Rajesh Patel, DAB CR6835 (2026)

DECISION

The Inspector General (IG) of the United States Department of Health and Human Services excluded Petitioner, Rajesh Motibhai Patel, from participation in Medicare, Medicaid, and all other federal health care programs based on Petitioner’s convictions for criminal offenses related to the abuse of a patient in connection with the delivery of a health care item or service.

For the reasons discussed below, I conclude that the IG has a basis for excluding Petitioner because he was convicted of two offenses, including abusive sexual contact, that were committed against a patient in connection with the delivery of a health care item or service.  I also affirm the 10-year exclusion period because the IG has proven two aggravating factors and there are no mitigating factors present.

I.  Background

By letter dated July 31, 2025, the IG notified Petitioner that, pursuant to section 1128(a)(2) of the Social Security Act (Act), 42 U.S.C. § 1320a-7(a)(2), he was being excluded from participation in Medicare, Medicaid, and all federal health care programs

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for a minimum period of 10 years, effective 20 days from the date of the letter.  IG Exhibit (Ex.) 1 at 1.  In the letter, the IG’s office informed Petitioner of the factual basis for the exclusion, stating:

The OIG is imposing this exclusion under section 1128(a)(2) of the Act, due to your conviction (as defined in section 1128(i) of the Act), in the United States District Court, Northern District of Georgia, of a criminal offense related to the neglect or abuse of a patient, in connection with the delivery of a health care item or service.

IG Ex. 1 at 1.  The IG extended the exclusion period from the statutory minimum of five years to ten years based on the presence of two aggravating factors:

1. The action that resulted in the conviction was premeditated, was part of a continuing pattern of behavior, or consisted of non-consensual sexual acts. You were convicted of Abusive Sexual Contact.

2. The sentence imposed by the court included incarceration.  The court sentenced you to 24 months of incarceration.

Id.  Petitioner timely filed a request for hearing before an administrative law judge that was dated August 6, 2025, and received on August 13, 2025.  In his request for hearing, Petitioner requested that I stay these proceedings until the 11th Circuit Court of Appeals ruled on the appeal of his criminal conviction and his motion for release from incarceration pending a ruling on his appeal.  On September 17, 2025, I convened a prehearing conference by telephone pursuant to 42 C.F.R. § 1005.6, during which I clarified the issues of the case, denied Petitioner’s motion to stay the proceedings pending the 11th Circuit’s rulings, and established an extended schedule for the submission of prehearing briefs and exhibits.  I summarized the prehearing conference and set the briefing schedule in my September 19, 2025 Order and Schedule for Filing Briefs and Documentary Evidence (Scheduling Order).

On October 28, 2025, my office received Petitioner’s informal brief (P. Br.), his affidavit,1 and a proposed exhibit list which contained references to four documents filed in his underlying criminal, civil and employment proceedings but not the actual documents.  Departmental Appeals Board (DAB) E-filing Docket No. 8.  Petitioner also requested to supplement his submissions following the expiration of the January 6, 2026,

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filing deadline that I set in my Scheduling Order.  On November 20, 2025, I denied Petitioner’s motion as premature and advised that he may supplement his prehearing exchange by the January 6, 2026 deadline, as detailed in my Scheduling Order.  I further ordered that Petitioner submit all proposed exhibits in compliance with my Standing Order and the Civil Remedies Division Procedures (CRDP).

Pursuant to my Scheduling Order, the IG filed an informal brief (IG Br.) along with four proposed exhibits (IG Exs. 1-4) and also filed a reply brief (IG Reply).2  The IG further filed objections to Petitioner’s proposed exhibits.  Petitioner filed a reply brief (P. Reply) and a supplemental exhibit list, which contained documents (P. Exs. 6-8) regarding his employment termination proceedings, and an affidavit from his wife, Yogini Patel.3  DAB E-filing Docket No. 11.

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Petitioner did not submit documents for P. Exs. 1-4 and thus they are not part of the record.  Standing Order ¶ 8; CRDP ¶ 14.

The IG objects to Petitioner’s proposed Exhibit 5, Petitioner’s affidavit, and Exhibit 6, the affidavit of Yogini Patel as irrelevant and immaterial pursuant to 42 C.F.R. § 1005.17(c) as these documents are offered to impermissibly collaterally attack the underlying criminal conviction.  42 C.F.R. § 1001.2007(d).  I agree with the IG that these exhibits are not particularly relevant to the issues before me except as background information.  However, because the background information is relevant, I will admit these documents into evidence.  Thus, P. Exs. 5-6 are admitted.

