United States of America v. Sardar Ashrafkhan, aka Dr. Khan

RECOMMENDED FOR PUBLICATION
Pursuant to Sixth Circuit I.O.P. 32.1(b)
File Name: 25a0042p.06
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
UNITED STATES OF AMERICA,
Plaintiff-Appellee,
v.
SARDAR ASHRAFKHAN, aka Dr. Khan,
Defendant-Appellant.
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No. 24-1452
Appeal from the United States District Court for the Eastern District of Michigan at Detroit.
No. 2:11-cr-20551-12—Laurie J. Michelson, District Judge.
Decided and Filed: March 3, 2025
Before: COLE, WHITE, and MATHIS, Circuit Judges.
_________________
COUNSEL
ON BRIEF: Benton C. Martin, FEDERAL COMMUNITY DEFENDER OFFICE, Detroit,
Michigan, for Appellant. Wayne F. Pratt, UNITED STATES ATTORNEY’S OFFICE, Detroit,
Michigan, for Appellee.
_________________
OPINION
_________________
COLE, Circuit Judge. A district court sentenced Sardar Ashrafkhan for conspiring to
distribute and possess with intent to distribute a controlled substance, conspiring to commit
health care fraud, and money laundering. After a retroactive amendment to the United States
Sentencing Guidelines, Ashrafkhan moved for a sentence reduction under 18 U.S.C.
§ 3582(c)(2). To be eligible for the reduction, a defendant must meet ten criteria, including
showing that “the defendant did not receive an [aggravating role adjustment] and was not
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engaged in a continuing criminal enterprise[].” USSG Amend. 821, Pt. B; § 4C1.1(a)(10). Since
Ashrafkhan received an aggravating role adjustment, the district court determined he was
ineligible and denied his motion. Ashrafkhan appeals, arguing he meets the criteria despite the
aggravating role adjustment because he did not engage in a continuing criminal enterprise. We
affirm.
I.
Sardar Ashrafkhan owned and operated a sham medical practice where doctors wrote and
billed Medicare for fraudulent prescriptions. Associates would visit specific pharmacies to fill
the false prescriptions, and those pharmacies would pay Ashrafkhan kickbacks. The scheme
resulted in the collection of millions of dollars from fake Medicare claims and the sale of
hundreds of thousands of opioid-based drugs on the illegal street market.
Ashrafkhan was indicted in 2013 with dozens of coconspirators and tried in 2015
alongside two doctors he employed. At trial, the government presented evidence that
Ashrafkhan masterminded the scheme. The jury convicted Ashrafkhan of drug conspiracy,
health care fraud conspiracy, and money laundering.
At sentencing, Ashrafkhan’s total offense level was 43. He received an adjustment for
being an “organizer or leader of a criminal activity that involved five or more participants or was
otherwise extensive” under USSG § 3B1.1(a). Ashrafkhan had no criminal history points, so his
criminal history category was I. Since those calculations would result in a guidelines range
exceeding the total maximum term of imprisonment that could be imposed under the statute,
Ashrafkhan’s applicable guidelines range was set at the statutory maximum of 600 months.
Varying downwards, the district court sentenced him to 276 months of imprisonment. We
affirmed. See United States v. Ashrafkhan, 964 F.3d 574, 577, 580 (6th Cir. 2020); United States
v. Askrafkhan, 821 F. App’x 428, 431 (6th Cir. 2020).
After Ashrafkhan’s sentencing, the United States Sentencing Commission promulgated a
new guideline, USSG § 4C1.1, to provide a two-point reduction in the offense level for
defendants who received no criminal history points at sentencing, otherwise referred to as “zero-
point offenders.” Notice of Final Action Regarding Amendment 821, 88 Fed. Reg. 60534,

