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1128%28b%29%284%29exclusioncoterminouswithlossoflicense

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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programs, because your license to provide health care was revoked, suspended, or
otherwise lost for a reason described at section 1128(b)(4) of the Social Security
Act. The length of the exclusion is for a period of time that is not less than the
period when your license is revoked, suspended, or otherwise lost.
The issue in this case is whether the I.G. is authorized to exclude you.
I. Was your license revoked, suspended, or otherwise lost, or did you
surrender your license, under the circumstances that are described at section
1128(b)(4)?
A. Do you agree that your license to provide health care was revoked,
suspended, or otherwise lost as a consequence of action taken by a State
licensing authority?
)
)
)
)
)
)
)
)
)
)
Docket No. C-
-
Yes
No
XXX
XX
If you disagree, explain why you disagree. State which exhibits support
your argument and explain why they do.
B. Do you agree that your license to provide health care was revoked,
suspended, or otherwise lost for reasons bearing on your professional
competence, professional performance, or financial integrity?
If you disagree, explain why you disagree. State which exhibits support
your argument and explain why they do.
C. (Answer the following question only if your license to provide
health care was lost, suspended, or otherwise revoked based on an
agreement reached between you and a State licensing authority). Do
you agree that you surrendered your license to provide health care while a
State formal disciplinary proceeding was pending against you and the
proceeding concerned your professional competence, professional
performance, or financial integrity?
If you disagree, explain why you disagree. State which exhibits support
your argument and explain why they do.
Yes
No
No
Yes
No
Yes
II. 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 item I.
3. An explanation of why the proposed testimony does not duplicate
something that is already stated in an exhibit.
No
Yes
No
Yes
III. 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 23 February 2020

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