United States v. Shradha Agarwal

Court of Appeals for the Seventh Circuit·Decided August 6, 2026·No. 24-2236·Published·Scudder

Opinion

In the

United States Court of Appeals For the Seventh Circuit ____________________

Nos. 24-2230 & 24-2236 UNITED STATES OF AMERICA, Plaintiff-Appellee,

v.

RISHI SHAH and SHRADHA AGARWAL, Defendants-Appellants.

____________________

Appeals from the United States District Court for the Northern District of Illinois, Eastern Division. No. 1:19-cr-00864 — Thomas M. Durkin, Judge. ____________________

ARGUED FEBRUARY 10, 2026 — DECIDED AUGUST 6, 2026 ____________________

Before EASTERBROOK, SCUDDER, and KIRSCH, Circuit Judges. SCUDDER, Circuit Judge. In 2019, the federal government in- dicted Rishi Shah and Shradha Agarwal for orchestrating a multi-year, multi-million-dollar fraud scheme through their company, Outcome Health. Over three years later, and 2 Nos. 24-2230 & 24-2236

following an 11-week trial, a jury convicted both Shah and Agarwal on multiple mail, wire, and bank fraud counts, and Shah on money laundering counts. Shah and Agarwal now appeal their convictions. Their main challenge focuses on an expansive, pretrial protective order that froze assets purportedly traceable to Outcome’s fraud. They contend that the order was overbroad and vio- lated their Sixth Amendment right to counsel of choice by im- properly restraining assets—so much so that they lacked the resources to continue paying the firms and lawyers they had hired to represent them in the case. Shah and Agarwal also allege that the government violated their Fifth Amendment due process rights when an FBI accountant knowingly made a false statement (related to the pretrial asset restraint) to the grand jury and the government failed to correct it. Finally, they argue that the district court abused its discretion by ad- mitting certain evidence at trial and in its instructions to the jury. While what transpired with the pretrial asset freeze is complicated and troubling, we see no error in the district court’s finding that Shah and Agarwal received sufficient in- formation during discovery to identify and challenge the over-restraint well before trial. Nor do we see any merit to Shah and Agarwal’s remaining challenges. All of this leads us to affirm. I A. Outcome Health In 2006, Rishi Shah founded Outcome Health, a healthcare technology company that provided television screens and tablets displaying ads and educational content in doctors’ Nos. 24-2230 & 24-2236 3

offices. Shah served as Outcome’s CEO. Shradha Agarwal, Shah’s college classmate, joined the company in 2008 as its Chief Marketing Officer and Chief Strategy Officer before transitioning to President and Co-Founder in 2013. Outcome generated revenue by selling ad space on screens to pharmaceutical companies and advertising agencies. To contract with Outcome, a company would provide a list of doctors’ offices it wanted an ad campaign to target. Outcome would then perform a “list match” of offices where its screens were installed to find the overlap. Ad campaign contracts of- ten promised the client a return on their investment, meas- ured by the amount of money earned in prescriptions or other revenue for every dollar spent on ads. By 2017, Outcome expanded from a 20-person startup to a company of over 500 employees with multiple offices. Tur- moil ensued in October 2017, when the Wall Street Journal re- ported that Outcome had been defrauding its clients by over- selling ad space and inflating performance metrics. Federal criminal charges followed, with the indictment alleging that Outcome’s multi-million-dollar fraud scheme ran from at least 2011 to 2017, and targeted both clients and investors. Outcome still operates today, rebranded as PatientPoint. 1. Fraud on Clients Outcome defrauded its clients to solve challenges associ- ated with its business model. To evolve from a startup to a nationwide enterprise, the company required enough screens to run ads and thereby attract advertisers. At the same time, it needed more ad revenue to purchase more screens. To bridge the gap between inventory and revenue needs, Out- come told clients it had more screens than it did to induce 4 Nos. 24-2230 & 24-2236

them to enter larger advertising contracts. When a client sent Outcome a list of doctors to target, the company inflated its list match using what was really a projected (and not actual) inventory figure. At least some clients did not know the list matches they received overstated Outcome’s current inven- tory. So they signed contracts believing their ads would run on screens that Outcome did not in fact have. And while some clients agreed to “weighted” contracts that promised growth over a certain period to reach an average projected figure, most contracted for current inventory. Outcome executives si- loed information about the list manipulation from sales em- ployees interfacing with clients. Outcome consistently overstated its inventory and under- delivered on ads, thereby also failing to generate promised returns, while all along billing clients for full service. The company referred to these performance gaps as “deltas.” It then hid the deltas from clients by manipulating information used to conduct ad campaign performance studies. Evidence at trial demonstrated that Shah, and to a lesser extent, Agarwal, knew of these problems but ignored or silenced em- ployees who tried to sound an alarm. 2. Fraud on Lenders and Investors Outcome defrauded its lenders and investors too. By 2016, the company began seeking outside investment. To help se- cure capital, Outcome hired Deloitte to audit its 2015 and 2016 financial statements. But in the process, the company hid its fraud by making misrepresentations to the auditors within misstated financial statements. Outcome nonetheless used those financial statements, and Deloitte’s resulting clean audit opinions, to secure $485 million in loans from JPMorgan and other lenders in April and December 2016, and over $487 Nos. 24-2230 & 24-2236 5

million from equity investors from March to July 2017. From the proceeds of the financing, Outcome paid a $225 million dividend to Gravitas Holdings, LLC, an entity controlled by Shah and Agarwal. B. Civil Settlement After Outcome’s fraud scheme became public in October 2017, its lenders and investors sued. The parties settled in Jan- uary 2018. Shah and Agarwal agreed to resign, surrender their controlling interest in Outcome, and pay about $190 mil- lion from Gravitas to the company and investors. The settle- ment allowed them to keep $31 million from Gravitas. In an- ticipation of a federal indictment, Shah and Agarwal paid $10.3 million of the $31 million to their attorneys as a retainer fee. C. Indictment and Forfeiture Allegations In November 2019, a grand jury indicted Shah and Agarwal on multiple counts of mail, wire, and bank fraud. Shah also faced a separate money laundering charge. Federal law allows the government to seek a pretrial pro- tective order freezing a defendant’s assets traceable to crimi- nal activity alleged in the indictment. See 21 U.S.C. § 853(e)(1)(A). The indictment against Shah and Agarwal in- cluded forfeiture allegations stating that “[a]ll right, title, and interest … including but not limited to” certain funds in cer- tain assets held by two of Shah and Agarwal’s companies (Gravitas Holdings and Jumpstart Ventures II) were traceable to the fraud and therefore forfeitable upon conviction. To arrive at the indictment’s forfeiture allegations prior to the grand jury, the government assembled a multi-agency team to identify Shah and Agarwal’s forfeitable assets. For her 6 Nos. 24-2230 & 24-2236

part, FBI forensic accountant Megan Poelking traced the as- sets. Given the complexity of the case, Poelking received as- sistance from the DOJ’s Money Laundering and Asset Recov- ery Section and the U.S. Marshals Service Complex Asset Unit.

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§ 853
21 U.S.C. § 853
§ 1341
18 U.S.C. § 1341
§ 1343
18 U.S.C. § 1343
§ 1344
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§ 1957
18 U.S.C. § 1957