The IG also objects to Petitioner’s proposed Exhibits 7 and 8 under 42 C.F.R. § 1005.17(c) as irrelevant and immaterial as these documents relate to Petitioner’s employment termination proceedings.  I agree with the IG and decline to admit these documents.

In the absence of any objections, I admit into evidence IG Exs. 1-4.

On February 9, 2026, Petitioner submitted a motion for leave to file a material fact via email.  DAB E-filing Docket No. 13.  Petitioner advised that he timely filed a motion for panel rehearing with the 11th Circuit after his petition for review was denied.  See id.  Counsel for the IG advised that it did not object to this motion.  DAB E-filing Docket No. 15.  Petitioner’s motion is therefore granted and I take notice of his pending petition for panel rehearing.  As will be discussed further below, however, Petitioner’s pending petition for panel rehearing does not change the fact that he has been convicted under the statute.  See 42 U.S.C. § 1320a-7(i).

Because neither party has requested to cross-examine any witness, a hearing is unnecessary.  Standing Order ¶¶ 11-12; see James Brian Joyner, M.D., DAB No. 2902 at 11-12 (2018).  I will decide this case on the written submissions and documentary evidence.  Standing Order ¶¶ 12, 16; CRDP § 19(d).

II. Issues

Whether there is a basis for exclusion, and, if so, whether the length of the exclusion that the IG has imposed is unreasonable.  42 C.F.R. § 1001.2007(a)(1).

III.  Jurisdiction

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

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IV. Legal Background

The Secretary of Health and Human Services (Secretary) shall exclude an individual from participation in Medicare, Medicaid, and all other federally funded health care programs if that individual “has been convicted, under Federal or State law, of a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care item or service.”  Act § 1128(a)(2); 42 U.S.C. § 1320a-7(a)(2).  Five years is the mandatory minimum length of an exclusion under sections 1128(a)(1)-(a)(4).  Act § 1128(c)(3)(B); 42 U.S.C. § 1320a-7(c)(3)(B).

In exclusion cases, the IG has the burden of proving the basis for the exclusion and the existence of any aggravating factors.  42 C.F.R. § 1005.15(c); Standing Order ¶ 7.  Petitioner has the burden of proving any affirmative defenses or factors to mitigate the length of the exclusion if aggravating factors have been established.  42 C.F.R. § 1005.15(c); Standing Order ¶ 7.  The standard of proof is a preponderance of the evidence, which means a fact is proven if the evidence shows that it is more likely true than not true.  42 C.F.R. §§ 1001.2007(c), 1005.15(d). 

An excluded individual may request a hearing before an administrative law judge (ALJ), but only on the issues of whether the IG had a basis for the exclusion and whether an exclusion longer than the required minimum period is unreasonable in light of any applicable aggravating and mitigating factors.  42 C.F.R. §§ 1001.2007(a), 1005.2(a).

V.  Findings of Fact, Conclusions of Law, and Analysis4

1. Petitioner was convicted of a criminal offense related to the neglect or abuse of a patient, committed in connection with the delivery of a health care item or service, which subjects him to a mandatory exclusion from all federal health care programs for a minimum of five years.

To prevail, the IG must prove that:

1) Petitioner was convicted of a criminal offense under state or federal law;
2) The offense related to the neglect or abuse of patients; and
3) The offense was committed in connection with the delivery of a health care item or service.

Act § 1128(a)(2); 42 U.S.C. § 1320a-7(a)(2); 42 C.F.R. § 1001.101(b).

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a. Petitioner was convicted of a criminal offense.

Under the Act, an individual is considered to have been 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 “there has been a finding of guilt against the individual or entity by a Federal, State, or local court.”  Act § 1128(i)(1), (2) (42 U.S.C. § 1320a-7(i)(1), (2)); see also 42 C.F.R. § 1001.2 (paragraphs (a) and (b) under the definition of “Convicted”).

