Clifford Glassman, DAB CR6838 (2026)

DECISION

I affirm the seven-year exclusion of Petitioner, Clifford Glassman, from participation in all federal health care programs.

I. Background and Procedural History

In an April 30, 2025 notice, the Inspector General (IG) of the Department of Health and Human Services excluded Petitioner from participation in all federal health care programs under section 1128(a)(3) of the Social Security Act (42 U.S.C. § 1320a-7(a)(3)) for seven years due to his felony conviction in the United States District Court for the Central District of California (District Court) of a criminal offense related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct, in connection with the delivery of a health care item or service.  See 42 U.S.C. § 1320a-7(a)(3).  The notice also identified the following aggravating factor to lengthen the exclusion from the statutorily required minimum five years to seven years:  “The individual or entity has been convicted of other offenses besides those that formed the basis for the exclusion.  [Petitioner was] convicted on 1 count of Subscribing To False Federal Income Tax Return.”  IG Ex. 1 at 1.

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Petitioner mailed a request for an administrative law judge hearing on May 3, 2025; however, the Civil Remedies Division (CRD) only received that request on September 12, 2025.  IG Ex. 2.  On September 16, 2025, CRD acknowledged receipt of the hearing request, gave notice of a telephone prehearing conference, and issued my Standing Order.

On October 16, 2025, I held a telephone prehearing conference with the parties, the substance of which is summarized in my October 20, 2025 Order Following Prehearing Conference and Setting Schedule for Prehearing Submissions (Oct. 20 Order).  During the conference, I did the following:  allowed Petitioner to file all documents by physical mail rather than through the electronic filing system (E-File); set January 5, 2026, as Petitioner’s due date for his prehearing exchange; confirmed Petitioner’s email address and that he regularly checks his email; and indicated that email communication among the parties and CRD should be used.  Oct. 20 Order at 1-2.

On November 20, 2025, the IG submitted a prehearing exchange consisting of a brief (IG Br.) and five proposed exhibits (IG Exs. 1-5).  CRD did not receive any submission from Petitioner.  On January 21, 2026, CRD sent an email to Petitioner asking him to confirm whether he mailed his prehearing exchange.  E-File Doc. No. 12.  CRD received no reply.

II. Admission of Exhibits

Absent objection, I admit IG Exhibits 1 through 5 into the record.  Standing Order ¶ 13; see 42 C.F.R. § 1005.8(c).  Petitioner did not offer any exhibits.

III. Decision on the Written Record

I directed the parties to submit written direct testimony from all witnesses that the parties wanted to present and advised that the opposing party could request to cross-examine the witnesses.  Standing Order ¶¶ 11-12; see also 42 C.F.R. § 1005.16(b).  I also stated:

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.

All deadlines for submitting prehearing exchanges have passed and neither party filed written direct testimony.  The IG has also affirmatively stated that witness testimony and an in-person hearing are not necessary.  IG Br. at 9-10.  Therefore, I do not need to hold an in-person hearing and may issue a decision based on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 12 (2022); EI Med., Inc., DAB No. 3117 at 15 (2023).

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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)(3).
2. Whether a seven-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 April 4, 2019, Petitioner signed a Plea Agreement in which Petitioner agreed to plead guilty to an Information not yet filed with the District Court, which charged Petitioner with health care fraud and subscribing to a false federal income tax return.  IG Ex. 5.
2. In the Plea Agreement, Petitioner stated that he “understands and acknowledges that, as a result of pleading guilty pursuant to this agreement, [Petitioner] will be excluded from Medicare, Medicaid, and all federal health care programs.  [Petitioner] agrees to complete and execute all necessary documents provided by the United States Department of Health and Human Services . . . to effectuate this exclusion within 60 days of receiving the documents.”  IG Ex. 5 at 5-6.
3. On April 18, 2019, the United States Attorney’s Office filed a two-count Information with the District Court charging Petitioner with health care fraud in violation of 18 U.S.C. § 1347 and subscribing to a materially false corporate Internal Revenue Service Return in violation of 26 U.S.C. § 7206.  IG Ex. 4.
4. For the charge of health care fraud, Petitioner stipulated to the following: 1) Petitioner, a chiropractor, agreed to refer patients who were covered under the University of California’s Student Health Insurance Program (UCSHIP) to a certain pharmacy in exchange for a referral fee/kickback; 2) Petitioner and the pharmacy’s representatives agreed that the prescriptions would be based on a purported clinical trial to create the appearance of legitimacy and medical necessity; 3) prescription medications were selected based on maximum reimbursement rather than medical necessity; 4) Petitioner would direct patients to certain physicians who would prescribe the medications to be filled by the pharmacy; 5) the reimbursement paid by UCSHIP for one-month’s supply for each patient was $2,355, which was more than the average annual premium paid by each patient to UCSHIP; 6) Petitioner posted online advertisements to persuade

