Lakshmi Bethi, DAB CR6787 (2026)

DECISION

I affirm the ten-year exclusion of Petitioner, Lakshmi Bethi, from participation in all federal health care programs. 

I. Background and Procedural History

In a May 30, 2025 notice, the Inspector General (IG) of the United States Department of Health and Human Services excluded 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 ten years due to her conviction in the United States District Court for the District of Connecticut of a criminal offense related to the delivery of an item or service under Medicare or a state health care program.  The notice identified the following aggravating factor to lengthen the exclusion from the statutory minimum five years to ten years:  the acts that resulted in the conviction, or similar acts, were committed for over one year, i.e., from about June 2016 to about April 2023.  IG Ex. 1 at 1. 

Petitioner requested a hearing to dispute the imposition of the exclusion and the length of the exclusion.  On June 30, 2025, the Civil Remedies Division acknowledged receipt of 

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the hearing request, gave notice of a telephonic prehearing conference, and issued my Standing Order.  On July 22, 2025, I held a telephonic prehearing conference with the parties, the substance of which is summarized in my July 22, 2025 Order Following Prehearing Conference and Setting Schedule for Prehearing Submissions. 

On August 25, 2025, the IG submitted a prehearing exchange consisting of a brief (IG Br.) and four proposed exhibits (IG Exs. 1-4).  On September 30, 2025, Petitioner filed her prehearing exchange; however, at my direction, Petitioner filed a perfected prehearing exchange on October 8, 2025.  This exchange included a prehearing brief (P. Br.) and a total of 18 proposed exhibits, which comprised Petitioner Exhibits 1 through 14 (P. Exs. 1-14) and written direct testimony from four witnesses (P. Wit. Test. 1-4).  The IG filed a reply brief (IG Reply). 

II. Admission of Exhibits

I admit IG Exhibits 1 through 4 and Petitioner Exhibits 1 through 14 into the record, without objection.  Standing Order ¶ 13; see 42 C.F.R. § 1005.8(c). 

Petitioner submitted written direct testimony from herself and three other individuals.  The IG objects that the written testimony is irrelevant “as it does not pertain to the specific regulatory mitigating factors that may be considered as a basis for reducing the period of exclusion.”  IG Reply at 4-5. 

The testimony from Petitioner’s witnesses are character references and, as argued by the IG, do not support a mitigating factor in the regulations.  P. Wit. Test. 2-4.  Because character references are not relevant to the basis for exclusion or the aggravating and mitigating factors raised in this case, I must exclude P. Wit. Test. 2-4 from the record.  42 C.F.R. §§ 1001.101(a), 1001.102(c), 1005.17(c); Baldwin Ihenacho, DAB No. 2667 at 8 (2015).  

I overrule the IG’s objection to Petitioner’s written direct testimony.  While Petitioner’s testimony is of limited evidentiary value, her testimony provides some relevant background and support for her arguments in this case.  P. Wit. Test. 1.  Therefore, I admit Petitioner’s testimony into the record. 

III. Decision on the Written Record

Consistent with 42 C.F.R. § 1005.16(b), I required the parties to file written direct testimony from all witnesses, except for expert witnesses or witnesses from whom written direct testimony could not be obtained.  Standing Order ¶ 11.  Also consistent with 42 C.F.R. § 1005.16(b), I informed the parties as follows: 

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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.  Because the IG did not request to cross-examine Petitioner, there is no need to conduct an in-person hearing, and I issue this decision based on the written record.  Amgad Mikhail, DAB No. 3206 at 5-6 (2025). 

IV. Issues

• 1) Whether the IG had a legitimate basis to exclude Petitioner from participation in all federal health care programs under 42 U.S.C. § 1320a-7(a)(1).
• 2) Whether a ten-year 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. 

