Rebekah Lee Pringle, DAB CR6678 (2025)

DECISION

The Inspector General (IG) of the United States Department of Health and Human Services excluded Rebekah Lee Pringle (Petitioner) from participation in Medicare, Medicaid, and all other federal health care programs for five years pursuant to section 1128(a)(3) of the Social Security Act (Act) (42 U.S.C. § 1320a-7(a)(3)).  For the reasons discussed below, I find the IG has a basis to exclude Petitioner from program participation and the five-year mandatory exclusionary period must be imposed.  The IG’s exclusion determination is affirmed.

I.     Background and Procedural History

By letter dated November 29, 2024, the IG excluded Petitioner from participating in Medicare, Medicaid, and all Federal health care programs pursuant to section 1128(a)(3) of the Act for a minimum of five years, effective 20 days from the date of the letter.  IG Exhibit (Ex.) 1.  Petitioner was excluded due to a felony conviction related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct, in connection with the delivery of a health care item or service, or with respect to any act or omission in a health care program.  IG Ex. 1.

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On January 26, 2025, the Civil Remedies Division (CRD) received Petitioner’s timely request for hearing before an administrative law judge (ALJ) to contest the exclusion imposed by the IG.  On January 29, 2025, the CRD issued an Acknowledgment Notice, Standing Prehearing Order, and the CRD Procedures.

A prehearing conference was held on February 13, 2025.  An Order Following Prehearing Conference and Setting Schedule for Pre-Hearing Submissions (Prehearing Order) was issued on the same day.  On March 11, 2025, the IG filed a brief (IG Br.) and five exhibits (IG Exs. 1-5).  This case was transferred to me on March 27, 2025.

On April 22, 2025, I issued an Order to Show Cause (OSC) based on Petitioner’s failure to file her prehearing exchange.  Petitioner uploaded a response (P. Br.) on the same day.  Petitioner did not attach any exhibits.  I accept Petitioner’s filing and find that the OSC is now moot.

On April 23, 2025, the IG filed a notice of no reply.

II.     Admissions of Exhibits and Decision on the Written Record

Absent objections, IG Exhibits 1-5 are admitted into evidence.  Petitioner did not submit any exhibits.

Neither party offered witnesses to testify.  Therefore, this matter will be decided on the written record.  Prehearing Order ¶ 16.

III.     Issues

Whether the IG has a basis to exclude Petitioner from participation in Medicaid, Medicare, and any federal healthcare programs under section 1128(a)(3) of the Act.

Because the IG imposed the mandatory minimum exclusion term of five years, I do not have the authority to review the reasonableness of the length of the exclusion.

IV.     Jurisdiction

This tribunal has jurisdiction to adjudicate this case.  42 C.F.R. §§ 1001.2007(a)(1)-(2), 1005.2; see also 42 U.S.C. § 1320a-7(f)(1).

V.     Legal Authorities

The Act requires the Secretary of Health and Human Services (Secretary) to exclude certain individuals from participation in any federal health care programs, as defined in

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Section 1128B(f) of the Act.  Act § 1128(a).  The Secretary has delegated this exclusion authority to the IG.  42 C.F.R. § 1001.101.

Section 1128(a)(3) mandates the exclusion of any individual convicted of a criminal offense related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct in connection with the delivery of a health care item or service, or with respect to any act or omission in a health care program other than Medicare or Medicaid, operated by, or financed in whole or in part by any federal, state, or local agency.  The Act requires a minimum exclusion period of five years when the exclusion is mandated under section 1320a-7(a).  42 U.S.C. § 1320a-7(c)(3)(B).

The IG has the burden of proving the basis for the exclusion and the existence of any aggravating factors.  42 C.F.R. §§ 1005.15(b)(2), 1001.102(b).  Petitioner bears the burden of proof and the burden of persuasion on any affirmative defenses or mitigating factors.  42 C.F.R. §§ 1005.15(b)(1), 1001.102(c).  The standard of proof is a preponderance of the evidence, and there may be no collateral attack of the conviction that provides the basis of the exclusion.  42 C.F.R. §§ 1001.2007(c), 1005.15(d).

An excluded individual may request a hearing before an ALJ, but only on the issues of whether the IG had a basis for the exclusion and whether an exclusion longer than the required minimum period is unreasonable in light of any applicable aggravating and mitigating factors.  42 C.F.R. §§ 1001.2007(a), 1005.2(a).

VI.     Findings of Fact

Petitioner was a personal care services attendant in Tennessee.  IG Ex. 2.  As part of her job, Petitioner acted as the caregiver for an elderly adult.  Id.; IG Ex. 4.

