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1128%28a%29%281%295years

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United States Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Civil Remedies Division
In the Case of:
Date:
Petitioner,
- v. -
The Inspector General.
INFORMAL BRIEF OF PETITIONER
The Inspector General (I.G.) argues that he must exclude you from participating in
Medicare, Medicaid, and other federally-funded health care programs for at least
five years, because you were convicted of a criminal offense that is described in
section 1128(a)(1) of the Social Security Act.
The issue in this case is whether the I.G. is required to exclude you.
I. Were you convicted of a criminal offense?
Do you agree that you were convicted of a criminal offense?
Docket No. C-
-
)
)
)
)
)
)
)
)
)
)
No
Yes
No
Yes
XXX
XX
If you disagree, explain why you disagree. State which exhibits support your
argument and explain why they do.
II. Were you convicted of an offense for which exclusion is required?
The I.G. argues that he must exclude you, because your conviction related to the
delivery of an item or service under Medicare or a State health care (a State
Medicaid) program. Do you disagree with the I.G.’s argument?
If you disagree, explain why you disagree. State which exhibits support your
argument and explain why they do.
III. Do you believe that an in-person hearing is necessary to decide your
case?
Do you have any testimony that you wish to offer at an in-person hearing?
If you have testimony that you wish to offer, provide the following:
No
Yes
No
Yes
No
Yes
1. The name of each witness whose testimony you want to offer.
2. A description of each witness’ proposed testimony and an explanation
of why you believe that the testimony relates to any of the arguments you
want to offer in connection with items I and II.
3. An explanation of why the proposed testimony does not duplicate
something that is already stated in an exhibit.
IV. Do you have any other arguments you wish to make? If so, please state
them here. State which exhibits support your argument(s) and explain why they
do.
Petitioner or Petitioner’s Representative
Date:
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1128%28a%29%281%295years

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Completed 3 March 2020

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