VI. Findings of Fact

1. On September 4, 2024, the United States Attorney for the District of Connecticut filed an Information with the United States District Court for the District of Connecticut (District Court) charging Petitioner with one count of Conspiracy to Violate the Anti-Kickback Statute in violation of 18 U.S.C. § 371 and 42 U.S.C. § 1320a-7b(b)(2)(A). IG Ex. 2.
2. On September 4, 2024, Petitioner signed a document confirming an agreement to plead guilty to the single count of Conspiracy to Violate the Anti-Kickback Statute. IG Ex. 3.  Petitioner stipulated to the following facts:  
   1. Connecticut licensed Petitioner as a dentist in or about 2013, and Petitioner was continuously enrolled as a dental provider in the Connecticut Medicaid program since on or about May 14, 2013.  IG Ex. 3 at 11; P. Ex. 2 at 11.  
   2. From approximately March 2015 through the date of the plea agreement, Petitioner was the principal of a dental practice with the following names:  New Haven Family Dental LLC; New Haven Family Dental Group LLC; and New Haven Dental LLC.  Each of these entities did business under the  name Horizon Dental, and each practice was enrolled as a provider in the Connecticut Medicaid program.  IG Ex. 3 at 11; P. Ex. 2 at 11.  
   3. On her own behalf and that of her various dental entities, Petitioner signed Connecticut Medicaid program provider agreements indicating that Petitioner understood that the law prohibited “any giving or seeking of kickbacks, rebates, or similar remuneration.”  IG Ex. 3 at 11-12; P. Ex. 2 at 11-12.  
   4. An individual with the initials J.M. and his company, as well as an individual identified as Recruiter 1, “recruited patients to receive dental services and items from [Petitioner] and other dental practices that could be reimbursed through Connecticut Medicaid, in exchange for a portion of those reimbursements.”  IG Ex. 3 at 12; P. Ex. 2 at 12.  
   5. “Beginning on or about June 30, 2016 and continuing to on or about April 6, 2023, in the District of Connecticut, [Petitioner] agreed with third-party patient recruiters, including [J.M.], Recruiter 1, and other recruiters, to pay kickbacks to those recruiters on a per-patient basis for Connecticut Medicaid patients that the recruiters brought to [Petitioner’s] practice for dental services.  [Petitioner] also paid kickbacks to certain Connecticut Medicaid dental patients to induce them to receive dental services from [Petitioner].”  IG Ex. 3 at 12; P. Ex. 2 at 12.  
   6. “[J.M.] recruited Connecticut Medicaid beneficiaries using a variety of channels, including in person and via social media, advertising the payment of ‘cash’ in exchange for beneficiaries attending dental appointments.”  IG Ex. 3 at 12; P. Ex. 2 at 12.  
   7. “[Petitioner] submitted claims to Connecticut Medicaid for the dental services provided to the Connecticut Medicaid beneficiaries recruited by [J.M.]  After the beneficiaries’ dental appointments, [Petitioner] paid [J.M.] kickbacks.  [J.M.], in turn, provided smaller kickbacks to beneficiaries via cash or electronic payments, with the knowledge of [Petitioner].”  IG Ex. 3 at 12; P. Ex. 2 at 12.  
   8. “[Petitioner] also worked with other patient recruiters, including Recruiter 1 and others, who agreed to recruit Connecticut Medicaid beneficiaries to attend dental appointments, for which [Petitioner] submitted claims to Connecticut Medicaid.  In exchange, [Petitioner] agreed to pay and did pay kickbacks to Recruiter 1 and other recruiters.  Recruiter 1 and other recruiters also paid smaller kickbacks to the Connecticut Medicaid  

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9. beneficiaries they recruited to attend dental appointments with [Petitioner].”  IG Ex. 3 at 13; P. Ex. 2 at 13.  
10. “In total, it is a reasonable estimate that from approximately June 30, 2016 through approximately April 6, 2023, Connecticut Medicaid paid approximately $2,207,251.61 to [Petitioner] for all services rendered to patients that had been recruited to [Petitioner’s] practices by recruiters using kickback payments.  During that period, [Petitioner] paid kickbacks in the amount of approximately $369,063.”  IG Ex. 3 at 13; P. Ex. 2 at 13.  
11. 3. In a December 18, 2024 Judgment in a Criminal Case, the District Court stated that Petitioner pleaded guilty to Count 1 of the Information and that Petitioner was adjudicated guilty of 18 U.S.C. § 371 and 42 U.S.C. § 1320a-7b, Conspiracy to Violate the Anti-Kickback Statute.  IG Ex. 4 at 1; P. Ex. 1 at 1.  
    1. The District Court sentenced Petitioner to 2 years of probation.  IG Ex. 4 at 2; P. Ex. 1 at 2.  
    2. The District Court ordered Petitioner to forfeit $500,000.  IG Ex. 4 at 4; P. Ex. 1 at 4, 6-7.   

