Miguel Angel Saravia, DAB CR6892 (2026)

DECISION

Respondent, the Inspector General for the United States Department of Health and Human Services (the IG), excluded Petitioner, Miguel Angel Saravia, from participation in Medicare, Medicaid, and all other federal health care programs for 10 years based on his conviction for a criminal offense related to the delivery of an item or service under a state health care program.  Petitioner challenges his exclusion.  As explained below, I affirm the IG’s exclusion action. 

I. Procedural History

On July 31, 2025, the IG notified Petitioner of his exclusion from participation in Medicare, Medicaid, and all other federal health programs under sections 1128(a)(1) and (a)(3) of the Social Security Act for at least 10 years.  IG Ex. 1 at 1; 42 U.S.C. § 1320a-7(a)(1), (a)(3).  The IG explained he took this action based on Petitioner’s conviction in the U.S. District Court for the District of Massachusetts (District Court) for a criminal offense that:  (1) related to the delivery of an item or service under the Medicare or a state health care program, including the performance of management or administrative services relating to the delivery of items or services under any such program; and (2) 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, or with 

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respect to any act or omission in a health care program (other than Medicare and a state health care program) operated by, or financed in whole or in part, by any federal, state or local government agency.  Id. at 1. 

Petitioner timely sought review by an administrative law judge (ALJ) in the Civil Remedies Division, resulting in my designation to hear and decide this case.  I held a pre-hearing conference by telephone with the parties on November 19, 2025, the substance of which is summarized in my November 20, 2025 Order Summarizing Pre-hearing Conference and Setting Briefing Schedule (Summary Order).  See 42 C.F.R. § 1005.6.  I directed the parties to file pre-hearing briefs and identify witnesses and exhibits in support of their arguments.  Summary Order at 6-7. 

On December 11, 2025, the IG issued an amended notice of exclusion to Petitioner informing him his 10-year exclusion period no longer arose under section 1128(a)(3) of the Act but solely under section 1128(a)(1).  IG Ex. 2.  The IG filed a brief (IG Br.) and six proposed exhibits (IG Exs. 1-6) shortly thereafter.  Petitioner filed a short-form brief (P. Br.) and two proposed exhibits (P. Exs. 1-2). 

II. Admission of Exhibits and Decision on the Record

Neither party objected to the opposing party’s proposed exhibits.  I therefore enter IG Exhibits 1 through 6 and Petitioner Exhibits 1 and 2 into the record. 

Neither party believes a hearing is necessary in this matter.  IG Br. at 7; P. Br. at 6. Accordingly, I decide this case on the briefs submitted and the exhibits of record.  Summary Order at 7; Civ. Remedies Div. P. §  9(d).  

III.  Issues

Whether the IG had a basis to exclude Petitioner from participating in Medicare, Medicaid, and all other federal health care programs under 42 U.S.C. § 1320a-7(a)(1).  See 42 C.F.R. § 1001.2007(a)(1)(i). 

If so, whether the 10-year exclusion period selected by the IG is reasonable.  42 C.F.R. § 1001.2007(a)(1)(ii). 

IV. Jurisdiction

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

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V. Applicable Law

The Secretary of Health and Human Services1 must exclude from participation in Medicare, Medicaid, and all other federal health care programs “[a]ny individual or entity that has been convicted of a criminal offense related to the delivery of an item or service under title XVIII or under any State health care program.”  42 U.S.C. § 1320a-7(a)(1); 42 C.F.R. § 1001.101(a). 

The Act considers an individual “convicted” of a criminal offense when:  (1) a judgment of conviction has been entered against him or her in a federal, state, or local court whether an appeal is pending or the record of the conviction is expunged; (2) there is a finding of guilt by a court; (3) a plea of guilty or no contest is accepted by a court; or (4) the individual has entered into any arrangement or program where judgment of conviction is withheld.  42 U.S.C. § 1320a-7(i).  The Act does not distinguish between misdemeanor and felony convictions.  There may be no collateral attack of the conviction that provides the basis of the exclusion.  42 C.F.R. § 1001.2007(d). 

