Nura Yasin, M.D., DAB CR6919 (2026)

DECISION

Petitioner, Nura Yasin, M.D., was a licensed medical doctor in the State of Michigan.  She plead guilty to one count of health care fraud.  Based on her convictions, the Inspector General (IG) has excluded her for eight years from participating in the Medicare, Medicaid, and all federal health care programs, as authorized by section 1128(a)(1) of the Social Security Act (Act).  Petitioner now challenges the exclusion. 

For the reasons discussed below, I find that the IG properly excluded Petitioner and that the eight-year exclusion falls within a reasonable range. 

Background

In a letter dated June 30, 2025, the IG notified Petitioner that she was excluded from participating in Medicare, Medicaid, and all federal health care programs for a period of eight years because she had been convicted 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 the delivery of items or

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services, under any such programs.  The letter explained that section 1128(a)(1) of the Act authorizes the exclusion.  IG Ex. 1.  Petitioner timely requested review. 

Each party submitted a written argument (IG Br.; P. Br.).  The IG submitted ten exhibits (IG Exs. 1- 10).  Petitioner submitted forty-four exhibits (P. Exs. 1-44).  In the absence of any objection, I admit into evidence IG Exs. 1-10 and P. Exs. 1-44. 

Neither party requested to cross-examine the other’s proposed witnesses.  As a result, an in-person hearing is not necessary.  The matter can be decided on the written record.  See Standing Order p. 7-8. 

Discussion

1.  Petitioner must be excluded from program participation, because she was convicted 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 the delivery of items or services, under any such programs, within the meaning of section 1128(a)(1) of the Act.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, including the performance of management or administrative services relating to the delivery of items or services under any such program.  42 C.F.R. § 1001.101(a). 

Here, Petitioner admits that she was convicted of a criminal offense for which exclusion is required.  P. Br. at 1-2; Dr. Yasin affidavit.  Petitioner’s brother, Dr. Fares Yasin, is also a licensed medical doctor in Michigan.  I.G. Ex. 2.  Dr. Fares Yasin’s billing privileges were suspended for two years, from January 1, 2015 to December 31, 2016.  Id.  During the period that her brother’s billing privileges were suspended, Petitioner agreed to bill for services he rendered under her name and NPI number.  I.G. Ex. 5.  Petitioner also signed patient files on behalf of her brother.  I.G. Ex. 6.  The result was that Medicare paid for services that were not provided by Petitioner.  I.G. Ex. 2. 

The indictment alleges that Petitioner received 20% of each false claim in what was referred to as a crossover patient billing scheme.  I.G. Ex. 2 at 6; I.G. Ex. 6.  Petitioner was initially charged with Health Care Fraud in violation of 18 U.S.C. § 1347 and

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Conspiracy to Commit Health Care Fraud in violation of 18 U.S.C. § 1349.  I.G. Ex. 2.  Medicare was billed nearly $1,000,000 as a result of this scheme.  I.G. Ex. 6. 

Petitioner’s brother plead guilty to Count One of the indictment and the language of his plea agreement made it clear that he worked with Petitioner who was named as a co-defendant.  I.G. Ex. 9. 

Petitioner entered into a plea agreement in which she agreed to plead guilty to one count of Health Care Fraud in violation of 18 U.S.C. § 1347.  I.G. Ex. 5.  Petitioner admits in the plea agreement that she knew her brother was suspended from billing Medicare.  Id. at 6.  Petitioner admitted to being part of the crossover billing scheme from November 1 through December 31, 2016.  Id.  Petitioner further admitted that she billed for patients seen by her brother, not her, and that she signed patient files so that Medicare would pay for the services, as if she had provided the services.  Id. at 7.  The plea agreement establishes that $101,179 were paid for patients seen by Dr. Fares Yasin, but billed through Petitioner, that she had not seen.  Id.  As a result, the parties agreed to restitution in the amount of $101,179 payable to the Medicare Trust Fund. 

Petitioner was sentenced to three years of probation and ordered to pay the restitution.  I.G. Ex. 7. 

Petitioner checked the box on her prehearing brief asserting that she disagrees that her conviction was related to the delivery of an item or service under Medicare of a State health care program.  P. Br. at 2.  However, she provides no argument for that assertion.  Id.  Petitioner was convicted of health care fraud and admitted that her crime resulted in a loss to Medicare.  As a result, there can be no argument that Petitioner’s conviction was not related to the delivery of an item or service under Medicare. 

Petitioner was thus convicted of a program-related crime and must be excluded for at least five years.  I now consider whether the length of her exclusion, beyond five years, falls within a reasonable range. 