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60534–36 (Sept. 1, 2023). To be eligible for the reduction, the defendant must meet ten criteria
set forth in § 4C1.1(a).1 USSG Amend. 821, Pt. B. This appeal concerns only the tenth
criterion: “[T]he defendant did not receive an adjustment under § 3B1.1 (Aggravating Role) and
was not engaged in a continuing criminal enterprise, as defined in 21 U.S.C. § 848.” USSG
§ 4C1.1(a)(10).2 Made retroactively applicable, § 4C1.1 can serve as the basis for a motion for a
sentence reduction pursuant to 18 U.S.C. § 3582(c)(2). USSG Amend. 825; USSG § 1B1.10.
Arguing that he qualified for a two-level reduction based on the amendment, Ashrafkhan
moved for a sentence reduction under 18 U.S.C. § 3582(c)(2). The government did not respond
to his motion, though the probation office advised that Ashrafkhan would be ineligible for the
reduction based on his aggravating role adjustment.
1The text of the amendment states—
(a) Adjustment.—If the defendant meets all of the following criteria:
(1) the defendant did not receive any criminal history points from Chapter Four, Part A;
(2) the defendant did not receive an adjustment under §3A1.4 (Terrorism);
(3) the defendant did not use violence or credible threats of violence in connection with the
offense;
(4) the offense did not result in death or serious bodily injury;
(5) the instant offense of conviction is not a sex offense;
(6) the defendant did not personally cause substantial financial hardship;
(7) the defendant did not possess, receive, purchase, transport, transfer, sell, or otherwise dispose
of a firearm or other dangerous weapon (or induce another participant to do so) in connection
with the offense;
(8) the instant offense of conviction is not covered by §2H1.1 (Offenses Involving Individual
Rights);
(9) the defendant did not receive an adjustment under §3A1.1 (Hate Crime Motivation or
Vulnerable Victim) or §3A1.5 (Serious Human Rights Offense); and
(10) the defendant did not receive an adjustment under §3B1.1 (Aggravating Role) and was not
engaged in a continuing criminal enterprise, as defined in 21 U.S.C. § 848;
decrease the offense level determined under Chapters Two and Three by 2 levels.
2Section 4C1.1(a) was further amended effective November 1, 2024, to strike 4C1.1(a)(10) and replace it
with new paragraphs (10) and (11): “(10) the defendant did not receive an adjustment under § 3B1.1 (Aggravating
Role); and (11) the defendant was not engaged in a continuing criminal enterprise, as defined in 21 U.S.C. § 848.”
USSG Amend. 831. The Commission explained that the amendment “makes technical changes” to “clarify the
Commission’s intention that a defendant is ineligible for the adjustment if the defendant meets either of the
disqualifying conditions in the provision.” Id. As the district court issued its order before the enactment of this
amendment, we rely on solely the statutory text from Amendment 821.

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The district court denied the motion. It reasoned that, although Ashrafkhan had zero
criminal history points, his aggravating role adjustment rendered him ineligible for the reduction.
Ashrafkhan appealed.
II.
“A § 3582(c)(2) proceeding involves a two-step process for determining whether to
reduce a defendant’s sentence based on a retroactive guidelines amendment.” United States v.
Hanson, 124 F.4th 1013, 1016 (6th Cir. 2025). First, the district court determines the
defendant’s eligibility for a sentence reduction. United States v. Thompson, 714 F.3d 946, 948
(6th Cir. 2013) (citing Dillon v. United States, 560 U.S. 817, 825–26 (2010)). If the district court
determines that the defendant is eligible, it next considers whether the authorization is warranted
according to the factors provided in 18 U.S.C. § 3553(a). Id. at 949.
This appeal concerns only the first inquiry: whether Ashrafkhan was eligible for a
sentence reduction. We review the district court’s determination of a defendant’s eligibility for a
sentence reduction de novo. United States v. Webb, 760 F.3d 513, 517 (6th Cir. 2014) (quoting
United States v. Smith, 658 F.3d 608, 611 (6th Cir. 2011)). And we use accepted rules of
statutory interpretation to understand the Sentencing Guidelines. United States v. Tate, 999 F.3d
374, 378 (6th Cir. 2020).
III.
To receive the zero-point offender reduction under § 4C1.1, a defendant must “meet[] all
of [that provision’s] criteria,” including that “the defendant did not receive an adjustment under
§ 3B1.1 (Aggravating Role) and was not engaged in a continuing criminal enterprise, as defined
in 21 U.S.C. § 848.” USSG § 4C1.1(a)(10).
Under Ashrafkhan’s reading, the word “and” joins two elements into a single
disqualifying condition. Accordingly, he argues that a defendant fails to meet the criterion only
if he both received an aggravating role enhancement and was engaged in a continuing criminal
enterprise.