The evidence shows that on April 19, 2023, a grand jury in the United States District Court for the Northern District of Georgia, Atlanta Division returned a true bill of indictment charging that Petitioner committed eight criminal offenses.  IG Ex. 2.  In relevant part, Count Seven of the indictment stated:

On or about January 14, 2020, at the Atlanta Veterans Affairs Medical Center, in Decatur, DeKalb County, Georgia, within the Northern District of Georgia, the defendant, RAJESH MOTIBHAI PATEL, while acting under color of law, willfully deprived A.H. of liberty without due process of law, including the right to bodily integrity, a right secured and protected by the Constitution and laws of the United States, by rubbing A.H.’s vagina and clitoris, squeezing A.H.’s nipple, and digitally penetrating A.H.’s vagina, all without A.H’s consent and without a legitimate medical purpose.

All in violation of Title 18, United States Code, Section 242.

IG Ex. 2 at 4.

Count Eight of the indictment stated:

On or about January 14, 2020, at the Atlanta Veterans Affairs Medical Center, in Decatur, DeKalb County, Georgia, within the Northern District of Georgia and the territorial jurisdiction of the United States, the defendant, RAJESH MOTIBHAI PATEL, knowingly engaged in sexual contact with A.H., without A.H.’s permission, by intentionally rubbing A.H.’s vagina and clitoris, squeezing A.H.’s nipple, and digitally penetrating A.H.’s vagina.

All in violation of Title 18, United States Code, Section 2244(b).

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IG Ex. 2 at 5.  Following a jury trial, Petitioner was found not guilty on Counts One through Six of the indictment and guilty on Counts Seven and Eight of the indictment.  IG Ex. 3.  As a result of the jury’s verdict, Petitioner was sentenced to imprisonment for a term of 24 months.  IG Ex. 4 at 2.

Petitioner argues that he has not been convicted because his conviction is currently under appeal as he is now seeking panel rehearing before the 11th Circuit.  P. Br. at 2-3; DAB E-filing Docket No. 13 at 1-2.  At the outset, the fact that his conviction may not be final does not preclude exclusion.  42 U.S.C. § 1320a-7(i) (“an individual or entity is considered to have been “convicted” of a criminal offense” when a judgment of conviction has been entered against the individual . . . regardless of whether there is an appeal pending . . . .”) (emphasis added).  I further note that during the course of these proceedings, the 11th Circuit Court of Appeals affirmed Petitioner’s conviction and sentence.  See U.S. v. Patel, No. 25-10653, 2025 WL 3751845 (11th Cir. Dec. 29, 2025).  Finally, even if Petitioner appeals further (including a petition for panel rehearing) and any other authority reverses or vacates Petitioner’s conviction, the IG will reinstate Petitioner into the Medicare, Medicaid, and other federal health care programs retroactive to the effective date of the exclusion.  42 C.F.R. § 1001.3005(a).

Petitioner also appears to claim that his exclusion is not justified because his indictment and conviction were based on “materially false testimony” and that he was deprived of due process.  See P. Br at 2-3; P. Reply at 1.  This argument, however, attacks the validity of the conviction, claiming false testimony by a witness.  P. Br. at 2-3.  This argument is a collateral attack on the underlying convictions and therefore impermissible in these proceedings.  42 C.F.R. § 1001.2007(d).  “[T]he regulations governing this proceeding authorize hearing and appeal rights only with respect to specific federal agency determinations.”  Douglas Bradley, M.D., DAB No. 2663 at 16 (2015) (citing 42 C.F.R. §§ 498.3, 498.5).  “Nothing in those regulations, or in the Medicare statute, even remotely suggests that they were intended [to] provide a forum to collaterally challenge adverse decisions by federal or state courts or non-federal regulatory bodies.”  Id.; see also Mark Koch, D.O., DAB No. 2610 at 3-4 (2014) (holding that allegations questioning the validity of a criminal conviction upon which the supplier’s revocation was based were immaterial because the revocation was based on the fact of the conviction, and because there was no evidence that the conviction had been vacated or overturned).  Thus, to the extent Petitioner is arguing that no crime was committed due to materially false testimony, that argument amounts to a collateral attack on his conviction that cannot be raised in this forum.

I therefore conclude Petitioner was convicted of a criminal offense within the meaning of the Act.  Act § 1128(i)(1), (2) (42 U.S.C. § 1320a-7(i)(1), (2)); 42 C.F.R. § 1001.2.

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b. Petitioner’s conviction related to the abuse of a patient.

