Faith Newton, DAB CR6846 (2026)

DECISION

The Inspector General (IG) of the United States Department of Health and Human Services excluded Petitioner, Faith Newton, from participation in Medicare, Medicaid, and all other federal health care programs for 87 years pursuant to section 1128(a)(1) of the Social Security Act (Act) (42 U.S.C. § 1320a-7(a)(1)).  For the reasons discussed below, I conclude that the IG has a basis to exclude Petitioner from program participation and that an 87-year exclusion is not unreasonable based on the evidence provided.  The IG’s exclusion determination is affirmed. 

I.  Background and Procedural History

By letter dated May 30, 2025, the IG notified Petitioner that she was excluded from participating in Medicare, Medicaid, and all federal health care programs pursuant to section 1128(a)(1) of the Act for a minimum period of 87 years, effective 20 days from the date of the letter.  IG Exhibit (Ex.) 1 at 1.  Petitioner was excluded because she was convicted in the United States District Court for the District of Massachusetts of a criminal offense related to the delivery of an item or service under Medicare or a State

Page 2

health care program, including the performance of management or administrative services relating to the delivery of such items or services.  IG Ex. 1 at 1. 

The IG identified four aggravating factors which resulted in an increased exclusion period:  1) The acts that resulted in conviction were intended to cause a financial loss to a government agency or program of $50,000 or more.  Petitioner was ordered to pay restitution of approximately $99,734,500; 2) The acts that resulted in the conviction, or similar acts, were committed over a period of one year or more, occurring from “about January 2013 to about January 2017”; 3) The sentence imposed by the court included incarceration.  Petitioner was sentenced to 144 months of incarceration; and 4) Petitioner was the subject of any other adverse action by a state agency or board if the adverse action is based on the same set of circumstances that serves as the basis for the imposition of the exclusion.  Petitioner had her nursing license suspended by the Commonwealth of Massachusetts Board of Registration in Nursing.  IG Ex. 1 at 1. 

On June 23, 2025, Petitioner timely requested a hearing before an administrative law judge (ALJ) to contest the 87-year exclusion imposed by the IG.  Along with her hearing request, Petitioner filed a copy of the memorandum in opposition to forfeiture of $99,734.517.50 she filed in the United States District Court, District of Massachusetts. 

On June 24, 2025, the Civil Remedies Division (CRD) issued an Acknowledgement Notice, my Standing Pre-Hearing Order, and the CRD Procedures (Civ. Remedies Div. P.). 

I held a prehearing conference on August 5, 2025, and issued an order summarizing the prehearing conference on August 6, 2025. 

The IG filed a brief (IG Br.) along with six exhibits (IG Exs. 1-6) on October 16, 2025.  In the absence of objections, I admit IG Exs. 1-6.  I issued an order to show cause on December 2, 2025 after Petitioner failed to timely file her pre-hearing exchange.  On or around December 23, 2025, Petitioner filed her brief along with an extension request indicating that the government shutdown had affected her ability to comply with her prehearing exchange deadline.  Petitioner Prehearing Exchange (P. Br.) at 1.  As a result, I discharged the show cause order and accepted Petitioner’s filings.  Petitioner included the opening appeal brief she filed in the United States Court of Appeals for the First Circuit, numerous motions and emails, and a request for clemency or a pardon from the President of the United States. 

The IG filed a reply to Petitioner’s brief on January 9, 2026 and objected to the admission of any of Petitioner’s supporting documents attached to her prehearing brief, arguing that they are irrelevant to the proceedings before me.  Petitioner did not respond to the IG’s objections. 

Page 3

I also gave Petitioner until February 9, 2026 to file any additional arguments or documents she may have.  Petitioner did not make any additional filings. 

I am required to exclude evidence that is irrelevant.  42 C.F.R. § 1005.17(c).  The documents Petitioner submitted generally pertain to her appeal in the First Circuit.  While they may not pertain directly to the issue before me, I admit Petitioner’s submitted filings as background information in the event that they provide context for my decision. 

