{"attribution":{"source":"legal.exploreworldai.com","canonical":"https://legal.exploreworldai.com/api/public/v1/judgment-text?id=us:ca1-24-1716-2026-09-21","cite_as":"NovaCopilot, legal.exploreworldai.com (https://legal.exploreworldai.com/api/public/v1/judgment-text?id=us:ca1-24-1716-2026-09-21)","license":"https://legal.exploreworldai.com/revision","version":"legal-2026-10-17","fingerprint":"ewai:us:e7344b","proof":"sha256:463ef0fd0329c037d042c492be3700d7d432097107de28bb0965d9d851efd3d0","jurisdiction":"us","lang":"en","publisher":"NovaCopilot by ExploreWorld Legal","terms":"https://legal.exploreworldai.com/om"},"brand_source":"Source: NovaCopilot","item":{"schema_version":"1.0.0","id":"us:ca1-24-1716-2026-09-21","jurisdiction":"us","lang":"en","brand_source":"Source: NovaCopilot","brand":{"product":"NovaCopilot","platform":"ExploreWorldAI","infrastructure":"ExploreWorld Legal","infrastructure_url":"legal.exploreworldai.com","legal_entity":"Valkiv Ventures AB","permanent_url":"https://legal.exploreworldai.com/novacopilot","source":"Source: NovaCopilot","powered_by":"Powered by NovaCopilot","license":"https://legal.exploreworldai.com/licensvillkor"},"sections":[{"title":"United States Court of Appeals","paragraphs":[]},{"title":"For the First Circuit","paragraphs":[]},{"title":"Nos. 24-1592","paragraphs":[]},{"title":"24-1716","paragraphs":["para_5","para_6","para_7","para_8","para_9"]},{"title":"APPEALS FROM THE UNITED STATES DISTRICT COURT","paragraphs":[]},{"title":"FOR THE DISTRICT OF MASSACHUSETTS","paragraphs":["para_12"]},{"title":"Before","paragraphs":["para_14","para_15"]},{"title":"Judith H. Mizner, Assistant Federal Public Defender, for the","paragraphs":["para_17"]},{"title":"Alexia R. DeVincentis, Assistant United States Attorney, with","paragraphs":["para_19","para_20"]},{"title":"September 21, 2026","paragraphs":["para_22","para_23"]},{"title":"Gustavo Kinrys challenges the intended loss and restitution","paragraphs":["para_25","para_26","para_27","para_28"]},{"title":"Kinrys worked as a licensed psychiatrist, operating his","paragraphs":["para_30","para_31","para_32"]},{"title":"Aetna, Optum, Beacon, and Medicare. For example, he billed for","paragraphs":["para_34","para_35","para_36","para_37","para_38","para_39"]},{"title":"Over the next two years, at least two insurers asked him to provide","paragraphs":["para_41","para_42","para_43","para_44","para_45","para_46","para_47","para_48","para_49"]},{"title":"A couple of years later, the federal government indicted","paragraphs":[]},{"title":"Kinrys for fraud. And in October 2023, a jury convicted Kinrys","paragraphs":["para_52"]},{"title":"At sentencing, the district court calculated Kinrys's","paragraphs":["para_54","para_55","para_56","para_57","para_58","para_59","para_60","para_61","para_62","para_63"]},{"title":"Kinrys appeals the loss calculation for his sentencing","paragraphs":["para_65","para_66","para_67","para_68"]},{"title":"Yoon, 167 F.4th 556, 564 (1st Cir. 2026) (application of","paragraphs":["para_70","para_71","para_72","para_73"]},{"title":"We start with the loss amount under the sentencing","paragraphs":["para_75","para_76","para_77","para_78"]},{"title":"Kinrys's billing, determined that he intended to steal a little","paragraphs":["para_80","para_81","para_82","para_83","para_84","para_85","para_86","para_87"]},{"title":"1 Generally, courts use the version of the sentencing","paragraphs":["para_89","para_90","para_91","para_92"]},{"title":"The level of deference that courts owe to commentary notes in the","paragraphs":["para_94","para_95"]},{"title":"2026) (Mem.) (granting certiorari). But we may avoid the question","paragraphs":["para_97"]},{"title":"Sentencing Commission amended the guidelines so that the","paragraphs":["para_99"]},{"title":"U.S.S.G. § 2B1.1 amend. 827. As Kinrys concedes, this amendment","paragraphs":["para_101","para_102","para_103","para_104"]},{"title":"The government bears the burden to prove that a","paragraphs":["para_106"]},{"title":"United States v. Alphas, 785 F.3d 775, 784 (1st Cir. 2015). In","paragraphs":["para_108","para_109","para_110"]},{"title":"Yoon, 167 F.4th at 565-66. That approach permits a sentencing","paragraphs":["para_112","para_113","para_114","para_115","para_116","para_117","para_118","para_119","para_120","para_121"]},{"title":"F.4th at 565 (quoting U.S.S.G. § 2B1.1, cmt. n.3(C)). The court","paragraphs":["para_123","para_124","para_125","para_126","para_127","para_128","para_129"]},{"title":"After the court indicated that it would start with the face