VII. Conclusions of Law and Analysis

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

The IG must exclude an individual from participation in all federal health care programs 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, such as Medicaid.1  42 U.S.C. § 1320a‑7(a)(1).  As explained below, the elements for a mandatory exclusion are met in the present case. 

For purposes of exclusion, an individual is “convicted” of a criminal offense “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” or “when a plea of guilty or nolo contendere by the individual or entity has been accepted 

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by a Federal, State, or local court.”  42 U.S.C. § 1320a‑7(i)(1), (3).  As found in Findings of Fact 2 and 3, Petitioner pleaded guilty to Conspiracy to Violate the Anti-Kickback Statute, the District Court accepted that plea, and the District Court issued a judgment of conviction.  Therefore, Petitioner was “convicted” of a criminal offense. 

In addition, as stated in Finding of Fact 2, Petitioner admitted that her crime involved her payment of money to individuals who recruited Medicaid beneficiaries to receive dental services from Petitioner, and Petitioner obtained payment from the Medicaid program for the dental services she provided.  The recruiters, in turn, would pay a kickback to the Medicaid beneficiaries who received the dental services.  There is no doubt that Petitioner’s criminal offense meets the requirement that it be “related to” the delivery of an item or service under the Medicaid program.  See 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); see also Baxter v. Kennedy, 136 F.4th 70, 86 (4th Cir. 2025) (holding that mandatory exclusion under 42 U.S.C. § 1320a-7(a)(1) means that the conviction must “merely . . . be related to . . . a delivery [of an item or service].  So there was no need to prove that [the excluded individual’s company] shipped an item to an identified [Medicaid participant].  The causal chain that [the excluded individual] pleaded to–misbranding as an attempt to get [Medicaid] to cover [a new medication]–is more than enough.”). 

Because the IG has met the burden of proving the elements for a mandatory exclusion under 42 U.S.C. § 1320a-7(a)(1), I affirm the IG’s determination to exclude Petitioner from participating in all federal health care programs. 

Petitioner did not expressly dispute the facts, as found above, or that those facts meet the elements necessary to impose a mandatory exclusion under 42 U.S.C. § 1320a-7(a)(1).  Rather, Petitioner asserts that her criminal offense “triggers a ‘Permissible Exclusion’ not a ‘Mandatory Exclusion.’”  P. Br. at 2.  Petitioner also argues that her criminal conduct was “unintentional involvement with marketing of services in a manner that violated the Anti-Kickback law. . . .  She did not willfully engage in the illegal activity with an intention to violate the Anti-Kickback law.”  P. Br. at 3; P. Ex. 8 at 1. 

I reject both arguments.  Although Petitioner’s brief indicates that she should only be subject to a permissive exclusion, rather than a mandatory one, Petitioner does not explain why this is so.  P. Br. at 2, 7, 11.  It appears that Petitioner believes her misconduct falls under the permissive exclusion provision in 42 U.S.C. § 1320a-7(b)(7), which permits exclusion when an individual violates the Anti-Kickback Statute (42 U.S.C. § 1320a-7b).  H’rg Req. at 1. 

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This argument is fundamentally flawed because the IG’s exclusion under 42 U.S.C. § 1320a-7(a)(1) is derivative of Petitioner’s conviction, whereas a permissive exclusion under 42 U.S.C. § 1320a-7(b)(7) is an original action in which the IG would need to prove that Petitioner violated 42 U.S.C. § 1320a-7b.  Because Petitioner was already convicted of violating 42 U.S.C. § 1320a-7b, the IG no longer needs to prove such a violation to exclude Petitioner.  A federal court addressed this issue in detail. 

• Plaintiff first contends the ALJ’s imposition of a period of exclusion under the mandatory exclusion provision of 42 U.S.C. § 1320a–7(a)(1) was an erroneous application of law, and the ALJ should have applied the permissive exclusion provisions of 42 U.S.C. § 1320a–7(b)(7).  

