguing that the loss should be limited to
Medicare payments for the eight patients specifically
mentioned in the indictment-for a total loss of only $14,
449. She argued for a prison sentence of 12 to 18 months. She
did not object to the recommended term or conditions of
supervised release. The government recommended a
below-guidelines sentence of 120 months in prison, a 24-month
term of supervised release, and $15.6 million in restitution.
sentencing the judge concluded that the evidence established
an "overwhelming and massive scheme" to defraud the
Medicare program. He rejected Gumila's argument that the
government was required to present specific evidence to prove
the fraudulent nature of each individual transaction
contributing to the total financial loss. He also determined
that the PSR's loss estimate of $15.6 million was
reasonable. The judge imposed a sentence of 72 months in
prison (less than half the low end of the guidelines range)
and 24 months of supervised release. He also imposed the 18
conditions of supervision recommended by the PSR and ordered
Gumila to pay $15.6 million in restitution.