Giang Din Nguyen, DAB CR6904 (2026)

Petitioner, Giang Din Nguyen, is a nurse practitioner, licensed to practice in Illinois.  In 2020, she pleaded guilty, in a Kentucky criminal court, to Theft by Deception – a felony – and possession of a forged instrument – a misdemeanor.  When she subsequently applied to enroll in the Medicare program, she twice did not disclose the convictions.  Based on her felony conviction, as well as her failing to disclose her adverse legal history, the Centers for Medicare and Medicaid Services (CMS) has denied her enrollment application, imposed a ten-year reapplication bar, and has placed her on the Medicare “preclusion list.” 

Petitioner now challenges these actions. 

I find that CMS is authorized to deny Petitioner Nguyen’s Medicare enrollment application and to place her on the preclusion list because:  1) within the ten years preceding her filing the application, she was convicted of a felony that CMS reasonably determined is detrimental to the best interests of the Medicare program and its beneficiaries; and 2) notwithstanding her criminal convictions, on her Medicare applications, she falsely denied any adverse legal history.  42 C.F.R. §§ 424.530(a)(3). 

I also find that Petitioner’s felony conviction justified including her on CMS’s preclusion list.

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Background

The initial determinations.  On July 3, 2024, Petitioner Nguyen filed a Medicare enrollment application.  By letter dated July 23, 2024, the Medicare contractor, National Government Services, denied the application.  CMS Ex. 3.  The contractor based its denial on: 

• 42 C.F.R. § 424.530(a)(3) because, on January 26, 2021, Petitioner was convicted of Theft by Deception, a felony, in violation of Kentucky Revised Statute § 514.040, and Criminal Possession of a Forged Instrument, in violation of Kentucky Revised Statute § 56.060.  The letter explained that CMS determined that Petitioner’s felony conviction is detrimental to the best interests of the Medicare program and its beneficiaries; and
• 42 C.F.R. § 424.530(a)(4) because, in responding to a direct question on her Medicare enrollment applications, she denied any adverse legal history. 

The letter further advised Petitioner that, pursuant to 42 C.F.R. §§ 422.2, 422.222, 423.100, and 423.120(c)(6), she would be placed on the CMS preclusion list because she engaged in behavior for which CMS could have revoked her enrollment, had she been enrolled in the Medicare program.  CMS also determined that her conduct was detrimental to the best interests of the Medicare program.  It explained that, had she been enrolled in the Medicare program, CMS would have imposed a 10-year reenrollment bar.  She would therefore remain on the preclusion list for that length of time.  CMS Ex. 3 at 1-2. 

Petitioner apparently did not receive the notice letter and, on August 14, 2024, filed a new application.  CMS Ex. 4.1  In that application, she again did not disclose her criminal convictions. 

In error, the Medicare contractor initially sent Petitioner a notice, dated September 27, 2024, advising her that it approved her enrollment.  CMS Ex. 5.  When it recognized its mistake, the contractor subsequently reopened and revised its initial determination pursuant to 42 C.F.R. § 498.30 (authorizing reopening within 12 months after the date of

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the notice of the initial determination), and § 498.32 (directing CMS to give notice of the reopening and revised determination). 

In a second notice letter, dated November 8, 2024, the contractor again denied Petitioner Nguyen’s application based on 42 C.F.R. § 424.530(a)(3), citing her criminal convictions.  The contractor also denied her application based on 42 C.F.R. § 424.530(a)(4) because she had twice denied any adverse legal history – on both her July 3 and August 14, 2024 applications.  CMS Ex. 3. 

The letter further advised Petitioner that she was being added to CMS’s preclusion list because she engaged in behavior for which CMS could have revoked her enrollment, had she been enrolled in the Medicare program.  CMS again advised her that it had determined that her conduct is detrimental to the best interests of the Medicare program and that, had she been enrolled in the Medicare program, CMS would have imposed a 10-year reenrollment bar; she would therefore remain on the preclusion list for that length of time.  CMS Ex. 6 at 2. 

