Sonny Sagar, DAB, CR6885 (2026)

DECISION

The Inspector General of the United States Department of Health and Human Services (IG) excluded Sonny Saggar, M.D. (Petitioner) from participation in Medicare, Medicaid, and all other federal health care programs for a minimum period of 12 years pursuant to section 1128(a)(l) of the Social Security Act (Act) (42 U.S.C. § 1320a-7(a)(l)).  For the reasons discussed below, it is determined that the IG has a legal basis to exclude Petitioner from program participation, and a mandatory exclusion must be imposed.  Based on the facts and evidence presented in this case, I find that a 12-year exclusion is not unreasonable based on the presence of four aggravating factors and no mitigating factors. 

I. Background and Procedural History

By notice letter dated September 30, 2025, the IG informed Petitioner that he was being excluded from participating in Medicare, Medicaid, and all federal health care programs for a minimum period of 12 years pursuant to section 1128(a)(1) of the Act.  42 U.S.C. § 1320-a7(a)(1).  The exclusion was imposed due to Petitioner’s conviction, in the United States District Court for the Eastern District of Missouri (District Court), “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

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the delivery of items or services under any such program.”  IG Exhibit (Ex.) 1.  The IG identified four aggravating factors that serve as the basis for extending Petitioner’s exclusion beyond the five-year mandatory minimum.  IG Ex. 1 at 1. 

The Civil Remedies Division (CRD) received Petitioner’s request for a hearing on October 20, 2025. 

On October 22, 2025, the CRD issued my Standing Pre-Hearing Order (Standing Order) and an Acknowledgement Letter, acknowledging receipt of Petitioner’s hearing request.  The letter notified the parties that a telephone prehearing conference was scheduled for December 2, 2025, at 11:00 a.m. EST.  On the date of the pre-hearing conference, an attorney representative appeared on behalf of the IG and Petitioner appeared pro se.  The parties agreed to a briefing schedule.  On December 10, 2025, an Order Following Prehearing Conference and Setting Briefing Schedule (December 10, 2025 Order) was issued and it included dates for the parties to submit their prehearing exchanges.  

On December 2, 2025, Petitioner filed a Motion to Dismiss. 

The IG filed a reply to Petitioner’s Motion to Dismiss on December 11, 2025.  

On January 23, 2026, the IG filed a brief (IG Br.) along with 5 exhibits (IG Exs. 1-5). 

On January 28, 2026, I issued an order denying Petitioner’s Motion to Dismiss. 

Petitioner filed a brief (P. Br.) on March 3, 3026.  

The IG filed a reply brief on March 20, 2026. 

On March 25, 2026, Petitioner filed a Notice of Supplemental Authority. 

On April 7, 2026, a notice was filed stating that Petitioner no longer has access to the Trust Fund Limited Inmate Computer System.  

Petitioner filed a reply brief on April 14, 2026. 

II. Admission of Exhibits and Decision on the Written Record

Absent objection, IG Exs. 1-5 are admitted into evidence. 

As stated in the December 10, 2025 Order, a hearing will be held only if a party asks to cross-examine a witness for whom the opposing party has provided written direct testimony and the witness’ proposed testimony is found to be relevant and non-

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cumulative.  December 10, 2025 Order at 5; CRPD § 19(d).  Neither party proposed witnesses.  Therefore, this case will be decided based on the record before me. 

III. Issues

The issues to be decided are:  

Whether the IG has a basis to exclude Petitioner from participation in Medicare, Medicaid, and all other federal health care programs under section 1128(a)(1) of the Act.  42 C.F.R. § 1001.2007(a)(1)(i). 

Whether the 12-year exclusion imposed by the IG is unreasonable.  42 C.F.R. § 1001.2007(a)(1)(ii). 

IV. Jurisdiction

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

V. Findings of Fact

Petitioner has been a medical doctor for 27 years and was licensed to practice in the state of Missouri. IG Ex. 2 at 3.  Since approximately 2012, Petitioner operated several healthcare businesses including Downtown Urgent Care LLC; Creve Coeur Urgent Care LLC; and St. Louis General Hospital, an urgent care and primary care clinic.  IG Ex. 2 at 3. 

