Legarda Catalon, DAB CR6717 (2025)

DECISION

I affirm the exclusion of Petitioner, Legarda Catalon, from participation in all federal health programs until reinstated. 

I. Background

In a November 29, 2024 notice, the Inspector General (IG) of the Department of Health and Human Services excluded Petitioner from participation in all federal health care programs under section 1128(b)(4) of the Social Security Act (42 U.S.C. § 1320a-7(b)(4)) because Petitioner’s “licenses to provide health care as a certified nursing assistant and home health aide in the State of California were revoked, suspended, or otherwise lost or were surrendered while a formal disciplinary proceeding was pending, for reasons bearing on [Petitioner’s] professional competence, professional performance, or financial integrity.”  IG Ex. 1 at 1.  The notice further stated that the exclusion remains in effect until the IG reinstates Petitioner, which can only occur if Petitioner regains at least one of her California certifications, obtains a health care license in another state, or serves at least three years of the exclusion.  IG Ex. 1 at 1.  Finally, the IG stated that “[t]his exclusion does not affect your rights or the rights of your family members to 

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collect benefits to which you or they may be entitled as a beneficiary under any Federal program such as Medicare, Medicaid, or Social Security.”  IG Ex. 1 at 2. 

On January 13, 2025, the Civil Remedies Division (CRD) received Petitioner’s Request for Hearing (RFH).  Electronic Filing System (E-File) Doc. No. 1.  Petitioner included supporting documentation with the RFH.  RFH Supp. Doc. 1 (E-File Doc. No. 1b); RFH Supp. Doc. 2 (E-File No. 1c).  On February 6, 2025, CRD received from Petitioner a copy of the November 29, 2024 exclusion notice.1  E-File Doc. No. 1a. 

On February 14, 2025, CRD acknowledged receipt of the RFH, gave notice I would hold a prehearing conference, and issued my Standing Order.  On March 11, 2025, I held a telephonic prehearing conference with the parties, the substance of which is summarized in my March 12, 2025 Order Following Prehearing Conference and Setting Schedule for Prehearing Submissions. 

On April 14, 2025, the IG submitted a prehearing exchange consisting of a brief (IG Br.) and three proposed exhibits (IG Exs. 1-3).  The IG also submitted legal authority marked as attachments (IG Attachs. A-B).  Petitioner did not file an exchange. 

II. Admission of Exhibits

I admit all of the documentary evidence submitted by the parties (i.e., IG Exs. 1-3; RFH Supp. Docs. 1-2), without objection.  Standing Order ¶ 13; see 42 C.F.R. § 1005.8(c). 

III. Decision on the Written Record

I directed the parties to submit written direct testimony from all witnesses that the parties wanted to present in this case and stated that the opposing party could request to cross-examine the witnesses.  Standing Order ¶¶ 11-12; see also 42 C.F.R. § 1005.16(b); Civil Remedies Division Procedures (CRDP) § 16(b).  I also advised the following: 

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• I will not conduct a hearing in this case unless a party files admissible, written direct testimony, and the opposing party asks to cross-examine one or more witnesses.  If I do not conduct a hearing, then I will issue [a decision] based on the written record. 

Standing Order ¶ 12; see also CRDP § 19(b).  Consistent with my Standing Order, the CRDP states the following: 

• The ALJ may determine that an oral hearing is unnecessary and not in the overall interest of judicial economy if the parties do not identify any proposed witnesses, do not offer the written direct testimony of any witnesses when ordered to do so, or do not request an opportunity to cross-examine a witness whose written direct testimony has been offered.  Under these circumstances, the ALJ may decide the case based on the written record. 

CRDP § 19(d). 

In the present case, all deadlines for submitting prehearing exchanges have passed and neither party filed written direct testimony.  The IG does not have any witnesses to testify in this case, and the IG stated that an in-person hearing is not necessary.  IG Br. at 5.  Therefore, I do not need to hold an in-person hearing and may issue a decision based on the written record.  EI Medical, Inc., DAB No. 3117 at 15 (2023); Vandalia Park, DAB No. 1940 (2004).  Petitioner’s failure to file a prehearing exchange does not preclude me from issuing a decision based on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 12 (2022). 

IV. Issue

1. Whether the IG had a legitimate basis to exclude Petitioner under 42 U.S.C. § 1320a-7(b)(4).
2. Whether the length of exclusion is unreasonable.

V. Jurisdiction

I have jurisdiction to adjudicate this case.  42 U.S.C. § 1320a-7(f)(1); 42 C.F.R. §§ 1001.2007, 1005.2. 