A “patient” is defined as “any individual who is receiving health care items or services, including any item or service provided to meet his or her physical, mental or emotional needs or well-being (including a resident receiving care in a facility as described in part 483 of this chapter), whether or not reimbursed under Medicare, Medicaid and any other Federal health care program and regardless of the location in which such item or service is provided.”  42 C.F.R. § 1001.2.  Here, A.H., the identified victim in the indictment was a patient seeking medical care at the Atlanta Veterans Affairs Medical Center, where Petitioner worked as a physician.  See IG Ex. 2 at 1.  Thus, I find that A.H. is considered a patient as defined in the regulation.

Section 1128 of the Act does not provide a definition for abuse.  When a word is undefined in the Act or regulations, DAB decisions have utilized the common and ordinary meaning of the word.  Robert C. Hartnett, DAB No. 2740 at 9 n.7 (2016).  The regulations for skilled nursing facilities define abuse as “the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish,” including “verbal abuse, sexual abuse, physical abuse, and mental abuse . . . .”  42 C.F.R. § 483.5.  Using the common definition of abuse yields the same result, as it is defined as, “to treat in a harmful, injurious, or offensive way.”5

Whether a conviction is related to abuse or neglect “is a legal determination to be made by the Secretary based on the facts underlying the conviction.  Further, the offense that is the basis for the exclusion need not be couched in terms of patient abuse or neglect.”  57 Fed. Reg. 3298, 3303 (Jan. 29, 1992).  The DAB has discussed in detail the law applicable to this analysis:

ALJ’s [sic] are not limited to considering the bare elements or labels of the criminal statutes under which the individual was convicted.  Summit S. Shah, DAB No. 2836, at 7 (2017) (“The [DAB] has long held . . . that an ALJ is free to look beyond the narrow constructs of a state’s criminal statutes.”); Narendra M. Patel, DAB No. 1736, at 10 (2000) (Congress did not intend to limit the [IG’s] exclusion authority through “dependence on the vagaries of state criminal law definitions or record development”), aff’d, Patel v. Thompson, 319 F.3d. 1317 (11th Cir. 2003), cert. denied, 539 U.S. 959 (2003); 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”).  Rather, ALJ’s [sic] may look

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at “evidence as to the nature of an offense” such as “facts upon which the conviction was predicated.”  Id.; Patel at 10 (“[T]he conviction is not required to be for patient neglect or abuse, but rather the circumstances that surrounded the actual offense need only show a relation to the neglect or abuse of a patient”); [Michael S.] Rudman[, M.D., DAB No. 2171] at 9 [(2008)] (an ALJ may consider “evidence regarding the nature of the offense, rather than the state’s labeling of the admitted offense, to determine whether it involved conduct warranting exclusion”).

Funmilola Mary Taiwo, DAB No. 2995 at 8 (2020).

Here, the underlying facts which served as the basis of the indictment involve Petitioner, a physician, sexually abusing a patient in a Veterans Affairs Medical Center and being convicted of two federal offenses.  See IG Exs. 2, 3; see 18 U.S.C. § 2244(b) (Abusive sexual contact - “Whoever . . ., knowingly engages in sexual contact with another person without that other person’s permission shall be fined under this title, imprisoned not more than two years, or both); 18 U.S.C. § 242 (Deprivation of rights under color of law - “Whoever . . .willfully subjects any person . . . to the deprivation of any rights, privileges, or immunities secured or protected by the Constitution or laws of the United States, or to different punishments, pains, or penalties, on account of such person being an alien, or by reason of his color, or race, than are prescribed for the punishment of citizens, shall be fined under this title or imprisoned not more than one year, or both.).

As such, based on the information before me, I find that the underlying basis for Petitioner’s conviction was directly related to the abuse of a patient while seeking treatment in a Veterans Affairs Medical Center.

c. Petitioner’s offense was committed in connection with the delivery of a health care item or service.

The regulations require that the offense be committed “in connection with” the delivery of a health care item or service.  The DAB has repeatedly held that the words “in connection with” only require a showing of a minimal nexus between the offense and the delivery of a health care item or service.  Robert C. Hartnett, DAB No. 2740 at 10 (2016) (quoting Bruce Lindberg, D.C., DAB No. 1386 at 8 (1993)).

