Jerrica Sims, DAB CR6939 (2026)

DECISION

The Inspector General (IG) of the United States Department of Health and Human Services excluded Jerrica Sims (Petitioner) from participation in Medicare, Medicaid, and all other federal health care programs for five years pursuant to section 1128(a)(2) of the Social Security Act (Act) (42 U.S.C. § 1320a-7(a)(2)).  For the reasons discussed below, it is determined that the IG had a legal basis to exclude Petitioner from program participation and that the five-year mandatory exclusion period must be imposed.  The IG’s exclusion determination is affirmed.

     I.  Background and Procedural History

By letter dated January 30, 2026, the IG excluded Petitioner from participating in Medicare, Medicaid, and all Federal health care programs pursuant to section 1128(a)(2) of the Act for five years, effective 20 days from the date of the letter.  IG Exhibit (Ex.) 1.  Petitioner was excluded due to a conviction of a criminal offense related to the neglect or abuse of a patient, in connection with the delivery of a health care item or service.  IG Ex. 1.  The conviction took place in the Justice Court of Tunica County, State of Mississippi (state court).  IG Ex. 1.

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On February 10, 2026, the Civil Remedies Division (CRD) received Petitioner’s timely request for hearing (P. Rfh) before an administrative law judge (ALJ) to contest the five-year exclusion imposed by the IG.  On February 12, 2026, the CRD issued an Acknowledgment Notice, my Standing Prehearing Order, and the Civil Remedies Division Procedures (CRDP). 

A prehearing conference was held by telephone, on March 3, 2026, and an Order Following Prehearing Conference and Setting Briefing Schedule (Prehearing Order) was issued the following day.  On April 9, 2026, the IG filed a brief (IG Br.) and five exhibits (IG Exs. 1-5).  On May 23, 2026, Petitioner filed a brief (P. Br.).  On June 4, 2026, the IG filed a reply brief (IG Reply Br.).

     II.  Admissions of Exhibits and Decision on the Written Record

Petitioner did not propose any exhibits and did not object to the IG’s proposed exhibits.  Absent objection, IG Exs. 1-5 are admitted into the record.

The IG indicated that an in-person hearing is not necessary to resolve this matter.  IG Br. at 4.  During the prehearing conference, Petitioner indicated that an in-person hearing was necessary, but she did not identify witnesses nor provide written direct testimony.  Prehearing Order § 7.  The Prehearing Order advised the parties that a hearing would be held only if a party asks to cross-examine a witness for whom the opposing party has provided written direct testimony.  Prehearing Order § 7.  Therefore, Petitioner’s request for an in-person hearing is denied, and this matter will be decided on the written record.  See CRDP at § 19(d).

     III.  Issue

Whether the IG had a basis to exclude Petitioner from participation in Medicaid, Medicare, and other federal health care programs under section 1128(a)(2) of the Act.  42 C.F.R. § 1001.2007(a)(2).

If it is determined that the IG has a legal basis for excluding Petitioner, then the mandatory five-year exclusion must be imposed.

     IV.  Jurisdiction

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

     V.  Legal Authorities

The Secretary of Health and Human Services (Secretary) shall exclude an individual from

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participation in Medicare, Medicaid, and all other federally funded health care programs if that individual “has been convicted, under Federal or State law, of a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care item or service.” Act § 1128(a)(2); 42 U.S.C. § 1320a-7(a)(2).  Five years is the mandatory minimum length of an exclusion under sections 1128(a)(1)-(a)(4).  Act § 1128(c)(3)(B); 42 U.S.C. § 1320a-7(c)(3)(B).

In exclusion cases, the IG has the burden of proving the basis for the exclusion and the existence of any aggravating factors.  42 C.F.R. § 1005.15(c); Standing Order ¶ 6.  Petitioner has the burden of proving any affirmative defenses or factors to mitigate the length of the exclusion if aggravating factors have been established.  42 C.F.R. § 1005.15(c); Standing Order ¶ 6.  The standard of proof is a preponderance of the evidence, which means a fact is proven if the evidence shows that it is more likely true than not true.  42 C.F.R. §§ 1001.2007(c), 1005.15(d).