• * * *

• Plaintiff was convicted of conspiracy to commit kickback violations, in violation of 18 U.S.C. § 371 and offering and paying bribes in violation of 42 U.S.C. § 1320a–7b(b), one of the statutes expressly referenced in the permissive exclusion provision of 42 U.S.C. § 1320a–7(b)(7).  

• * * *

• Pursuant to the plain language of 42 U.S.C. § 1320a–7(a)(1), the mandatory exclusion provision applies to individuals convicted of program-related crimes, that is crimes related to the delivery of an item or service.  On the other hand, 42 U.S.C. § 1320a–7(b)(7) provides that the permissive exclusion provision Plaintiff references applies to individuals that the Secretary determines has committed an act described in certain statutes, including the Anti–Kickback Statute.  Obviously, if a jury has convicted an individual of committing a program-related crime, the Secretary need not make a determination that the individual has engaged in the underlying conduct; a jury has found beyond a reasonable doubt that the person has committed the conduct.  Mandatory exclusion thus applies to those convicted of program-related crimes, while permissive exclusion applies to those the Secretary has determined (in an administrative proceeding) have committed certain acts described in specific statutes.  
• If legislative intent was not apparent from the plain language of the statute, the ALJ could have resorted to legislative  

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• history.  But the legislative history does not support the interpretation urged by Plaintiff.  The legislative history explains that § 1320a–7(b)(7) is a very different exclusion authority than the exclusion authority of § 1320a–7(a)(1) for program-related convictions.  Exclusion authority under § 1320a–7(b)(7) rests on a determination by the Secretary that the individual has committed an act described in §§ 1320a–7a, 1320a–7b, or 1320a–8.  A permissive exclusion proceeding under § 1320a–7(b)(7) is initiated by Defendant’s Office of Inspector General, and the respondent has the right to a pre-exclusion hearing in which the Office of Inspector General must introduce evidence to establish, by a preponderance of the evidence, that a violation of any of the enumerated sections has occurred.  The legislative history of section 1320a–7(b)(7) indicates it was enacted as an alternative to criminal prosecution or where a program-related conviction does not exist.   

Anderson v. Thompson, 311 F. Supp. 2d 1121, 1124-1127 (D. Kan. 2004). 

Petitioner’s second argument is equally unavailing.  Petitioner now asserts that she did not intend to violate the Anti-Kickback Statute.  However, Petitioner’s plea agreement states that she signed Connecticut Medicaid program provider agreements indicating that she understood that the law prohibited “any giving or seeking of kickbacks, rebates, or similar remuneration.”  IG Ex. 3 at 11-12; P. Ex. 2 at 11-12.  Further, in the plea agreement, Petitioner stipulated that she “understands” that the following essential elements must be satisfied to be guilty of conspiracy to violate the Anti-Kickback Statute: 

1. An agreement existed between at least two people to violate the anti-kickback provision in 42 U.S.C. § 1320a-7b(b)(2), as described in the Information;
2. The [Petitioner] knowingly joined that agreement, with the specific intent to commit the violation that was the object of the conspiracy; and
3. One of the co-conspirators committed an overt act during the period of the conspiracy in an effort to further the purpose of the conspiracy.   
    

IG Ex. 3 at 1.  Therefore, Petitioner’s argument that she did not intend to violate the Anti-Kickback Statute is an impermissible collateral attack on her conviction because Petitioner admitted she joined the conspiracy with the specific intent to violate the Anti-Kickback Statute.  42 C.F.R. § 1001.2007(d); see also Anderson, 311 F. Supp. 2d at 1127 (identifying a collateral attack on the underlying criminal conviction as improper). 

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2. 2. 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). 

3. 3. The IG has proven that an aggravating factor exists in this case to extend the length of exclusion beyond the minimum five-year requirement.

Although individuals excluded under 42 U.S.C. § 1320a‑7(a)(1) must be excluded for a minimum of five years, the statute does not preclude a longer term of exclusion.  The applicable regulations provide a list of aggravating factors that may serve as the basis for extending an exclusion beyond five years.  42 C.F.R. § 1001.102(b). 

The regulations provide the following as an aggravating factor:  “The acts that resulted in conviction, or similar acts, were committed over a period of one year or more.”  42 C.F.R. § 1001.102(b)(2).  As stated in Finding of Fact 2(e), Petitioner admitted in the plea agreement that her criminal conspiracy lasted from June 30, 2016 to April 6, 2023.   Petitioner did not dispute that this aggravating factor exists in this case.  P. Br. at 3-4. 