The reconsideration.  Petitioner requested reconsideration.  CMS Ex. 7.  In a reconsidered determination, dated December 16, 2025, a CMS hearing officer upheld the enrollment denial and the ten-year reapplication bar, citing both 42 C.F.R. §§ 424.530(a)(3) and 424.530(a)(4).  The hearing officer concluded that:  1) on December 8, 2020, Petitioner was convicted of a felony offense detrimental to the Medicare program and its beneficiaries; and 2) she provided false or misleading information in order to enroll in the Medicare program.  The hearing officer also determined that Petitioner’s conduct formed an appropriate basis for placing her on  CMS’s preclusion list for ten years.  CMS Ex. 8 at 9. 

Petitioner appealed. 

Decision based on the written record.  CMS moves for summary judgment, which Petitioner opposes. 

My initial order instructs the parties to list any proposed witnesses and to submit their written direct testimony.  Acknowledgment and Prehearing Order at 4, 5 (¶¶ 4(c)(iv), 8); see CRD Procedures ¶ 16b.  The order also directs the parties to indicate which, if any, of the opposing side’s witnesses the party wishes to cross-examine and explains that an in-person hearing is needed only if a party wishes to cross-examine the opposing side’s witnesses.  Order at 5, 6 (¶¶ 9, 10).  CMS lists no witnesses.  Petitioner lists one witness, herself, and provides a written declaration.  P. Ex. 1.  CMS, however, has not asked to cross-examine her.  Because there are no witnesses to be further examined or cross-examined, an in-person hearing would serve no purpose, and I may decide this case based

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on the written record.  See El Medical, Inc., DAB No. 3117 at 15 (2023); CRD Procedures ¶ 19b.2 

Exhibits

CMS has submitted its motion and brief (CMS Br.), along with ten exhibits (CMS Exs. 1-10).  Petitioner has submitted her own brief (P. Br.) with twelve exhibits (P. Exs. 1-12).  In the absence of any objections, I admit into evidence CMS Exs. 1-10 and P. Exs. 1-12. 

Discussion

The Medicare Program.  The Medicare program, Title XVIII of the Social Security Act (Act), is a federally-subsidized insurance program that provides health care benefits to the elderly, disabled, and those suffering from end stage renal disease.  Medicare is divided into four parts:

• Part A is the hospital insurance program.  It covers hospital services, post-hospital extended care, home health, and hospice care.  Act § 1811 (42 U.S.C. § 1395c);
• Part B, which is voluntary, is the supplementary medical insurance program, covering physician, home health,3 hospice, and other services.  Act § 1831 (42 U.S.C. § 1395j);
• Part C is the Medicare Advantage program, which allows its participants to enroll in “Medicare + Choice” plans, managed by organizations, such as health maintenance organizations, that receive a fixed payment for each enrollee.  Act § 1851 (42 U.S.C. § 1395w-21); and
• Part D is the voluntary prescription drug benefit program.  Act § 1860D (42 U.S.C. § 1395w-101). 

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The Medicare program is administered by CMS, acting on behalf of the Secretary of Health and Human Services.  CMS contracts with Medicare administrative contractors, who process and pay reimbursement claims and perform other duties necessary to carry out program purposes.  Act § 1842 (42 U.S.C. § 1395u).  Contractors pay claims to “providers” (Part A) and “suppliers” (Part B). 

Practitioners, such as Petitioner, who furnish healthcare services, may participate in the program as “suppliers” of services; however, they must enroll in the program in order to receive Medicare payments.  Act §§ 1861(d) (42 U.S.C. §§ 1395x(d)); 42 C.F.R. §§ 400.202; 424.505.  If an enrollment application is denied, it means that the supplier is “ineligible to receive Medicare billing privileges for Medicare covered items or services provided to Medicare beneficiaries.”  42 C.F.R. § 424.502; Anthony Del Piano, M.D., DAB No. 3096 at 2 (2023). 

CMS may deny a Medicare enrollment application for any of the reasons listed in 42 C.F.R. § 424.530(a). 