It is undisputed that the incident in question occurred when Petitioner was employed as a physician at the Atlanta Veterans Affairs Medical Center, and the victim was a patient at the facility and treated by Petitioner.  See Request for Hearing at 1-2; P. Br at 2; P. Reply at 2; P. Ex. 5.  Therefore, there is a clear nexus between Petitioner’s conviction and the delivery of a health care item or service.

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Thus, at a minimum, a mandatory five-year exclusion is warranted because Petitioner was convicted of two offenses involving the abuse of a patient in connection with the delivery of a health care item or service.  42 U.S.C. § 1320a-7(a)(2).  See Clemenceau Theophilus Acquaye, DAB No. 2745 at 4-5 (2016)(concluding that third-degree criminal sexual contact on a patient warranted exclusion pursuant to section 1128(a)(2)); Narendra M. Patel, M.D., DAB No. 1736 (2000) (concluding that a sexual battery conviction was a criminal offense relating to the abuse of a patient and warranted exclusion pursuant to section 1128(a)(2)).

2. A 10-year exclusion is not unreasonable based on the presence of two aggravating factors and no mitigating factors.  

As previously discussed, the Act requires a minimum exclusion period of five years when the exclusion is mandated under section 1320a-7(a).  42 U.S.C. § 1320a-7(c)(3)(B).  The IG increased the exclusion period from the minimum five years to ten years based on the consideration of two aggravating factors.  IG Ex. 1 at 1.  The IG has the discretion to impose an exclusion longer than the minimum period when there are aggravating factors present.  See 42 C.F.R. § 1001.102(b).

The IG asserts that the presence of two aggravating factors warrant an exclusion for ten years, and Petitioner has not proven that there are any regulatory mitigating factors present that may be considered as a basis for reducing the period of exclusion to no less than five years.  See 42 C.F.R. § 1001.102(a)-(c). The first aggravating factor is that Petitioner’s conduct consisted of non-consensual sexual acts.  42 C.F.R. § 1001.102(b)(4).  The second aggravating factor is that Petitioner’s sentence imposed included incarceration, specifically, 24 months of incarceration.  42 C.F.R. § 1001.102(b)(5).

a. Petitioner’s actions underlying his conviction consisted of non-consensual sexual acts, which justifies lengthening the exclusion period pursuant to 42 C.F.R. § 1001.102(b)(4).

First, the IG properly considered that Petitioner’s actions underlying his conviction consisted of non-consensual sexual acts.  42 C.F.R. § 1001.102(b)(4).  Here, there is no question that the actions for which Petitioner was convicted involved non-consensual sexual acts, and that factor, by itself, justifies significantly increasing the period of his exclusion.  As a physician who worked at a Veterans Affairs Medical Center, he was entrusted with caring for patients and veterans who trusted him.  Petitioner betrayed that trust when he sexually assaulted a patient under the guise of providing care.  Few actions could demonstrate more dramatically that an individual cannot be trusted and should therefore be excluded for a substantial period.

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b. Petitioner was sentenced to 24 months of incarceration, which justifies lengthening the exclusion period pursuant to 42 C.F.R. § 1001.102(b)(5).

Second, the IG properly considered the period of incarceration – 24 months – to be an aggravating factor in this case.  42 C.F.R. § 1001.102(b)(5).  While any period of incarceration justifies increasing the period of exclusion, the DAB has repeatedly held that longer periods of incarceration are relevant in determining whether a period of exclusion is reasonable.  See Jason Hollady, M.D. a/k/a Jason Lynn Hollady, DAB No. 1855 at 12 (2002) (stating that a nine-month period of incarceration was “relatively substantial”); Gary Alan Katz, R.Ph., DAB No. 1842 at 10 (2002) (“Incarceration for an indeterminate period with a minimum of one year and a maximum of seven is significant in and of itself and certainly justifies a longer period of exclusion than if there was no incarceration or incarceration of a lesser type or shorter period.); Clemenceau Theophilus Acquaye, DAB No. 2745 at 9 (2016) (concluding that a 13-year exclusion based on a single aggravating factor of a three to a maximum of 15 years of incarceration was reasonable).

c. Petitioner has not established that a mitigating factor exists to reduce the exclusion duration pursuant to 42 C.F.R. § 1001.102(c).