The Act requires a minimum exclusion period of five years for individuals excluded under section 1128(a) of the Act.  42 U.S.C. § 1320a-7(c)(3)(B); 42 C.F.R. § 1001.102(a).  Exclusion is effective 20 days from the date of the notice of exclusion.  42 C.F.R. § 1001.2002(b).  The IG may extend the period of exclusion based on the presence of specified aggravating factors.  42 C.F.R. § 1001.102(b).  If the IG applies aggravating factors to extend an exclusion period beyond five years, the regulations identify specific mitigating factors he must consider to reduce the period of exclusion.  42 C.F.R. § 1001.102(c). 

Section 1128(f) of the Act provides Petitioner with rights to an administrative hearing and judicial review of the final action of the Secretary.  42 U.S.C. § 1320a-7(f)(1), incorporating by reference 42 U.S.C. § 405(b)(1), (g).  The Secretary’s regulations implement the right to a hearing before an ALJ at 42 C.F.R. §§ 1001.2007(a) and 1005.2.  The rights of both the sanctioned party and the IG to participate in a hearing are set forth at 42 C.F.R. § 1005.3.  The standard of proof is a preponderance of the evidence.  42 C.F.R. § 1001.2007(c).  Petitioner bears the burden of proof and the burden of persuasion as to affirmative defenses or mitigating factors, while the IG bears the burden on all other issues.  42 C.F.R. §§ 1001.2007(c), 1005.15(b), (c). 

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VI. Findings of Fact, Conclusions of Law, and Analysis

My conclusions of law are set forth in bold and followed by pertinent findings of fact and analysis. 

1. A. Relevant Facts

Petitioner was Chief Executive Officer of Dana Group Associates, a behavioral health practice that provided mental health care clinicians on a contract basis to Nova Psychiatric Services, a provider of psychiatric and behavioral health services to patients in nursing homes, for whom Petitioner also acted as Chief Operating Officer.  IG Ex. 5 at 1-2.  On September 9, 2024, Petitioner executed an agreement with the government to plead guilty to six counts specified in an information the government would file.  IG Ex. 3.  Petitioner admitted he “committed the crimes specified in these counts and is in fact guilty.”  Id. at 1.  

On September 10, 2024, the Acting U.S. Attorney for the District of Massachusetts charged Petitioner by information with six felony counts of Health Care Fraud in violation of 18 U.S.C. § 1347.  IG Ex. 5 at 9-10.  The government asserted that from approximately January 2017 to April 2022, Petitioner orchestrated a scheme to defraud health care benefit programs by submitting false billing claims for patient visits.  Id. at 6. 

The government set forth specific instances involving six patients where Petitioner directed other individuals, referred to as “billers,” to submit improper claims for psychotherapy services.  Id. at 6-9.  In four instances where a clinician saw a patient but provided only medication management services, Petitioner directed billers to submit claims for “add-on” psychotherapy the clinician did not provide.  Id. at 6-8.  In one instance where the clinician provided 45 minutes of psychotherapy, Petitioner directed billers to submit a claim for a 90-minute psychotherapy session.  Id. at 8-9.  In the last instance, Petitioner directed billers to submit a claim for 45 minutes of psychotherapy where the clinician did not see the patient at all.  Id. at 7. 

The District Court accepted Petitioner’s guilty plea and entered judgment against him on May 2, 2025.  IG Ex. 4 at 1.  The Court imposed a sentence of 14 weeks’ incarceration.  Id. at 2.  It also ordered Petitioner to repay $561,141.89 in restitution, $332,381.81 of which would be paid to the Medicare program.  Id. at 5, 12.  

1. B. The IG has established a basis to exclude Petitioner pursuant to section 1128(a)(1) of the Act.

Section 1128(a)(1) of the Act mandates exclusion from participation in Medicare, Medicaid, and all other federal health care programs where an individual has been convicted, under federal or state law, of a criminal offense related to the delivery of an 

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item or service under Medicare or any state health care program.  42 U.S.C. § 1320a-7(a)(1); 42 C.F.R. § 1001.101(a).  The IG has established these elements by a preponderance of the evidence. 

