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1128%28a%29%281%29morethan5years

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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
_______ years, because you were convicted of a criminal offense that is described
at section 1128(a)(1) of the Social Security Act and because there is evidence that
justifies the length of the exclusion that the I.G. determined to impose.
The issues in this case are whether:
1. The I.G. is required to exclude you; and
2. The length of the exclusion that the I.G. determined to impose is
reasonable.
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. Is the length of your exclusion unreasonable? The I.G. argues that there is
evidence relating to certain aggravating factors that he says supports the length of
the exclusion.
A. Do you disagree with the I.G.’s identification of aggravating factors
in your case?
No
Yes
No
Yes
No
Yes
If you disagree, state which of the aggravating factors cited by the I.G. you
believe are not present. Explain why you disagree. State which exhibits
support your argument(s) and explain why they do.
B. If you agree that there is/are an aggravating factor or factors
present in your case but believe that the exclusion is nonetheless not
justified by the presence of that factor or factors, explain your reasons
for your argument. State which exhibits support your arguments and
explain why they do.
C. Do you believe that a mitigating factor or factors exist(s) that
support(s) reducing the length of your exclusion (before answering this
question, read the list of potentially mitigating factors that is set forth at
42 C.F.R. § 1001.102(c))?
If you believe that a mitigating factor or factors exist(s), state what it is/they
are and explain why the presence of the factor or factors should support
reducing the length of your exclusion. State which exhibits support your
argument(s) and explain why they do.
No
Yes
IV. 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:
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, II, and III.
3. An explanation of why the proposed testimony does not duplicate
something that is already stated in an exhibit.
No
Yes
No
Yes
V. 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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Completed 3 March 2020

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