value","paragraphs":["para_131","para_132","para_133","para_134","para_135","para_136","para_137"]},{"title":"The district court was unpersuaded. It provided two","paragraphs":["para_139","para_140","para_141"]},{"title":"BCBS and another against Optum -- alleging, inter alia, that the","paragraphs":["para_143","para_144","para_145","para_146","para_147","para_148","para_149","para_150"]},{"title":"2 Kinrys's civil suits were subsequently removed to","paragraphs":["para_152","para_153"]},{"title":"Kinrys had intended to \"scoop\" as much as he could from the","paragraphs":["para_155"]},{"title":"On appeal, Kinrys repeats his arguments that intended","paragraphs":["para_157","para_158","para_159","para_160"]},{"title":"United States v. Arif, 897 F.3d 1, 11 (1st Cir. 2018). Surmounting","paragraphs":["para_162","para_163","para_164"]},{"title":"2023) (quoting United States v. Centeno-González, 989 F.3d 36, 50","paragraphs":["para_166"]},{"title":"To begin, Kinrys's decision to refrain from collecting","paragraphs":["para_168","para_169","para_170","para_171","para_172","para_173","para_174","para_175","para_176","para_177"]},{"title":"The other fact that Kinrys cites -- his status as an","paragraphs":["para_179","para_180","para_181","para_182","para_183","para_184","para_185","para_186","para_187","para_188","para_189","para_190","para_191","para_192"]},{"title":"566-67. Here, by contrast, Kinrys's assertion that he intended","paragraphs":["para_194","para_195","para_196","para_197","para_198","para_199"]},{"title":"Nevertheless, considering all the information before the","paragraphs":["para_201","para_202","para_203","para_204","para_205","para_206","para_207","para_208","para_209","para_210","para_211","para_212","para_213","para_214"]},{"title":"Kinrys acknowledges these facts but responds that the","paragraphs":["para_216","para_217","para_218","para_219","para_220","para_221","para_222","para_223","para_224","para_225","para_226","para_227","para_228","para_229","para_230","para_231"]},{"title":"Kinrys may have had evidence that the civil suits and","paragraphs":["para_233","para_234","para_235","para_236","para_237"]},{"title":"Cir. 2024) (affirming summary judgment where the plaintiff failed","paragraphs":["para_239","para_240","para_241","para_242","para_243","para_244"]},{"title":"See Yoon, 167 F.4th at 565. Between the evidence relied upon by","paragraphs":["para_246","para_247","para_248","para_249","para_250","para_251"]},{"title":"Kinrys also challenges the district court's restitution","paragraphs":["para_253","para_254","para_255","para_256","para_257","para_258","para_259"]},{"title":"F.4th 1, 64 (1st Cir. 2021); United States v. De Jesús-Torres, 64","paragraphs":[]},{"title":"F.4th 33, 44 (1st Cir. 2023). The goal of restitution is to make","paragraphs":["para_262","para_263"]},{"title":"2008)). But restitution orders should \"not . . . confer a","paragraphs":["para_265","para_266"]},{"title":"On appeal, Kinrys argues that his roughly $6.5 million","paragraphs":["para_268","para_269","para_270","para_271","para_272","para_273","para_274","para_275","para_276","para_277","para_278","para_279","para_280","para_281","para_282"]},{"title":"A restitution hearing is not a place to bring civil","paragraphs":["para_284","para_285"]},{"title":"2000) (per curiam). Kinrys's allegedly legitimate claims","paragraphs":["para_287","para_288","para_289","para_290"]},{"title":"Kinrys appears to have submitted all these claims toward","paragraphs":["para_292","para_293","para_294","para_295"]},{"title":"(and whether they may now be owed) is a question to be resolved","paragraphs":[]},{"title":"3 No party indicates that Kinrys submitted legitimate","paragraphs":["para_298","para_299","para_300","para_301","para_302"]},{"title":"F.3d 536, 540 n.3 (8th Cir. 1999) (per curiam). But a criminal","paragraphs":["para_304","para_305","para_306","para_307","para_308","para_309"]}],"paragraphs":[{"text":"United States Court of Appeals","paragraph_id":"para_1"},{"text":"For the First Circuit","paragraph_id":"para_2"},{"text":"Nos. 24-1592","paragraph_id":"para_3"},{"text":"24-1716","paragraph_id":"para_4"},{"text":"UNITED STATES,","paragraph_id":"para_5"},{"text":"Appellee,","paragraph_id":"para_6"},{"text":"v.","paragraph_id":"para_7"},{"text":"GUSTAVO KINRYS,","paragraph_id":"para_8"},{"text":"Defendant, Appellant.","paragraph_id":"para_9"},{"text":"APPEALS FROM THE UNITED STATES DISTRICT COURT","paragraph_id":"para_10"},{"text":"FOR THE DISTRICT OF MASSACHUSETTS","paragraph_id":"para_11"},{"text":"[Hon. Denise