Stipulated Relevant Conduct Defines the “Offense” for Excessive Fines Proportionality Review in Plea Cases

Case: United States v. Gulam Mukhdomi (and Abida Mukhdomi)
Court: United States Court of Appeals for the Sixth Circuit
Date: March 17, 2026

Introduction

This appeal arises from a federal healthcare billing prosecution involving two physicians, Abida and Gulam Mukhdomi, who owned and operated a pain management practice and its laboratory. After a multi-count indictment (including drug distribution and healthcare fraud theories), each defendant entered a plea to one count of making false statements relating to health care matters. The plea agreements included (1) a broad appellate waiver and (2) stipulated facts admitting that the defendants submitted 2,986 claims for medically unnecessary urine drug screens, resulting in payments totaling $166,632.22.

The district court imposed probation, joint-and-several restitution of $166,632.22, and a $125,000 fine on each defendant (above the Guidelines fine range). On appeal, the defendants challenged the fines as procedurally and substantively unreasonable and as unconstitutional under the Eighth Amendment’s Excessive Fines Clause.

The Sixth Circuit’s decision is significant for two reasons: it enforces broad appellate waivers against routine reasonableness challenges to fines, and—more notably—it clarifies that, for Excessive Fines proportionality review, the “offense” may be defined by the full scope of relevant conduct admitted in plea stipulations, not merely the single count’s narrowest factual unit.

Summary of the Opinion

  • Appellate waiver enforced: The court held the defendants’ procedural and substantive reasonableness challenges to the fines fell within their waiver of “the right to appeal the conviction and sentence imposed” (unless exceeding the statutory maximum), and the waivers were knowing and voluntary.
  • Eighth Amendment claim rejected on the merits: Assuming without deciding that the waiver did not bar constitutional review, the court held the $125,000 fines were not “grossly disproportional” under United States v. Bajakajian because the proportionality baseline included the defendants’ admitted scheme (2,986 claims; $166,632.22 paid), not the $62.14 paid on the single charged claim.
  • Key holding: “The plea agreements’ stipulated facts define the offense for our Excessive Fines Clause analysis.”

Analysis

Precedents Cited

The opinion is built from established Sixth Circuit waiver doctrine and Supreme Court proportionality doctrine, then extends those principles to the specific question of what “offense” anchors Excessive Fines review after a plea with stipulations.

  • United States v. Smith, 344 F.3d 479 (6th Cir. 2003)
    Cited for the standard of review (de novo) when evaluating whether an appellate waiver bars an appeal. This frames waiver enforcement as a legal question, not a discretionary one, reinforcing predictable enforcement when the record supports knowing and voluntary waiver.
  • United States v. Toth, 668 F.3d 374 (6th Cir. 2012)
    Supplies the two-step waiver framework: (1) scope—does the claim fall within the waiver; (2) validity—was the waiver knowing and voluntary. The panel uses Toth both to dispose of reasonableness claims and to discuss the limited exceptions the Sixth Circuit has recognized (e.g., ineffective assistance).
  • United States v. Grundy, 844 F.3d 613 (6th Cir. 2016)
    Quoted for the proposition that waiving the right to appeal the “sentence” waives challenges to the sentence’s “constituent elements,” with restitution given as an example. The opinion uses this logic to treat fines as unquestionably part of the sentence and therefore within a general waiver.
  • United States v. Moon, 808 F.3d 1085 (6th Cir. 2015) and United States v. Pitts, 997 F.3d 688 (6th Cir. 2021)
    These cases confirm that substantive and procedural reasonableness challenges are paradigmatic “sentence” appeals barred by broad waivers, foreclosing attempts to repackage ordinary sentencing arguments as appealable issues.
  • United States v. Ferguson, 669 F.3d 756 (6th Cir. 2012)
    Identifies recognized exceptions where waivers may not be enforced, including sentences based on racial discrimination or those exceeding the statutory maximum. The panel references this to emphasize that the Sixth Circuit has not adopted an open-ended “unlawful or unconstitutional sentence” exception.
  • United States v. Mathews, 534 F. App'x 418 (6th Cir. 2013) (per curiam)
    Noted as an unpublished source suggesting, without holding, a possible “miscarriage of justice” exception. The panel mentions this cautiously and ultimately avoids deciding whether any extra exception applies because the Eighth Amendment claim fails anyway.
  • United States v. Hack, 999 F.3d 980 (6th Cir. 2021)
    Used to clarify that appellate waivers are not jurisdictional bars; the court retains adjudicatory power and may, where appropriate, reach the merits.
  • Hunter v. United States, No. 24-1063 (2026)
    Referenced as a potentially forthcoming Supreme Court clarification on exceptions to general appellate waivers. The Sixth Circuit flags doctrinal uncertainty while still resolving this case under existing law and merits analysis.
  • United States v. Hughes, 632 F.3d 956 (6th Cir. 2011)
    Establishes de novo review for Excessive Fines claims in the Sixth Circuit, underscoring that proportionality is a constitutional question.
  • United States v. Bajakajian, 524 U.S. 321 (1998)
    The controlling Supreme Court test: a punitive fine violates the Excessive Fines Clause only if it is “grossly disproportional” to the gravity of the offense. The panel also draws from Bajakajian the deference owed to the legislature’s punishment judgments, relevant to comparing the imposed fine with statutory maxima.
  • United States v. Kappes, 936 F.2d 227 (6th Cir. 1991)
    Cited to explain the purpose of Guidelines “relevant conduct”: enabling sentences “commensurate with the gravity of the offense.” This becomes the bridge from Guidelines concepts to the constitutional proportionality baseline.
  • United States v. Zakharia, 418 F. App'x. 414 (6th Cir. 2011)
    Provides a practical factor list for “gross disproportionality” review (nature of offense, Guidelines fine range, statutory maxima, harm caused). The panel applies these factors and also cites Zakharia for deterrence and punishment rationales.
  • United States v. Woods, 367 F. App'x 607 (6th Cir. 2010)
    Supports the proposition that restitution and a fine may both be imposed. This answers the defendants’ argument that restitution alone should suffice, distinguishing compensatory and punitive purposes.