2.  Based on the aggravating factors present in this case, the eight-year exclusion falls within a reasonable range. 

An exclusion under section 1128(a)(1) must be for a minimum period of five years.  Act § 1128(c)(3)(B); 42 C.F.R. §§ 1001.102(a), 1001.2007(a)(2).  Federal regulations set forth criteria for lengthening exclusions beyond the five-year minimum.  42 C.F.R. § 1001.102(b).  Evidence that does not pertain to one of the aggravating or mitigating factors listed in the regulations may not be used to decide whether an exclusion of a particular length is reasonable. 

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Among the factors that may serve as bases for lengthening the period of exclusion are three relied on by the IG in determining the length of Petitioner’s exclusion here:  1) the acts resulting in the conviction, or similar acts, resulted in a financial loss to Medicare or state health care programs of $50,000 or more; and 2) the individual has been the subject of an adverse action by a state agency or board based on the same set of circumstances as her conviction.  42 C.F.R. § 1001.102(b)(1), (9).  The presence of an aggravating factor or factors not offset by any mitigating factor or factors justifies lengthening the mandatory period of exclusion. 

Program financial loss (42 C.F.R. § 1001.102(b)(1)):  Petitioner’s actions resulted in program financial losses more than double the $50,000 threshold for aggravation.  The sentencing judge ordered her to pay $101,179 in restitution.  IG Ex. 7.  Restitution has long been considered a reasonable measure of program losses.  Jason Hollady, M.D., DAB No. 1855 (2002).  Because the financial losses were in excess of the threshold amount for aggravation, the IG may justifiably increase Petitioner’s period of exclusion.  See Jeremy Robinson, DAB No. 1905 (2004); Donald A. Burstein, Ph.D., DAB No. 1865 (2003). 

Petitioner argues that she only admitted to a single instance of billing using her NPI for her brother and that the result was only $588.35 being incorrectly billed to Medicare.  However, Petitioner’s plea agreement established that $101,179 was paid for patients seen by Dr. Fares Yasin and billed through Petitioner’s NPI.  Additionally, she agreed to restitution in the amount of $101,179. 

Exclusion from Michigan Medicaid Program (42 C.F.R. § 1001.102(b)(9)).  On March 4, 2020, the Michigan Department of Health and Human Services ordered Petitioner to be suspended from any direct or indirect participation in the Michigan Medicaid program and any Managed Care Organization that is enrolled in the Michigan Medicaid Program.  I.G. Ex. 8.  The suspension by the Michigan Department of Health and Human Services was based on the same set of circumstances that led to her exclusion by the I.G.  Id.  Petitioner does not contest this factor. 

No mitigating factors.  The regulations consider there to be just three mitigating factors:  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 that reduced his culpability; and 3) a petitioner’s cooperation with federal or state officials resulted in others being convicted or excluded, or additional cases being investigated, or a civil money penalty being imposed.  42 C.F.R. § 1001.102(c).  Characterizing the mitigating factor as “in the nature of an affirmative defense,” the Departmental Appeals Board has ruled that a petitioner has the burden of proving any mitigating factor by a preponderance of the evidence.  Barry D. Garfinkel, M.D., DAB No. 1572 at 8 (1996). 

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Because Petitioner was convicted of a felony, the first factor does not apply here.  Nor does this record suggest that Petitioner had a mental, physical, or emotional condition that reduced her culpability.  I see no suggestion that she cooperated with federal or state officials in any respect. 

Petitioner filed many exhibits included reference letters and character letters stating that she is a good doctor.  She also shows that her probation was terminated early due to her compliance and that restitution has been paid.  Petitioner argues that the other aggravating factors do not apply, and, therefore, her exclusion should be for the mandatory minimum.  Petitioner also appears to attack the underlying revocation that affected her brother.  None of these arguments can be considered mitigating factors.  Petitioner’s arguments may be viewed as requests for equitable relief.  However, I have no authority to grant Petitioner any equitable relief.  Matthew J. Girardy, DMD, DAB No. 2987 at 7 (2020). 

Thus, no mitigating factor offsets the aggravating factors present in this case. 

Conclusion

Petitioner must be excluded for at least five years because she was convicted of a felony related to the delivery of items and services under Medicare. 

So long as the period of exclusion is within a reasonable range, based on demonstrated criteria, I have no authority to change it.  Joann Fletcher Cash, DAB No. 1725 at 7, citing 57 Fed. Reg. 3298, 3321 (1992).  In this case, Petitioner’s crime demonstrates that she presents significant risks to the integrity of health care programs.  Petitioner engaged in illegal conduct that cost the Medicare program a significant amount of money and was excluded from the Michigan Medicaid Program by the Michigan Department of Health and Human Services. 

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 as reasonable the eight-year period of exclusion.