Background
Five pharmacists operating five pharmacies in Michigan and Ohio engaged in a scheme to bill insurers for prescriptions they did not dispense. They targeted patients who did not pick up medications, forged signatures, and replaced brand-name drugs with generics to pocket insurance payments. Qlarant, a government contractor, detected the fraud by comparing wholesaler invoices to billing records, calculating a loss of over thirteen million dollars. Four defendants went to trial and were convicted of conspiracy to commit healthcare and wire fraud, with one also convicted of substantive healthcare fraud.
The court’s reasoning
The court held that the expert witness, Johanna Sullivan, did not violate the Confrontation Clause because she performed her own analysis and verification of the data rather than merely acting as a mouthpiece for non-testifying analysts. The district court properly excluded evidence of legitimate billing and PBM bias as irrelevant to the specific charges of fraud. The court found no variance between the indictment and trial evidence, as the defendants shared a common goal and used identical methods across all pharmacies. Sentencing challenges were rejected due to the lack of procedural or substantive unreasonableness.
Defendants have not shown that Sullivan’s testimony violated the Confrontation Clause. The right of confrontation did not prevent Sullivan from testifying to her independent interpretation of data provided by others.
United States v. Hamaed, 26a0166p.06 (6th Cir. 2026)
What it means going forward
The decision clarifies that expert witnesses may rely on data prepared by others in fraud cases provided they conduct their own independent analysis and verification, reinforcing the admissibility of complex financial evidence in healthcare fraud prosecutions.