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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 is authorized to exclude you from
participating in Medicare, Medicaid, and other federally-funded health care
programs for at least three years, because you were convicted of one of the
offenses that is described in section 1128(b)(1) of the Social Security Act.
The issues in this case are whether:
1. The I.G. has the authority 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 authorized?
The I.G. argues that your exclusion is authorized, because you were convicted of
one of the following offenses:
A. A misdemeanor occurring after August 21, 1996, relating to fraud,
theft, embezzlement, breach of fiduciary responsibility, or other financial
misconduct –
(i) in connection with the delivery of a health care item or service, or
(ii) with respect to any act or omission in a health care program,
other than Medicare or a State health care program (a State Medicaid
program), operated by, or financed in whole or in part by, any
federal, State, or local government agency; or
B. A criminal offense relating to fraud, theft, embezzlement, breach of
fiduciary responsibility, or other financial misconduct with respect to any
act or omission in a program (other than a health care program) operated
by, or financed in whole or in part by, any federal, State, or local
government agency.
Do you disagree with the I.G.’s argument?
No
Yes
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 the
length of the exclusion that he determined to impose is reasonable.
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. §
1001.201(b)(3))?
If you believe that a mitigating factor or factors exist(s), state what 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.
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?
No
Yes
No
Yes
No
Yes
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.
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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