Cristie Chapman, DAB CR6687 (2025)

DECISION

The Inspector General of the United States Department of Health and Human Services (the IG) excluded Petitioner, Cristie Chapman, from participation in Medicare, Medicaid, and all other federal health care programs for five years pursuant to section 1128(a)(2) of the Social Security Act (Act) (42 U.S.C. § 1320a-7(a)(2)).  Petitioner challenges the imposition of the exclusion.  For the reasons below, I affirm the IG’s exclusion determination.

I.     Background and Procedural History

Petitioner is a nurse who worked at a residential healthcare facility, Millcreek of Magee Treatment Center, in Simpson County, Mississippi.  IG Ex. 5 at 8, 18.  According to a Medicaid Fraud Control Unit (MFCU) Investigation Report, Petitioner was one among several health care workers who were responsible for the care of 17-year-old resident J.B.  IG Ex. 5.  J.B. had multiple diagnoses including profound intellectual disability, a history of seizures, Cerebral Palsy, and Hydrocephalus.  Id. at 1, 9.  On June 20, 2021, J.B. was

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admitted to a hospital unresponsive, he was resuscitated, air-lifted to another hospital in critical condition, and ultimately declared brain-dead and taken off life-support two days later.  Id. at 2.  As a result, the Jackson, Mississippi MFCU investigated the circumstances leading up to J.B.’s death.  Id.

The MFCU Report appears to conclude that a discontinuation or break in J.B.’s Ventriculoperitoneal (VP) shunt tube, which would drain excess cerebrospinal fluid from J.B.’s brain due to his Hydrocephalus, was the contributing factor causing J.B. to have seizures and the subsequent events ultimately leading to his passing.  Id. at 8, 12.  The MFCU report does not ascertain the cause for the break in J.B.’s VP shunt tube or the time of its occurrence, but it identifies a number of separate concerns pertaining to the care of J.B. leading up to his becoming unresponsive on June 20, 2021.  See generally id.

Specifically relating to Petitioner, the MFCU report noted that Petitioner was on the 15th hour of a 16-hour double shift at the time J.B. began seizing on June 20, 2021.  Id. at 8.  The MFCU identified a discrepancy in J.B.’s Medication Administration Record (MAR) that indicated Petitioner provided J.B. with his oral medication at 1400 hours, but Petitioner admitted she had prepared and charted in advance to get ahead on paperwork and she had not in fact provided J.B. his oral medication because he was seizing at the time.  Id. at 4, 7.  Conversely, Petitioner stated to the MFCU investigators that she administered a shot of Ativan to J.B. while he was seizing in accordance with the doctor’s order, but she forgot to indicate that administration in J.B.’s chart.  Id. at 7.  The MFCU Report also indicates that Petitioner and another nurse on duty could not give a corroborating statement as to where each of them was located during the incident with J.B.  Id. at 18-19.

The MFCU Report enumerates a number of other concerns pertaining to J.B.’s care; e.g., unreported incidents where J.B. sustained multiple injuries from his roommate and the facility continued the same roommate arrangement (id. at 13), no orders or tests to determine the functionality of J.B.’s VP shunt from his admission to Millcreek on November 11, 2019 until the incident leading to his death (id. at 14), numerous missing entries in J.B.’s Bowel Movement Sheet with J.B. ending up with severe constipation and Coffee Ground Vomitus (id. at 2, 3, 15, and 19), failure to appropriately monitor J.B.’s vitals following the initial seizure activity (id. at 8, 15-16, 19, and 20), not appropriately maintaining supervision during quarantine procedures (id. at 3, 17, and 20); but none of these failures are attributed to Petitioner.  See IG Ex. 5.  Importantly, a number of the statements excerpted from the MFCU Report and included in the IG’s Brief pertain to another nurse that was also on duty on June 20, 2021, an attending physician responsible for J.B.’s care, as well as other health care professionals that were on duty and tasked with different aspects of J.B.’s care.  IG Br. at 2-3.

Subsequently, on June 8, 2023, Petitioner was charged with Misdemeanor Neglect of a Vulnerable Person pursuant to MS Code § 43-47-19(1) and (2) alleging that, through

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failure to provide proper patient care, she willfully committed an act or omitted the performance of a duty which tended to contribute to or result in physical pain, injury, or mental anguish of a vulnerable person.  IG Ex. 2 at 1.  In conjunction with her charging, the state court issued an arrest warrant for Petitioner.  Id. at 2.

Petitioner initially pleaded not guilty, and a trial was set.  IG Ex. 4.  At trial, Petitioner changed her plea to “guilty nonadjudication” of misdemeanor neglect of a vulnerable person.  Id.  And the state court entered a judgment of “nonadjudicated” and ordered her to pay a fine of $250 and fees to the state court and attorney general.1  Id.

