Jonnie Adams-Jones, DAB CR5711 (2020)

DECISION

Petitioner, Jonnie Adams-Jones, submitted false claims to the Kentucky Medicaid program.  She pled guilty to four counts of theft by unlawful taking.  Based on her guilty plea, the Inspector General (IG) has excluded her for five years from participating in Medicare, Medicaid, and all federal health care programs, as authorized by section 1128(a)(1) of the Social Security Act (Act).  Petitioner appeals the exclusion.  For the reasons discussed below, I find that the IG properly excluded Petitioner Adams-Jones and that the statute mandates a minimum five-year exclusion.

Background

In a letter dated January 31, 2020, the IG notified Petitioner that she was excluded from participating in Medicare, Medicaid, and all federal health care programs for a period of five years because she had been convicted of a criminal offense related to the delivery of an item or service under Medicare or a state health care program.  The letter explained that section 1128(a)(1) of the Act authorizes the exclusion.  IG Ex. 1.

Petitioner requested review.

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The IG submitted a written argument (IG Br.) and six exhibits (IG Exs. 1-6).  Petitioner responded to the IG’s brief (P. Br.). 

In the absence of any objections, I admit into evidence IG Exs. 1-6.

The parties agree that in-person hearing is not necessary.  IG Br. at 4; P. Br. at 2.

Discussion

Petitioner must be excluded from program participation for a minimum of five years because she was convicted of a criminal offense related to the delivery of an item or service under a state health care program.  Act § 1128(a)(1).1

Under section 1128(a)(1) of the Act, the Secretary of Health and Human Services must exclude an individual who has been convicted under federal or state law of a criminal offense related to the delivery of an item or service under Medicare or a state health care program.  42 C.F.R. § 1001.101(a). 

Petitioner was the primary caregiver and daughter of a Medicaid beneficiary.  IG Ex. 6.  She was charged with four felony counts of theft by unlawful taking of property from the Kentucky Medical Assistance program.  IG Ex. 5.  On June 28, 2019, the charges were reduced to misdemeanors, and Petitioner pled guilty to all four misdemeanor counts.  IG Exs. 3, 4.  The state court accepted her plea and sentenced her to 18 months probation.  IG Exs. 3, 4.

Petitioner was thus convicted within the meaning of the Act.  Because her conviction was directly related to the delivery of services under a state health care program (Medicaid), she is subject to exclusion.  An exclusion brought under section 1128(a)(1) must be for a minimum period of five years.  Act § 1129(c)(3)(B); 42 C.F.R. § 1001.2007(a)(2).

Petitioner suggests that she was not really guilty of a crime, but “made a mistake on a confusing time card with no intentions to fraud.”  P. Br. at 2.  The regulations preclude such a collateral attack on Petitioner’s underlying convictions: 

When the exclusion is based on the existence of a . . .  determination by another Government agency, or any other prior determination where the facts were adjudicated and a final decision was made, the basis for the underlying . . .

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determination . . . is not reviewable and the individual or entity may not collaterally attack it, either on substantive or procedural grounds, in this appeal. 

42 C.F.R. § 1001.2007(d); Marvin L. Gibbs, Jr., M.D., DAB No. 2279 at 8-10 (2009); Roy Cosby Stark, DAB No. 1746 (2000).

Conclusion

For these reasons, I conclude that the IG properly excluded Petitioner from participation in Medicare, Medicaid and all federal health care programs, and I sustain the five-year exclusion.