1. 1. Petitioner was convicted of a criminal offense within the meaning of section 1128(a)(1) of the Act.

Petitioner concedes his conviction of a criminal offense.  P. Br. at 1.  The IG has established this element necessary for exclusion under section 1128(a)(1) of the Act. 

2. 2. Petitioner’s criminal offense related to the delivery of an item or service under Medicare or a state health care program within the meaning of section 1128(a)(1) of the Act.

Petitioner concedes his offense of conviction related to the delivery of an item or service under Medicare or a state health care program.  P. Br. at 2.  The IG has established this necessary element for exclusion under section 1128(a)(1) of the Act. 

1. C. Petitioner must be excluded for a minimum period of five years.

Because I have concluded a basis exists to exclude Petitioner under 42 U.S.C. § 1320a-7(a)(1), he must be excluded for a minimum period of five years.  42 U.S.C. § 1320a-7(c)(3)(B); 42 C.F.R. §§ 1001.102(a), 1001.2007(a)(2). 

1. D. The IG has established three aggravating factors to support increasing Petitioner’s exclusion period beyond the five-year statutory minimum.

The regulations establish aggravating factors the IG may consider to increase the exclusion period beyond five years.  42 C.F.R. § 1001.102(b).  In this case, the IG identified three aggravating factors to justify excluding Petitioner for at least 10 years:  his criminal offense resulted in a loss to a government agency or other entities of at least $50,000; his criminal acts took place over a period of one year or more; and the sentence he received included incarceration.  IG Ex. 1 at 1-2; 42 C.F.R. § 1001.102(b)(1), (2), (5).  Petitioner concedes the IG correctly identified these aggravating factors as a basis to increase his period of exclusion beyond five years.  P. Br. at 2.  The IG has established a valid basis to increase Petitioner’s period of exclusion.  

1. E. Petitioner has not established a mitigating factor recognized by the Secretary’s regulations.

The IG did not recognize a mitigating factor in this case.  IG Br. at 5.  Petitioner argues his cooperation with the government warrants consideration as a mitigating factor.  P. Br. at 3-5.  He cites his active cooperation with the government’s investigation against him.  

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Petitioner explains he analyzed Nova’s billing practices to generate summaries that described the fraud scheme perpetrated by that entity.  Id. at 3.  He asserts Nova’s fraud predated his involvement and his belief he was hired to work there because he had no expertise in medical billing, presumably to allow the true fraudsters to continue their scheme.  Id. at 4.  However, Petitioner concedes the federal prosecutor assigned to his case declined to characterize his efforts as formal cooperation with the government.  Id. at 5.  He also concedes the government did not pursue criminal cases against other individuals and entities referenced in the scheme described in the information against him.  Id. 

Petitioner’s assertions cannot establish a mitigating factor under the regulations.  To establish cooperation as mitigating factor, Petitioner must demonstrate his cooperation with the government resulted in the conviction or exclusion of other individuals, the investigation of other cases, the issuance of reports to identify program vulnerabilities, or the imposition of a civil money penalty or assessment against others.  42 C.F.R. § 1001.102(c)(3).  By Petitioner’s own admission, the government declined to even characterize his actions as cooperation.  P. Br. at 5.  And even if I were to accept his characterization, Petitioner has otherwise failed to identify others subject to conviction, investigation, exclusion, or other penalties because of his cooperation.  Nor has he alleged his efforts resulted in the generation of reports to identify program vulnerabilities.  In fact, Petitioner’s description of the acts he took after the government began investigating him serves chiefly to minimize his role in the fraud scheme, not to establish cooperation within the meaning of the regulations.  See id. at 3-5.  The IG correctly declined to find a mitigating factor applicable here. 

1. F. A 10-year exclusion period is not unreasonable.

Under the Act’s implementing regulations, an excluded individual may seek a hearing before an ALJ to determine whether the length of an exclusion period increased by the IG beyond five years is “unreasonable.”  42 C.F.R. § 1001.2007(a)(1)(ii).  The drafters of this regulation explained:  

• [s]o long as the amount of time chosen by the OIG is within a reasonable range, based on demonstrated criteria, the ALJ has no authority to change it under this rule.  We believe that the deference § 1001.2007(a)(2) grants to the OIG is appropriate, given the OIG’s vast experience in implementing exclusions under these authorities. 

