Miguel Caldera, DAB, CR6886 (2026)

DECISION

Petitioner, Miguel Caldera, was a registered nurse, licensed in the State of Florida.  The Florida Board of Nursing revoked his license because it determined that, when he applied for it, he had misrepresented his academic credentials.  Because his license was revoked, the Inspector General (IG) has excluded him from participating in Medicare, Medicaid, and all other federal health care programs pursuant to section 1128(b)(4) of the Social Security Act (Act).  The exclusion remains in effect until he is reinstated.  To be eligible for reinstatement, he must regain his Florida nursing license, obtain another healthcare license, or have been excluded for a minimum period of three years. 

Petitioner now appeals the exclusion. 

For the reasons set forth below, I find that the Florida Board of Nursing revoked Petitioner Caldera’s license to provide health care as a registered nurse for reasons bearing on his professional competence.  The IG therefore is authorized to exclude him from program participation, and I may not disturb the IG’s exercise of that authority. 

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Background

In a letter dated July 31, 2025, the IG notified Petitioner Caldera that he was excluded from participation in Medicare, Medicaid, and all other federal health care programs because his license to provide health care as a registered nurse in the State of Florida was revoked, suspended, or otherwise lost, or surrendered while a formal disciplinary proceeding was pending, for reasons bearing on his professional competence, professional performance, or financial integrity.  The letter explained that section 1128(b)(4) authorizes the exclusion.  The letter also explained that the exclusion would remain in effect until he is reinstated by the IG.  To be eligible for reinstatement, he had to regain his Florida nursing license.  In the alternative, the letter explained, the IG would consider early reinstatement if he obtained a health care license in any state or after he had been excluded for a minimum of three years.  IG Ex. 1. 

Petitioner requested review. 

Prehearing conference and order.  During a September 16, 2025 prehearing conference, IG counsel suggested that, notwithstanding the loss of his Florida license, Petitioner might qualify for early reinstatement. 

Petitioner is a licensed practical nurse in the State of California, and, if the California Licensing Board does not pursue a disciplinary action against him, he may be eligible for reinstatement based on his California license.  In an order, dated September 16, 2025, I granted the parties a significant extension of time in which to explore the possibility of resolving the matter through the early reinstatement process.  Order Memorializing the Prehearing Conference (E-file # 4); see IG Ex. 4. 

The parties did not resolve the matter, and, on November 13, 2025, I issued an order directing them to submit briefs and documentary evidence.  Order Setting the Schedule for Filing Briefs and Documentary Evidence (E-file # 6).  Pursuant to my order, on March 18, 2026, the IG submitted his prehearing exchange – a written brief (IG Br.) and four exhibits (IG Exs. 1-4). 

Petitioner’s submissions were due on April 17, 2026.  He did not submit a prehearing exchange nor request an extension of time.  Nevertheless, he has not indicated that he has abandoned his appeal.  I therefore decide this case based on the record before me. 

Because neither party proposes any witnesses, an in-person hearing would serve no purpose.  I therefore close the record and issue this decision based on the parties’ written submissions.  See Anil Hanuman, D.O., DAB No. 3080 at 11-12 (2022); Emery Cnty. Care & Rehab. Ctr., DAB No. 3006 at 5-8 (2020); James Brian Joyner, M.D., DAB No. 2902 at 12 (2018); CRDP ¶ 16(b). 

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

Discussion

Because Petitioner Caldera’s license to practice as a registered nurse in Florida was revoked for reasons bearing on his professional competence, the IG may exclude him from participating in Medicare, Medicaid, and all other federally funded health care programs.1

The Act authorizes the Secretary of Health and Human Services to exclude from program participation an individual whose license to provide health care has been revoked or suspended for reasons bearing on his “professional competence, professional performance, or financial integrity.”  Act § 1128(b)(4) (codified at 42 U.S.C. § 1320a-7(b)(4)); accord 42 C.F.R. § 1001.501(a)(1).  The exclusion “will not be for a period of time less than the period during which an individual’s . . . license is revoked . . . as a result of . . . a State licensing agency action.”  42 C.F.R. § 1001.501(b)(1) (authorized by Act § 1128(c)(3)(E)).  Under certain circumstances, the IG may lengthen the period of exclusion.  42 C.F.R. § 1001.501(b)(2).  

