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 INSPECTOR GENERAL
The Inspector General (I.G.) determined to exclude Petitioner, _____________,
from participating in Medicare, Medicaid, and other federally-funded health care
programs. The statutory basis given for the exclusion is section(s) ______ of the
Social Security Act (Act). The duration of the exclusion is for at least _____ years,
or, in the case of an exclusion imposed pursuant to sections 1128(b)(4),
1128(b)(5), or 1128(b)(14) of the Act, until _______.
The issues in this case are whether:
1. The I.G. has the authority to exclude Petitioner; and
2. The length of the exclusion is reasonable, in the case of any
exclusion that is not for a minimum mandatory period.
I. Authority for the exclusion. Describe each fact that supports the I.G.’s
determination that Petitioner may or must be excluded pursuant to section(s)
of the Act and explain why these facts support your argument that an exclusion is
authorized or mandated.
Docket No. C-
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XXX
XX
In doing so, cite to each exhibit that supports your statement of facts and explain
why it does.
II. Whether the length of the exclusion is reasonable.
A. Is the exclusion for a minimum mandatory period of five years
(applicable only in cases where the exclusion is imposed pursuant to
section 1128(a) of the Act)?
Is it for a minimum mandatory period of three years (applicable only in
cases where the exclusion is imposed pursuant to section 1128(b) of the
Act)?
B. If the exclusion is for other than a minimum mandatory period, state
each regulatory aggravating factor that you contend is present in the case.
Cite the relevant regulatory section that states each aggravating factor that
you contend is present. Describe the facts that support the presence of each
aggravating factor or factors. Cite to each exhibit that supports your
contentions and explain why it does.
No
Yes
No
Yes
C. If there are mitigating factors present in this case, state each mitigating
factor that you contend is present. Cite the relevant regulatory section that
states each mitigating factor that you contend is present. Describe the facts
that support the presence of each mitigating factor or factors. Cite to each
exhibit that supports your contentions and explain why it does.
D. Explain why the facts that relate to the aggravating and, if any,
mitigating factors that you contend are present support a finding that the
length of the exclusion is reasonable.
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?
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.
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.
Counsel for the I.G.
Date:
No
Yes
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