On July 26, 2023, Petitioner was indicted by Grand Jury for one count of Conspiracy in violation of 18 U.S.C. § 371; and eight counts of Making False Statements Related to Health Care Matters in violation of 18 U.S.C.§ 1035.  IG Ex. 3. 

Petitioner entered into a plea agreement in which he voluntarily pled guilty to Conspiracy (Count 1 of the indictment).  IG Ex. 2 at 1.  Petitioner admitted that 1) two or more persons reached an agreement or came to an understanding to make false statements relating to health care matters, 2) that he voluntarily and intentionally joined in the agreement or understanding, either at the time it was first reached or at some later time; 3) he knew the purpose of the agreement or understanding; 4) and knowingly did one or more overt acts for the purpose of carrying out or carrying forward the agreement or understanding.  IG Ex. 2 at 3.  Specifically, Petitioner conspired to bill Medicare and Medicaid for un-reimbursable services performed by assistant physicians, but billed as if the services were performed by Petitioner.  IG Ex. 2 at 11. 

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The District Court accepted Petitioner’s guilty plea and imposed judgment on February 19, 2025.  IG Ex. 4 at 1.  Petitioner was sentenced to 35 months of incarceration and three years of supervised release upon release of imprisonment.  Id at 3.  Petitioner was also ordered to pay $642,942.70 to the Medicare program and $99,585.37 to the Missouri Medicaid program.  IG Ex. 4 at 6. 

On April 8, 2025, the State of Illinois Department of Financial and Professional Regulation Division of Professional Regulation issued an order indefinitely suspending Petitioner’s physician and surgical licenses, without a hearing, based on his conviction in District Court.  IG Ex. 5 at 1. 

VI. Legal Authorities

The Secretary of the United States Department of Health and Human Services (Secretary) shall exclude an individual from participation in Medicare, Medicaid, and all other federal health care programs if that individual has been convicted 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).  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). 

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 ¶ 6.  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. § 1001.102(c); Standing Order ¶ 6.  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 an item or service under Medicare or a state health care program.  Additionally, the IG has the burden of proving the existence of four aggravating factors as identified in the notice letters. 

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). 

VII. Analysis and Conclusions of Law

1. Petitioner was convicted of a criminal offense related to the delivery of an item or service under the Medicare program, which subjects him to a mandatory exclusion from all federal healthcare programs.

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To prevail, the IG must prove that Petitioner was convicted of a criminal offense related to the delivery of an item or service under Medicare or a state health care program.  Act § 1128(a)(1) (42 U.S.C. § 1320a-7(a)(1)); 42 C.F.R. § 1001.101(a).  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)(1) (42 U.S.C. § 1320a-7(i)(1)); see also 42 C.F.R. § 1001.2 (paragraph (a) under the definition of “Convicted”).  Here, it is undisputed that the District Court accepted Petitioner’s guilty plea and entered judgement on February 19, 2025.  IG Ex. 4 at 1.  Petitioner does not dispute that he was convicted of a criminal offense.  P. Br. at 3. The evidence proves that Petitioner was convicted of a criminal offense as defined under section 1128(a)(1) of the Act.  

Next, to prove that Petitioner’s conviction was related to the delivery of an item or service under Medicare, the IG must show a nexus between the offense and the delivery of an item or service under Medicare.  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 an item or service under Medicare.  Summit S. Shah, M.D., DAB No. 2836 at 6 (2017).  The IG argues, and the evidence shows, that Petitioner was convicted of conspiracy to bill un-reimbursable services to Medicare and Medicaid that were performed by assistant physicians, but billed as if they were performed by the Petitioner.  IG Ex. 2 at 11; IG Br. at 3.  Additionally, the District Court ordered Petitioner to pay restitution to the Medicare program.  The evidence shows that Petitioner’s conviction is related to the delivery of an item or service under Medicare. 