57 Fed. Reg. 3298, 3321 (Jan. 29, 1992).  

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The Board similarly stated ALJs may not substitute their own judgment for that of the IG in determining a reasonable exclusion period.  Richard E. Bohner, DAB No. 2638 at 2 (2015) (citations omitted), aff’d, Bohner v. Burwell, No. 15-cv-4088, 2016 WL 8716339 (E.D. Pa. Dec. 2, 2016).  The Board reasoned it appropriate to defer to the IG’s selection owing to his extensive experience in exclusion and because exclusion actions are, according to the Board, remedial and non-punitive in nature.  Id. at 9.  ALJs should therefore only review “whether the facts as proven show the resulting period to be not unreasonable.”  Edwin L. Fuentes, DAB No. 2988 at 9 (2020); see also Craig Richard Wilder, DAB No. 2416 at 8 (2011). 

To do so, I consider both aggravating and mitigating factors, if any.  42 C.F.R. § 1001.102(b), (c).  The quality of the aggravating or mitigating factors is of greater significance than the mere number of the factors present in a given case.  The preamble to the final rule publishing the exclusion regulations provides:  

• 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 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.  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. at 3314-15. 

In assessing the IG’s qualitative application of aggravating and mitigating factors, I may not consider how the IG weighed those factors in other exclusion actions.  Eugene Goldman, M.D., DAB No. 2635 at 11 (2015) (characterizing the selection of an exclusion period to be so uniquely case-specific that even comparing the IG’s selection in other similarly situated cases is “of limited value” and “not dispositive on the question of reasonableness of an exclusion period in a given case.”).  The IG has no obligation to articulate his reasoning for the period of exclusion he does select.  The Board has instead held ALJs may not “intrude on the [IG’s] internal decision-making process” in selecting a proposed exclusion period.  Fuentes, DAB No. 2988 at 10-11. 

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In sum, the Act’s implementing regulations permit an excluded individual to challenge whether the IG’s selection of an exclusion period beyond five years is unreasonable.  42 C.F.R. § 1001.2007(a)(1)(ii).  But the IG need not articulate the method, if any, by which he selected the prolonged period.  He need not explain the weight he gave to aggravating or mitigating factors to increase or reduce the prolonged period.  Nor may I consider similar exclusion actions to assess comparative reasonableness.  I must instead defer to the IG’s “vast experience” in excluding individuals.  57 Fed. Reg. at 3321. 

It is difficult to imagine a circumstance where, if the IG correctly identifies applicable aggravating and mitigating factors, any ALJ could find any exclusion period selected by the IG anything but “not unreasonable.”2  Constraining an impartial adjudicator’s review to this degree is arguably inconsistent with the Act, which affords excluded individuals the right to a determination that articulates the reasons for an adverse outcome.  42 U.S.C. § 1320a-7(f)(1), incorporating by reference 42 U.S.C. § 405(b)(1) (requiring any wholly or partially unfavorable determination include “the reason or reasons upon which it is based.”).  This cramped reading of what evidence or explanation the IG must provide to justify a prolonged exclusion period before me may vitiate the right to impartial adjudication Congress intends ALJs to provide under the auspices of the Administrative Procedures Act. 

As such, it is possible a reviewing court could find a regulatory regime that allows the IG essentially unfettered authority to extend periods of exclusion without meaningful explanation arbitrary and capricious, either on its face or in application.  Until that time, however, I apply the regulations and applicable Board decisions to determine whether the period of exclusion selected by the IG is unreasonable.  Doing so, I am unable to find the 10-year period of exclusion selected by the IG here unreasonable. 
Petitioner’s criminal conduct resulted in significant loss to various health insurance programs – over $500,000 – and over $300,000 to the Medicare program alone.  IG Ex. 4 at 5, 12.  Petitioner orchestrated and participated in a fraud scheme that caused a loss to the Medicare program approximately 11 times the regulatory minimum of $50,000 in program loss to be considered an aggravating factor.  42 C.F.R. § 1001.102(b)(1); Laura Leyva, DAB No. 2704 at 9-10 (2016) (citations omitted) (observing it “entirely reasonable” to give significant weight to loss amounts substantially larger than the minimum regulatory threshold).  The IG reasonably assessed Petitioner’s untrustworthiness to participate in federal health care programs in light of the loss he 

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caused and his critical role in the scheme as a chief management official for both Dana Group and Nova Psychiatric Services.  IG Ex. 5 at 1-2. 