On July 10, 2023, Petitioner was indicted with one count of financial exploitation of a vulnerable or elderly adult pursuant to TCA § 39-15-502.  IG Ex. 4.  The indictment read as follows:

The Grand Jurors of Putnam County, Tennessee, duly empowered and sworn upon their oath present that Rebekah Lee Pringle heretofore between the 5th day of January, 2023 and the 2nd day of February, 2023, in Putnam County, Tennessee and before the finding of this indictment did unlawfully and knowingly financially exploit an elderly or vulnerable adult . . . by obtaining or exercising control over [the victim’s] property with intent to benefit Rebekah Lee Pringle all while acting as a caregiver . . . [.]

IG Ex. 4.

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On July 18, 2024, Petitioner entered into a plea agreement in the criminal court for Putnam County, Tennessee, in which she pleaded guilty to one count of theft - $2,500 - $10,000 in violation of TCA § 39-14-103, a class D felony.  IG Exs. 3, 5.  

The Court accepted Petitioner’s plea and sentenced her to three years of probation.  IG Ex. 3 at 2.  Petitioner was also ordered to complete 50 hours of community service and pay restitution in the amount of $1,060.26.  Id.  Petitioner was also placed on the vulnerable adult abuse registry.  IG Ex. 5 at 2.

VII.     Analysis

1. Petitioner was convicted of a criminal offense because the Court accepted her guilty plea, adjudicated her guilty, and issued a judgment of conviction.

In order to prevail, the IG must prove, by a preponderance of the evidence, that Petitioner was convicted, under federal or State law, of a criminal offense that occurred after August 21, 1996, consisting of a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct that was committed in connection with the delivery of a health care item or service.  42 U.S.C. § 1320a-7(a)(3); 42 C.F.R. § 1001.101(c)(1).

The regulations provide that an individual is “convicted” of a criminal offense when:  (1) a judgment of conviction has been entered against him or her in a federal, state, or local court, regardless of whether an appeal is pending or the record of the conviction is expunged; (2) there is a finding of guilt by a court; (3) a plea of guilty or nolo contendere is accepted by a court; or (4) the individual has entered into a first offender program, deferred adjudication program, or other arrangement where a judgment of conviction is withheld.  42 U.S.C. § 1320a-7(i).

Petitioner pleaded guilty to a class D Felony on July 18, 2024 and was sentenced on August 7, 2024.  IG Ex. 3.  Therefore, Petitioner has been convicted of a criminal offense.

2. Petitioner was convicted of a felony that was related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct, in connection with the delivery of a healthcare item or service.

Section 1128(a)(3) of the Act requires the exclusion of individuals subject to felony convictions related to “fraud, theft, embezzlement, breach of fiduciary responsibility or other financial misconduct.”  42 U.S.C. § 1320a-7(a)(3).  Petitioner pleaded guilty to a single count of theft over $2,500 pursuant to TCA § 39-14-103.  Theft over $2,500 is a felony offense related to financial misconduct.  Petitioner does not argue that the

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underlying facts of her conviction do not involve “fraud, theft, embezzlement, breach of fiduciary responsibility or other financial misconduct.”

Petitioner also does not argue that her offense does not relate to the delivery of a health care item or service.  To determine whether an offense is related to the delivery of a health care item or service, one must look to whether there is a “common sense connection” between the offense of which a petitioner was convicted and the delivery of a health care item or service.  Erik D. DeSimone, R.Ph., DAB No. 1932 (2004); see also Quayum v. U.S. Dep’t of Health & Human Servs., 34 F. Supp. 2d 141, 143 (E.D.N.Y. 1998); Friedman v. Sebelius, 686 F.3d 813, 820 (D.C. Cir. 2012) (describing the phrase “related to” in another part of section 1320a-7 as “deliberately expansive words,” “the ordinary meaning of [which] is a broad one,” and one that is not subject to “crabbed and formalistic interpretation”) (internal quotation marks omitted).  The evidence shows that Petitioner’s conviction involved theft from a patient.  Therefore, the IG has proven that the offense was related to the delivery of a health care item or service.

3. Petitioner must be excluded for a minimum of five years.

Exclusions imposed under section 1128(a)(3) carry a five-year mandatory minimum exclusion period.  Act § 1128(c)(3)(B) (42 U.S.C. § 1320a-7(c)(3)(B)); 42 C.F.R. § 1001.102(a).  Petitioner makes arguments in equity for a reduced period of exclusion.  P. Br.  However, an ALJ does not have the authority to grant such relief.  Matthew J. Girardy, DAB No. 2987 at 7 (2020).  Congress required Petitioner’s exclusion pursuant to 1128(a)(3) and that requirement is binding upon the Secretary and me.  42 C.F.R. § 1005.4(c)(1).

VIII.     Conclusion

The IG has proven, by a preponderance of the evidence, that Petitioner was:  1) convicted of a criminal offense; 2) related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct; 3) in connection with the delivery of a healthcare item or service.  Therefore, Petitioner shall be excluded from participating in Medicare, Medicaid, and other federal health care programs for the mandatory five-year period.  The five-year exclusion imposed by the IG is AFFIRMED.