2. The IG identified four aggravating factors that support an exclusion beyond the five-year minimum. 

Exclusions imposed under section 1128(a)(1) carry a five-year mandatory minimum exclusion period.  Act § 1128(c)(3)(B) (42 U.S.C. § 1320a-7(c)(3)(B)); 42 C.F.R. § 1001.102(a).  The IG may extend the five-year exclusion period based on the application of the aggravating factors listed in 42 C.F.R. § 1001.102(b).  If any of the aggravating factors set forth in 42 C.F.R. § 1001.102(b) justifies an exclusion longer than five years, mitigating factors listed at 42 C.F.R. § 1001.102(c) may be considered as a basis for reducing the period of exclusion to no less than five years.  In this case, the IG has proposed a 12-year exclusion based on three aggravating factors. 

The IG identified the following aggravating factors as a basis for imposing a 12-year exclusion against Petitioner:  the acts resulting in the conviction, or similar acts, caused, or were intended to cause, a financial loss to a government agency or program of $50,000 or more; the acts that resulted in the conviction, or similar acts, were committed over a

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period of one year or more; the sentence imposed by the court included incarceration; and the individual or entity 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 the imposition of the exclusion.  IG Ex. 1; 42 C.F.R. § 1001.102(b)(1)-(2), (5).  Each factor is discussed below. 

A. The acts resulting in the conviction, or similar acts, caused, or were intended to cause, a financial loss to a government program of $50,000 or more. 

The District Court ordered Petitioner to pay $742,500 in restitution.  IG Ex. 1.  In his plea agreement, Petitioner agreed that he was responsible for causing a total loss of $742,528.07 to the Medicare and Missouri Medicaid programs for claims for services that were rendered by assistant physicians, but billed under Petitioner’s name from July 10, 2018 through July 2023.  IG Ex. 2 at 15. 

Petitioner argues that restitution is a “negotiated figure, not a judicial finding of actual loss” and that there is no stipulation that “Medicare’s actual loss exceeded $50,000.”.  P. Br. at 4.  However, it is well-established that an amount ordered as restitution constitutes proof of the amount of financial loss to a government program.  Yolanda Hamilton, DAB No. 3061 at 12-14 (2022).  Petitioner also argues that there is no evidence that he was personally enriched from the scheme.  P. Br. at 5.  The Board has addressed this argument, stating that the regulation does not say that an individual or entity has to benefit from the program loss, only that the offense “caused” or “intended to cause” the loss.  Craig Richard Wilder, DAB No. 2416 at 9 (2011).  The evidence shows, and the IG has established, that the restitution amount may be used as an aggravating factor. 

B. The acts that resulted in Petitioner’s conviction, or similar acts, were committed over a period of one year or more. 

The second aggravating factor identified by the IG is the acts that resulted in the conviction, or similar acts, were committed over a period of one year or more.  The evidence shows that Petitioner engaged in the criminal scheme from approximately July 2018 to July 2023.  Participation in this criminal act for approximately five years causes one to question Petitioner’s judgment and trustworthiness.  “[T]he purpose of this aggravating factor ‘is to distinguish between petitioners whose lapse in integrity is short-lived from those who evidence a lack of such integrity over a longer period . . . .’”  Vinod Chandrashekhar Patwardhan, M.D., DAB No. 2454 at 7 (2012) (quoting Donald A. Burstein, Ph.D., DAB No. 1865 at 8 (2003)).  Petitioner argues that this aggravating factor has not been established because he was unaware that the improper billing was occurring.  P. Br. at 5.  Petitioner also argues that duration cannot be used to imply knowledge and says that he did not “design, implement, or personally execute the billing practices at issue”.  P. Br. at 6. 

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In his plea agreement, Petitioner accepted responsibility for claims being submitted for services rendered by assistant physicians, but billed under his name from July 10, 2018 through July 2023.  IG Ex. 2 at 11.  This aggravating factor does not require that the Petitioner design, implement, or personally execute the scheme for over one year,  only that the acts be committed for over a period of one year or more.  Participating in a criminal scheme for over one year is indicative of deliberate participation and is not merely a temporary lapse in judgment.  The IG has proven the existence of a second aggravating factor which is significant and supports an enhancement to the mandatory minimum five-year exclusion. 