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Under the government’s reading, the word “and” connects two distinct conditions, both
of which must be satisfied to meet the criterion. Accordingly, the defendant meets the criterion
only if he did not receive an aggravating role adjustment and was not engaged in a continuing
criminal enterprise.
The text and context of § 4C1.1(a)(10), as well as our past interpretation of near-identical
statutory language, yield the government’s reading as the only correct construction.3 See, e.g.,
United v. Bazel, 80 F.3d 1140, 1142 (6th Cir. 1996); see also Pulsifer v. United States, 601 U.S.
124, 141 (2024). Several of our sister circuits agree. See United States v. Cervantes, 109 F.4th
944, 946 (7th Cir. 2024) (per curiam) (“[T]he role adjustment that [the defendant] received under
§ 3B1.1 is sufficient to disqualify him from eligibility for a two-level reduction under § 4C1.1.”);
United States v. Morales, 122 F.4th 590, 595 (5th Cir. 2024) (“[T]o receive the zero-point-
offender reduction, a defendant must show both that he did not receive a § 3B1.1 adjustment and
that he was not engaged in a continuing criminal enterprise. The failure to meet either one of
those requirements precludes relief.”); United States v. Milchin, 128 F.4th 199, 201 (3d Cir.
2025); United States v. Shaw, No. 24-6638, 2024 WL 4824237, at *1 (4th Cir. Nov. 19, 2024)
(per curiam) (unpublished).
Consequently, § 4C1.1(a)(10) creates an eligibility checklist and specifies two necessary
conditions for eligibility under the amendment: a defendant must have not received an
aggravating role adjustment and a defendant must not have engaged in a continuing criminal
enterprise to meet the criterion. Failure to satisfy either condition renders the defendant
ineligible.
A.
“When interpreting a [guideline], we begin with the plain meaning of the [provision’s]
language.” King v. Zamiara, 788 F.3d 207, 212 (6th Cir. 2015) (citation omitted). To do so, we
3In an unpublished opinion, we observed that “[b]oth interpretations are plausible” when undertaking a
review for plain error. United States v. Pearce, No. 23-6079, 2024 WL 3458085, at *9 (6th Cir. July 18, 2024). We
concluded that the absence of precedent and the grammatical plausibility of both interpretations sufficed to show
that the district court did not plainly err when it determined that an aggravating role adjustment disqualified a
defendant from receiving the zero-point offender reduction. Id. at *8-9.

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examine the text, as well as the “language and design of the [guideline] as a whole.” United
States v. Henry, 983 F.3d 214, 218 (6th Cir. 2020) (internal citation and quotation marks
omitted). If the language is unclear, we may turn to the guideline’s legislative history. Id.
(quoting United States v. Parrett, 530 F.3d 422, 429 (6th Cir. 2008)). And “[i]f the [guideline]
remains ambiguous after consideration of its plain meaning, structure, and legislative history, we
apply the rule of lenity in favor of criminal defendants.” Id. (first alteration in original) (internal
citation and quotation marks omitted).
We begin with the text. See United States v. Jackson, 995 F.3d 522, 524 (6th Cir. 2021).
Section 4C1.1(a) lists the criteria that a defendant must meet to be eligible for the zero-point
offender reduction. It phrases each criterion in the negative, identifying conditions that a
defendant must show were not true to be eligible. The tenth criterion requires a defendant to
show that he “did not receive an adjustment under § 3B1.1 (Aggravating Role) and was not
engaged in a continuing criminal enterprise, as defined in 21 U.S.C. § 848.” § 4C1.1(a)(10). In
other words, to remain eligible for the reduction, a defendant must show that (1) he has not
received an aggravating role adjustment, and (2) he has not engaged in a continuing criminal
enterprise. If a defendant received an aggravating-role adjustment, a defendant cannot show that
he “did not receive an adjustment under § 3B1.1 (Aggravating Role).” Id. Accordingly, the
adjustment alone would render him ineligible by the plain terms of the provision, regardless of
his involvement in a continuing criminal enterprise. See Morales, 122 F.4th at 596.
Ashrafkhan argues that the Commission “could have listed the two exclusions
separately, as it did for exclusions (2) through (8) in § 4C1.1.” (Appellant Br. 10.) He contends
that Amendment 831, which indeed divides subsection (10) into two distinct paragraphs to
clarify that a defendant is ineligible for the adjustment if the defendant meets either of the
disqualifying conditions in the provision, supports his position that § 4C1.1(a)(10) is ambiguous.
We disagree. For the reasons provided in this opinion, the meaning of the provision is
plain, and the Sentencing Commission’s effort to promulgate a “technical change” to provide
greater clarity due to continuing litigation over its meaning does not itself render the provision
ambiguous. USSG Amend. 831.