II.  Issues

The issues in this case are: 

1) Whether the IG is authorized to exclude Petitioner from participation in Medicare, Medicaid, and all other federal health care programs based on section 1128(a)(1) of the Act (42 U.S.C. § 1320a-7(a)(1)).  42 C.F.R. § 1001.2007(a)(1)(i); and

2) If so, whether the 87-year period of exclusion, which is longer than the required 5-year minimum under 42 C.F.R. § 1001.102(a), is unreasonable in light of any applicable aggravating and mitigating factors.  42 C.F.R. §§ 1001.2007(a)(1)(ii), 1005.2(a).  

III.  Jurisdiction

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

IV.  Admission of Exhibits and Decision on the Written Record

Absent objection, Petitioner’s attachments to her brief and IG Exs. 1-6 are admitted into evidence. 

Neither Petitioner nor the IG proposed witnesses.  Therefore, a hearing is not necessary, and this matter will be decided on the merits of the written record.  Civ. Remedies Div. P. § 19(d). 

V.  Findings of Fact

Petitioner was an owner and operator of Arbor Homecare Services LLC (“Arbor”), a home health care agency located in Chelmsford, Massachusetts.  IG Ex. 3 at 4.  In August 2013, Arbor enrolled in MassHealth, Massachusetts’ combined Medicaid and Children’s Health Insurance program.  Id. 

On January 28, 2021, Petitioner was indicted in the United States District Court, District of Massachusetts for Conspiracy to Commit Health Care Fraud, Health Care Fraud,

Page 4

Aiding and Abetting, Conspiracy to Pay and Receive Kickbacks, Money Laundering Conspiracy, and Money Laundering, among others.  IG Ex. 3 at 1.  The indictment alleged that Petitioner devised a scheme to defraud health care benefit programs including Medicare and MassHealth.  IG Ex. 3 at 5.  Specifically, the indictment alleged that between January 2013 and January 2017, Medicare and MassHealth paid Arbor over $165 million for home health care services.  Id.  It was determined that over $100 million of those claims were fraudulent.  Id.  The indictment also alleged that Petitioner and a family member paid themselves approximately $40 million from Arbor’s profits.  Id. 

On July 19, 2024, Petitioner was found guilty of five counts from the indictment.  IG Ex. 2 at 1-3.  Petitioner was found guilty of conspiracy to commit health care fraud, health care fraud or aiding and abetting health care fraud, and multiple counts of money laundering.  Id.  Petitioner was found not guilty of conspiracy to commit money laundering.  Id. 

The District Court entered judgment following the jury verdict on January 23, 2025.  IG Ex. 4.  Petitioner was sentenced to 144 months in prison, in addition to three years of supervised release.  Id. at 3-4.  Petitioner was also ordered to pay $99,734,517.50 in restitution to MassHealth.  Id. at 7. 

VI.  Legal Authorities

The Secretary of the U.S. Department of Health and Human Services shall exclude an individual from participation in Medicare, Medicaid, and all other federally funded health care programs if that individual or entity has been convicted of a criminal offense related to the delivery of an item or service under title XVIII of the Act (the Medicare program) or any State health care program.  42 U.S.C. § 1320a-7(a)(1).  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 has the discretion to impose an exclusion longer than the minimum period when aggravating factors are present.  42 C.F.R. § 1001.102.  Here, the IG has imposed an 87‑year exclusion. 

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. § 1001.102(b).  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).  In this case, the IG must prove that Petitioner was convicted of an offense related to the delivery of a health care item or service under the Medicare program. 

An excluded individual may request a hearing before an 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). 

Page 5

VII.  Analysis and Conclusions of Law

1.  Petitioner was convicted of a criminal offense related to the delivery of a health care item or service under the Medicare program, which subjects her to a mandatory exclusion from all federal health care programs for a minimum of five years. 

The IG has the burden of proving that Petitioner was convicted of a criminal offense that was related to the delivery of a health care item.  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 the criminal record has been expunged.”  Act § 1128(i)(3) (42 U.S.C. § 1320a-7(i)(3)); see also 42 C.F.R. § 1001.2 (paragraph (c) under the definition of “Convicted”).  It is undisputed that Petitioner was found guilty of five counts from the indictment including conspiracy to commit health care fraud, health care fraud or aiding and abetting health care fraud, and multiple counts of money laundering.  IG Ex. 4 at 1-2.  The District Court entered a judgment of conviction against Petitioner on January 23, 2025.  Id. 

