Hannah Danielle Christmas, DAB CR6831 (2026)

DECISION

Respondent, the Inspector General for the United States Department of Health and Human Services (IG), excluded Petitioner, Hannah Danielle Christmas, from participation in Medicare, Medicaid, and all other federal health care programs for five years based on her conviction for a criminal offense related to the delivery of an item or service under the Medicare or a state health care program.  Petitioner challenges her exclusion before me.  For the reasons stated below, I affirm the IG’s exclusion action. 

I. Procedural History

By letter dated July 31, 2025, the IG notified Petitioner of her exclusion for five years from participation in Medicare, Medicaid, and all federal health care programs under section 1128(a)(1) of the Social Security Act (Act) (42 U.S.C. § 1320a-7(a)(1)).  IG Ex. 1.  The IG explained that this action was based on Petitioner’s “conviction . . . , in the Circuit Court of Pulaski County, Arkansas, of a criminal offense related to the delivery of an item or service under Medicare or a State health care program, including the performance of management or administrative services relating to the delivery of items or services under any such program.”  Id. at 1. 

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Petitioner timely requested a hearing before an administrative law judge (ALJ) in the Civil Remedies Division, resulting in my designation to hear and decide this case.  I held a pre-hearing conference by telephone with the parties on October 22, 2025, the substance of which is set forth in my Order Summarizing Pre-hearing Conference and Schedule for Filing Briefs and Documentary Evidence (Summary Order) issued that same day.  See 42 C.F.R. § 1005.6.  Among other things, I directed the parties to file pre-hearing briefs articulating their respective arguments as well as identifying witnesses and exhibits in support thereof.  Summary Order at 3-4. 

The IG filed a brief (IG Br.) and three proposed exhibits (IG Exs. 3).  Petitioner filed a brief (P. Br.) with nineteen proposed exhibits (P Exs.1-19).1

II. Admission of Exhibits and Decision on the Record

Neither party has objected to the other parties’ proposed exhibits.  I therefore enter IG Exhibits 1 through 3 and Petitioner’s Exhibits 1 through 19 into the record. 

I directed the parties to submit written direct testimony for any witnesses that they wanted to present in this case (except for expert witnesses).  42 C.F.R. § 1005.16(b); Standing Order ¶ 11; Summary Order at 3.  I also stated that unless a party files admissible written direct testimony and the opposing party requests to cross-examine that witness, then I would not conduct a hearing and would issue a decision based on the written record.  Standing Order ¶ 12; see also 42 C.F.R. § 1005.16(b). 

In the present case, the IG has no witnesses to present and did not indicate that a hearing is necessary.  See generally IG Br.  While Petitioner stated that a hearing is unnecessary, she listed two witnesses to testify, in her short-form brief, but did not submit any written direct testimony, even though I highlighted this requirement at the pre-hearing conference.  P. Br at 2-3; Summary Order at 3.  As a result, an in-person hearing is not necessary, and I issue a decision based on the written record.  Vandalia Park, DAB No. 1940 (2004).  

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III. Issue

Whether the IG had a basis to exclude Petitioner from participating in Medicare, Medicaid, and all other federal health care programs pursuant to 42 U.S.C. § 1320a-7(a)(1).  See 42 C.F.R. § 1001.2007(a)(1).  If I affirm the basis for exclusion, I must affirm the five-year length of exclusion as that is the minimum exclusion period required by the Act for mandatory exclusions.  42 C.F.R. § 1001.102(a). 

IV. Applicable Law

Section 1128(f) of the Act provides Petitioner with the right to a hearing before an ALJ and judicial review of the final action of the Secretary of Health and Human Services (Secretary).  42 U.S.C. § 1320a-7(f); see also 42 C.F.R. §§ 1001.2007(a) and 1005.2.  The rights of both the sanctioned party and the IG to participate in a hearing are specified by 42 C.F.R. § 1005.3. 

The Act requires the Secretary to exclude from participation in federal health care programs “[a]ny individual or entity that has been convicted of a criminal offense related to the delivery of an item or service under title XVIII [of the Act] or under any State health care program.”  42 U.S.C. § 1320a-7(a)(1); see also 42 C.F.R. § 1001.101(a). 