C. The District Court sentenced Petitioner to 35 months of incarceration

It is undisputed that the District Court sentenced Petitioner to 35 months of incarceration.  This substantial prison term reflects the seriousness of Petitioner’s offense, justifying a longer period of exclusion.  See, e.g., Gracia L. Maynard, M.D., DAB No. 2767 at 8 (2017) (quoting Raymond Lamont Shoemaker, DAB No. 2560 at 8 (2014) (petitioner’s sentence is “an unmistakable reflection of the . . . Court’s assessment of Petitioner’s untrustworthiness.”); see also Juan de Leon, Jr., DAB No. 2533 at 6 (2013) (noting that “a substantial period of incarceration would, on its own, justify the I.G. in increasing an exclusion significantly in excess” of the mandatory minimum and noting that the Board “once characterized a nine month incarceration, which included a period of work release, as relatively substantial”); Jason Hollady, M.D., DAB No. 1855 at 12 (2002) (the Board characterizing a nine-month incarceration as “relatively substantial”).  

The IG has proven the existence of a third aggravating factor.  

D. Petitioner was subject to an adverse action by a state board based on the same set of circumstances that serve as the basis of the imposition of the exclusion.

If the circumstances that serve as the basis of the exclusion also resulted in an adverse action by any Federal, State, or local government agency or board, the IG may consider that as an aggravating factor.  42 C.F.R. § 1001.102(b)(9). 

The State of Illinois Department of Financial and Professional Regulation Division of Professional Regulation indefinitely suspended Petitioner’s Illinois Physician and Surgeon licenses due to his conviction being identified as a criminal health care or insurance fraud offense.  IG Ex. 5 at 1, 2.  Illinois law requires automatic and indefinite suspension of health care workers licenses based on the conviction of certain offenses.  IG Ex.  The IG has proven the existence of this aggravating factor.  

3. Petitioner has not identified any mitigating factors which may be considered

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Petitioner argues that several mitigating factors should be considered when determining the length of the exclusion.  P. Br.at 9, 10.  Petitioner argues that he has not had any disciplinary issues in prison, which demonstrate low risk of future misconduct.  P. Br. at 7.  Petitioner lists several additional factors for consideration including that he had no personal gain, there was no patient harm, he had a lack of knowledge for more than three years, full compliance with bond and monitoring, heavy restitution burden, and experience in healthcare systems, software, and education.  P. Br. at 10.  

However, the regulations provide only three mitigating factors that may be considered to reduce an exclusion to no less than five years if aggravating factors are present:  (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 the court determined that a petitioner had a mental, physical, or emotional condition before or after the commission of the offense that reduced their culpability; and (3) a petitioner’s cooperation with federal or state officials resulted in others being convicted or excluded, additional cases being investigated, or a civil money penalty being imposed.  42 C.F.R. § 1001.102(c). 

Here, Petitioner has not identified any mitigating factors that may be considered in determining the length of his exclusion.  

4. Based on four aggravating factors and no mitigating factors, I find that the 12-year exclusion imposed by the IG is not unreasonable.  

In determining whether the length of exclusion is unreasonable, I must determine whether the length of the exclusion falls into a “reasonable range” based on the facts and circumstances of this case.  The regulations provide that the IG’s proposed exclusion must be upheld as long as the length of exclusion is not unreasonable.  42 C.F.R. § 1001.2007(a)(1)(ii).  It is important to note that it is the quality of the aggravating (or mitigating) factors that is most important when considering the length of exclusion and not the sheer number of aggravating factors that are present in a given case.  The Secretary stated in the preamble to the final rule establishing the exclusion regulations that:  

We do not intend for the aggravating and mitigating factors to have specific values; rather, these factors must be evaluated based on the circumstances of a particular case.  For example, in one case many aggravating factors may exist, but the subject’s cooperation with the OIG may be so significant that it is appropriate to give that one mitigating factor more weight than all of the aggravating.  Similarly, many mitigating factors may exist in a case, but the acts could have

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had such a significant physical impact on program beneficiaries that the existence of that one aggravating factor must be given more weight than all of the mitigating factors. The weight accorded to each mitigating and aggravating factor cannot be established according to a rigid formula, but must be determined in the context of the particular case at issue.  