To prove that Petitioner’s conviction was related to the delivery of a health care item, the IG must show that there is a nexus between the offense and the delivery of a health care item or service.  The Departmental Appeals Board (Board) has repeatedly held that the phrase “related to” within the context of section 1128(a)(1) requires only that a common‑sense nexus exist between the offense and the delivery of a health care item or service under the Act or a state healthcare program.  See Summit S. Shah, M.D., DAB No. 2836 at 6 (2017) (citations omitted).  The evidence shows that Petitioner, as the owner of Arbor, a home health care agency, caused Arbor to submit over $100 million in false and fraudulent claims to Medicare and MassHealth.  The IG has proven, through documentary evidence, that a common-sense nexus exists between Petitioner’s conviction for conspiracy to commit health care fraud, health care fraud or aiding and abetting health care fraud, and multiple counts of money laundering and the delivery of a health care item or service under the Medicare program.  Therefore, the IG has proven, by a preponderance of the evidence, that Petitioner was convicted of a criminal offense related to the delivery of an item or service under the Medicare program.  As a result, Petitioner must be excluded pursuant to section 1128(a)(1) of the Act. 

2.  Based on the aggravating factors and no mitigating factor, the 87-year exclusion falls within a reasonable range. 

An exclusion brought under section 1128(a)(1) must be for a minimum period of five years.  Act § 1128(c)(3)(B); 42 C.F.R. § 1001.102(a).  I now consider whether the length

Page 6

of the exclusion, beyond five years, falls within a reasonable range.  42 C.F.R. § 1001.2007(a)(2); see Edwin L. Fuentes, DAB No. 2988 at 8-9 (2020); Hussein Awada, M.D., DAB No. 2788 at 5-6 (2017). 

Among the factors that may serve as a basis for lengthening the period of exclusion are the four that the IG relies on in this case:  1) the acts that resulted in the conviction, or similar acts, caused a government program or another entity financial losses of $50,000 or more; 2) the acts that resulted in the conviction, or similar acts, were committed over a period of one year or more; 3) the sentence imposed by the court included incarceration; and 4) the individual has been the subject of any other adverse action by any federal, state, or local government agency or board, if the adverse action is based on the same set of circumstances that serves as the basis for imposing the exclusion.  IG Ex. 1; 42 C.F.R. § 1001.102(b).  The presence of an aggravating factor or factors, not offset by any mitigating factor or factors, justifies lengthening the mandatory period of exclusion.  

“[S]imply meeting the threshold for an aggravating factor is a clear indication of untrustworthiness.”  Awada, DAB No. 2788 at 10. 

As the following discussion shows, the IG correctly identified the four aggravating factors and correctly determined that there are no mitigating factors. 

Program financial loss (42 C.F.R. § 1001.102(b)(1)).  Financial losses of even one dollar over the $50,000 threshold justify extending the length of the period of exclusion.  Fuentes, DAB No. 2988 at 13.  Significant evidence – including the sentencing court’s order of restitution – establishes that the losses suffered by the Medicare and Medicaid programs were many times greater than the $50,000 threshold for aggravation. 

The indictment alleged that Petitioner caused a loss of over $100 million to Medicare and MassHealth because of fraudulent claims made as a result of her health care fraud.  IG Ex. 3 at 5.  After Petitioner was convicted, the trial court agreed with the estimated losses and ordered Petitioner to pay $99,734,517.50 in restitution to MassHealth.  IG Ex. 4 at 7. 

An exclusion is designed to protect program integrity and program beneficiaries.  In directing me to consider program losses, the regulation recognizes that the amount of loss reflects, in part, the seriousness of the individual’s crime and thus the level of threat she poses to program integrity.  While the process is inexact, so long as the IG reasonably translates the aggravating factor into an increase in the period of exclusion, I must affirm the determination.  That a corrupt practitioner and the schemes in which she participates can cause health care programs substantial losses underscores the importance of excluding the unscrupulous.  Over time, health care programs simply cannot withstand these losses.  See Brandon Michael Coburn, DAB CR5247 at 4 (2019).  