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Alternatively, Ashrafkhan argues that “[h]ad the Sentencing Commission meant to
exclude people with either an aggravating role enhancement or engaged in a [continuing criminal
enterprise], it would have written ‘or.’” (Appellant Br. 10.) But “conjunctions are versatile
words, which can work differently depending on context.” Pulsifer, 601 U.S. at 151. And this
argument cuts against Ashrafkhan. If the Sentencing Commission had replaced “and” with “or,”
then Section 4C1.1(a)(10) would carry the meaning that Ashrafkhan prefers: It would state that a
defendant remains eligible for the reduction if he “did not receive an [Aggravating Role]
adjustment . . . or was not engaged in a continuing criminal enterprise.” That the Sentencing
Commission instead used “and” shows that it sought to require a defendant to show the absence
of both conditions—rather than the absence of only one.
The Supreme Court’s recent examination of the criminal history requirement of the
“safety valve” provision, 18 U.S.C. § 3553(f)(1), which similarly lists three criteria a defendant
must show he “does not have” to be eligible, is instructive. Pulsifer, 601 U.S. at 129. That
statutory sentencing reduction applies when “the defendant does not have—(A) more than 4
criminal history points, . . . (B) a prior 3-point offense, . . . and (C) a prior 2-point violent
offense[.]” 18 U.S.C. § 3553(f)(1). The grammatical structure of that provision created an
interpretive challenge: “[T]he phrase ‘does not have A, B, and C’” is susceptible to multiple
plausible readings. Pulsifer, 601 U.S. at 127. On one hand, as the defendant argued, the
provision could be read to “set[] out a single, amalgamated condition for relief,” such that “a
defendant meets the requirement [] so long as he does not have the combination of A, B, and C.”
Id. at 127. On the other hand, as the government argued, “does not have” could be read to
“operate[] on” each of the three requirements independently—i.e., the statute could be read to
“require[] that the defendant does not have A, and also does not have B, and finally does not
have C.” Id. at 134.
The Court explained that the government’s reading would have been the correct one if
Congress had “repeat[ed]” the negative phrase “does not have” before each requirement in the
statutory list. Id. at 137. In other words, if the statute had stated explicitly that “the defendant
must not have ‘more than 4 criminal history points’ and must not have a ‘3-point offense’ and
must not have a ‘2-point violent offense,’” then it would have more clearly “require[d] the

