Introduction
In United States v. Kinrys, decided September 21, 2026, the First Circuit considered two consequences of a psychiatrist’s health-insurance fraud conviction: how to measure the loss he intended for sentencing purposes, and whether unpaid claims for allegedly legitimate services should reduce restitution. Gustavo Kinrys argued that his contracts as an in-network provider meant he expected only negotiated reimbursement rates, not the larger amounts he billed. He also sought to offset restitution by separate claims that insurers had not paid. The court rejected both challenges, while leaving open the possibility that the unpaid claims could be pursued through other processes.
Summary of the Opinion
Between 2015 and 2018, Kinrys submitted fraudulent claims to public and private insurers, including claims for sessions when he or the purported patient was outside the country. A jury convicted him on fourteen of fifteen counts. At sentencing, the district court treated the more than $19 million he billed as intended loss, producing a twenty-level guidelines enhancement. It imposed a 99-month prison sentence on the first seven counts, concurrent 60-month sentences on the remaining counts, and $6,537,309.59 in restitution.
The First Circuit affirmed. Although Kinrys’s in-network contracts supported his argument that he anticipated roughly $8.3 million in reimbursement—a figure that would have produced an eighteen-level enhancement—the district court did not clearly err in finding that he intended to obtain as much as insurers would pay, up to the billed amounts. The court also upheld restitution based on payments for fraudulent claims, refusing to reduce it by separate, disputed claims for which Kinrys had not been paid.
Analysis
Intended loss: the rule and its application
Under the applicable sentencing rule, loss is the greater of actual loss or intended loss. Intended loss turns on the pecuniary harm the defendant purposely sought to cause, not simply the amount an insurer ultimately paid. The government bears the ultimate burden of establishing a sentencing enhancement by a preponderance of the evidence.
For a billing scheme “rife with fraud,” the face value of the claims may serve as prima facie evidence of intended loss. The defendant may then produce evidence that he intended to receive less; the sentencing court must assess the full record and make a reasonable estimate. This is a shift in the burden of producing rebuttal evidence, not a transfer of the government’s ultimate burden of proof.
Kinrys had a substantial rebuttal argument: his in-network contracts set predictable payment rates below his billed charges. The First Circuit expressly recognized that this distinguished him from an out-of-network provider who might not know what an insurer would pay. But the district court had countervailing evidence. In pro se civil complaints filed shortly before trial, Kinrys asserted entitlement to billed charges and sought even greater damages, albeit principally for a period after the charged conduct. During the fraud period, he also sometimes received the full amount billed and did not return the excess. His decision not to collect patient co-pays did not compel the opposite inference: collecting them might have alerted patients to nonexistent services. Nor did counsel’s arguments replace evidence rebutting the inference drawn from his bills.
The holding is therefore fact-specific. It does not establish that billed charges always measure an in-network provider’s intended loss. It holds that, on this record and under clear-error review of the finding about Kinrys’s subjective intent, the district court could reasonably use them.
Restitution: compensation without adjudicating separate claims
The Mandatory Victims Restitution Act requires restitution for qualifying fraud offenses. Unlike intended loss, restitution compensates victims for actual losses caused by the offense; it must make them whole without giving them a windfall. Kinrys did not contend that the restitution award included payments for legitimate services. Instead, he sought credit for different claims that insurers had left unpaid.
The First Circuit declined to turn the restitution hearing into a proceeding over those separate reimbursement disputes. The unpaid claims appeared to have been submitted when insurers required preauthorization or billing records that Kinrys did not provide. Whether payment was properly withheld remained unresolved. An appropriate civil or insurer-administered process—not this criminal restitution calculation—could address any entitlement Kinrys might establish. Rejecting the offset did not decide that those claims were invalid.
Precedents cited and their roles
- United States v. Yoon supplied the intended-loss framework, including the opportunity to rebut billed charges and the need for a reasonable estimate. Its out-of-network defendant provided an important contrast to Kinrys’s contracted rates. United States v. Cardozo supplied the standards of appellate review for restitution.
- United States v. Alphas established that billed claims in a fraud-ridden scheme can be prima facie evidence of intended loss, while also recognizing that legitimate claims cannot be included as fraudulent restitution losses. United States v. Iwuala supported considering whether a defendant meant to take as much as he could obtain.
- United States v. Carrasquillo-Vilches grounded intended loss in the defendant’s subjective purpose and described restitution’s make-whole, no-windfall limits. United States v. Singh supported Kinrys’s competing position by recognizing that medical providers may know insurers’ fixed payment rates.
- United States v. Arif treated subjective intent as a factual issue. United States v. Gonzalez and United States v. Centeno-González articulated the demanding clear-error standard: reversal requires a definite and firm conviction that the finding was mistaken. Rios v. Centerra Grp. LLC reinforced that attorney argument cannot substitute for missing evidence.
- United States v. Simon and United States v. De Jesús-Torres characterized criminal restitution as compensation for actual loss. United States v. Innarelli supplied the make-whole formulation, while United States v. Naphaeng cautioned against a victim windfall. United States v. Maurer and United States v. Cupit supported leaving distinct, contested reimbursement claims to civil or administrative avenues.
- Beaird v. United States concerned the pending question of deference to sentencing-guidelines commentary. The panel avoided that issue because the loss definition had moved into the guidelines’ text and Kinrys conceded the amendment was clarifying. The opinion cited Unites States v. Cates for the treatment of clarifying amendments.
Complex concepts simplified
Intended loss versus restitution: Intended loss asks how much money the defendant meant to obtain or cause the victim to lose, even if the attempt failed. Restitution asks what victims actually lost because of the crime. The two amounts need not match.
Prima facie evidence and rebuttal: Fraudulent bills can provide a sufficient starting point for estimating intended loss. A defendant may challenge what those bills reveal about his intentions with evidence of a lower target amount.
Clear-error review: An appellate court does not decide afresh which plausible interpretation of the evidence it prefers. It reverses a factual finding only when convinced the district court made a mistake.