United States v. Zehrung, No. 11-1974 (1st Cir. 2013)
Annotate this CaseDefendant worked in a doctor's office in Maine first as a billing clerk and then as a billing manager. When Defendant began running the billing process on her own, she started carrying out an "upcode" scam wherein she bilked money out of payers like MaineCare, Medicare, and others by changing the codes to overstate what services had been provided, thus fetching higher payments. Defendant was later arrested and pled guilty to healthcare fraud. At sentencing, the judge enhanced Defendant's sentence under U.S.S.G. 3B1.3, which is appropriate if a defendant used a position of trust in such a way that made the crime easier to carry out or cover up. The First Circuit Court of Appeals vacated the sentence and remanded because the sentencing judge did not explain the basis for his findings to the extent necessary to permit effective appellate review, and therefore, the Court could not confirm that an abuse-of-trust enhancement was inevitable on the record.
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