Alethea Faith Jayne (Shrum) Farris Also known as: Alethea Faith Jayne Farris, Alethea Faith Shrum, and Alethea Shrum Farris, DAB CR6941 (2026)

DECISION

Petitioner is excluded from participating in Medicare, Medicaid, and all federal health care programs pursuant to section 1128(a)(1) of the Social Security Act (Act) (42 U.S.C. § 1320a-7(a)(1)), effective November 20, 2025.  There is a basis for exclusion.  Petitioner’s exclusion for a minimum of five years is required by section 1128(c)(3)(B) of the Act (42 U.S.C. § 1320a-7(c)(3)(B)).1 

Page 2

I.  Background

The Inspector General (IG) of the U.S. Department of Health and Human Services notified Petitioner by letter dated October 31, 2025, that she was excluded from participation in Medicare, Medicaid, and all federal health care programs for five years.  The IG cited section 1128(a)(1) of the Act as the basis for Petitioner’s exclusion.  The IG stated that the exclusion was based on Petitioner’s conviction in the District Court of Oklahoma County, State of Oklahoma (state court), of a criminal offense related to the delivery of an item or service under Medicare or a state health care program.  IG Exhibit (Ex.) 1 at 1. 

Petitioner requested a hearing by letter dated and postmarked January 12, 2026 (RFH).  On January 23, 2026, the case was assigned to me to hear and decide.  I convened a telephone prehearing conference on February 25, 2026, the substance of which is memorialized in my Prehearing Conference Order and Schedule for Filing Briefs and Documentary Evidence issued on February 26, 2026 (Prehearing Order). 

The IG filed a motion for summary judgment and supporting memorandum on April 9, 2026, with IG Exs. 1 through 4.  Petitioner did not object to my consideration of IG Exs. 1 through 4 and all are admitted as evidence. 

On June 11, 2026, Petitioner filed two letters addressing her case.  Departmental Appeals Board Electronic Filing System (DAB E-File) ## 8-9. Petitioner also filed documents for my consideration not marked as exhibits but described in DAB E-File as Appendix A through F.  DAB E-File ## 10-15.  The IG did not object to my consideration of Petitioner’s Appendices A through F.  But I am required by 42 C.F.R. § 1005.17(c) to exclude irrelevant or immaterial evidence.  An ALJ determines the admissibility of evidence and is not bound by the Federal Rules of Evidence but refers to them as appropriate.  42 C.F.R. § 1005.17(a)-(b).  Under the Federal Rules of Evidence, the test for whether evidence is relevant is whether the evidence has “any tendency to make a fact more or less probable than it would be without the evidence;” and the fact is material, that is, “the fact is of consequence in determining the action.”  Fed. R. Evid. 401.  In Petitioner’s case there is only one issue, that is, whether the IG is required to exclude Petitioner under section 1128(a)(1) of the Act.  The facts that trigger Petitioner’s exclusion under section 1128(a)(1) of the Act are not in dispute.  RFH, DAB E-File ## 8-9.  Also, Petitioner’s conviction is not subject to collateral attack before me.  42 C.F.R. § 1001.2007(d).  There is no issue of whether the five-year exclusion is unreasonable because five years is the minimum period of exclusion required by Congress.  Act § 1128(c)(3)(B); 42 C.F.R. § 1001.2007(a)(2).  Appendices A through F support Petitioner’s statements in her request for hearing and letters.  I accept Petitioner’ assertions of fact as true for purposes of summary judgment and draw all reasonable favorable inferences for her as I am required to do.  But the facts Petitioner asserts, which I accept for purposes of summary judgment, do not tend to show that there was no basis

Page 3

for her exclusion and the duration of her exclusion is not subject to my review.  Therefore, Appendices A through F are not relevant and not admitted. 

On June 17, 2026, the IG filed a reply brief. 

II.  Discussion

A.  Applicable Law

Section 1128(f) of the Act (42 U.S.C. § 1320a-7(f)) establishes Petitioner’s right to a hearing by an administrative law judge (ALJ) and judicial review of the final action of the Secretary of Health and Human Services (the Secretary). 

Pursuant to section 1128(a)(1) of the Act, the Secretary must exclude from participation in any federal health care program any individual 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.  A state health care program includes a state Medicaid program.  Act § 1128(h) (42 U.S.C. § 1320a-7(h)). 

