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 contractor for the Centers for Medicare and Medicaid Services, detected the fraud through invoice reviews, calculating a loss of over thirteen million dollars. Four defendants went to trial and were convicted of conspiracy to commit healthcare fraud and wire fraud, with one defendant 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 court found that evidence of legitimate billing was properly excluded as it was not relevant to the charged conspiracy. The court also determined that the evidence supported a single conspiracy charge due to the common goal of profit, identical methods, and overlapping participants. Challenges to the sentencing and evidentiary rulings were rejected as the district court acted within its discretion.
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, 25-1056 (6th Cir. 2026)
What it means going forward
The decision clarifies that expert witnesses may rely on data collected by others in fraud investigations provided they conduct their own independent analysis and verification, reinforcing the admissibility of complex financial evidence in healthcare fraud prosecutions.