Blanca Vanessa Alvarado, DAB CR6785 (2025)

DECISION

The Inspector General (IG) of the Department of Health and Human Services excluded Petitioner, Blanca Vanessa Alvarado, from participating in all federal health care programs for a minimum period of five years under 42 U.S.C. § 1320a‑7(a)(1).  Petitioner requested a hearing before an administrative law judge (ALJ) to dispute the exclusion.  For the reasons explained below, I find the IG properly excluded Petitioner.  Because the statute mandates a minimum five-year exclusion, the length of her exclusion is, by law, reasonable. 

I. Case Background and Procedural History

In a May 30, 2025 notice, the IG informed Petitioner that she was excluding Petitioner from participation in all federal health care programs under section 1128(a)(1) of the Social Security Act (42 U.S.C. § 1320a-7(a)(1)) for a period of five years due to her conviction, in the New York County Supreme Court of the State of New York, of a criminal offense related to the delivery of an item or service under Medicare or a state health care program.  IG Ex. 1 at 1. 

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Petitioner timely requested an ALJ hearing to challenge the exclusion.  On June 17, 2025, the Civil Remedies Division issued an Acknowledgment Letter along with my Standing Prehearing Order (Standing Order).  These documents provided notice of a prehearing conference and the procedures that govern this case. 

On July 8, 2025, I held a prehearing conference by telephone, the substance of which is summarized in my Order Summarizing Prehearing Conference and Schedule for Filing Briefs and Documentary Evidence (Prehearing Conference Order).  At the conference, Petitioner confirmed that she was appealing the imposition of the exclusion.  With the agreement of the parties, I established a prehearing submission schedule.  Prehearing Conference Order at 2. 

In conformance with the Standing Order and the Prehearing Conference Order, the IG filed a brief (IG Br.) and four exhibits (IG Exs. 1-4).  Petitioner did not file a prehearing exchange. 

An Order to Show Cause was issued on September 18, 2025.1  The show cause order warned that a failure to file a prehearing exchange or an extension request could result in dismissal of this case.  Departmental Appeals Board Electronic Filing System (DAB E-File) Document No. 8. 

Petitioner neither filed an exchange nor requested an extension of time. 

II. Issue

1. Whether the IG has a basis for excluding Petitioner from participating in all federal health care programs under 42 U.S.C. § 1320a-7(a)(1).

III. Admission of Evidence and Decision on the Written Record

Petitioner did not object to the IG’s proposed exhibits.  Therefore, I admit IG Exhibits 1 through 4 into the record.  Standing Order ¶ 13; see also 42 C.F.R. § 1005.8(c); Civil Remedies Division Procedures (CRDP) § 14(e). 

I directed the parties to submit written direct testimony for any witnesses that they wanted to present in this case (except for expert witnesses).  Standing Order ¶ 11.  I also directed the parties to file a request if either party wanted to cross-examine any witness 

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from whom written direct testimony had been submitted.  Standing Order ¶ 12.  Finally, I stated that: 

• Except for proposed expert witness testimony, 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 (emphasis added). 

In the present case, the IG has no witnesses to present.  Petitioner did not submit written direct testimony from any witnesses.  As a result, a hearing is not necessary, and I may issue a decision based on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 12 (2022) (concluding that a decision on the record may be issued when a party fails to file a prehearing exchange); Vandalia Park, DAB No. 1940 (2004); CRDP §§ 16(b), 19(b), (d). 

IV. Jurisdiction

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

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

1. 1. On June 12, 2024,2 Petitioner pleaded guilty to the crime of Petit Larceny in the Supreme Court of New York County for stealing property from Amida Care, Inc. The Court accepted Petitioner’s plea, found Petitioner guilty, and sentenced Petitioner to a conditional discharge. 

In October 2019, the New York Attorney General charged Petitioner with multiple criminal offenses.  IG Ex. 4 at 1-2.  The charges were related to Petitioner’s participation in a scheme in which property was stolen from Amida Care, Inc., a managed care organization funded by the New York State Medical Assistance Program.  IG Ex. 4.  The value of the stolen property was alleged to be in excess of one million dollars.  Id. at 3. 

On June 12, 2024, Petitioner pleaded guilty to one count of Petit Larceny in the Supreme Court of New York County.  IG Exs. 2-3.  The Court accepted Petitioner’s plea and sentenced Petitioner to conditional discharge.  IG Ex. 3 at 6, 8. 

