US v. Chikvashvili: Chikvashvili ran a "diagnostic imaging company" - they provided portable x-rays, sonograms and such wherein a company tech would go to a patient's location, do the imaging, then transmit the images to a doctor. However, Chikvashvili developed an "elaborate, longstanding conspiracy to cheat Medicare" via fraud that included (among other things) using the technicians to interpret the imaging results, then fraudulently stating that a qualified doctor had given the results. Then Medicare would be billed for work allegedly done by doctors but actually "done" by lower-paid techs. The techs sometimes misread the images and in two cases patients died after images were misread and various conditions were missed. Chikvashvili was charged with two counts of healthcare fraud resulting in death. After a pair of Government experts testified at trial that the misread images led to the patients' deaths, a jury convicted Chikvashvili on both counts (as well as dozens of others). He was sentenced to 120 months in prison.
On appeal, the Fourth Circuit affirmed Chikvashvili's fraud resulting in death convictions. First, the court held that a resulting in death count can be based on the "execution of a fraudulent scheme" rather than only on the submission of a false claim. There was sufficient evidence to convict on those counts. Second, the court held that the jury was properly instructed about that standard. Finally, the court held that the Government's expert on causation was properly allowed to testify.