Yolanda Hamilton v. United States

Medicare reimburses healthcare providers who provide home-health services to qualifying Medicare patients. Congress requires a physician to certify a patient for home-healthcare services based on a number of specific considerations that amount to a showing of medical necessity for the services. Can a physician be criminally liable for Medicare fraud when the Government fails to produce medical expert testimony and instead relies solely on lay testimony to establish the lack of medical necessity?

In a case without any showing or finding of pervasive fraud, is it permissible to increase the baselevel punishment by extrapolating two claims presented at trial to thousands of Medicare claims without any proof that these additional claims were themselves fraudulent?