An excluded individual may request a hearing before an administrative law judge (ALJ), but only on the issues of whether the IG had a basis for the exclusion and whether an exclusion longer than the required minimum period is unreasonable in light of any applicable aggravating and mitigating factors.  42 C.F.R. §§ 1001.2007(a), 1005.2(a).

     VI.  Findings of Fact

Petitioner has been in the healthcare field for 13 years.  P. Rfh.  At the time relevant to this case, Petitioner was a certified nursing assistant (CNA) at Tunica County Health & Rehab in Tunica, Mississippi.  IG Ex. 2.

On August 13, 2025, an arrest warrant was issued for Petitioner in Tunica, Mississippi on the charge of Abuse of a Vulnerable Adult.  IG Ex. 3.  It was alleged that on February 5, 2025, Petitioner improperly lifted D.M.C.1, a patient at the rehab facility, resulting in an acute tibial fracture.  IG Ex. 5.  D.M.C. complained of pain in her leg and reported that Petitioner dropped her during a transfer and that her leg had fallen between the bed and the footboard.  IG Ex. 5.  D.M.C. required a two-person lift.  Petitioner initially stated that the lift was conducted with another staff member, but later admitted that she conducted the lift alone, in violation of policy.  IG Ex. 5.

On September 3, 2025, Petitioner pleaded guilty to one count of abuse of a vulnerable person in violation of Mississippi Code§ 43-47-19(2)(a).  The state court accepted Petitioner’s guilty plea and sentenced her to one year of probation, pay a $250 investigate fee to the Mississippi Attorney General’s office, and pay $400 in court costs and fees.  IG Ex. 4.  After one year and upon payment of the fines and conditions of probation,

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Petitioner was allowed to petition the court for a final non-adjudication of the case.  IG Exs. 4, 5.

     VII.  Analysis and Conclusions of Law

1. Petitioner was convicted of a criminal offense related to the neglect or abuse of a patient, committed in connection with the delivery of a health care item or service, which subjects her to a mandatory exclusion from all federal health care programs for a minimum of five years.

To prevail, the IG must prove that:

1) Petitioner was convicted of a criminal offense under state or federal law;
2) The offense related to the neglect or abuse of patients; and
3) The offense was committed in connection with the delivery of a health care item or service. Act § 1128(a)(2); 42 U.S.C. § 1320a-7(a)(2); 42 C.F.R. § 1001.101(b).

Act § 1128(a)(2); 42 U.S.C. § 1320a-7(a)(2); 42 C.F.R. § 1001.101(b).

1. Petitioner was convicted of a criminal offense

Under the Act, an individual is considered to have been convicted of a criminal offense when “a plea of guilty or nolo contendere by the individual or entity has been accepted by a Federal, State, or local court,” or “an individual or entity has entered into participation in a first offender, deferred adjudication or other program or arrangement where judgment of conviction has been withheld”, Act § 1128(i)(1), (3) (42 U.S.C. § 1320a 7(i)(1), (3)); see also 42 C.F.R. § 1001.2 (paragraphs (c) and (d) under the definition of “Convicted”).

The evidence shows that on September 3, 2025, the state court accepted Petitioner’s guilty plea to one count of abuse of a vulnerable adult, a misdemeanor in violation of Mississippi Code § 43-47-19(2)(a).  IG Ex. 4.  Petitioner does not dispute that she was convicted of a criminal offense, but she contests the underlying events that lead to the conviction.  P. Rfh; P. Br.

2. Petitioner’s conviction related to the abuse of a patient.

A “patient” is defined as “any individual who is receiving health care items or services, including any item or service provided to meet his or her physical, mental or emotional needs or well-being (including a resident receiving care in a facility as described in part 483 of this chapter), whether or not reimbursed under Medicare, Medicaid and any other Federal health care program and regardless of the location in which such item or service

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is provided.” 42 C.F.R. § 1001.2.  Here, D.M.C., the identified victim in the attorney general’s investigation, was a vulnerable adult at a health and rehab facility where Petitioner worked as a CNA.  See IG Ex. 5.  I find that D.M.C. is a patient as defined in the regulation.