The ALJ’s authority.  The Departmental Appeals Board has consistently held that an administrative law judge’s review of CMS’s enrollment determinations is limited to deciding whether CMS has established one or more of the grounds specified in section 424.530(a).  So long as one regulatory basis for denying a supplier’s Medicare enrollment application exists, I must uphold the denial.  Robert Tomlinson, M.D., DAB No. 2916 at 5 (2018), aff’d sub. nom. Tomlinson v. Azar, No. 19-cv-05114, 2020 WL 376657 (W.D. Ark. Jan. 23, 2020); Anthony Del Piano M.D., DAB No. 3096 at 11; Edward J.S. Picardi, DAB No. 3045 at 11 (2021); Ronald Paul Belin, DPN, DAB No. 2629 at 5 (2015); John A. Hartman, D.O., DAB No. 2911 at 17 (2018); see William Garner, MD, DAB No. 3026 at 16 (2020); Norman Johnson, M.D., DAB No. 2779 at 11 (2017), and cases cited therein. 

CMS has the discretion to consider “unique or mitigating circumstances in deciding whether, or how, to exercise its revocation authority.”  I do not have similar authority.  I may not substitute my discretion for that of CMS in determining whether the revocation is appropriate.  Norman Johnson at 11, citing Care Pro Home Health, Inc., DAB No. 2723 at 9 n.8 (2016); Abdul Razzaque Ahmed, M.D., DAB No. 2261 at 19 (2009), aff’d., Ahmed v. Sebelius, 710 F. Supp.2d 167 (D. Mass. 2010).4 

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1. CMS may deny Petitioner enrollment in the Medicare program, pursuant to 42 C.F.R. § 424.530(a)(3), because, within the ten years preceding the date of her enrollment applications, she was convicted of a felony that CMS reasonably finds detrimental to the best interests of the Medicare program and its beneficiaries.5

Enrollment denial.  CMS may deny a provider’s or supplier’s enrollment in the Medicare program if, within the preceding ten years, she was convicted of a felony offense that CMS “has determined to be detrimental to the best interests of the program and its beneficiaries.”  42 C.F.R. § 424.530(a)(3); see also Social Security Act (Act) §§ 1842(h)(8) and 1866(b)(2)(D).  Offenses for which billing privileges may be denied include – but are not limited to – financial crimes such as extortion, embezzlement, income tax evasion, insurance fraud, and similar crimes.  42 C.F.R. § 424.530(a)(3)(i)(B). 

Petitioner’s felony offense and conviction.  Between May 2014 and February 20, 2020, Petitioner worked as an administrative assistant at a counseling and psychiatry office in Lexington, Kentucky.  P. Ex. 1 at 1 (Nguyen Decl. ¶ 7).  In that capacity, she forged checks, stealing thousands of dollars from her employer.  CMS Ex. 1 at 36-40; P. Ex. 1 at 1 (Nguyen Decl. ¶ 10). 

In a 100-count indictment, dated October 5, 2020, Petitioner was charged with “Theft by Deception” and “Criminal Possession of a Forged Instrument,” both felonies.  CMS Ex. 1 at 1-35.  On December 4, 2020, she pleaded guilty to one felony count of Theft by Deception and three misdemeanor counts of Criminal Possession of a Forged Instrument.  She admitted that she had stolen, from her employer, between $500 and $10,000.  CMS Ex. 1 at 36-38. 

On December 8, 2020, the Kentucky criminal court entered judgment against her.  CMS Ex. 1 at 39-40.  The court subsequently sentenced her to three years of probation and ordered her to pay $10,907 in restitution.  CMS Ex. 1 at 39-44. 

Financial crime.  Stealing money by forging checks is unquestionably a financial crime, and Petitioner’s crime is therefore per se detrimental to the best interest of the Medicare program.  42 C.F.R. § 424.530(a)(3)(i)(B).  Cornelius M. Donohue, DPM, DAB No.