J. Casper, U.S. District Judge]","paragraph_id":"para_12"},{"text":"Before","paragraph_id":"para_13"},{"text":"Montecalvo, Thompson, and Aframe,","paragraph_id":"para_14"},{"text":"Circuit Judges.","paragraph_id":"para_15"},{"text":"Judith H. Mizner, Assistant Federal Public Defender, for the","paragraph_id":"para_16"},{"text":"appellant.","paragraph_id":"para_17"},{"text":"Alexia R. DeVincentis, Assistant United States Attorney, with","paragraph_id":"para_18"},{"text":"whom Leah B. Foley, United States Attorney, was on brief, for the","paragraph_id":"para_19"},{"text":"appellee.","paragraph_id":"para_20"},{"text":"September 21, 2026","paragraph_id":"para_21"},{"text":"-2-","paragraph_id":"para_22"},{"text":"AFRAME, Circuit Judge. In this sentencing appeal,","paragraph_id":"para_23"},{"text":"Gustavo Kinrys challenges the intended loss and restitution","paragraph_id":"para_24"},{"text":"calculations resulting from his conviction for committing health","paragraph_id":"para_25"},{"text":"insurance fraud. We affirm the district court's decisions in both","paragraph_id":"para_26"},{"text":"respects.","paragraph_id":"para_27"},{"text":"I.","paragraph_id":"para_28"},{"text":"Kinrys worked as a licensed psychiatrist, operating his","paragraph_id":"para_29"},{"text":"own private practice in Massachusetts. During the charged conduct","paragraph_id":"para_30"},{"text":"period, between 2015 and 2018, Kinrys defrauded private and public","paragraph_id":"para_31"},{"text":"health insurers, including Blue Cross Blue Shield (\"BCBS\"), Tufts,","paragraph_id":"para_32"},{"text":"Aetna, Optum, Beacon, and Medicare. For example, he billed for","paragraph_id":"para_33"},{"text":"over a thousand sessions while either he or the purported patient","paragraph_id":"para_34"},{"text":"was out of the country. For at least some of the defrauded","paragraph_id":"para_35"},{"text":"insurers, Kinrys was an \"in-network\" provider, which means that he","paragraph_id":"para_36"},{"text":"had a contract with the insurer that detailed the amount that it","paragraph_id":"para_37"},{"text":"would pay for a given service.","paragraph_id":"para_38"},{"text":"Starting in 2017, Kinrys's conduct caught up with him.","paragraph_id":"para_39"},{"text":"Over the next two years, at least two insurers asked him to provide","paragraph_id":"para_40"},{"text":"more detailed billing records. Kinrys delayed responding by","paragraph_id":"para_41"},{"text":"directing the insurers to a fictitious office manager. He also","paragraph_id":"para_42"},{"text":"created false records indicating that he had provided services","paragraph_id":"para_43"},{"text":"that he had not actually rendered. Eventually, at least one","paragraph_id":"para_44"},{"text":"insurer informed Kinrys that it would stop paying his invoices","paragraph_id":"para_45"},{"text":"until he complied with its records request. And another insurer","paragraph_id":"para_46"},{"text":"-3-","paragraph_id":"para_47"},{"text":"paid Kinrys contingent on his obtaining preauthorization for a","paragraph_id":"para_48"},{"text":"submitted service.","paragraph_id":"para_49"},{"text":"A couple of years later, the federal government indicted","paragraph_id":"para_50"},{"text":"Kinrys for fraud. And in October 2023, a jury convicted Kinrys","paragraph_id":"para_51"},{"text":"on fourteen of fifteen counts arising from his scheme.","paragraph_id":"para_52"},{"text":"At sentencing, the district court calculated Kinrys's","paragraph_id":"para_53"},{"text":"base offense level to be seven and then added twenty-eight","paragraph_id":"para_54"},{"text":"levels-worth of enhancements, including a twenty-level enhancement","paragraph_id":"para_55"},{"text":"for the loss amount. This yielded a recommended guideline range","paragraph_id":"para_56"},{"text":"of 168 to 210 months for the first seven counts of conviction, and","paragraph_id":"para_57"},{"text":"sixty months for the remaining counts. The district court","paragraph_id":"para_58"},{"text":"sentenced Kinrys to ninety-nine months in prison on the first seven","paragraph_id":"para_59"},{"text":"counts and sixty concurrent months in prison on the remaining","paragraph_id":"para_60"},{"text":"counts. It also required Kinrys to pay $6,537,309.59 in","paragraph_id":"para_61"},{"text":"restitution and $6,527,391.19 in criminal forfeiture.","paragraph_id":"para_62"},{"text":"II.","paragraph_id":"para_63"},{"text":"Kinrys appeals the loss calculation for his sentencing","paragraph_id":"para_64"},{"text":"enhancement and the restitution amount imposed. Kinrys