On October 31, 2024, the IG issued a notice to Petitioner that she would be excluded from participation in Medicare, Medicaid, and all federal health care programs for five years under section 1128(a)(2) of the Act effective 20 days from the letter.  IG Ex. 1 at 1.  The IG specified that Petitioner’s exclusion was due to her conviction, as the term is defined in section 1128(i) of the Act (42 U.S.C. § 1320a-7(i)), in the Simpson County Justice Court, Mississippi, of a criminal offense related to the neglect or abuse of a patient, in connection with the delivery of a health care item or service.  Id.

Petitioner timely requested a hearing, and I was designated to hear and decide this case.  The Civil Remedies Division issued my Standing Prehearing Order on December 9, 2024, as well as an acknowledgment letter notifying the parties that I had scheduled a telephonic pre-hearing conference in this matter.

I conducted the pre-hearing telephone conference on January 22, 2025, the substance of which is memorialized in my January 27, 2025 Order (Summary Order), including a schedule for submission of arguments and evidence by the parties.  The IG submitted a brief (IG Br.) and five exhibits (IG Exs. 1-5).  Petitioner submitted a brief (P. Br.) and two exhibits (P. Exs. 2-3).2

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II.     Admission of Exhibits

Neither Party objects to the admission of the other Party’s exhibits.  Therefore, I admit IG Exs. 1-5 and P. Exs. 2-3 into evidence.

III.     Decision on the Record

Both parties indicated that an in-person hearing is not necessary in this matter and did not identify any witnesses.  IG Br. at 6-7; P. Br. at 2.  Therefore, I find that a hearing with live oral testimony is unnecessary and proceed to a decision based on the record before me.  See Civ. Remedies Div. P. § 19(d).

IV.     Issues

The Secretary of Health and Human Services (the Secretary) has by regulation limited my scope of review to two issues in mandatory exclusion cases:  whether the IG has a basis for excluding Petitioner from participating in Medicare, Medicaid, and all other federal health care programs, and, if so, whether an exclusionary period greater than five years imposed by the IG is unreasonable.  See 42 C.F.R. § 1001.2007(a)(1).  Because Petitioner was excluded for the mandatory minimum period of five years, only the basis for the exclusion is at issue.

V.     Applicable Law

Section 1128(f) of the Act (42 U.S.C. § 1320a-7(f)) establishes Petitioner’s right to a hearing by an administrative law judge (ALJ) and judicial review of the final action of the Secretary.  The right to a hearing before an ALJ is set forth in 42 C.F.R. §§ 1001.2007(a) and 1005.2, while the rights of both the sanctioned party and the IG to participate in a hearing are specified at 42 C.F.R. § 1005.3.

Pursuant to section 1128(a)(2) of the Act, the Secretary must exclude from participation in any federal health care program any individual convicted under federal or state law of a criminal offense related to neglect or abuse of patients in connection with the delivery of a healthcare item or service.

In turn, an individual is convicted of a criminal offense for purposes of this mandatory exclusion when, among other things, “the individual or entity has entered into participation in a first offender, deferred adjudication, or other arrangement or program

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where judgment of conviction has been withheld.”  Section 1128(i)(4) of the Act (42 U.S.C. § 1320a-7(i)(4)).  The Secretary has promulgated regulations implementing these provisions of the Act.  42 C.F.R. § 1001.101(b).

Exclusion for a minimum period of five years is mandatory for any individual or entity convicted of a criminal offense for which exclusion is required by section 1128(a) of the Act.  Act § 1128(c)(3)(B) (42 U.S.C. § 1320a-7(c)(3)(B)).  Pursuant to 42 C.F.R. § 1001.102(b), an individual’s period of exclusion may be extended based on the presence of specified aggravating factors.  Only if the aggravating factors justify an exclusion of longer than five years, however, are mitigating factors considered as a basis for reducing the period of exclusion to no less than five years.  42 C.F.R. § 1001.102(c).

In this proceeding, the standard of proof is a preponderance of the evidence.  42 C.F.R. § 1001.2007(c).  Petitioner bears the burden of proof and the burden of persuasion on any affirmative defenses or mitigating factors, and the IG bears the burden on all other issues.  42 C.F.R. § 1005.15(b), (c); Standing Prehearing Order ¶ 5.

VI.     Findings of Fact, Conclusions of Law, and Analysis

My conclusions of law are set forth in bold and followed by pertinent findings of fact and analysis.

1. I have jurisdiction to hear this case.

Petitioner timely requested a hearing.  I therefore have jurisdiction to hear and decide this case.  See 42 C.F.R. §§ 1001.2007(a)(1)-(2), 1005.2(a); see also 42 U.S.C. § 1320a-7(f)(1). 