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defendant not to have . . . each of the three.” Id. at 139–40. But Congress was not so explicit, so
the Court went beyond the statute’s text and adopted the government’s reading based on
statutory “context” and “function.” Id. at 141–49.
Ashrafkhan makes effectively the same argument as the defendant in Pulsifer.
Ashrafkhan argues that he remains eligible for the zero-point offender reduction if “he does not
have the combination” of an aggravating role adjustment and a continuing criminal enterprise
conviction. Id. at 127. (Appellant Br. 6.) Since he has only one of the two, Ashrafkhan asserts
that he remains eligible. But that argument fails because § 4C1.1(a)(10) makes explicit what the
statute in Pulsifer left implicit. Rather than placing one negative phrase at the beginning of a list
of requirements, the guideline includes a negative phrase at the beginning of each requirement in
the list. The guideline states that a defendant is eligible for the reduction if he “did not receive
an [Aggravating Role] adjustment . . . and was not engaged in a continuing criminal enterprise.”
USSG § 4C1.1(a)(10) (emphasis added). Thus, the guideline expressly “requires the defendant
not to have . . . each” of the two conditions. See Pulsifer, 601 U.S. at 140.
Therefore, § 4C1.1(a)(10) avoids the grammatical structure that created interpretive
challenges in Pulsifer. Each negative phrase constitutes a “separate requirement.” Morales, 122
F.4th at 594 (quoting Cervantes, 109 F.4th at 946). Simplified, the guideline states a defendant
is eligible for a reduction if he “does not have X and did not do Y”—so if a defendant does have
X, or did do Y, he is ineligible. Id. Since Ashrafkhan has an aggravating role adjustment, that
alone makes him ineligible for the reduction by the plain terms of the sentencing guideline.
B.
Inquiry into guideline’s context likewise clarifies § 4C1.1(a)(10). Reading the provision
to set out a single condition—that the defendant does not have the combination of an aggravating
role enhancement and engagement in a continuing criminal enterprise—creates two statutory
difficulties resolved by construing the provision as an eligibility checklist.
First, Ashrafkhan’s reading would render § 4C1.1(a)(10) largely superfluous. Various
provisions of the Sentencing Guidelines operate to, generally, exclude a defendant from
receiving an aggravating role adjustment if they engaged in a continuing criminal enterprise.

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The application notes of the guideline provision, § 2D1.5, of the continuing criminal enterprise
statute, 21 U.S.C § 848(C), instruct sentencing courts to “not apply any adjustment from Chapter
Three, Part B (Role in the Offense).” The background commentary explains that such an
adjustment, which includes an aggravating role adjustment, “is not authorized [b]ecause a
conviction under 21 U.S.C. § 848 establishes that a defendant controlled and exercised
authorized over one of the most serious types of ongoing criminal activity” and so “already
reflects an adjustment for role in the offense.” USSG § 2D1.5. In other words, the sentencing
guidelines instruct courts to avoid applying the aggravating role adjustment to a defendant
convicted of engaging in a continuing criminal enterprise. Id. So, under Ashrafkhan’s reading,
§ 4C1.1(a)(10) applies only to a group of defendants that may not exist—those that “have both
an aggravating role [adjustment] and a [continuing criminal enterprise] conviction.” (Appellant
Br. 14.) We decline to render § 4C1.1(a)(10) a “nullity.” Milchin, 128 F.4th at 202.
Ashrafkhan argues that a hypothetical defendant could still meet § 4C1.1(a)(10) under his
reading “if a person is convicted of multiple counts of convictions—a [continuing criminal
enterprise] offense and other offenses” such that the “person may receive aggravating role
enhancements on the additional offenses other than the [continuing criminal enterprise]
conviction.” (Reply Br. 4–5.) To begin, it is not clear that Ashrafkhan is correct. The
guidelines commentary states that an aggravating role adjustment “is not authorized” for a
defendant with “a conviction under 21 U.S.C. § 848.” USSG § 2D1.5. For that reason, the Third
Circuit has stated that “a defendant found to have engaged in a continuing criminal enterprise
will never receive an [aggravating role] adjustment.” Milchin, 128 F.4th at 202. Ashrafkhan
provides no authority to suggest that an additional conviction alters that categorical bar. But
even if such a rare defendant exists, Ashrafkhan’s reading would constrain the application of
§ 4C1.1(a)(10) so narrowly as to effectively render the criterion inapplicable. And we avoid
construing guidelines in a manner that would render their words superfluous. United States v.
Wilkes, 78 F.4th 272, 280 (6th Cir. 2023) (citation omitted); see also United States v. Menasche,
348 U.S. 528, 538–39 (1955) (“The cardinal principle of statutory construction is to save and not
to destroy.” (internal citation and quotation marks omitted)).