preserved","paragraph_id":"para_65"},{"text":"both challenges. Accordingly, for these issues, we review","paragraph_id":"para_66"},{"text":"findings of fact for clear error, interpretations of law de novo,","paragraph_id":"para_67"},{"text":"and judgment calls for abuse of discretion. See United States v.","paragraph_id":"para_68"},{"text":"Yoon, 167 F.4th 556, 564 (1st Cir. 2026) (application of","paragraph_id":"para_69"},{"text":"enhancement); United States v. Cardozo, 68 F.4th 725, 733 (1st","paragraph_id":"para_70"},{"text":"Cir. 2023) (restitution calculation).","paragraph_id":"para_71"},{"text":"-4-","paragraph_id":"para_72"},{"text":"A.","paragraph_id":"para_73"},{"text":"We start with the loss amount under the sentencing","paragraph_id":"para_74"},{"text":"guidelines. In this context, the loss amount is the greater of","paragraph_id":"para_75"},{"text":"actual or intended loss. U.S.S.G. § 2B1.1(b)(1)(A). 1 The","paragraph_id":"para_76"},{"text":"district court pegged Kinrys's intended loss to the amount he","paragraph_id":"para_77"},{"text":"billed and so, based on the presentence report's accounting of","paragraph_id":"para_78"},{"text":"Kinrys's billing, determined that he intended to steal a little","paragraph_id":"para_79"},{"text":"over nineteen million dollars. As we indicated above, this","paragraph_id":"para_80"},{"text":"yielded a twenty-level sentencing enhancement. See U.S.S.G.","paragraph_id":"para_81"},{"text":"§ 2B1.1(b)(1)(K). Kinrys argues that the amount he billed does","paragraph_id":"para_82"},{"text":"not accurately reflect his intended loss. He contends that a more","paragraph_id":"para_83"},{"text":"appropriate measure of his intended loss is the amount he","paragraph_id":"para_84"},{"text":"anticipated receiving pursuant to the contract reimbursement","paragraph_id":"para_85"},{"text":"rates, which, at roughly $8.3 million, would yield an","paragraph_id":"para_86"},{"text":"eighteen-level enhancement. Id. § 2B1.1(b)(1)(J).","paragraph_id":"para_87"},{"text":"1 Generally, courts use the version of the sentencing","paragraph_id":"para_88"},{"text":"guidelines in effect at the time of sentencing. See Yoon, 167","paragraph_id":"para_89"},{"text":"F.4th at 564 n.6. At the time of Kinrys's sentencing in June 2024,","paragraph_id":"para_90"},{"text":"a commentary to the guidelines defined loss as the greater of","paragraph_id":"para_91"},{"text":"actual or intended loss. See U.S.S.G. § 2B1.1 cmt. n.3(A) (2023).","paragraph_id":"para_92"},{"text":"The level of deference that courts owe to commentary notes in the","paragraph_id":"para_93"},{"text":"guidelines is an issue currently before the Supreme Court. See","paragraph_id":"para_94"},{"text":"Beaird v. United States, ___ S. Ct. ___, 2026 WL 1052007 (Apr. 20,","paragraph_id":"para_95"},{"text":"2026) (Mem.) (granting certiorari). But we may avoid the question","paragraph_id":"para_96"},{"text":"of whether we must apply this note because the United States","paragraph_id":"para_97"},{"text":"Sentencing Commission amended the guidelines so that the","paragraph_id":"para_98"},{"text":"definition of loss now appears in the guidelines' main text. See","paragraph_id":"para_99"},{"text":"U.S.S.G. § 2B1.1 amend. 827. As Kinrys concedes, this amendment","paragraph_id":"para_100"},{"text":"\"clarif[ies]\" the guidelines and thus applies retroactively to his","paragraph_id":"para_101"},{"text":"sentencing. Unites States v. Cates, 897 F.3d 349, 358 n.4 (1st","paragraph_id":"para_102"},{"text":"Cir. 2018).","paragraph_id":"para_103"},{"text":"-5-","paragraph_id":"para_104"},{"text":"The government bears the burden to prove that a","paragraph_id":"para_105"},{"text":"sentencing enhancement applies by a preponderance of the evidence.","paragraph_id":"para_106"},{"text":"United States v. Alphas, 785 F.3d 775, 784 (1st Cir. 2015). In","paragraph_id":"para_107"},{"text":"cases like this one, where the defendant's scheme was \"rife with","paragraph_id":"para_108"},{"text":"fraud,\" courts may calculate intended loss using the","paragraph_id":"para_109"},{"text":"burden-shifting framework derived from Alphas. Id.; see also","paragraph_id":"para_110"},{"text":"Yoon, 167 F.4th at 565-66. That approach permits a sentencing","paragraph_id":"para_111"},{"text":"court to use the billed amount as prima facie evidence of intended","paragraph_id":"para_112"},{"text":"loss. Alphas, 785 F.3d at 784. The burden then shifts to the","paragraph_id":"para_113"},{"text":"defendant, who may \"rebut\" the face value of the bills by","paragraph_id":"para_114"},{"text":"\"proffering evidence establishing that he intended to reap some","paragraph_id":"para_115"},{"text":"lesser amount.