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VI. Findings of Fact

• 1)    Petitioner was certified by the California Department of Public Health as a Certified Nurse Assistant (CNA No. 315868) and a Home Health Aide (HHA No. 075654).  See IG Ex. 2 at 1.  
• 2)    On January 8, 2024, Petitioner signed a California Department of Public Health form entitled “Certified Nurse Assistant (CNA) and/or Home Health Aide (HHA) Renewal Notice/Application.”  RFH Supp. Doc. 2 at 1.  
• 3)    On January 8, 2024, Petitioner signed two California Department of Public Health forms entitled “Certified Nurse Assistant (CNA)/Home Health Aide (HHA) In-Service Training/Continuing Education Units (CEUS),” for the “certification period” from April 14, 2022, to April 14, 2024, which state that Petitioner took 17 classes on various nursing/medical subjects at the Golden Heart School of Nursing from May 2022 through January 2024.  RFH Supp. Doc. 1 at 1, 3.  Petitioner also submitted copies of the Certificates of Completion for those 17 classes.  RFH Supp. Doc. 1 at 4-20.  
• 4)    The California Department of Public Health issued a Notice of Certification to Petitioner indicating that she had successfully satisfied the requirements for the Nurse Assistant Certification, which was effective May 8, 2024, through April 14, 2027.  RFH Supp. Doc. 1 at 21.  
• 5)    The Investigation Branch of the California Department of Health completed an investigation on May 30, 2024, into an allegation that Petitioner submitted falsified CEUS with her application to renew her certification.  IG Ex. 3.  
• 6)    The May 30, 2024 Investigation Report concluded that Petitioner provided falsified CEUS with Petitioner’s renewal application, which Petitioner signed under penalty of perjury.  For multiple instances where Petitioner claimed attendance at classes, Petitioner’s signature did not appear on the class attendance sheets for those classes, and records showed Petitioner was working during part of the time that some of the classes were held.  IG Ex. 3 at 7.  Petitioner did not respond to multiple calls and messages from an investigator.  IG Ex. 3 at 5.  The investigator recommended that the California Department of Public Health revoke Petitioner’s CNA and HHA certifications, and two investigation managers concurred with that recommendation.  IG Ex. 3 at 8.  
• 7)    In a May 30, 2024 notice, the California Department of Public Health revoked Petitioner’s CNA and HHA certifications because Petitioner submitted “falsified documented proof of completion” of CEUS.  IG Ex. 2 at 1.  The notice further stated that Petitioner’s “actions constitute unprofessional conduct and support a 

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• revocation of [Petitioner’s] certification pursuant to Health and Safety Code, sections 1337.9, subsections (b)(1), (b)(4), (b)(5), and (b)(8), and 1736.5, subsections (c)(1)(A), (c)(1)(D), (c)(1)(E), and (c)(1)(H).”  IG Ex. 2 at 1; see also IG Attach. B at 1.  

VII.  Conclusions of Law and Discussion

1. A. The IG excluded Petitioner under 42 U.S.C. § 1320a-7(b)(4)(A), and the IG has proven each required element under the statute.

The IG cites 42 U.S.C. § 1320a-7(b)(4) as the basis for Petitioner’s permissive exclusion.  IG Ex. 1.  The statute provides, in pertinent part: 

• (b) PERMISSIVE EXCLUSION. – The Secretary may exclude the following individuals and entities from participation in any Federal health care program.

• * * * *

• (4) LICENSE REVOCATION OR SUSPENSION. – Any individual or entity –
• (A) whose license to provide health care has been revoked or suspended by any State licensing authority, or who otherwise lost such a license or the right to apply for or renew such a license, for reasons bearing on the individual’s or entity’s professional competence, professional performance, or financial integrity.  

42 U.S.C. § 1320a-7(b)(4)(A); see also 42 C.F.R. § 1001.501. 

As stated in Findings of Fact No. 7, the California Department of Public Health revoked Petitioner’s certifications to practice as a CNA and HHA for “unprofessional conduct” under California law.  Therefore, the record supports the elements for a permissive exclusion under 42 U.S.C. § 1320a-7(b)(4). 

Petitioner’s RFH expressed confusion as to why the exclusion notice states that Petitioner’s certifications had been suspended or revoked.  RFH at 1.  Petitioner disputed the exclusion because she did not think that her California certifications had been suspended or revoked.  March 12, 2025 Order Following Prehearing Conference and Setting Schedule for Prehearing Submissions at 3.  However, Petitioner did not provide evidence contradicting the California Department of Public Health’s notice revoking her certifications (i.e., IG Ex. 2).  Without such evidence, I must uphold the exclusion. 

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1. B. The length of Petitioner’s exclusion is reasonable as a matter of law.

Under 42 U.S.C. § 1320a-7(c)(3)(E), the period of exclusion “shall not be less than the period during which the individual’s or entity’s license to provide health care is revoked, suspended, or surrendered . . . .”  Because Petitioner has not asserted that either of her certifications have been reinstated, I conclude that an indefinite period of exclusion is warranted under 42 U.S.C. § 1320a-7(c)(3)(E). 

VIII.  Conclusion

I affirm the IG’s determination to exclude Petitioner from participating in all federal health care programs under 42 U.S.C. § 1320a-7(b)(4).