Aaron Walton, DAB CR6720 (2025)

DECISION

Petitioner Walton was a personal aide, who was supposed to provide services to a Medicaid beneficiary.  Even though he did not provide the services, he billed the Medicaid program for them.  He was caught, charged with Medicaid fraud, and pleaded guilty.  

Based on his conviction, the Inspector General (IG) has excluded Petitioner from participating in Medicare, Medicaid, and all federal health care programs for a minimum period of five years, 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 Walton.  Because the statute mandates a minimum five-year exclusion, the length of his exclusion is, by law, reasonable. 

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Background

In a letter dated December 31, 2024, the IG notified Petitioner that he was excluded from participating in all federal health care programs for a period of five years because he 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 at 1. 

Petitioner timely requested review, and the matter is before me. 

The IG submitted a written argument (IG Br.) and four exhibits (IG Exs. 1-4).  Petitioner submitted his own written argument (P. Br.) with multiple pages of documents that are not properly marked.  Each page is marked as a separate exhibit, but all pages are submitted as one entry (E-file # 7).  Petitioner also mailed in – but did not upload into the e-file system – various photographs of the Medicaid beneficiary’s apartment and possessions.  The IG submitted a reply brief. 

In the absence of any objections, I admit into evidence IG Exs. 1-4.  I find that Petitioner’s submissions, by which he attempts to revisit facts already adjudicated during the underlying criminal case, are irrelevant and decline to admit them.  42 C.F.R. § 1005.17(c) (“The ALJ must exclude irrelevant or immaterial evidence.”). 

Hearing on the written record.  Neither party proposes any witnesses, so an in-person hearing would serve no purpose.  See IG Br. at 5; Order and Schedule for Filing Briefs and Documentary Evidence at 3-4 (¶ 7).  I therefore close the record and issue this decision based on the parties’ submissions.  

Discussion

1. Petitioner must be excluded from program participation for a minimum of five years because he 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). 

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Petitioner was hired to provide home care services to a disabled Medicaid beneficiary.  Petitioner and his co-worker/wife were supposed to provide five hours of services per day (9:00 am to 10:00 am and 5:00 pm to 9:00 pm).  IG Ex. 4 at 1.  After the beneficiary complained that they were not showing up or providing services, a special agent with Ohio’s Medicaid Fraud Control Unit investigated.  The beneficiary’s building had a video monitoring system that recorded who entered and exited the building.  Review of the videos confirmed that, from August 2022 through April 2023, Petitioner Walton had not been going into the beneficiary’s building.  In an interview with the Special Agent, Petitioner Walton admitted that he did not provide the services to the beneficiary for which he billed the Medicaid program.  IG Ex. 4 at 2.  He billed $3,346.14 for services that he did not provide.  Id. 

In a criminal complaint, Petitioner Walton was charged with one count of Medicaid fraud, in violation of Ohio Rev. Code § 2913.40(B).  IG Ex. 3. 

On September 26, 2024, Petitioner pleaded guilty to Medicaid fraud.  Based on his stipulation of guilt, the court accepted his plea and found him guilty.  IG Ex. 2.  Petitioner’s conviction for Medicaid fraud is thus obviously related to the delivery of services under a state health care program. 

Petitioner has not challenged any of this but claims that he and his co-worker/wife did the job and were simply trying to accommodate the beneficiary.  He claims that they didn’t know they were doing anything wrong.  Having pleaded guilty, Petitioner may not use this forum to argue that he was not, in fact, guilty of any crime.  The regulations preclude such a collateral attack on an underlying conviction: 

When the exclusion is based on the existence of a criminal conviction . . . or any other prior determination where the facts were adjudicated and a final decision was made, the basis for the underlying conviction . . . 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); Yolanda Hamilton, M.D., DAB No. 3061 at 9-10 (2022); Funmilola Mary Taiwo, DAB No. 2995 at 8 (2020); Delores L. Knight, DAB No. 2945 at 9 (2019); Marvin L. Gibbs, Jr., M.D., DAB No. 2279 at 8-10 (2009); Roy Cosby Stark, DAB No. 1746 (2000). 

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). 

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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.