\" Yoon, 167 F.4th at 565; see also United States","paragraph_id":"para_116"},{"text":"v. Iwuala, 789 F.3d 1, 14 (1st Cir. 2015). Once both parties have","paragraph_id":"para_117"},{"text":"put forth their competing loss amounts and the record is fully","paragraph_id":"para_118"},{"text":"formed, the district court must make a \"reasonable estimate of the","paragraph_id":"para_119"},{"text":"loss,\" bearing in mind that the government retains the ultimate","paragraph_id":"para_120"},{"text":"burden of proving the applicability of the enhancement. Yoon, 167","paragraph_id":"para_121"},{"text":"F.4th at 565 (quoting U.S.S.G. § 2B1.1, cmt. n.3(C)). The court","paragraph_id":"para_122"},{"text":"determines reasonable loss based on the defendant's subjective","paragraph_id":"para_123"},{"text":"intent, that is, the \"pecuniary harm that the defendant purposely","paragraph_id":"para_124"},{"text":"sought to inflict.\" United States v. Carrasquillo-Vilches, 33","paragraph_id":"para_125"},{"text":"F.4th 36, 42-43 (1st Cir. 2022) (quoting U.S.S.G. § 2B1.1 amend.","paragraph_id":"para_126"},{"text":"792).","paragraph_id":"para_127"},{"text":"-6-","paragraph_id":"para_128"},{"text":"The district court applied the Alphas framework here.","paragraph_id":"para_129"},{"text":"After the court indicated that it would start with the face value","paragraph_id":"para_130"},{"text":"of Kinrys's claims, Kinrys attempted to rebut the presumption that","paragraph_id":"para_131"},{"text":"he intended to be reimbursed for the full billed amount by","paragraph_id":"para_132"},{"text":"contending that as an \"in-network\" provider, he expected to obtain","paragraph_id":"para_133"},{"text":"the contract amount for the given claim, regardless of the billed","paragraph_id":"para_134"},{"text":"amount. He further argued that his inaction in collecting co-pays","paragraph_id":"para_135"},{"text":"from his patients was proof that he intended to obtain only the","paragraph_id":"para_136"},{"text":"contract amount.","paragraph_id":"para_137"},{"text":"The district court was unpersuaded. It provided two","paragraph_id":"para_138"},{"text":"reasons that supported its decision to stick with the billed amount","paragraph_id":"para_139"},{"text":"as the appropriate metric. First, in 2023, as his criminal trial","paragraph_id":"para_140"},{"text":"was approaching, Kinrys filed two pro se civil suits -- one against","paragraph_id":"para_141"},{"text":"BCBS and another against Optum -- alleging, inter alia, that the","paragraph_id":"para_142"},{"text":"insurers had breached their contract with him for services he","paragraph_id":"para_143"},{"text":"alleged to have rendered between 2017 and 2021, largely after the","paragraph_id":"para_144"},{"text":"charged conduct. He asserted that the insurers had refused to","paragraph_id":"para_145"},{"text":"reimburse him for \"billed charges,\" rather than the negotiated","paragraph_id":"para_146"},{"text":"in-network amount, and requested damages that exceeded the amount","paragraph_id":"para_147"},{"text":"he had billed. 2 Second, during the offense period, Kinrys","paragraph_id":"para_148"},{"text":"sometimes received the full amount that he billed and kept that","paragraph_id":"para_149"},{"text":"full payment. Based on these facts, the district court found that","paragraph_id":"para_150"},{"text":"2 Kinrys's civil suits were subsequently removed to","paragraph_id":"para_151"},{"text":"federal court and have since been dismissed.","paragraph_id":"para_152"},{"text":"-7-","paragraph_id":"para_153"},{"text":"Kinrys had intended to \"scoop\" as much as he could from the","paragraph_id":"para_154"},{"text":"insurers. (Quoting Iwuala, 789 F.3d at 14).","paragraph_id":"para_155"},{"text":"On appeal, Kinrys repeats his arguments that intended","paragraph_id":"para_156"},{"text":"loss is captured better by the amounts he anticipated receiving","paragraph_id":"para_157"},{"text":"under his agreements with the insurers as compared to the amount","paragraph_id":"para_158"},{"text":"he billed. Kinrys's subjective intent is a factual question, so","paragraph_id":"para_159"},{"text":"we review the district court's decision for clear error. See","paragraph_id":"para_160"},{"text":"United States v. Arif, 897 F.3d 1, 11 (1st Cir. 2018). Surmounting","paragraph_id":"para_161"},{"text":"the clear error standard is difficult because it requires us to","paragraph_id":"para_162"},{"text":"have a \"definite and firm conviction\" that there has been a","paragraph_id":"para_163"},{"text":"mistake. United States v. Gonzalez, 68 F.4th 699, 703 (1st Cir.","paragraph_id":"para_164"},{"text":"2023) (quoting United States v. Centeno-González, 989 F.3d 36, 50","paragraph_id":"para_165"},{"text":"(1st Cir. 2021)). We are not so convinced.","paragraph_id":"para_166"},{"text":"To begin, Kinrys's decision to refrain from collecting","paragraph_id":"para_167"},{"text":"co-pays from his patients does not move us to conclude that he","paragraph_id":"para_168"},{"text":"clearly intended to accept only the contract amounts. Had Kinrys","paragraph_id":"para_169"},{"text":"sought to supplement payment for services never rendered, he would","paragraph_id":"para_170"},{"text":"have drawn his patients' attention to his fraud scheme. Moreover,","paragraph_id":"para_171"},{"text":"many doctors choose not to pass along excess costs to their","paragraph_id":"para_172"},{"text":"patients as it can discourage those patients from returning to the","paragraph_id":"para_173"},{"text":"provider. So Kinrys's decision to write off co-pays from patients","paragraph_id":"para_174"},{"text":"does not show that he intended to obtain from insurers less than","paragraph_id":"para_175"},{"text":"he billed them.","paragraph_id":"para_176"},{"text":"-8-","paragraph_id":"para_177"},{"text":"The other fact that Kinrys cites -- his status as an","paragraph_id":"para_178"},{"text":"in-network provider -- has more force. The insurance contracts","paragraph_id":"para_179"},{"text":"that Kinrys signed established predictable amounts that Kinrys","paragraph_id":"para_180"},{"text":"would receive in return for the claims he submitted. They support","paragraph_id":"para_181"},{"text":"his assertion, then, that he expected to take only the amounts","paragraph_id":"para_182"},{"text":"contemplated by the agreements, regardless of the amount that he","paragraph_id":"para_183"},{"text":"billed. Indeed, that Kinrys was an in-network provider","paragraph_id":"para_184"},{"text":"distinguishes this case from our recent decision in Yoon, which","paragraph_id":"para_185"},{"text":"also applied the Alphas framework to a health insurance fraud","paragraph_id":"para_186"},{"text":"scheme. 167 F.4th at 565-67. There, the defendant was an","paragraph_id":"para_187"},{"text":"out-of-network provider. Id. at 566. And based on that fact, we","paragraph_id":"para_188"},{"text":"affirmed the district court's determinations that he would not","paragraph_id":"para_189"},{"text":"have known how much he would receive in response to each bill and,","paragraph_id":"para_190"},{"text":"because he failed to detail the amount he expected, it was fair to","paragraph_id":"para_191"},{"text":"assume that he intended to take as much as he could get. Id. at","paragraph_id":"para_192"},{"text":"566-67. Here, by contrast, Kinrys's assertion that he intended","paragraph_id":"para_193"},{"text":"to obtain only the contract amounts is stronger, given that his","paragraph_id":"para_194"},{"text":"contracts with the insurers dictated that he would receive an","paragraph_id":"para_195"},{"text":"amount that was less than the amount he billed. See United States","paragraph_id":"para_196"},{"text":"v. Singh, 390 F.3d 168, 193 (2d Cir. 2004) (rejecting use of billed","paragraph_id":"para_197"},{"text":"amount by acknowledging that providers often are familiar with the","paragraph_id":"para_198"},{"text":"fixed rates that insurers pay for medical services).","paragraph_id":"para_199"},{"text":"Nevertheless, considering all the information before the","paragraph_id":"para_200"},{"text":"district court, Kinrys's status as an in-network provider does not","paragraph_id":"para_201"},{"text":"-9-","paragraph_id":"para_202"},{"text":"demonstrate that the court clearly erred in determining, as a","paragraph_id":"para_203"},{"text":"factual matter, that Kinrys intended to take from the insurers as","paragraph_id":"para_204"},{"text":"much as he could, up to the billed amounts. As the court pointed","paragraph_id":"para_205"},{"text":"out, Kinrys filed multiple pro se civil lawsuits on the eve of his","paragraph_id":"para_206"},{"text":"criminal trial. In the complaints for these suits, Kinrys","paragraph_id":"para_207"},{"text":"asserted that the insurers had breached their respective contracts","paragraph_id":"para_208"},{"text":"and owed him for the amounts he billed. Moreover, he sought","paragraph_id":"para_209"},{"text":"damages that reflected even greater amounts. Though these