The duration of Petitioner’s criminal offense conduct fails to suggest the IG’s selection of a 10-year exclusion period to be unreasonable.  Petitioner orchestrated a scheme to intentionally defraud the Medicare program for over five years.  Id. at 6.  The persistence of his conduct reflects a sustained lack of integrity rather than a momentary lapse of judgment.  Donald A. Burstein, Ph.D., DAB No. 1865 at 8 (2003) (“The purpose of the aggravating factor is to distinguish . . . petitioners whose lapse in integrity is short-lived from those who evidence a lack of such integrity over a longer period . . . .”).  The IG properly weighed this aggravating factor in determining Petitioner’s period of exclusion.  

The seriousness of Petitioner’s offense is reflected by the District Court’s determination to subject Petitioner to 14 weeks’ incarceration.  IG Ex. 4 at 1.  A sentence of incarceration is a “reasonable proxy . . . for untrustworthiness in the context of deciding how much weight to give the aggravating factor for incarceration.”  Goldman, DAB No. 2635 at 5.  Petitioner correctly observes the District Court imposed a sentence well below the guidelines range for his criminal offense to suggest the IG unreasonably weighed the significant of his incarceration.  P. Br. at 7-8. 

It is true that a 14-week sentence of incarceration on its face does not suggest a serious offense.  But the opposite inference can be drawn from the fact that despite the white-collar nature of his offense and generally favorable impression he made in the sentencing phase, the District Court still opted to impose a sentence of incarceration.  Petitioner points out the Court opined that Petitioner required little in the way of specific deterrence and was unlikely to recidivate.  P. Br. at 7; IG Ex. 6 at 12.  But as the IG noted, the Court also observed “[t]here needs to be a punishment for people that do what you did . . . I’m also very confident that at some point you understood that what you were doing wasn’t right and you kept doing it anyway. . . .  I just can’t ignore the magnitude of the crime or the length of the time that it went.”  IG Br. at 6-7 (quoting IG Ex. 6 at 23).  

In this context, the imposition of even a relatively short period of incarceration reflects its significance as an aggravating factor.  See Roji Esha, DAB No. 3076 at 26 (2022) (“[W]hile the [90-day] term of incarceration in [p]etitioner’s sentence was relatively short, the fact that her sentence included a term of incarceration alone serves as evidence of additional untrustworthiness . . . .”); Jason Hollady, M.D., DAB No. 1855 at 8 (2002) (characterizing a sentence of nine months as “relatively substantial”).  The IG did not unreasonably consider the sentencing court’s imposition of a relatively short sentence of incarceration to nevertheless reflect a level of untrustworthiness that warranted excluding Petitioner for an extended period.  

Petitioner orchestrated a scheme to submit false and fraudulent bills to numerous health insurers, including this nation’s safety net insurance program for the elderly and disabled.  

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He did so for over five years.  He helped cause over a half-million dollars in losses to those programs.  He did not stop because of a change in heart; he stopped because he was caught.  His characterization before me of his efforts to “cooperate” is a self-serving attempt to minimize his role in the fraud scheme which does not suggest he has learned the error of his ways.  See P. Br. at 3-5.  Under these circumstances, I cannot say excluding Petitioner from participation in Medicare, Medicaid, and all other federal health care programs for 10 years is unreasonable. 

VII.  Conclusion

For the foregoing reasons, I conclude the IG had a basis to exclude Petitioner from participation in Medicare, Medicaid, and all federal health care programs pursuant to section 1128(a)(1).  I cannot find the IG’s selection of a 10-year minimum period of exclusion unreasonable.