Page 7

Here, the program losses were many times the threshold amount.  Such losses, by themselves, justify increasing the period of exclusion well beyond the five-year minimum.  See Shaun Thaxter, DAB No. 3053 at 31-32 (2021); Robert Kolbusz, M.D., DAB No. 2759 at 6-7 (2017); Jeremy Robinson, DAB No. 1905 (2004); Donald A. Burstein, PhD., DAB No. 1865 (2003). 

Duration of criminal conduct (42 C.F.R. § 1001.102(b)(2)).  We consider the length of Petitioner’s participation in criminal activity in order to distinguish the individual whose lapse in integrity is short-lived from those who display a lack of integrity over a longer period of time.  “Participation in, or even knowing but silent acquiescence in, a continuing fraudulent scheme that could be expected to cause repeated misrepresentations and repeated harm over a period of time evidences a continuing lack of integrity.”  Awada, DAB No. 2788 at 8. 

Petitioner’s convictions and the indictment leave no doubt that Petitioner began fraudulently billing MassHealth as early as January 2013 and continuing through January 2017.  IG Ex. 1; IG Ex. 3 at 5.  Petitioner thus committed her illegal acts for approximately four years.  Petitioner disputes that she committed illegal acts but presents no evidence to dispute the duration of the fraudulent billing. 

Petitioner actively engaged in her criminal activities for approximately four years (from January 2013, through January 2017).  This is four times the one-year threshold for aggravation and justifies a period of exclusion that is longer than the minimum.  See Rosa Velia Serrano, DAB No. 2923 at 9 (2019) (stating that participation in Medicaid fraud for four years demonstrated “a protracted period of criminal conduct” that showed petitioner was “extremely untrustworthy”), recon. denied, DAB Ruling No. 2019-2 (April 25, 2019); Laura Leyva, DAB No. 2704 at 10 (2016) (stating that participation in a conspiracy to defraud Medicare that lasted more than two years “amply demonstrates more than a short-lived lapse in integrity”); Vinod Chandrashekar Patwardhan, M.D., DAB No. 2454 at 7 (2012) (finding that a three-year scheme demonstrated an “ongoing lack of integrity”). 

Incarceration (42 C.F.R. § 1001.102(b)(5)).  The court sentenced Petitioner to a substantial period of incarceration – 144 months.  IG Ex. 4.  While any period of incarceration justifies increasing the period of exclusion, the Board has repeatedly held that longer periods of incarceration are relevant in determining whether a period of exclusion is reasonable.  Eugene Goldman, M.D. a/k/a Yevgeniy Goldman, M.D., DAB No. 2635 at 6 (2015) (and cases cited therein).  Generally, the longer the jail time, the longer the exclusion, because a lengthy sentence evidences a more serious offense. 

Petitioner argues that her sentence is unfair and is under appeal.  P. Br. at 2.  However, just because Petitioner argues that she should not have been convicted or that her conviction is subject to appeal, does not mean that the IG has not proven this aggravating

Page 8

factor.  The fact still remains that Petitioner was found guilty by a jury and sentenced to 144 months in prison.  Whether or not Petitioner agrees with this outcome is not determinative of its validity. 

Moreover, the length of incarceration must be considered in light of the other aggravating factors.  In Laura Leyva, DAB No. 2704 at 11, the Board declined to characterize the petitioner’s period of incarceration (a weekend in jail followed by eight months of home confinement) but weighed it with the other aggravating factors – $216,000 in program losses and conduct lasting more than two years – in determining that a ten-year exclusion was reasonable. 

I consider a twelve-year jail term significant.  It is one of four factors that, considered together, establish that Petitioner is not trustworthy. 

Other adverse actions (42 C.F.R. § 1001.102(b)(9)).  Petitioner was subject to an adverse action by a state medical board, based on the same set of circumstances that serve as the basis for this exclusion. 