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2888 at 4-5 (2018), quoting Stanley Beekman, D.P.M., DAB No. 2650 at 7 (2015) (“All financial crimes” are “deemed detrimental to Medicare.”). 

Petitioner, however, denies that her offenses “fall within the scope and severity of the offenses enumerated in section 424.530(a)(3)(i)(B).”  P. Br. at 7.  According to Petitioner, because theft by deception is not one of the crimes specifically listed in the regulation (extortion, embezzlement, income tax evasion, insurance fraud), she is not subject to denial of enrollment under section 424.530(a)(3). 

The regulation explicitly says otherwise.  The listed crimes are examples (“crimes, such as”) (emphasis added).  Lest there be any doubt, the regulation adds “and other similar crimes.”  See Hossain Sahlolbei, M.D., DAB No. 3139 at 7-8 (2024).  Moreover, the Departmental Appeals Board has upheld denials of enrollment and revocations in cases involving a wide variety of financial crimes that are not specifically mentioned in the regulation.  See, e.g., Sahlolbei (grand theft by false pretenses); Tammy Dobbin APN and Ebony Wellness, LLC, DAB No. 3136 (2024) and Stanley Beekman, DAB No. 2650 (filing false loan applications); Daniel Wiltz, M.D., DAB No. 2864 (2018) (making false statements to investigators in an insurance fraud probe). 

Because she was convicted of a financial crime, CMS is authorized to deny Petitioner’s enrollment application under section 424.530(a)(3)(i)(B). 

2. In the alternative, CMS may deny Petitioner enrollment in the Medicare program because she submitted false and misleading information on her Medicare enrollment applications.  42 C.F.R. § 424.530(a)(4). 

CMS may also deny enrollment if the supplier submits false or misleading information on her Medicare application.  42 C.F.R. § 424.530(a)(4). 

Petitioner’s enrollment applications.  On July 3, 2024, Petitioner submitted a Medicare enrollment application, by means of PECOS.6  The application asked the following question:  “Has a final adverse legal action ever been imposed against an applicant under any current or former name or business entity?”  Notwithstanding her felony conviction, Petitioner answered, “no.”  CMS Ex. 2 at 3. 

In Petitioner’s August 14, 2024 application, she again responded “no,” when asked if a final adverse legal action had been imposed.  CMS Ex. 4 at 3. 

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Petitioner argues that she was not responsible for the misinformation provided.  According to Petitioner, her employer required her to enroll in the Medicare program, and her employer completed the application “on her behalf [,] without her input.”  She signed the application without “thoroughly” reviewing it.  P. Br. at 22; see P. Ex. 1 at 4 (Nguyen Decl. ¶¶ 33, 34, 36). 

Petitioner’s brief conflates the July and August applications.  P. Br. at 4.  However, her written declaration addresses the July application only:  “In or around June or July 2024, I received an email to my work issued email address. . . . requesting that I add my electronic signature to a Medicare enrollment application . . . that was already completed on my behalf.”  P. Ex. 1 at 4 (Nguyen Decl. ¶ 33) (Emphasis added).  She does not mention the August 14 application. 

In any event, section 424.530(a)(4) “does not require proof that [the applicant] subjectively intended to provide false information, only proof that [she] in fact provided misleading or false information that [she] certified as true.”  Sandra E. Johnson, CRNA, DAB No. 2708 at 15 (2016), quoting Mark Koch, D.O., DAB No. 2610 at 4-5 (2014). 

[I]t is ultimately immaterial whether [the petitioner] actually completed the [application] forms herself, or someone else completed the forms for her and intentionally or negligently omitted [from the forms] information about the negative . . . history. . . .  Nor is it relevant whether a billing person did or did not provide [the petitioner] an opportunity to review the forms before they were filed. 

Id. at 14 (Emphasis added).  See Angela R. Styles, DAB No. 2882 at 9-10 (2018) (holding that an applicant may not escape her obligation to report by shifting the responsibility to someone else); Tammy Dobbins, APN and Ebony Wellness, LLC, DAB 13-14. 