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Second, Ashrafkhan’s reading would constrain the applicability of § 4C1.1(a)(10) to
defendants convicted of specific drug offenses. This is because the continuing criminal
enterprise statute, 21 U.S.C. § 848, is “directly aimed at the organizers and leaders of narcotics
operations,” United States v. Sinito, 723 F.2d 1250, 1261 (6th Cir. 1983) (citation omitted). The
aggravating role adjustment under § 3B1.1, which applies to criminal activities beyond narcotics,
has no such constraint. See, e.g., United States v. Christian, 804 F.3d 819, 821 (6th Cir. 2015)
(considering an aggravating role adjustment for involvement in a truck theft ring).
Aggravating role adjustments and continuing criminal enterprise offenses thus target
similar conduct—leadership or managerial roles in multi-participant criminal organizations—but
in different contexts. See Bazel, 80 F.3d at 1144 (“[O]ne possible reason for grouping leadership
roles and involvement in [continuing criminal enterprises] in the same subsection is that
Congress and the Sentencing Commission believed that there is a certain logical connection
between the extent of a criminal activity and the nature of a defendant’s leadership role, if any, in
a criminal organization.”). Requiring that a defendant exhibit a combination of both to be
rendered ineligible under § 4C1.1(a)(10) distorts the provision’s logic.
IV.
Reading § 4C1.1(a)(10) as an eligibility checklist also comports with our interpretation in
Bazel of a near-identical provision in the safety-valve statute. Id. at 1140–41; see also United
States v. Draheim, 958 F.3d 651, 657–58 (7th Cir. 2020) (adopting Bazel’s analysis and
approach). That provision provides that, for certain drug offenses, the sentencing court “shall
impose a sentence [] without regard to any statutory minimum sentence, if the court finds at
sentencing [] that [] the defendant was not an organizer, leader, manager, or supervisor of others
in the offense, as determined under the sentencing guidelines and was not engaged in a
continuing criminal enterprise [].” 18 U.S.C. § 3553(f)(4); see also USSG § 5C1.2(4). Like
Ashrafkhan, the defendant in Bazel contended he was eligible under the provision, despite
having been an “organizer, leader, manager, or supervisor” of a criminal operation, because he
was not engaged in a continuing criminal enterprise. Bazel, 80 F.3d at 1141.

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We observed in Bazel that the defendant’s argument may have prevailed if the provision
“were phrased in terms of what the government would have to prove was true of the defendant.”
Id. at 1143. Instead, as here, “the statute is phrased in terms of what the defendant must show
was not true of him.” Id. Consequently, we explained that “[r]ecognizing that each and every
‘criterion’ must be met [] makes the defendant’s argument that [§ 3553(f)(4)] requires the
government to establish that the defendant was both an ‘organizer, leader, manager, or
supervisor’ and was ‘engaged in a continuing criminal enterprise’ [], simple to dismiss.” Id. at
1142.
We also noted that interpreting the subsection as setting forth two separate conditions the
defendant had to meet accorded “with the grammatical structure, the logic, and the legislative
history of § 3553(f).” Id. at 1143. That reasoning included the observation that requiring that a
defendant be both an “organizer, leader, manager, or supervisor” and be engaged in a continuing
criminal enterprise “would render the ‘organizer, leader, manager, or supervisor’ requirement
superfluous, as the definition of a person engaged in a [continuing criminal enterprise] already
encompasses such a leadership requirement.” Id. at 1144–45.
Ashrafkhan tries to distinguish Bazel by arguing that it addresses the safety-valve
provision and not the specific guideline provision here. Ashrafkhan also notes that both
provisions had distinct legislative histories and goals. This is true. But Bazel’s reasoning mainly
rested on the natural reading of the text itself—it did not find the text so ambiguous as to require
relying on legislative history and purpose to discern its meaning. Id. at 1142. Consequently,
Bazel’s textual analysis remains persuasive here, and the differences between the provisions are
not so significant as to demand that we interpret nearly identical text differently.
V.
Finally, we reject Ashrafkhan’s efforts to invoke the rule of lenity. “The rule of lenity
[] applies only when, after consulting traditional canons of statutory construction, we are left
with an ambiguous statute.” United States v. Shabani, 513 U.S. 10, 17 (1994). For the reasons
explained above, although there are two grammatically plausible readings of § 4C1.1(a)(10),

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in context its text is susceptible to only one possible construction. That “leav[es] no role for
lenity to play.” Pulsifer, 601 U.S. at 153.
VI.
For the foregoing reasons, we affirm.

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