Legal Reasoning

  1. Waiver scope and validity: The court treats the fine as part of the “sentence imposed” and holds that general appellate waivers cover reasonableness challenges to fines unless the sentence exceeds the statutory maximum. The record (signed plea agreements, plea colloquy acknowledgment of the waiver and maximum penalties) supported a knowing and voluntary waiver under the Toth framework.
  2. Merits-first pragmatism on the constitutional claim: Rather than deciding whether an Eighth Amendment challenge is categorically waivable (or whether a “miscarriage of justice” exception exists), the panel assumes the claim is reviewable and rejects it on the merits—avoiding a broader pronouncement while still providing guidance.
  3. Defining the “offense” for proportionality: The core doctrinal move is rejecting the defendants’ attempt to shrink the “offense” to the single $62.14 claim charged in the count of conviction. The court reasons:
    • Under U.S. Sent'g Guidelines Manual § 1B1.3, offense conduct includes “all acts and omissions” occurring during the commission of the offense of conviction.
    • The defendants expressly stipulated to the broader scheme in their plea agreements and confirmed those facts during the plea colloquy as the basis of the plea.
    • The district court already used those stipulated facts to calculate offense level and restitution (unchallenged), and the defendants offered no authority or persuasive principle to forbid using the same admitted conduct to evaluate a punitive fine’s proportionality.
    The court therefore holds that “the plea agreements’ stipulated facts define the offense” for Excessive Fines review in this posture.
  4. Applying gross disproportionality factors: Considering the year-long fraudulent billing scheme ($166,632.22 paid), the $125,000 fine per defendant was:
    • Above the Guidelines fine range ($5,500 to $55,000),
    • But well below the statutory ceiling (the greater of $250,000 or twice the loss: $333,264.44), and
    • Imposed alongside probation (below the Guidelines imprisonment range), signaling an overall sentencing package.
    The court also emphasizes non-monetary harms—undermining trust in healthcare and encouraging similar misconduct—and accepts deterrence as a legitimate punitive objective distinct from restitution’s compensatory role.

Impact

The decision’s most consequential feature is its clarification of the proportionality baseline in plea cases with factual stipulations: defendants cannot plausibly cabin Excessive Fines review to the narrowest charged statement when they have admitted a broader fraudulent course of conduct as the factual basis of the plea.

Practically, the case is likely to:

  • Strengthen the government’s position that stipulated “scheme” facts can support substantial fines (and defend them against Eighth Amendment challenges) even when the conviction count is a single false statement.
  • Increase the drafting and litigation importance of plea stipulations because those stipulations may define the constitutional “gravity of the offense” for fines.
  • Reinforce waiver enforcement against ordinary fine reasonableness appeals, channeling defendants’ objections to sentencing (including fine-related findings) into the district court or into narrower preserved appellate issues.
  • Leave open (for now) the broader question of whether and when constitutional sentencing claims fall outside appellate waivers—an issue the opinion flags in light of Hunter v. United States, No. 24-1063 (2026).

Complex Concepts Simplified

  • Appellate waiver: A promise in a plea agreement that the defendant will not appeal the conviction or sentence (subject to listed exceptions). Courts enforce these if the defendant understood them and agreed voluntarily.
  • Procedural vs. substantive reasonableness:
    • Procedural asks whether the court followed the right steps (correct calculations, adequate explanation).
    • Substantive asks whether the end result is too harsh or too lenient given the circumstances.
    A broad waiver typically blocks both kinds of claims.
  • Excessive Fines Clause (“gross disproportionality”): The Eighth Amendment does not forbid large fines; it forbids fines that are wildly out of scale compared to the seriousness of the offense.
  • Relevant conduct (Guidelines): Sentencing can account for a defendant’s related acts that are part of the same course of wrongdoing, not just the narrowest act described in the conviction count.
  • Restitution vs. fine: Restitution repays the victim’s loss; a fine punishes and can deter. Courts may impose both because they serve different purposes.
  • Statutory maximum and “twice the loss” fine: Some statutes allow a fine up to a fixed cap (e.g., $250,000) or, if larger, up to twice the gain or loss from the offense. Here, that alternative cap raised the maximum to $333,264.44.

Conclusion

United States v. Gulam Mukhdomi confirms robust enforcement of appellate waivers against standard reasonableness challenges to fines and, more importantly, holds that in a plea case the “offense” for Eighth Amendment Excessive Fines proportionality review may be defined by the plea agreement’s stipulated scheme facts. Applying Bajakajian, the Sixth Circuit deemed $125,000 fines constitutionally permissible given the admitted year-long fraudulent billing conduct, the statutory fine framework, and the broader public harms to the healthcare system beyond mere reimbursed dollars.