suits","paragraph_id":"para_210"},{"text":"covered payments that occurred largely after his charged conduct,","paragraph_id":"para_211"},{"text":"they still shed light on Kinrys's intent when he submitted claims","paragraph_id":"para_212"},{"text":"throughout his scheme, particularly because he wrote and filed his","paragraph_id":"para_213"},{"text":"complaint pro se.","paragraph_id":"para_214"},{"text":"Kinrys acknowledges these facts but responds that the","paragraph_id":"para_215"},{"text":"civil complaints also refer to the \"negotiated contract rates\" he","paragraph_id":"para_216"},{"text":"had with each insurer. He argues that these references suggested","paragraph_id":"para_217"},{"text":"that he had the contracted amounts in mind when he submitted the","paragraph_id":"para_218"},{"text":"claims. Kinrys's reading of the complaint is plausible and could","paragraph_id":"para_219"},{"text":"have supported a decision to rely on the contract amount instead","paragraph_id":"para_220"},{"text":"of the billed amount to determine intended loss. But, on this","paragraph_id":"para_221"},{"text":"question, we do not step into the district court's shoes; we","paragraph_id":"para_222"},{"text":"determine only whether it committed a clear error. The court","paragraph_id":"para_223"},{"text":"conducted a full trial and sentencing hearing, where it heard","paragraph_id":"para_224"},{"text":"firsthand the evidence and the respective parties' case","paragraph_id":"para_225"},{"text":"presentations. Indeed, the district court's view of Kinrys's","paragraph_id":"para_226"},{"text":"-10-","paragraph_id":"para_227"},{"text":"complaints is buttressed by the other fact it relied on, namely,","paragraph_id":"para_228"},{"text":"that the insurers sometimes paid Kinrys the full amount billed and","paragraph_id":"para_229"},{"text":"that he did not reimburse the insurers for payments that exceeded","paragraph_id":"para_230"},{"text":"the contract rate.","paragraph_id":"para_231"},{"text":"Kinrys may have had evidence that the civil suits and","paragraph_id":"para_232"},{"text":"his acceptance of overpayments were not probative of his intent.","paragraph_id":"para_233"},{"text":"But if he did, he failed to present it at his sentencing hearing.","paragraph_id":"para_234"},{"text":"Instead, he chose to rely exclusively on argument by his counsel.","paragraph_id":"para_235"},{"text":"\"Attorney argument or embellishment cannot substitute for missing","paragraph_id":"para_236"},{"text":"evidence.\" Rios v. Centerra Grp. LLC, 106 F.4th 101, 118 n.5 (1st","paragraph_id":"para_237"},{"text":"Cir. 2024) (affirming summary judgment where the plaintiff failed","paragraph_id":"para_238"},{"text":"to produce record evidence supporting his employment retaliation","paragraph_id":"para_239"},{"text":"claim). That is particularly true here: Because Kinrys submitted","paragraph_id":"para_240"},{"text":"claims rife with fraud and because the Alphas framework allows the","paragraph_id":"para_241"},{"text":"sentencing court to use the billed amount as prima facie evidence","paragraph_id":"para_242"},{"text":"of intended loss, the burden shifted to Kinrys to demonstrate that","paragraph_id":"para_243"},{"text":"he intended to receive a lesser amount than the amount he billed.","paragraph_id":"para_244"},{"text":"See Yoon, 167 F.4th at 565. Between the evidence relied upon by","paragraph_id":"para_245"},{"text":"the district court and Kinrys's failure to proffer contrary","paragraph_id":"para_246"},{"text":"evidence, we see no clear error in the court's determination that","paragraph_id":"para_247"},{"text":"Kinrys intended to take as much as he could from the insurers,","paragraph_id":"para_248"},{"text":"even up to the billed amounts.","paragraph_id":"para_249"},{"text":"-11-","paragraph_id":"para_250"},{"text":"B.","paragraph_id":"para_251"},{"text":"Kinrys also challenges the district court's restitution","paragraph_id":"para_252"},{"text":"calculation. Under the Mandatory Victims Restitution Act of 1996,","paragraph_id":"para_253"},{"text":"defendants convicted of certain crimes -- including \"any offense","paragraph_id":"para_254"},{"text":"committed by fraud or deceit\" -- are required to pay restitution","paragraph_id":"para_255"},{"text":"to their victims. 