Adarsh Kumar Gupta, DAB, CR6905, (2026)

DECISION

Petitioner Adarsh Kumar Gupta was a physician, licensed to practice in New Jersey and Pennsylvania.  He worked as an independent contractor for the “AffordAdoc” network, a group of telemedicine companies.  In that capacity, he signed orders for medically-unnecessary orthotic braces.  The company submitted claims for those braces to the Medicare program and paid Petitioner kickbacks.  He was caught, charged with conspiracy, health care fraud, and making false statements relating to health care matters. 

Following a jury trial, he was convicted on three counts of health care fraud and two counts of making false statements relating to health care matters. 

Based on his conviction, the Inspector General (IG) has excluded Petitioner from participating in Medicare, Medicaid, and all federal health care programs for a minimum period of five years, as authorized by section 1128(a)(1) of the Social Security Act (Act).  Petitioner appeals the exclusion. 

Page 2

For the reasons discussed below, I find that the IG properly excluded Petitioner Gupta.  Because the statute mandates a minimum five-year exclusion, the length of his exclusion is, by law, reasonable. 

Background

In a letter dated December 31, 2025, the IG notified Petitioner that he was excluded from participating in all federal health care programs for a period of five years because he had been convicted of a criminal offense related to the delivery of an item or service under Medicare or a state health care program.  The letter explained that section 1128(a)(1) of the Act authorizes the exclusion.  IG Ex. 1 at 1. 

Petitioner timely requested review, and the matter is before me. 

The IG submitted a written argument (IG Br.) and three exhibits (IG Exs. 1-3).  Petitioner submitted his own written argument (P. Br.) with 11 exhibits (P. Exs. 1-11).  The IG submitted a reply brief. 

In the absence of any objections, I admit into evidence IG Exs. 1-3 and P. Exs. 1-11. 

Hearing on the written record.  The parties agree that an in-person hearing is not necessary.  IG Br. at 5; P. Br. at 2.  I therefore close the record and issue this decision based on the parties’ written submissions. 

Discussion

1.  Petitioner must be excluded from program participation for a minimum of five years because he was convicted of a criminal offense related to the delivery of an item or service under the Medicare program.  Act § 1128(a)(1).1 

Under section 1128(a)(1) of the Act, the Secretary of Health and Human Services must exclude an individual who has been convicted under federal or state law of a criminal offense related to the delivery of an item or service under Medicare or a state health care program.  42 C.F.R. § 1001.101(a). 

Although the record in this case is thin, it establishes that Petitioner worked as an independent contractor for a group of telemedicine companies.  IG Ex. 3 at 1, 2.  In that capacity, he knowingly submitted or caused to be submitted, to the Medicare program, “false and fraudulent claims” for orthotic braces that “were medically unnecessary, ineligible for Medicare reimbursement, and not provided as represented.”  IG Ex. 3 at 11-13.  He also knowingly “made

Page 3

materially false, fictitious, and fraudulent statements and entries, in connection with the delivery of and payment for health care benefits, items, and services, and in a manner involving . . . Medicare.”  IG Ex. 3 at 13-14. 

On April 26, 2024, a jury found Petitioner guilty on three counts of health care fraud and two counts of making false statements relating to health care matters.  On August 13, 2025, the federal district court entered judgment against him.  IG Ex. 2.  The court sentenced him to one year of probation and fined him $1,000.  The court ordered him to pay $4,475.75 in restitution to the U.S. Treasury, “for distribution to the U.S. Department of Health and Human Services, Medicare Trust Fund.”  IG Ex. 2 at 6. 

Petitioner’s conviction for submitting false claims to the Medicare program is thus obviously related to the delivery of services under Medicare. 

Petitioner concedes that he was convicted of a criminal offense but argues that an exclusion is not required.  P. Br. at 1.  He points out that he never admitted that he made a material misrepresentation regarding a Medicare benefit or payment.  He also attacks the “FBI fake witnesses and patients, who lied to [him].”  Id. 

Having been convicted, Petitioner may not use this forum to argue that he was not, in fact, guilty of crimes.  The regulations preclude such a collateral attack on an underlying conviction: 

When the exclusion is based on the existence of a criminal conviction . . . or any other prior determination where the facts were adjudicated and a final decision was made, the basis for the underlying conviction . . . 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); Yolanda Hamilton, M.D., DAB No. 3061 at 9-10 (2022); Funmilola Mary Taiwo, DAB No. 2995 at 8 (2020); Delores L. Knight, DAB No. 2945 at 9 (2019); Marvin L. Gibbs, Jr., M.D., DAB No. 79 at 8-10 (2009); Roy Cosby Stark, DAB No. 1746 (2000). 

Petitioner also points out, irrelevantly, he was one of several defendants charged in a multi-million-dollar case, and his convictions represented a very small part of that case.  Because Petitioner was convicted of program-related crimes, section 1128(a)(1) mandates that he be excluded, without regard to his level of involvement in a larger criminal enterprise.  That others involved in the activity were guilty of more significant crimes hardly exonerates him. 

By statute and regulation, 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. § 1001.2007(a)(2). 

Page 4

Conclusion

For these reasons, I conclude that the IG properly excluded Petitioner from participation in Medicare, Medicaid and all federal health care programs, and I sustain the five-year exclusion. 

_____________________

Carolyn Cozad Hughes

Administrative Law Judge