Because Petitioner’s enrollment applications did not disclose her criminal convictions, CMS was authorized to deny her Medicare enrollment pursuant to section 424.530(a)(4). 

3. CMS acted within its authority when it added Petitioner to its preclusion list because, within the previous ten years, she was convicted of a felony under state law that CMS reasonably deems detrimental to the best interests of the Medicare program.  I have no authority to review CMS’s determination as to the length of time she remains on the preclusion list.

The preclusion list.  Effective January 1, 2019, CMS implemented a “preclusion list” as part of its effort to “prevent fraud, waste, and abuse, and to protect Medicare enrollees,” particularly with respect to prescription drug abuse.7  Pursuant to 42 C.F.R. § 422.2 (Part

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C) and 42 C.F.R. § 423.100 (Part D), CMS’s “preclusion list” includes individuals and entities that: 

(3) regardless of whether they are or were enrolled in Medicare, [have] been convicted of a felony under Federal or State law within the previous 10 years that CMS deems detrimental to the best interests of the Medicare program.  Factors that CMS considers in making such a determination under this paragraph (3) are i) the severity of the offense; ii) when the offense occurred; and iii) any other information that CMS deems relevant to its determination. 

42 C.F.R. §§ 422.2; 423.100 (defining “Preclusion list”). 

An individual included on the Preclusion List because of a felony conviction remains on that list for ten years, beginning on the date of the conviction, unless CMS determines that a shorter length of time is warranted.  42 C.F.R. §§ 422.222(a)(5)(iii), 423.120(c)(6)(vii). 

Review of Petitioner’s inclusion on the preclusion list.  My review here is limited to whether CMS had the authority to include Petitioner on the preclusion list.  42 C.F.R. § 498.3(b)(20); see 83 Fed. Reg. 16,642-16643 (Apr. 16, 2018) (explaining that appeals are limited to the individual’s inclusion on the preclusion list). 

As discussed above, within the previous 10 years, Petitioner was convicted of a felony offense that CMS deems detrimental to the best interests of the Medicare program.  Not only was she convicted of a felony that is per se detrimental, CMS explicitly found that her offenses were “inherently fraudulent and deceptive.  Fraudulent conduct – regardless of the specific [context] – demonstrates a lack of honesty and integrity – key factors that are expected of CMS’s Medicare partners.”  CMS Ex. 8 at 5. 

CMS also considered Petitioner’s failing to disclose her convictions “a serious threat” to program integrity because the Medicare program depends on the “integrity and reliability of its partners.”  Id. at 8.  Moreover, Petitioner accepted no responsibility for submitting false information, attributing the errors to her employer. 

This deflection reflects a lack of insight and accountability, which raises continued concerns about her ability to abide by Medicare program rules

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and requirements.  It necessarily follows that an individual who does not recognize the seriousness of their actions or their obligations to uphold program standards poses an ongoing risk to program integrity. 

Id. 

Having determined that CMS properly added Petitioner to the preclusion list, I have no authority to review CMS’s determination as to how long she remains there.  See 42 C.F.R. § 498.3(b); Vijendra Dave, M.D., DAB No. 2672 at 9-12 (2016) (limiting ALJ review to the determinations in section 498.3(b)). 

Although the effective date for placing an individual or entity on the Preclusion List is generally the date the Medicare hearing officer denies her reconsideration request (42 C.F.R. §§ 422.222(a)(3)(i)(B), 423.120(c)(6)(v)(C)(1)(ii)), an individual placed on the preclusion list because of a felony conviction will remain on the list for ten years, beginning on the date of the felony conviction, in this case, December 8, 2020. 

Conclusion

CMS may deny Petitioner Nguyen’s Medicare enrollment because she was convicted of a felony that CMS reasonably determined is detrimental to the best interests of the Medicare program and its beneficiaries.  CMS may also include her on the preclusion list, effective the date of her conviction, December 8, 2020. 

In the alternative, CMS may deny Petitioner’s Medicare enrollment because she submitted false and misleading information on her Medicare applications. 

I therefore affirm CMS’s determinations.