Nasra Ali, DAB CR6708 (2025)

DECISION

Petitioner, Nasra Ali, worked as a personal care assistant for two Minnesota home health agencies:  Minnesota Professional Health Services, Inc. and Midwest Quality Home Care, Inc.  Both of these home health agencies provided services to Medicaid beneficiaries.  While employed by these agencies, Petitioner submitted time sheets for services that she did not provide.  She was indicted on four felony counts of theft by false representation.  She pleaded guilty to one of the counts.  

Based on her conviction, 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 Ali.  Because the statute mandates a minimum five-year exclusion, the length of her exclusion is, by law, reasonable. 

Page 2

Background

In a letter dated December 31, 2024, the IG notified Petitioner that she was excluded from participating in 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. 2. 

Petitioner timely requested review. 

The IG submitted a written argument (IG Br.) and six exhibits (IG Exs. 1-6).  Petitioner submitted her own written argument (P. Br.) with five exhibits (P. Exs. 1-5).  The IG submitted a reply brief. 

In the absence of any objections, I admit into evidence IG Exs. 1-6 and P. Exs. 1-5. 

Hearing on the written record.  The parties agree that an in-person hearing is not necessary to resolve this case.  IG Br. at 4; P. Br. at 3.  This case may therefore be resolved based on the written record.  

Discussion

1. 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 worked as a personal care assistant for two Minnesota home health agencies:  Minnesota Professional Health Services, Inc. and Midwest Quality Home Care, Inc.  Both of these home health agencies provided services to Medicaid beneficiaries.  While working for these agencies, Petitioner had another job, working for a company called Mains’l Services, Inc.  IG Ex. 3 at 4-5. 

Page 3

From January through October 2019, Petitioner reported to her home health agency employers that she had provided personal care services to Medicaid beneficiaries.  The home health agencies billed the Medicaid program for the hours she purportedly worked.  IG Ex. 3 at 5.  However, she could not have provided those services during the hours she claimed because she was either working at Mains’l or was out of the country, on vacation.  IG Ex. 3 at 1, 5. 

In a criminal complaint, issued on April 29, 2024, Petitioner was charged with four felony counts of Theft by False Representation (over $1,000), in violation of Minn. Stat § 609.52.2(a)(3)(iii).  IG Ex. 3 at 1-3. 

On September 4, 2024, in Minnesota District Court, Petitioner pleaded guilty to one felony count of Theft by False Representation.  IG Ex. 4.  The court accepted her plea and stayed judgment for three years.  The court imposed a sentence of 18 days of local confinement plus three years of probation, with community service, and ordered her to pay $3,114.35 in restitution to the Minnesota Department of Human Services (which administers the State Medicaid program) and $166.40 to UCare (a health insurance plan).  IG Exs. 5, 6.  

Thus, on its face, Petitioner’s conviction establishes that her theft by false representation resulted in her stealing more than $3,000 from the Medicaid program.  IG Exs. 4 at 4, 6. 

Petitioner concedes that she was convicted of a criminal offense but, without providing much explanation, does not agree with the IG’s argument that she must be excluded.  P. Br. at 1, 2.  She submits evidence to show that she successfully completed the conditions of her monitored probation and has moved to “administrative probation.”  P. Ex. 1, 2 (E-file ## 10, 11). 

Petitioner also submits character references, which are irrelevant.  P. Exs. 4, 5 (E-file ## 13, 14).  See, e.g., Donna Rogers, DAB No. 2381 at 6 (2011) (noting that the administrative law judge is bound by the statute and regulations and may not review the IG’s decision to exclude an individual “on the ground that . . . [she] is a good person or well-thought of in the profession....”).

Petitioner’s conviction falls squarely within the statutory and regulatory definition of “conviction,” and her crime was related to the delivery of services under a state health care program.  She is therefore subject to exclusion.  42 C.F.R. § 1001.2 (defining conviction as, among other things, when a “[s]tate court . . . has accepted a plea of guilty or nolo contendere by an individual” or when “[a]n individual or entity has entered into participation in a first offender, deferred adjudication or other program or arrangement where judgment of conviction has been withheld.”). 

Page 4

Petitioner also complains about the length of her exclusion.  She points out that her period of probation is three years, after which she could return to work in health care, but for the exclusion.  P. Br. at 2.  However, I cannot lower the period of exclusion.  By statute and regulation, an exclusion brought under section 1128(a)(1) must be for a minimum period of five years.  Act § 1128(c)(3)(B); 42 C.F.R. § 1001.2007(a)(2). 

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.