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4. University of California at Los Angeles students to participate in Petitioner’s fake clinical trial; 7) Petitioner brought interested students to certain physicians for examination in order to obtain the necessary prescriptions; 8) Petitioner would counsel the students as to the health conditions they should describe to the physicians during the examination even though no such health conditions existed; and 9) Petitioner’s scheme resulted in UCSHIP paying at least $8.7 million.  IG Ex. 5 at 42-45.
5. For the charge of false subscription to a federal income tax return, Petitioner stipulated to the following facts:  “For calendar year 2015, [Petitioner] willfully and knowingly caused entries on the Form 1120-S corporate income tax return and its supporting Form 1125-A for his wholly owned business, Glassman & Associates, Inc., to reflect that said entity had incurred approximately $300,800 in ‘purchases’ as a part of its costs of goods sold.  [Petitioner] signed that return on or about March 20, 2016.  At all relevant times, as [Petitioner] well knew, that entity had not incurred or made any such ‘purchases’ and [Petitioner] intended to inflate such a line item in order to reduce his tax liability.  As a result of inflating the above-referenced line item for costs of goods sold, and because [Petitioner] was responsible to pay income taxes on his business entity’s net taxable income as a pass-through entity, [Petitioner] willfully and knowingly did not report personal income of $269,428 for that same period.”  IG Ex. 5 at 45-46.
6. On October 25, 2024, the District Court issued a Judgment in which the District Court found Petitioner guilty of the crimes alleged in the Information and stated that Petitioner was convicted of those crimes.  The District Court sentenced Petitioner to three years of probation.  IG Ex. 3 at 1-2.

VII. Conclusions of Law and Analysis

1. Petitioner is subject to exclusion under 42 U.S.C. § 1320a‑7(a)(3) because he was convicted of a felony offense related to fraud in connection with the delivery of a health care item or service.

The Secretary of Health and Human Services (Secretary) must exclude an individual from participation in all federally funded health care programs when that individual:

[H]as been convicted for an offense which occurred after August 21, 1996, under Federal or State law, in connection with the delivery of a health care item or service . . . of a criminal offense consisting of a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct.

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42 U.S.C. § 1320a-7(a)(3).  As stated in the Secretary’s regulations, the three essential elements to support this mandatory exclusion are:  (1) a conviction under federal or state law of a felony that occurred after August 21, 1996; (2) the felony is related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct; and 3) the felony was in connection with the delivery of a health care item or service.  42 C.F.R. § 1001.101(c)(1).

As an initial matter, I do not think that Petitioner has the right to challenge the imposition of the exclusion.  Petitioner’s plea agreement states that he understands that he will be excluded and will assist in effectuating that exclusion when he receives notice of it.  IG Ex. 5 at 5-6.  Despite this, I provide the following analysis that confirms Petitioner is subject to a mandatory exclusion.

Petitioner was convicted of a felony that occurred after 1996.  For purposes of exclusion, individuals are deemed “convicted” of an 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 by a Federal, State, or local court.”  42 U.S.C. § 1320a‑7(i)(1), (3).  In the present case, Petitioner pleaded guilty to Health Care Fraud, the District Court accepted that plea and found Petitioner guilty, and the District Court issued a judgment of conviction.  IG Exs. 3, 5.  Further, the crime that Petitioner was convicted of committing has a maximum term of incarceration of ten years, making it a Class C felony.  18 U.S.C. §§ 1347(a)(2), 3559(a)(3).  Finally, Petitioner’s stipulation concerning his conduct indicates that all of the criminal acts took place long after 1996.  IG Ex. 5 at 42-45.