The Act defines an individual to be convicted of a criminal offense when:  (1) a judgment of conviction has been entered against him or her in a federal, state, or local court whether an appeal is pending or the record of the conviction is expunged; (2) there is a finding of guilt by a court; (3) a plea of guilty or nolo contendere is accepted by a court; or (4) the individual has entered into any arrangement or program where judgment of conviction is withheld.  Act § 1128(i) (42 U.S.C. § 1320a-7(i)); 42 C.F.R. § 1001.2.  Exclusion under this provision of the Act is mandatory and does not distinguish between misdemeanor and felony convictions.  Act § 1128(a)(1) (42 U.S.C. § 1320a-7(a)(1)).  Excluded parties seeking to challenge their exclusion may not collaterally attack the conviction upon which exclusion is based.  42 C.F.R. § 1001.2007(d). 

For exclusions imposed under section 1128(a) of the Act, section 1128(c)(3)(B) (42 U.S.C. § 1320a-7(c)(3)(B)) mandates a minimum five-year period of exclusion.  Exclusion is effective 20 days from the date the IG issues the notice of exclusion.  42 C.F.R. § 1001.2002(b).  The IG may elect to extend the period of exclusion based on the presence of certain aggravating factors.  42 C.F.R. § 1001.102(b).  If the IG has applied aggravating factors to increase the exclusion period beyond five years, the IG must consider the mitigating factors identified by the regulations as a basis for reducing the period of exclusion.  42 C.F.R. § 1001.102(c).  The IG’s determination of the length of exclusion enjoys deference only if it is not unreasonable.  42 C.F.R. § 1001.2007(a)(1)(ii). 

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The standard of proof is a preponderance of the evidence.  42 C.F.R. § 1001.2007(c).  Petitioner bears the burden of proof and the burden of persuasion on any affirmative defenses or mitigating factors; the IG bears the burden on all other issues.  42 C.F.R. §§ 1001.2007(e), 1005.15(b). 

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

My conclusions of law are set forth in bold and followed by pertinent findings of fact and analysis. 

1. A. Petitioner’s request for hearing was timely, and I have jurisdiction.

Petitioner timely requested a hearing.  I have jurisdiction to hear and decide this case.  See 42 C.F.R. §§ 1001.2007(a)(1)-(2), 1005.2(a); see also 42 U.S.C. § 1320a-7(f)(1). 

1. B. The IG has established a basis for Petitioner’s exclusion pursuant to section 1128(a)(1) of the Act.

Section 1128(a)(1) of the Act mandates exclusion from participation in Medicare, Medicaid, and all federal health care programs where an individual has been convicted, under federal or state law, of a criminal offense related to the delivery of an item or service under Medicare or any state health care program.  42 U.S.C. § 1320a-7(a)(1); 42 C.F.R. § 1001.101(a).  The IG has established these elements by a preponderance of the evidence. 

1. 1. Relevant facts

On October 25, 2024, a warrant of arrest was issued in the Pulaski County District Court, Arkansas accusing Petitioner of committing the offense of “Medicaid Fraud” a Class “B” felony in violation of Ark. Code. Ann. §5-55-111(1).  IG Ex. 2 at 1.  According to the reasonable cause affidavit that accompanied the arrest warrant, Petitioner worked as a physical therapist and was hired by Allen Therapy Services to provide therapy at the Hamburg, Dermott, and Lakeside School Districts.  Id. at 2-3.  Between August 2023 and April 2024, Petitioner billed for units of service at each school district that were not rendered.  Id.  Specifically, Petitioner billed 177 units (totaling $4,106.40) at Hamburg Public Schools, 64 units (totaling $1,291.52) in the Dermott School District, and 4 units (totaling $92.80) in the Lakeside Schools that were not rendered.  Id.  On March 10, 2025, Petitioner pleaded guilty to Medicaid Fraud.  IG Ex. 3.  The court accepted her plea and found her guilty.  Id.  She was ordered to pay restitution to the Arkansas Medicaid Fraud Trust Fund.  Id. at 3.  

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2. 2. Petitioner was convicted of a criminal offense within the meaning of the Act.

The Act provides an individual or entity is considered “convicted” when a judgment of conviction has been entered by a federal, state, or local court, or, relevant here, if a plea of guilty has been accepted by such a court.  42 U.S.C. § 1320a-7(i)(1), (3).  Here, the state court accepted Petitioner’s guilty plea and deemed her “convicted” of Medicaid Fraud.  IG Ex. 3.  This amounts to a conviction within the meaning of the Act.  Moreover, Petitioner concedes she was convicted of a criminal offense within the meaning of section 1128(a)(1) of the Act.  P. Br. at 1.  Therefore, I conclude Petitioner was convicted of a criminal offense within the meaning of the Act. 