If any aggravating factor applies to lengthen the five-year exclusion period, then only the three mitigating factors in 42 C.F.R. § 1001.102(c) may be applied as a basis for reducing the exclusion period to no less than five years.  42 C.F.R. § 1001.102(c).

In his brief, Petitioner asserts two mitigating factors warrant reducing the duration of the exclusion.  P. Br. at 3.  Petitioner argues that he was subject to retaliation and a hostile work environment.  Id.  However, neither of these are mitigating factors I may consider under the regulations to reduce Petitioner’s exclusion duration.  See Shaun Thaxter, DAB No. 3053 at 35 (2021) (“The mitigating factors that ALJs and the [DAB] may consider are limited to those listed in the regulation . . . .”); Anthony Joseph Moschetto, D.O., DAB No. 3030 at 14 (2021) (“only the mitigating factors in § 1001.102(c) may be considered for possible reduction of an exclusion period longer than the mandatory minimum period”); Hussein Awada, M.D., DAB No. 2788 at 8 (2017) (“only the mitigating factors in section 1001.102(c) may be considered for possible reduction of an exclusion period longer than the mandatory minimum period.”).

In summary, the 10-year period of Petitioner’s exclusion is not unreasonable based on the significant aggravating factors present in this case.  Petitioner was found guilty of offenses consisting of non-consensual sexual acts and ordered to be incarcerated for 24 months.  I have further reviewed each of the regulatory mitigating factors enumerated in 42 C.F.R. § 1001.102(c)(1)-(3), and I have determined the evidence does not indicate that any of those factors are applicable.

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Based on these two aggravating factors and no mitigating factors, a 10-year exclusion is warranted. I therefore conclude that the 10-year period of exclusion is not unreasonable.  See Jeremy Robinson, DAB No. 1905 at 3 (2004) (ALJ review must reflect the deference accorded to the IG by the Secretary).

3. I have no authority to review Petitioner’s remaining constitutional challenges or equitable arguments.

Petitioner argues that the 11th Circuit deprived him of due process.  P. Br. at 3-4; P. Ex. 5.  Petitioner also argues that he was wrongfully terminated from his employment at the Atlanta Veterans Affairs Medical Center and asks that I make him “whole” by reinstating his employment and vacating the indictment and his conviction.  P. Br. at 2-3; P. Reply at 1.  Finally, Petitioner requests that I review evidence that he argues the 11th Circuit prevented him from presenting.  P. Br. at 4.

I address Petitioner’s collateral attack on his conviction in section V(1)(a).  To the extent Petitioner’s arguments can be construed as constitutional challenges and prayers for equitable relief, I do not have the authority to grant relief on either ground.  First, I have no authority to review constitutional challenges.  Funmilola Mary Taiwo, DAB No. 2995 at 9-10; see also 42 C.F.R. § 1005.4(c)(1).  As the DAB has pointed out, federal courts have repeatedly rejected constitutional challenges to exclusion proceedings.  Ilya Kogan, DAB No. 3034 at 12 (2021) (citing Manocchio v. Kusserow, 961 F.2d 1539 (11th Cir. 1992); Green v. Sullivan, 731 F. Supp. 838 (E.D. Tenn. 1990); Parrino v. Price, 869 F.3d 392, 397-98 (6th Cir. 2017); Erickson v. United States ex rel. Dep’t of Health & Human Servs., 67 F.3d.858 (9th Cir. 1995)).  Second, I have no authority to grant Petitioner equitable relief.  Letatia Norris, DAB No. 3135 at 15 (2024) (citing Yolanda Hamilton, M.D., DAB No. 3061 at 25 (2022)) (“[T]he [DAB] has held that ALJs and the [DAB] have no authority to give Petitioner equitable relief.”).  Ultimately, none of Petitioner’s arguments provide a legal basis for me to reverse Petitioner’s exclusion or reduce its duration.

V.  Effective Date of Exclusion

The effective date of the exclusion, August 20, 2025 - 20 days from the date of the July 31, 2025 notice - is established by regulation, and I am bound by that provision.  42 C.F.R. §§ 1001.2002(b), 1005.4(c)(1).

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VI. Conclusion

For the foregoing reasons, I affirm the IG’s decision to exclude Petitioner from participation in Medicare, Medicaid, and all other federal health care programs for a minimum period of ten years, effective August 20, 2025.