Section 1128 does not provide a definition for abuse.  When a word is undefined in the Act or regulations, Departmental Appeals Board (Board) decisions have utilized the common and ordinary meaning of the word.  Robert C. Hartnett, DAB No. 2740 at 9 n.7 (2016).  The regulations for skilled nursing facilities define abuse as “the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.” 42 C.F.R. § 483.5.  Using the common definition of abuse yields the same result, as it is defined as, “to treat in a harmful, injurious, or offensive way.”  Whether a conviction is related to abuse or neglect “is a legal determination to be made by the Secretary [for Health and Human Services] based on the facts underlying the conviction.  Further, the offense that is the basis for the exclusion need not be couched in terms of patient abuse or neglect.”  57 Fed. Reg. 3298, 3303 (Jan. 29, 1992).

Here, Petitioner pleaded guilty to Abuse of a Vulnerable Adult which states:

Any person who willfully commits an act or willfully omits the performance of any duty, which act or omission contributes to, tends to contribute to, or results in neglect, physical pain, injury, mental anguish, unreasonable confinement or deprivation of services which are necessary to maintain the mental or physical health of a vulnerable person shall be guilty of a misdemeanor. 

Mississippi Code § 43-47-19(2)(a).

Petitioner argues that she is being falsely accused of an act that she did not commit.  P. Rfh. Petitioner also spends a great portion of her brief disputing the underlying facts of her conviction and denying the allegations set forth by the victim.  See P. Br.  However, this is not the forum to relitigate facts surrounding the underlying conviction.  Collateral attacks on the criminal conviction underlying an exclusion are not permitted on substantive or procedural grounds in this appeal.  42 C.F.R.§ 1001.2007(d).

Based on the information before me, I find that the underlying basis for Petitioner’s conviction was directly related to the abuse of a patient.

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3. Petitioner’s offense was committed in connection with the delivery of a health care item or service.

The regulations require that the offense be committed “in connection with” the delivery of a health care item or service.  The Board has repeatedly held that the words “in connection with” only require a showing of a minimal nexus between the offense and the delivery of health care item or service.  Robert C. Hartnett, DAB No. 2740 at 10 (2016) (citing Bruce Lindberg, D.C., DAB No. 1386 at 8 (1993)).  It is undisputed that the conviction arose out of an incident that occurred when Petitioner, who was working as a CNA, improperly transferred a resident at a rehab facility.  There is a clear nexus between Petitioner’s conviction and the delivery of a health care item or service.  The IG has proven that Petitioner’s offense was committed in connection with the delivery of a health care item or service.

2. Because it has been determined that Petitioner was convicted of a criminal offense related to the abuse of a patient in connection with the delivery of a health care item or service, a five-year exclusion must be imposed.

In appeals of mandatory exclusions, ALJs are restricted to considering whether there is a legal basis for the exclusion and whether the period of exclusion is reasonable.  42 C.F.R. § 1001.2007(a)(1).  However, where the IG imposes the mandatory minimum exclusion of five years, “the exclusion’s length is reasonable as a matter of law, and the excluded individual may request a hearing only on the issue” of whether there is a basis for exclusion.  Diane Marie Krupka, DAB No. 3020 at 2 (2020); 42 C.F.R. § 1001.2007(a)(2).  In this case, the IG has imposed the mandatory minimum five-year exclusion, so I do not have the authority to review whether the length of the exclusion is reasonable.

     VIII.  Conclusion

The IG has proven by a preponderance of the evidence that Petitioner was (1) convicted of a criminal offense; (2) the conviction was related to the abuse of a patient; and (3) the offense was committed in connection with the delivery of a health care item or service.  Therefore, Petitioner shall be excluded from participating in Medicare, Medicaid, and all other federal health care programs for the mandatory five-year period.  The five-year exclusion imposed by the IG is AFFIRMED.