In this Medicare and Medicaid fraud case, defendant physician challenges the two-level adjustment for abuse of a position of trust (pursuant to U.S.S.G. section 3B1.3) to his sentence. Judgment of sentence is affirmed, where: 1) defendant occupied a position of trust vis-a-vis Medicare and Medicaid as the medical director and manager of an authorized provider; 2) because no one supervised him, defendant was in a unique position to decide to pay illegal referral fees; and 3) defendant's position therefore contributed in a significant way to facilitating the commission or concealment of the offense because his level of authority and the lack of supervision over his actions enabled him to commit the offense and evade detection.