Unreported / Non-Citable
Background
Dr. David Young was an experienced emergency room physician in Fredericksburg, Texas who, beginning in 2017, supplemented his income by signing Medicare prescriptions for durable medical equipment (DME) and cancer genetic tests on behalf of three purported telehealth companies: Sunrise Medical, Expansion Media, and Momentum. All three companies represented to Dr. Young that patients had been triaged or examined by medical personnel before he reviewed their charts, but in reality no patients were ever evaluated by a medical professional. Dr. Young gave his login credentials to company employees, who pre-filled prescriptions for him to sign. Over a two-year period he became the fifth-highest prescriber of orthotic braces and seventh-highest prescriber of relevant genetic tests for Medicare patients nationwide, causing Medicare to be billed roughly $34.5 million for DME and $37.2 million for genetic tests. He was paid over $480,000 across the three companies.
In September 2021, Dr. Young was indicted on one count of conspiracy to commit health care fraud under 18 U.S.C. § 1349 and three counts of making false statements relating to health care matters under 18 U.S.C. § 1035(a). A superseding indictment followed in June 2023. After an eight-day trial featuring approximately twenty witnesses, a jury convicted him on all counts in May 2024. The district court denied his post-trial motions for acquittal and a new trial, sentenced him to 120 months in prison, and ordered him to pay $26,622,522.82 in restitution.
The Court’s Holding
The Fifth Circuit affirmed the conviction and sentence in full, finding no reversible error on any of Dr. Young’s challenges. On sufficiency of the evidence for the conspiracy count, the court held that the jury was entitled to infer Dr. Young’s knowing participation in the fraud from six categories of circumstantial evidence: the extraordinary volume and speed of his prescription signing; his surrender of login credentials allowing non-medical staff to pre-fill prescriptions; his orders that contravened standard medical practice (including incompatible braces that could not be worn concurrently); his active encouragement of Sunrise’s expansion into genetic testing after it was raided for DME fraud; the substantial payments he received for minimal medical work; and his continued signing after receiving explicit red-flag warnings about fraud. The court rejected his central defense—that he was deceived by the companies—holding that his certifications were independently false because he attested to having examined and spoken with patients he had never contacted.
On the false statement counts, the court noted that the letters of medical necessity bore Dr. Young’s personal attestation that he had discussed patient compliance with each patient; because he admittedly had not spoken to those patients, he necessarily knew those statements were false at the time of signing. His claim that software auto-generated the language after he signed was contradicted by evidence that the platform required doctors to view the full prescription before executing it—a credibility determination the jury was free to resolve against him. The court also held that Dr. Young waived his venue challenge by failing to raise it before trial or at the close of evidence, and that any error in admitting testimony from two other physicians about red flags they observed at Sunrise was harmless given the weight of the remaining evidence.
Key Takeaways
- A physician who certifies in a Medicare prescription that he examined or spoke with a patient—when he did not—makes a knowingly false statement regardless of whether a co-conspirator also deceived him about the underlying patient evaluations.
- Circumstantial evidence of conspiratorial agreement can be drawn from extreme prescription volume, credential-sharing with non-medical staff, medically impossible orders, financial gain disproportionate to work performed, and continuing to sign after receiving explicit fraud warnings.
- Venue objections in federal criminal cases must be raised before trial (or, if not apparent until then, at the close of the government’s evidence); a post-verdict challenge is waived, not merely forfeited, where the defendant had sufficient pre-trial notice of the potential defect.
- Lay or expert witness testimony about a defendant’s co-conspirators’ fraudulent conduct and red flags visible to similarly situated observers is admissible and does not impermissibly invade the defendant’s state of mind.
Why It Matters
This decision reinforces that the “I was lied to by my employer” defense carries little weight when the falsity is embedded in the physician’s own first-person certifications. Defense counsel in Medicare fraud prosecutions should counsel clients that rubber-stamping pre-filled prescriptions—even under representations of prior patient vetting—exposes the signing physician to independent criminal liability for each document bearing a false attestation of examination or consultation.
The venue waiver holding is also a practical reminder for criminal defense practitioners: venue defects that are apparent from the indictment and the defendant’s own knowledge of where events occurred must be litigated before or during trial. Waiting to see the verdict before raising venue, the court makes clear, is a strategic gamble the rules do not permit.