2. Petitioner was convicted of a criminal offense related to the neglect or abuse of a patient, in connection with the delivery of a healthcare item or service, requiring exclusion under 42 U.S.C. § 1320a-7(a)(2).

The IG must exclude an individual from participation in federal health care programs if the individual was convicted of a criminal offense related to neglect or abuse of patients in connection with the delivery of a healthcare item or service.  42 U.S.C. § 1320a-7(a)(2).  The facts of this case satisfy these statutory requirements.  Consequently, the IG was required to exclude Petitioner from participation in all Federal health care programs under this section.

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1. Petitioner was “convicted” of a criminal offense as that term is defined in section 1128(i) of the Act.

The crux of Petitioner’s contention that the IG’s exclusion is improper rests on whether Petitioner was “convicted” of a criminal offense for purposes of mandatory exclusion pursuant to 1128(a)(2) of the Act.  P. Br. at 2.  Petitioner argues that that she was not convicted of a prerequisite offense, because “[a] guilty plea with non-adjudication in Mississippi means that a defendant enters a guilty plea but the court withholds a formal conviction.”  Id.  Petitioner further adds that “[t]he defendant must complete a program of court-ordered conditions instead,” and “[i]f the defendant successfully completes the program, the charges are dismissed.”  Id.

While it is accurate that Petitioner ultimately pleaded “guilty nonadjudication” and the state court entered a judgment of “nonadjudicated” (IG Ex. 4), this judgment fits within the definition of “convicted” as that term is defined in section 1128(i)(4) of the Act for purposes of all mandatory and permissive exclusions.  42 U.S.C. § 1320a-7(i)(4).  The term convicted is defined broadly here and specifically includes when an individual enters into a deferred adjudication or other arrangement or program where judgement of conviction has been withheld.  Id.  Petitioner’s description of a guilty plea with non-adjudication fits within this statutory definition of “convicted.”  Compare P. Br. at 2 with 42 U.S.C. § 1320a-7(i)(4); see also 42 C.F.R. § 1001.2 (subsection (d) under the definition of “Convicted.”).

Petitioner has indeed demonstrated that the underlying misdemeanor charge of neglect of a vulnerable adult was nonadjudicated and dismissed on the day of her trial, her record was wholly expunged, and the same state court that entered her nonadjudication subsequently ordered that “this Court does hereby restore Cristie Chapman [Petitioner] in contemplation of the law to the status which she occupied before her arrest.”  P. Ex. 2 (August 8, 2024 Order Expunging Record) at 2.  Even so, this Expungement Order from the state court applies to the laws of Mississippi, but it does not remove or retroactively undo Petitioner’s conviction for purposes of Federal law.  See Funmilola Mary Taiwo, DAB No. 2995 at 6-7 (2020) (“[T]he Board has long held [post-conviction expungement] qualifies as a conviction under the Act.”). 

2. Petitioner’s offense is related to patient abuse or neglect.

Petitioner does not specifically dispute that the underlying misdemeanor charge of neglect of a vulnerable person relates to patient abuse or neglect.  See generally P. Br.  Nor does Petitioner dispute any of the statements contained within the MFCU report (IG Ex. 5), which provides the sole factual evidence in the record of the conduct leading to Petitioner’s misdemeanor charge.  See generally P. Br.

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I find that Petitioner’s offense is facially related to patient abuse or neglect, and the underlying conduct delineated in the MFCU report is also related to the neglect of patient J.B.  See supra § I; IG Ex. 5.

3. Petitioner’s “failure to provide proper patient care” occurred in connection with the delivery of a healthcare item or service.

Petitioner does not specifically dispute that the underlying conduct that led to her misdemeanor charge of neglect of a vulnerable person occurred in connection with the delivery of a healthcare item or service.  See generally P. Br.  Undoubtedly, Petitioner’s inaccurate charting of medications she administered to patient J.B. (IG Ex. 5 at 4), and her otherwise “failing to provide proper patient care” while on duty satisfies this statutorily required element (IG Ex. 2).  The IG was therefore required to exclude Petitioner pursuant to 42 U.S.C. § 1320a-7(a)(2). 

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

Because I have concluded that a basis exists to exclude Petitioner pursuant to 42 U.S.C. § 1320a-7(a)(2), she must be excluded for a minimum of five years.  42 U.S.C. § 1320a-7(c)(3)(B).  The exclusionary period is reasonable as a matter of law.

VII.     Conclusion

I affirm the IG’s determination to exclude Petitioner from participating in Medicare, Medicaid, and all other federal health care programs for five years.