Here, in an administrative complaint, the Florida Department of Health charged that: 

• On or about October 27, Petitioner Caldera submitted, to the Florida Board of Nursing, an application for licensure as a registered nurse;
• On the application, Petitioner indicated that he attended and graduated from Siena College of Health, an approved nursing school;
• Petitioner did not complete the requirements for graduation from Siena College of Health;
• Petitioner “knowingly misrepresented his educational history” by submitting to the nursing board an application with false information; and
• On or about September 15, 2022, Petitioner obtained a license to practice nursing in the State of Florida by “knowingly misrepresenting his educational credentials.”

IG Ex. 2 at 5.  

In a final order, dated January 10, 2025, the Florida Nursing Board “approved, adopted, and incorporated the complaint’s allegations.  Based on those findings, the Nursing Board

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concluded that Petitioner violated section 464.018(1)(a) of the Florida statutes by “procuring, attempting to procure, or renewing a license to practice nursing or the authority to practice professional nursing by bribery, by knowing misrepresentations, or through an error of the department or board.”  IG Ex. 2 at 2. 

The Board also found that Petitioner violated section 456.072(l)(m) of the Florida statutes by “making deceptive, untrue, or fraudulent representations in or related to the practice of a profession or by employing a trick or scheme in or related to the profession.”  Id. 

Based on these findings, the Board revoked Petitioner’s license to practice as a registered nurse.  Id. 

Contrary to the findings of the Florida Nursing Board, Petitioner claims:  that he did not know that the educational program he enrolled in “was not authorized to provide hybrid instruction”; that he did not know that the school was engaging in fraudulent activity, including the sale of fraudulent diplomas; and that his “sole intent” was to further his education and “complete the RN program in good faith.”  Hearing Request (E-file # 1). 

The regulations preclude such a collateral attack on an underlying determination: 

When the exclusion is based on the existence of a . . . determination by another government agency, or any other prior determination where the facts were adjudicated and a final decision was made, the basis for the underlying . . . determination is not reviewable, and the individual or entity may not collaterally attack it[,] either on substantive or procedural grounds[,] in this appeal. 

42 C.F.R. § 1001.2007(d); Delores L. Knight, DAB No. 2945 at 9 (2019); Marvin L. Gibbs, Jr., M.D., DAB No. 2279 at 8-10 (2009); Roy Cosby Stark, DAB No. 1746 (2000).2 

Petitioner’s license was thus revoked because he knowingly misrepresented his credentials, and he did not have the education required to qualify as a registered nurse.  These factors bear directly on his professional competence. 

Having concluded that Petitioner’s license was revoked for reasons bearing on his professional competence and performance, I have no discretion; I must follow the federal exclusion statute and regulations and sustain the exclusion.  42 C.F.R. § 1005.4(c)(5);

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Richard R. Jimenez, DAB No. 2986 at 5-6 (2020); Chirsty Nichols Frugia, DAB No. 2736 at 4-5 (2016); see Marvin L. Gibbs, Jr., M.D., DAB No. 2279 at 8-10 (2009). 

The statute requires that Petitioner Caldera’s period of exclusion “shall not be less than the period during which [his] license. . . is . . . revoked . . . .”  Act § 1128(c)(3)(E); see also 42 C.F.R. § 1001.501(b)(1).  Although the regulations give the IG some discretion to reinstate under other conditions (if he obtains a health care license in another state or has been excluded for three years), I have no authority to review the IG’s exercise of that discretion. 

Conclusion

For the above reasons, I conclude that the IG properly excluded Petitioner Caldera from participating in Medicare, Medicaid, and all other federal health care programs for so long as his license to practice as a registered nurse is revoked.