57 Fed. Reg. 3298, 3314-15 (Jan. 29, 1992).  

Here, Petitioner engaged in a fraudulent billing scheme, along with his co-conspirators, that resulted in the submission of over $700,000 in fraudulent claims to Medicare and Medicaid.  IG Ex. 2 at 7.  This is a significant amount of fraud, particularly for programs designed to provide healthcare to some of this country’s most vulnerable populations. Additionally, the Board has held that “it is entirely reasonable to consider a program loss amount substantially larger than” the threshold program loss amount to be “an ‘exceptional aggravating factor’ to be accorded significant weight.”  Laura Leyva, DAB No. 2704 at 9-10 (2016).  Here, the financial loss attributed to Petitioner is over 14 times the $50,000 threshold. 

It is very concerning that Petitioner willingly participated in the fraudulent scheme for approximately five years.  This calls into question Petitioner’s integrity and trustworthiness.  The amount of fraud, the length of participation in the fraudulent scheme, and the considerable length of incarceration are significant aggravating factors which justify an exclusion substantially longer than the mandatory minimum.  

Without authority, Petitioner argues that if he was a danger to patient or healthcare programs, then the District Court would have imposed clinical restrictions.  P. Br. at 7.  However, criminal sentencing and administrative exclusions have very different objectives.  “The goals of criminal law generally involve punishment and rehabilitation of the offender, possibly deterrence of future misconduct by the same or other persons, and various public policy goals,” whereas “[e]xclusions imposed by the [IG] . . . are civil sanctions, designed to protect the beneficiaries of health care programs and the federal fisc, and are thus remedial in nature rather than primarily punitive or deterrent.”  Henry L. Gupton, DAB No. 2058 at 7 (2007), aff’d, Henry L. Gupton v. Leavitt, 575 F. Supp. 2d 874 (E.D. Ill. 2008)); see also Gracia L. Mayard, DAB No. 2767 at 9 (2017) (noting that “criminal justice policy is irrelevant” in the exclusion context).  Petitioner states, “the sentencing court’s conditions reflect an assessment that Petitioner’s future risk, if any is financial in nature…”. P. Br. at 7.  However, financial risk is impactful when considering the need to protect federal healthcare programs from fraud and abuse. 

Here, the Petitioner received a significant 35-month prison sentence, the financial loss attributed to the scheme was over 14 times the $50,000 threshold, Petitioner participated

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in the scheme for several years, and Petitioner’s physician and surgeon licenses were indefinitely suspended by the State of Illinois.  The facts and circumstances surrounding this case warrant an increased exclusion period. 

Petitioner argues that he should be considered for a permissive exclusion under section 1128(b) of the Act and not a mandatory exclusion.  However, the Board has observed, and federal courts have “repeatedly held” that, when an offense falls under the mandatory exclusion statute, the I.G. is required to impose a mandatory exclusion even if an individual’s conduct also falls within the scope of the permissive exclusion provisions. Darling Navidad Oki, DAB No. 3176 (2025).  In his reply brief, Petitioner discusses the vulnerable populations that he served in his 27 years as a doctor and how imposing an exclusion would deprive these  populations of an experienced physician that is willing to serve them.  P. Reply Br. at 9.  Petitioner encourages me to ponder whether “any exclusion is warranted to protect Medicare and Medicaid beneficiaries from future risk posed by this individual.”  P. Reply Br. at 10.  The answer is yes.  Petitioner seemingly fails to recognize that he willingly defrauded government programs designed to aid the vulnerable populations that he once served.  The purpose of an exclusion is to protect federal health care programs and the beneficiaries that they serve from untrustworthy individuals.  Hamilton, DAB No. 3061 at 14.  Defrauding a public health program out of several hundreds of thousands of dollars comes with consequences and exclusion is one of them. 

I find that a 12-year exclusion is not unreasonable based on the facts and circumstances of this case.  

VIII. Conclusion

For the foregoing reasons, I find that the IG has proven, by a preponderance of the evidence, that Petitioner was convicted of an offense that requires exclusion under section 1128(a)(1) of the Act.  Based on four aggravating factors and no mitigating factors, I find that a 12-year exclusion is not unreasonable.