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2. 2. Petitioner was convicted of a criminal offense related to the delivery of a health care item or service under a state health care program;3 therefore, exclusion is required under 42 U.S.C. § 1320a‑7(a)(1).

The IG must exclude an individual from participation in any federal health care program if that individual was 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 U.S.C. § 1320a‑7(a)(1).  The facts in this case show that Petitioner meets this standard for exclusion. 

Petitioner was convicted of a criminal offense.  For purposes of exclusion, individuals are deemed “convicted” of an offense if any of the following are met: 

• (1) when a judgment of conviction has been entered against the individual or entity by a Federal, State, or local court, regardless of whether there is an appeal pending or whether the judgment of conviction or other record relating to criminal conduct has been expunged;
• (2) when there has been a finding of guilt against the individual or entity by a Federal, State, or local court;
• (3) when a plea of guilty or nolo contendere by the individual or entity has been accepted by a Federal, State, or local court; or
• (4) when the individual or entity has entered into participation in a first offender, deferred adjudication, or other arrangement or program where judgment of conviction has been withheld.   

42 U.S.C. § 1320a‑7(i)(1)-(4).  In the present case, all of these definitions for the term “convicted” are met.  Petitioner pleaded guilty to Petit Larceny, and the Court accepted that plea.  IG Ex. 2 at 6-7.  Further, the Court entered a judgment of conviction against Petitioner.  IG Ex. 2; IG Ex. 3.  Petitioner was sentenced to a one-year conditional discharge.  IG Ex. 2; IG Ex. 3. 

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Further, Petitioner’s criminal offense was “related to” the delivery of a health care item or service under a state health care program.  For purposes of exclusion, the term “related to” simply means that there must be a nexus or common-sense connection.  See Quayum v. U.S. Dep’t of Health & Hum. Servs., 34 F. Supp. 2d 141, 143 (E.D.N.Y. 1998); see also Friedman v. Sebelius, 686 F.3d 813, 820 (D.C. Cir. 2012) (describing the phrase “relating 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). 

While Petitioner pleaded guilty to Petit Larceny, the facts alleged in the Indictment make it clear that the theft of property was from Amida Care, Inc., a managed care organization funded by New York State Medical Assistance Program.  IG Ex. 4 at 3.  I conclude that there is a clear nexus between Petitioner’s conviction and the delivery of an item or service under Medicaid.  Berton Siegel, D.O., DAB No. 1467 at 6-7 (1994). 

Petitioner does not challenge any of the above.  In her request for hearing, Petitioner argues that her exclusion has hindered her ability to work with an impoverished community that needs her assistance.  DAB E-File Document No. 1.  I fully recognize that the exclusion has likely resulted in harsh consequences for Petitioner.  However, equitable considerations are not a basis to overturn Petitioner’s exclusion.  Appellate panels of the Departmental Appeals Board (DAB) have consistently rejected such arguments.  For example, in its decision in Henry L. Gupton, the panel stated: 

• [Petitioner’s] contentions are also in essence pleas for equity on the grounds that the length of the exclusion is excessive based on the particular circumstances which Petitioner asserts . . . .  The contentions have no merit, however, because the length of the exclusion imposed by the [IG] is the minimum mandated by the statute.  Section 1128(a) of the Act.  The [IG], the ALJ, and the [DAB] all lack discretion to reduce the exclusion below the statutory minimum. 

DAB No. 2058 at 13-14 (2007), aff’d, Gupton v. Leavitt, 575 F. Supp. 2d 874 (E.D. Tenn. 2008); see also Ioni D. Sisodia, M.D., DAB No. 2224 at 7 (2008).  

There is no evidence in the record that Petitioner was not convicted of the crime discussed above.  Accordingly, I conclude that the criminal conduct for which Petitioner was convicted was related to the delivery of a health care item or service under a state health care program.  See 42 U.S.C. § 1320a‑7(a)(1).  Therefore, the record fully supports Petitioner’s mandatory exclusion. 

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

Because I have concluded that a basis exists to exclude Petitioner under 42 U.S.C. § 1320a‑7(a)(1), Petitioner must be excluded for a minimum of five years.  42 U.S.C. § 1320a‑7(c)(3)(B).  As noted above, I have no authority to reduce the exclusion beyond the mandatory minimum. 

VI. Conclusion

For the foregoing reasons, I affirm the IG’s determination to exclude Petitioner for five years from participating in Medicare, Medicaid, and all federal health care programs pursuant to 42 U.S.C. § 1320a‑7(a)(1).