Pursuant to section 1128(i) of the Act (42 U.S.C. § 1320a-7(i)), an individual is 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.  The Secretary has promulgated regulations implementing these provisions of the Act.  42 C.F.R. § 1001.101(a), (c). 

Exclusion for a minimum period of five years is mandatory for any individual or entity convicted of a criminal offense for which exclusion is required by section 1128(a) of the Act.  Act § 1128(c)(3)(B) (42 U.S.C. § 1320a-7(c)(3)(B)).  Pursuant to 42 C.F.R § 1001.102(b), an individual’s period of exclusion may be extended based on the presence of specified aggravating factors.  Only if the aggravating factors justify an exclusion of longer than five years, however, are mitigating factors considered as a basis for reducing the period of exclusion to no fewer than five years.  42 C.F.R. § 1001.102(c). 

In this proceeding, 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 on any affirmative defenses or mitigating factors, and the IG bears the burden on all other issues.  42 C.F.R. § 1005.15(b), (c); Prehearing Order ¶ 4.  There may be no collateral attack of the conviction that is the basis for the exclusion.  42 C.F.R. § 1001.2007(d). 

Page 4

B.  Issues

The Secretary has by regulation limited my scope of review to two issues: 

Whether the IG has a basis for excluding Petitioner from participating in Medicare, Medicaid, and all other federal health care programs; and

Whether the length of the exclusion is unreasonable. 

42 C.F.R. § 1001.2007(a)(1). 

When, as in this case, the IG imposes the minimum authorized five-year exclusion under section 1128(a) of the Act, there is no issue as to whether the period of exclusion is unreasonable.  42 C.F.R. § 1001.2007(a)(2). 

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

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

1.  Petitioner timely filed her request for hearing, and I have jurisdiction. 

There is no dispute that Petitioner’s request for hearing was timely filed.  Prehearing Order ¶ 2.  I conclude that I have jurisdiction pursuant to section 1128(f) of the Act and 42 C.F.R. pt. 1005. 

2.  Summary judgment is appropriate. 

The IG has requested summary judgment.  Pursuant to section 1128(f) of the Act, a person subject to exclusion has a right to reasonable notice and an opportunity for a hearing.  The Secretary has provided by regulation that a sanctioned party has the right to a hearing before an ALJ, and both the sanctioned party and the IG have the right to participate in the hearing.  42 C.F.R. §§ 1005.2-.3.  Either or both parties may choose to waive appearance at an oral hearing and to submit only documentary evidence and written argument for my consideration.  42 C.F.R. § 1005.6(b)(5).  An ALJ may also resolve a case, in whole or in part, by summary judgment.  42 C.F.R. § 1005.4(b)(12). 

Summary judgment is appropriate in an exclusion case when there are no disputed issues of material fact and when the undisputed facts, which are clear and not subject to conflicting interpretation, demonstrate that one party is entitled to judgment as a matter of law.  Tanya A. Chuoke, R.N., DAB No. 1721 (2000); David A. Barrett, DAB No. 1461 (1994); Robert C. Greenwood, DAB No. 1423 (1993); Thelma Walley, DAB No. 1367

Page 5

(1992); Catherine L. Dodd, R.N., DAB No. 1345 (1992); John W. Foderick, M.D., DAB No. 1125 (1990).  When the undisputed material facts of a case support summary judgment, there is no need for a full evidentiary hearing, and neither party has the right to one.  Surabhan Ratanasen, M.D., DAB No. 1138 (1990); Foderick, DAB No. 1125.  In opposing a properly supported motion for summary judgment, the nonmovant must allege facts that show there is a genuine dispute of material fact that affects the proponent’s prima facie case or that might establish a defense.  The nonmovant may not rely upon mere allegations or denials to defeat a properly supported motion for summary judgment.  To defeat a properly supported motion for summary judgment and proceed to a trial, the nonmovant must show there is a genuine dispute as to a material fact that requires determination by the fact finder.  On summary judgment, the judge does not weigh the evidence or attempt to determine the truth.  Rather, the judge accepts the nonmovant’s evidence as true and draws all permissible inferences in the nonmovant’s favor.  Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-57 (1986). 