Therefore, I conclude that the IG proved this aggravating factor. 

4. 4. Petitioner did not prove the existence of any mitigating factors listed in the regulations to reduce the length of exclusion.

If there are aggravating factors that justify increasing the length of exclusion to exceed five years, then the length of exclusion can be reduced if certain mitigating factors listed in the regulations are present.  42 C.F.R. § 1001.102(c).  Petitioner asserts that the length of exclusion should be mitigated based on cooperation with government officials.  P. Br. at 5.  For the reasons explained below, I conclude that the record does not support the existence of the alleged mitigating factor. 

Petitioner claims that she “fully cooperated and shared material information with the Government.  Others were charged and convicted and the information shared by [Petitioner] was helpful to the Government in its prosecution of the offenses.”  P. Br. at 5.  Further, Petitioner argues that she “is continuing to cooperate with the State Office of the Attorney General Vender Fraud Unit to report instances of misconduct she has witnessed by certain dental providers.  This process is current and ongoing.”  P. Br. at 6. 

To qualify as a mitigating factor, an excluded individual must show the following: 

• (3) The individual’s or entity’s cooperation with Federal

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• or State officials resulted in— 
      (i) Others being convicted or excluded from Medicare, Medicaid and all other Federal health care programs, (ii) Additional cases being investigated or reports being issued by the appropriate law enforcement agency identifying program vulnerabilities or weaknesses, or (iii) The imposition against anyone of a civil money penalty or assessment under part 1003 of this chapter.   

42 C.F.R. § 1001.102(c)(3). 

While Petitioner alleges cooperation, she provided no details about this alleged cooperation in her written direct testimony and submitted no documentary evidence to prove it.  See P. Wit. Test. 1; P. Ex. 8.  Petitioner has the burden to prove any mitigating factors that she alleges.  See Stacey R. Gale, DAB No. 1941 (2004); Standing Order ¶ 7.  Evidence that federal or state officials took one of the actions specified in the regulations is essential to prove cooperation as a mitigating factor because that is the only way to validate the cooperation.  Gale, DAB No. 1941 at 10-11; see also 63 Fed. Reg. 46,676, 46,681 (Sept. 2, 1998); 57 Fed. Reg. 3298, 3315 (Jan. 29, 1992).  Because the record is devoid of evidence of the cooperation contemplated by the regulation, I conclude Petitioner did not prove this mitigating factor.  

Petitioner also asserts a variety of other mitigating factors that are not listed in the regulations.  Petitioner states that:  she did not intentionally violate the Anti-Kickback Statute and only had a lapse in integrity; her former partner from 2016 to 2018 also bore responsibility for the criminal conduct; she cooperated with prosecutors in her own case and voluntarily entered a plea agreement; her criminal conduct did not include providing services to Medicaid beneficiaries who did not need those services or other fraudulent activity; she requested a reduced sentence under the sentencing guidelines because she accepted responsibility by agreeing to pay a $500,000 forfeiture, lacked a prior criminal history, had a positive professional and personal standing among dental peers, lacked a history of substance abuse, was willing to serve the poor and needy, was unlikely to offend again, and did not cause an actual loss to the government; she has maintained her Connecticut dental license, without restriction, despite the criminal conviction; she has maintained her American Dental Association membership; and she has taken a continuing education class on professionalism and ethics.  P. Br. at 3-4, 8-12; P. Ex. 8. 

Despite all of the assertions and information as to the matters summarized above, I cannot consider them because they are not listed as mitigating factors in the regulations.  Meeks v. Sec’y, Dep’t of Health & Hum. Servs., No. 25-11689, 2025 WL 2827648, *4 n.2 (11th Cir. Oct. 6, 2025); Ihenacho, DAB No. 2667 at 8. 

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5. 5. The 10-year length of Petitioner’s exclusion is not unreasonable based on a qualitative analysis of the aggravating factors in this case.