The felony is related to fraud.  The term “fraud” in § 1320a-7(a)(3) is “targeting fraud generally,” which means that it encompasses any type of fraud and not merely fraud involving financial misconduct.  Morgan v. Sebelius, 694 F.3d 535, 538 (4th Cir. 2012). The words “relating to” mean that exclusion under § 1320a-7(a)(3) is not limited to individuals convicted of the generic offense of fraud (i.e., crimes with the core elements of fraud) but to all criminal conduct that has a factual relationship to fraud.  Friedman v. Sebelius, 686 F.3d 813, 821 (D.C. Cir. 2012).  This is because the words “relating to” in § 1320a-7 are “deliberately expansive” and have a broad “ordinary meaning” that is “to stand in some relation; to have bearing or concern; to pertain; refer; to bring into association with or connection with.”1  Friedman, 686 F.3d at 820; see also Yohannes Tinsae, DAB No. 3084 at 9-10 (2023).  In this case, Petitioner was convicted of health

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care fraud due to his use of deception to obtain improper payments from a health care insurer.  IG Ex. 3 at 1; IG Ex. 5 at 3, 42-45.

The felony was in connection with the delivery of a health care item or service. The term “in connection with” is equivalent to the term “relating to,” discussed above.  As explained by the Friedman court:

Congress used “relating to” and “in connection with” each to denote a factual relationship–respectively, the relationship between the facts underlying a person’s conviction and conduct that would qualify as “fraud”; and the relationship between that conduct and the delivery of health care.

686 F.3d at 822.  Because the “in connection with” phrase means that there simply needs to be a factual connection between the criminal conduct and the delivery of a health care item or service, exclusions under § 1320a-7(a)(3) are not limited “to offenses involving the actual delivery of healthcare . . . .”  Charice D. Curtis, DAB No. 2430 at 5 (2011); see also Baxter v. Kennedy, 136 F.4th 70, 86 (4th Cir. 2025) (holding that mandatory exclusion under § 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.”).  In the present case, Petitioner recruited patients who had a certain health insurance, took them to physicians for examinations, obtained prescriptions from the physicians for certain medications, and the patients were provided with the medications.  IG Ex. 5 at 42-45.  There is a direct connection between Petitioner’s conduct and the delivery of health care items or services.

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)(3), Petitioner must be excluded for a minimum of five years.  42 U.S.C. § 1320a‑7(c)(3)(B).

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)(3) 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).

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The regulations provide the following as an aggravating factor:  “The individual . . . has been convicted of other offenses besides those that formed the basis for the exclusion.”  42 C.F.R. § 1001.102(b)(8).  Petitioner was charged with and pleaded guilty to subscribing to false federal income tax return in violation of 26 U.S.C. § 7206(1).  IG Ex. 3 at 1; IG Ex. 5 at 3.  Therefore, I conclude that the IG proved this aggravating factor.

4. Petitioner neither alleged nor proved the existence of any mitigating factors to reduce the length of exclusion imposed by the IG.
5. The seven-year length of Petitioner’s exclusion is not unreasonable based on a qualitative analysis of the aggravating factor in this case.

Unlike Petitioner’s challenge to the imposition of the exclusion, which appears foreclosed by his Plea Agreement, Petitioner has the right to challenge the length of exclusion because the Plea Agreement does not discuss that matter.  IG Ex. 5 at 5-6.

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 seven-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, it is important to note 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).  For exclusions, the trustworthiness of the excluded individual is a key question.  See Morgan, 694 F.3d at 538 (“[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 the purpose of an exclusion is 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 was convicted of lying on a tax return to reduce his tax liability.  Petitioner did this by falsely stating that his corporation incurred approximately $300,000 in expenses.  IG Ex. 5 at 45-46.  Further, Petitioner’s underlying offense to the exclusion is health care fraud.  IG Ex. 3 at 1.  The Secretary

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contemplated this scenario when creating the aggravating factor at 42 C.F.R. § 1001.102(b)(8):

Inclusion of this aggravating factor will permit the OIG to increase a length of exclusion when an individual is convicted of Medicare fraud and any other offense, such as drug distribution or income tax evasion.  The aggravating factor will take into consideration separate and different types of convictions that occurred concurrently; we do not intend to use the basis of the OIG exclusion more than once as a factor in lengthening an exclusion.

63 Fed. Reg. 46,676, 46,680-81 (Sept. 2, 1998) (emphasis added).

Petitioner requested a hearing due to the “harshness of the finding,” which I interpret to mean the length of the exclusion.  IG Ex. 2 at 1.  However, the IG only lengthened the exclusion by two years.  Given that Petitioner’s federal tax offense exhibited dishonesty (as did his health care fraud offense), I cannot find that the seven-year length of exclusion is unreasonably long.  Petitioner is not trustworthy and presents a threat to federal health care programs.

VIII. Conclusion

I affirm the IG’s determination to exclude Petitioner for seven years from participating in all federal health care programs under 42 U.S.C. § 1320a-7(a)(3).