18 U.S.C. § 3663A(c)(1)(A)(ii). In the","paragraph_id":"para_256"},{"text":"criminal context, restitution is a non-punitive process through","paragraph_id":"para_257"},{"text":"which a defendant compensates victims for actual losses caused by","paragraph_id":"para_258"},{"text":"the defendant's criminal actions. United States v. Simon, 12","paragraph_id":"para_259"},{"text":"F.4th 1, 64 (1st Cir. 2021); United States v. De Jesús-Torres, 64","paragraph_id":"para_260"},{"text":"F.4th 33, 44 (1st Cir. 2023). The goal of restitution is to make","paragraph_id":"para_261"},{"text":"the victims \"whole again.\" Carrasquillo-Vilches, 33 F.4th at 46","paragraph_id":"para_262"},{"text":"(quoting United States v. Innarelli, 524 F.3d 286, 293 (1st Cir.","paragraph_id":"para_263"},{"text":"2008)). But restitution orders should \"not . . . confer a","paragraph_id":"para_264"},{"text":"windfall upon a victim.\" Id. (quoting United States v. Naphaeng,","paragraph_id":"para_265"},{"text":"906 F.3d 173, 179 (1st Cir. 2018)).","paragraph_id":"para_266"},{"text":"On appeal, Kinrys argues that his roughly $6.5 million","paragraph_id":"para_267"},{"text":"restitution order should be offset by claims for legitimate","paragraph_id":"para_268"},{"text":"services that went unpaid by the victims. In the past, we have","paragraph_id":"para_269"},{"text":"vacated and remanded restitution calculations when they include","paragraph_id":"para_270"},{"text":"both fraudulent and legitimate claims, explaining that only","paragraph_id":"para_271"},{"text":"fraudulent claims may serve as the basis for a restitution","paragraph_id":"para_272"},{"text":"calculation. See, e.g., Alphas, 785 F.3d at 786-87. But Kinrys","paragraph_id":"para_273"},{"text":"does not argue that the district court included legitimate claims","paragraph_id":"para_274"},{"text":"-12-","paragraph_id":"para_275"},{"text":"in its restitution calculation. Rather, he concedes that the","paragraph_id":"para_276"},{"text":"court's restitution calculation was based only on fraudulent","paragraph_id":"para_277"},{"text":"claims. Instead, Kinrys asserts that a separate set of","paragraph_id":"para_278"},{"text":"claims -- ones he submitted for which he was never paid -- are","paragraph_id":"para_279"},{"text":"legitimate. He contends that the court should have offset the","paragraph_id":"para_280"},{"text":"restitution amount by the sum claimed in these bills and that its","paragraph_id":"para_281"},{"text":"failure to do so afforded the insurers a windfall. We disagree.","paragraph_id":"para_282"},{"text":"A restitution hearing is not a place to bring civil","paragraph_id":"para_283"},{"text":"claims against victims, which is effectively what Kinrys seeks to","paragraph_id":"para_284"},{"text":"do here. See United States v. Maurer, 226 F.3d 150, 152 (2d Cir.","paragraph_id":"para_285"},{"text":"2000) (per curiam). Kinrys's allegedly legitimate claims","paragraph_id":"para_286"},{"text":"implicate a distinct set of reimbursement requests from those that","paragraph_id":"para_287"},{"text":"serve as the basis for the restitution amount. And it is unclear","paragraph_id":"para_288"},{"text":"whether Kinrys is entitled to payment for these allegedly","paragraph_id":"para_289"},{"text":"legitimate claims.","paragraph_id":"para_290"},{"text":"Kinrys appears to have submitted all these claims toward","paragraph_id":"para_291"},{"text":"the end of his scheme, in circumstances where an insurer had made","paragraph_id":"para_292"},{"text":"payment contingent on either preauthorization (which Kinrys failed","paragraph_id":"para_293"},{"text":"to obtain) or Kinrys's production of requested documents (which he","paragraph_id":"para_294"},{"text":"failed to complete).3 Whether those claims were properly withheld","paragraph_id":"para_295"},{"text":"(and whether they may now be owed) is a question to be resolved","paragraph_id":"para_296"},{"text":"3 No party indicates that Kinrys submitted legitimate","paragraph_id":"para_297"},{"text":"unpaid claims in circumstances where the insurers did not require","paragraph_id":"para_298"},{"text":"preauthorization or the production of billing records.","paragraph_id":"para_299"},{"text":"-13-","paragraph_id":"para_300"},{"text":"through a civil suit or an administrative process with the insurer,","paragraph_id":"para_301"},{"text":"avenues that Kinrys may attempt. See United States v. Cupit, 169","paragraph_id":"para_302"},{"text":"F.3d 536, 540 n.3 (8th Cir. 1999) (per curiam). But a criminal","paragraph_id":"para_303"},{"text":"restitution hearing, where distinct, unrelated, and contested","paragraph_id":"para_304"},{"text":"billing is not before the court, is not the proper venue to resolve","paragraph_id":"para_305"},{"text":"such claims. See Maurer, 226 F.3d at 152. 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