3. 3. Petitioner’s criminal offense is related to the delivery of an item or service under Medicare or a state health care program within the meaning of section 1128(a)(1) of the Act.

The Act requires an individual’s exclusion from participation in federal health care programs if convicted of an offense related to the delivery of an item or service under Medicare or a state health care program.  See 42 U.S.C. § 1320a-7(a)(1). 

Petitioner’s offense of conviction need only be “related to” the delivery of an item or service under Medicare or a state health care program.  The term “related to” simply means that there must be a nexus or common-sense connection.  See Friedman v. Sebelius, 686 F.3d 813, 820 (D.C. Cir. 2012) (describing the phrase “related 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 Quayum v. U.S. Dep’t of Health & Human Servs., 34 F. Supp. 2d 141, 143 (E.D.N.Y. 1998).  In determining the relatedness of an offense, I am not bound to the elements of the charged offense.  Berton Siegel, D.O., DAB No. 1467 at 4 (1994) (“[i]t is not the labeling of the offense under the state statute which determines whether the offense is program-related”).  Instead, I examine the nature of the offense, which properly includes the “facts upon which [the] conviction was predicated.”  Id. 

Here, Petitioner pleaded guilty to Medicaid Fraud.  IG Ex. 3 at 1-4.  The criminal offense conduct described in the arrest warrant and reasonable cause affidavit – billing the Arkansas Medicaid program for the provision of physical therapy services that were not rendered – plainly relates to the delivery of an item or service under a state health care program.  IG Ex.  2.  Moreover, Petitioner’s criminal conduct resulted in loss to the Arkansas Medicaid program, as evidenced by the order of restitution against her.  IG Ex. 3 at 3.  Such loss is axiomatically related to the delivery of an item or service under that program.  Travers v. Shalala, 20 F.3d 993, 998 (9th Cir. 1994) (filing improper claims with the Medicaid program is “a program‑related offense” and “such financial 

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misconduct is exactly what Congress sought to discourage” through imposing exclusions.); see also Siegel, DAB No. 1467 at 6-7 (a criminal offense resulting in financial loss to a State Medicaid program was “related to” the delivery of items or services under that program because it resulted “in less funds being available to pay for covered services” delivered to Medicaid patients).  I therefore must conclude Petitioner’s offense of conviction related to the delivery of an item or service under Medicare or a state health care program. 

Petitioner has not challenged any of IG’s assertions but claims that she “did not have the financial means” to contest her underlying criminal offense and further disputes the facts underlying the conviction.  See Request for Hearing at 1-2; P. Br at 2-3.  Petitioner also states that “after 2.5 years” she may have the “charges removed.”  Request for Hearing at 1.  

Having pleaded guilty, Petitioner may not use this forum to argue that she 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). 

Nor does the prospect of an expungement alter the fact that Petitioner was “convicted” within the meaning of the statute and regulations.  A person is “convicted” when “a judgment of conviction has been entered” regardless of whether that judgment has been – or could be – expunged or otherwise removed.  Act § 1128(i)(1); 42 C.F.R. § 1001.2(a)(2) (defining convicted); Henry L. Gupton, DAB No. 2058 at 9-10 (2007), aff’d sub nom. Gupton v. Leavitt, 575 F. Supp. 2d 874 (E.D. Tenn. 2008).  

1. C. Petitioner must be excluded for a minimum of five years; the period of exclusion is therefore reasonable as a matter of law.

Because I have concluded a basis exists to exclude Petitioner under 42 U.S.C. § 1320a-7(a)(1), she must be excluded for a minimum period of five years.  42 U.S.C. § 1320a-7(c)(3)(B); 42 C.F.R. §§ 1001.102(a), 1001.2007(a)(2).  

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VI. Conclusion

For the foregoing reasons, I affirm the IG’s exclusion action.  Petitioner is excluded from participation in Medicare, Medicaid, and all federal health care programs for five years pursuant to section 1128(a)(1) of the Act (42 U.S.C. § 1320a-7(a)(1)).  Her exclusion is effective 20 days from the date of the notice of exclusion issued to her by the IG.