Petitioner was licensed as a registered nurse in Massachusetts.  On February 3, 2021, the Executive Director of the Massachusetts Board of Registration in Nursing summarily suspended Petitioner’s license to practice as an RN and LPN in Massachusetts.  IG Ex. 5 at 7-8.  The suspension noted that the Office of Public Protection at the Bureau of Health Professions Licensure received a press release on February 2, 2021 from the United States Attorney’s Office indicating that Petitioner had been indicted on one count of conspiracy to commit health care fraud, one count of money laundering conspiracy, and seven counts of money laundering.  Id. at 7.  The suspension was deemed necessary to prevent an immediate and serious threat to public health, safety or welfare.  Id. 

Thus, based on the same set of circumstances that serves as the basis for imposing this exclusion, Petitioner was subject to an additional adverse action by the Massachusetts nursing board, and the IG may apply this factor to extend the period of her exclusion. 

Petitioner does not dispute that her license was suspended. 

No mitigating factors.  The regulations consider mitigating just three factors:  1) a petitioner was convicted of three or fewer misdemeanor offenses and the resulting financial loss to the program was less than $5,000; 2) the record in the criminal proceedings demonstrates that a petitioner had a mental, physical, or emotional condition that reduced her culpability; and 3) a petitioner’s cooperation with federal or state officials resulted in others being convicted or excluded, or additional cases being investigated, or a civil money penalty being imposed.  42 C.F.R. § 1001.102(c).  Characterizing the mitigating factor as “in the nature of an affirmative defense,” the

Page 9

Board has ruled that Petitioner has the burden of proving any mitigating factor by a preponderance of the evidence.  Barry D. Garfinkel, M.D., DAB No. 1572 at 8 (1996). 

No mitigating factors offset the significant aggravating factors present in this case.  Petitioner was convicted of felonies.  No evidence suggests that she had a mental, physical, or emotional condition that reduced her culpability.  There is no evidence to suggest Petitioner cooperated with federal or state officials.  

My role here is to “review the length of an exclusion de novo to determine whether it falls within a reasonable range[,] given the aggravating and mitigating factors and the circumstances underlying them.”  Fuentes, DAB No. 2988 at 8, quoting Sushil Aniruddh Sheth, M.D., DAB No. 2491 at 5 (2012).  Such an evaluation does not rest on the specific number of aggravating or mitigating factors or any rigid formula for weighing those factors; I make a case-specific determination of the weight to be accorded each factor based on a qualitative assessment of the circumstances surrounding the relevant factors.  Yolanda Hamilton, DAB No. 3061 at 12 (2022); Thaxter, DAB No. 3053 at 26; Kimberly Jones, DAB No. 3033 at 7 (2021); Sheth, DAB No. 2491 at 5.  So long as that period falls within a reasonable range, my role is not to second-guess the IG’s judgment.  Jeremy Robinson, DAB No. 1905 at 5 (ALJ review must reflect the deference accorded to the IG by the Secretary).  By design the IG has broad discretion to determine an exclusion’s length, and if the IG chooses an amount of time within a reasonable range, based on demonstrated criteria, the ALJ has no authority to change it, given the IG’s vast experience in implementing exclusions.  Elizabeth Holmes, DAB No. 3222 at 21 (2026). 

The goal here is to protect federal health care programs and beneficiaries from potential harm.  Joann Fletcher Cash, DAB No. 1725 (2000).  Petitioner’s crime was one of many that erode the financial viability of the federal and state healthcare programs.  Petitioner engaged in truly egregious conduct for approximately four years that cost the Medicare and MassHealth programs substantial amounts of money.  Her crime was serious enough to merit twelve years of incarceration.  Her Massachusetts nursing license was suspended.  Petitioner has shown a lack of integrity and that she poses a significant threat to health care programs and their beneficiaries.  I therefore conclude that the 87-year exclusion falls within a reasonable range. 

Conclusion

The IG properly excluded Petitioner from participating in Medicare, Medicaid, and other federal health care programs.  So long as the period of exclusion is within a reasonable range, based on demonstrated criteria, I have no authority to change it.  Joann Fletcher Cash, DAB No. 1725 at 7, citing 57 Fed. Reg. 3298, 3321 (1992). 

Page 10

I find that the 87-year exclusion falls within a reasonable range.