There are no genuine disputes of material facts in this case.  Petitioner does not dispute that she was convicted and that she is subject to mandatory exclusion pursuant to section 1128(a)(1) of the Act.  Petitioner requests consideration of her personal circumstances and evidence of her rehabilitation, compliance, and commitment as a basis for reducing her period of exclusion.  RFH; DAB E-File ## 8-9.  But five years is the minimum period of exclusion authorized by Congress.  Act § 1128(c)(3)(B).  Therefore, the issue of the reasonableness of Petitioner’s five-year exclusion must be resolved against her as a matter of law.  While Petitioner’s circumstances are truly unfortunate and she has worked to rehabilitate herself, those are not considerations that affect her exclusion for five years which is mandated by Congress.  I conclude that summary judgment for the IG is appropriate. 

3.  Section 1128(a)(1) of the Act requires Petitioner’s exclusion from participation in Medicare, Medicaid, and all other federal health care programs. 

a.  Facts

The parties were advised by my Prehearing Order ¶ 8 that on summary judgment a fact alleged and not specifically denied may be accepted as true and all evidence will be considered admissible and true absent specific objection to admissibility or accuracy.  The material facts are undisputed. 

On March 20, 2023, Petitioner was charged in the state court with one count of felony Medicaid fraud.  The charge alleged that between about January 11, 2020 and May 30, 2021, Petitioner willfully and knowingly caused the submission of claims totaling more than $2500 to Oklahoma Medicaid for occupational therapy services she rendered while not licensed as an occupational therapist.  IG Ex. 2 at 1. 

Page 6

On June 11, 2025, Petitioner pleaded guilty to the charge of Medicaid fraud in the state court in exchange for a sentence limitation.  IG Ex. 3.  The state court accepted Petitioner’s guilty plea on June 11, 2025.  IG Ex. 3 at 8.  The state court deferred sentencing until June 10, 2032, and placed Petitioner on unsupervised probation.  IG Ex. 3 at 9; IG Ex. 4.  The state court also ordered that Petitioner pay restitution of $37,134.31.  IG Ex. 4. 

Petitioner does not dispute that she was convicted by the state court on June 11, 2025, of Medicaid fraud.  RFH; DAB E-File ## 8-9. 

b.  Analysis

The IG cites section 1128(a)(1) of the Act as the basis for Petitioner’s mandatory exclusion.  The statute provides in relevant part: 

(a)  MANDATORY EXCLUSION. – The Secretary shall exclude the following individuals and entities from participation in any Federal health care program (as defined in section 1128B(f)): 

(1)  CONVICTION OF PROGRAM-RELATED CRIMES. – Any 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. 

Act § 1128(a)(1). 

Congress has, by the plain language of section 1128(a)(1) of the Act, required the Secretary to exclude from participation in Medicare, Medicaid, and all federal health care programs any individual or entity:  (1) convicted of a criminal offense, whether a misdemeanor or felony; (2) where the offense is related to the delivery of an item or service; and (3) the delivery of the item or service was under Medicare or a state health care program. 

The elements that trigger an exclusion under section 1128(a)(1) of the Act exist in this case.  Petitioner does not dispute that when her guilty plea was accepted by the state court on June 11, 2025 (IG Exs. 3, 4), she was convicted within the meaning of the Act.  Act § 1128(i)(3) (one is convicted of a criminal offense when a guilty plea or a plea of no contest is accepted).  Petitioner does not dispute that the charge of which she was convicted clearly alleged Medicaid fraud.  By pleading guilty Petitioner admitted to causing the filing of fraudulent claims with Oklahoma Medicaid for occupational therapy

Page 7

services that she was not licensed to provide totaling more than $2500.  IG Exs. 2, 3, 4.  I conclude, based on the undisputed facts, that there is a common-sense connection or nexus between Petitioner’s health care fraud and the delivery of an item or service under Oklahoma Medicaid.  Saadite A. Green, DAB No. 2940 at 6-7 (2019) (and cases cited therein). 

Accordingly, I conclude that all elements that trigger mandatory exclusion pursuant to section 1128(a)(1) of the Act are satisfied and the IG has a basis to exclude Petitioner.  Because I have found that there is a basis for Petitioner’s exclusion pursuant to section 1128(a)(1) of the Act, Congress has mandated her exclusion.  Neither the IG nor I have any discretion not to exclude Petitioner in this case as we are both bound to follow the federal statutes and regulations.  42 C.F.R. § 1005.4(c)(1). 