When considering the length of exclusion, “[t]he evaluation does not rest on the specific number of aggravating or mitigating factors or any rigid formula for weighing those factors, but rather on a case-specific determination of the weight to be accorded each factor based on a qualitative assessment of the circumstances surrounding the factors in that case.”  Farzana Begum, M.D., DAB No. 2726 at 2 (2016).  However, an excluded individual’s age, financial condition, and employment prospects are not considered.  Jeremy Robinson, DAB No. 1905 (2004); Zahid Imran, M.D., DAB No. 2680 at 14 (2016).  Ultimately, I must decide whether the 10-year length of exclusion is unreasonable, i.e., whether it is within a reasonable range based on the relevant factors.  42 C.F.R. § 1001.2007(a)(1)(ii); 57 Fed. Reg. 3298, 3321 (Jan. 29, 1992).  

When conducting this analysis, I also consider the fact that health care providers do not have a fundamental right to participate in federal health care programs; therefore, an exclusion only needs to be rationally related to a legitimate government interest, such as patient health or protecting federal health care programs from fraud and abuse.  Parrino v. Price, 869 F.3d 392 (6th Cir. 2017).  As a result, the trustworthiness of the excluded individual is a key question.  See Morgan v. Sebelius, 694 F.3d at 538 (4th Cir. 2012) (“[T]he legislative history to § 1320-7(a)(3) as it was originally enacted indicates that it was specifically intended to protect federal programs from untrustworthy individuals . . . .”); see also Susan Malady, R.N., DAB No. 1816 at 9 (2002).  Because exclusions are meant to protect federal health care programs from fraud and abuse, it is remedial and not punitive.  Manocchio v. Kusserow, 961 F.2d 1539, 1541-42 (11th Cir. 1992). 

Turning to the aggravating factor in this case, Petitioner engaged in a conspiracy to violate the Anti-Kickback Statute.  Finding of Fact 2 details Petitioner’s admissions concerning the conspiracy.  For purposes of the aggravating factor, Petitioner admitted that she engaged in the conspiracy for nearly seven years, receiving approximately $2.2 million based on Medicaid beneficiaries who had been referred based on kickbacks and paying out $369,063 in kickbacks. 

In this proceeding, Petitioner asserts that her criminal conduct was based on a misunderstanding of the statute and complex regulatory requirements involving health care reimbursement and that she would not intentionally violate the law.  P. Ex. 8 at 1.  However, it is impossible to overlook the fact that Petitioner’s conspiracy included kickback payments to the individual Medicaid beneficiaries who were receiving Medicaid reimbursed services from Petitioner.  A dentist paying money to a patient so that the dentist can provide services to that patient is a scenario the propriety of which any reasonable person would question.  Further, and pertinent to this aggravating factor, Petitioner engaged in this conduct for nearly seven years without questioning it or seeking legal advice as to its legality. 

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As stated by one court: 

• The Anti-Kickback Statute is designed to prevent Medicare and Medicaid fraud.  According to the Health Resources and Services Administration, the Statute was enacted to “protect the Medicare and Medicaid programs from increased costs and abusive practices resulting from provider decisions that are based on self-interest rather than cost, quality of care or necessity of services.”   

United States v. Patel, 778 F.3d 607, 612 (7th Cir. 2015).  As another court stated: 

• The Court is not persuaded that this practice of paying remuneration in exchange for doctors’ referral of patients, was not abusive, even if Plaintiff demonstrated patients were provided with quality care at competitive or reasonable prices. 

Anderson, 311 F. Supp. 2d at 1126-27. 

While there are various ways to violate the Anti-Kickback Statute and circumstances among health care providers will be different, the statute is aimed at ensuring that beneficiaries and health care providers are not incentivized to seek or provide services that are unnecessary.  Beneficiaries entitled to dental benefits should not need to be paid to seek those services if those services are needed and wanted by the beneficiaries.  While Petitioner’s criminal case does not include an order of restitution, Petitioner’s long-term conspiracy to violate a law meant to protect the Medicaid program from fraud endangered that program.  Further, I do not find it credible that Petitioner did not understand her actions were improper.  Therefore, I conclude that an increase in the length of exclusion from 5 to 10 years in length is not unreasonable based on the aggravating factor in this case.2 

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VIII.  Conclusion

I affirm the IG’s determination to exclude Petitioner for 10 years from participating in all federal health care programs under 42 U.S.C. § 1320a-7(a)(1).