4.  Pursuant to section 1128(c)(3)(B) of the Act, a five-year period of exclusion is mandatory. 

I have concluded that there is a basis to exclude Petitioner pursuant to section 1128(a)(1) of the Act.  Therefore, the IG must exclude Petitioner for a minimum period of five years pursuant to section 1128(c)(3)(B) of the Act.  The IG has no discretion to impose a lesser period, and I may not reduce the period of exclusion to fewer than five years. 

Petitioner does not dispute that she is subject to mandatory exclusion.  In her request for hearing, Petitioner argued that her exclusion for five years is unreasonable.  RFH.  But the IG and I have no discretion to impose a shorter period of exclusion.  Act § 1128(c)(3)(B).  In her letters, Petitioner shares information regarding her dire personal circumstances that contributed to her conviction, which are not summarized in this published decision out of respect for her privacy.  Petitioner admits that she failed to renew her occupational therapist license.  When she learned she needed to renew her license she immediately worked to renew the license.  But COVID-19 shutdowns, court delays, and complications related to her personal situation interfered with her ability to timely renew her license.  Petitioner ultimately renewed her occupational therapy license in Oklahoma, and the law was changed so that her license would not be subject to nonrenewal for the same reason it was before.  She also notes that as soon as she learned that her license was not renewed, she stopped working.  She spent five days in jail.  She remains committed to being accountable.  She states that her family has experienced years of financial and other hardships.  Petitioner requests mercy and understanding that her exclusion limits her ability to support her family.  DAB E-File ## 8-9.  I accept all Petitioner’s assertions as true for purposes of summary judgment.  But Congress has mandated Petitioner’s exclusion for five years, and the IG and I have no authority to do otherwise. 

Petitioner’s arguments in her request for hearing could be construed to be that her exclusion violates the United States Constitution because it is a cruel and unusual

Page 8

punishment or because she has been punished twice for the same conduct.  U.S. Const. amend. VIII.  Exclusions imposed by the IG are civil sanctions, remedial in nature and not punitive and criminal.  Because exclusions are remedial sanctions, they do not violate the double jeopardy clause or the prohibition against cruel and unusual punishment.  Manocchio v. Kusserow, 961 F.2d 1539 (11th Cir. 1992); Greene v. Sullivan, 731 F. Supp. 838 (E.D. Tenn. 1990); Joann Fletcher Cash, DAB No. 1725 (2000); Douglas Schram, R.Ph., DAB No. 1372 (1992); and Janet Wallace, L.P.N., DAB No. 1326 (1992).2  Arguments that the exclusion provisions are anything but remedial have been found to be without merit.  Manocchio, 961 F.2d at 1541-42; Greene, 731 F. Supp. at 839-40.  Many federal courts have also rejected claims that the Secretary’s exclusion procedures amount to a deprivation of due process, finding no constitutionally protected property or liberty interests.  Rodabaugh v. Sullivan, 943 F.2d 855 (8th Cir. 1991); Lavapies v. Bowen, 883 F.2d 465 (6th Cir. 1989); Hillman Rehab. Ctr. v. U.S. Dep’t. of Health & Human Servs., No. 98-3789 (GEB), slip op. at 16, 1999 WL 34813783, at 16 (D.N.J. May 13, 1999); Travers v. Sullivan, 801 F. Supp. 394, 404-05 (E.D. Wash. 1992), aff’d, Travers v. Shalala, 20 F.3d 993 (9th Cir. 1994).  Accordingly, I conclude that Petitioner’s possible constitutional arguments are without merit. 

Petitioner’s arguments may also be viewed as a request for equitable relief.  However, I have no authority to grant Petitioner any equitable relief.  Matthew J. Girardy, DMD, DAB No. 2987 at 7 (2020).  Congress required Petitioner’s exclusion pursuant to section 1128(a)(1) of the Act, the regulation establishes the effective date of a mandatory exclusion, and those requirements are binding upon me.  I am bound to follow the Act and the Secretary’s regulations.  42 C.F.R. § 1005.4(c)(1). 

The effective date of exclusion is 20 days after the date of the IG’s notice of exclusion.  42 C.F.R. § 1001.2002(b). 

Page 9

III.  Conclusion

For the foregoing reasons, Petitioner is excluded from participation in Medicare, Medicaid, and all other federal health care programs for a minimum period of five years, effective November 20, 2025.