Donald O. BERNSTEIN, Petitioner, v. Louis W. SULLIVAN, Secretary, Department of Health and Human Services, Respondent

914 F.2d 1395, 1990 U.S. App. LEXIS 16355, 1990 WL 132894
CourtCourt of Appeals for the Tenth Circuit
DecidedSeptember 18, 1990
Docket89-9528
StatusPublished
Cited by11 cases

This text of 914 F.2d 1395 (Donald O. BERNSTEIN, Petitioner, v. Louis W. SULLIVAN, Secretary, Department of Health and Human Services, Respondent) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Donald O. BERNSTEIN, Petitioner, v. Louis W. SULLIVAN, Secretary, Department of Health and Human Services, Respondent, 914 F.2d 1395, 1990 U.S. App. LEXIS 16355, 1990 WL 132894 (10th Cir. 1990).

Opinion

*1397 McWILLIAMS, Circuit Judge.

This is a petition for review of a final decision of the Secretary of Health and Human Services holding Dr. Donald O. Bernstein, a chiropractor, liable under the Civil Monetary Penalties Law (CMPL) for submitting false claims for Medicare reimbursement. 42 U.S.C. § 1320a-7a. Jurisdiction is based on 42 U.S.C. § 1320a-7a(e).

The Secretary’s decision imposed a civil monetary penalty on Dr. Bernstein in the sum of $49,200.00 and an additional assessment of $2,742.40. The principal issue in this proceeding is whether a six-year statute of limitations set forth in 42 U.S.C. § 1320a-7a(c)(l) applies to the Secretary’s proceeding against Dr. Bernstein. A review of the statutory scheme of the CMPL and the facts of Dr. Bernstein’s case will place that issue in focus.

On August 13, 1981, Congress enacted the CMPL, a statute providing for civil monetary penalties and assessments for individuals who file false Medicare or Medicaid claims. 42 U.S.C. § 1320a-7a(a)(l)(A). Such were “in addition to any other penalties that may be prescribed by law_” 42 U.S.C. § 1320a-7a(a). The CMPL also provided that upon conviction a false claimant would be excluded from continued participation in the Medicare and Medicaid programs. 42 U.S.C. § 1320a-7a(a).

The CMPL, as enacted in 1981, was intended to promote an administrative adjunct to criminal proceedings as an additional means of sanctioning persons who submit false claims for payment under the Medicare and Medicaid programs. A proceeding under the CMPL to impose penalties and assessments for fraudulent submission of claims against Medicare is a civil proceeding, not a criminal or quasi-criminal proceeding. Chapman v. United States Dep’t of Health & Human Services, 821 F.2d 523 (10th Cir.1987); in accord, Scott v. Bowen, 845 F.2d 856 (9th Cir.1988). The purpose behind the CMPL is to make the government whole for monies paid on fraudulent submissions and the cost of investigating such fraudulent submissions. The purpose of the 1987 amendments to the CMPL, about which more will be said later, was “to improve the ability of the Secretary and the Inspector General of the Department of Health and Human Services to protect Medicare, Medicaid, Maternal and Child Health Services Block Grant, and Title XX Social Services Block Grant Programs from fraud and abuse_” S.Rep. No. 100-109, 100th Cong., 1st Sess., 1-2 (1987), U.S.Code Cong. & Admin.News 1987, pp. 682, 683.

Under the CMPL, the Secretary may impose a civil penalty of “not more than $2,000 for each item or service” falsely claimed, and “an assessment of not more than twice the amount claimed for each such item or service in lieu of damages sustained by the United States or a State agency because of such claim.” 42 U.S.C. § 1320a-7a(a), as amended. The CMPL and regulations issued by the Secretary identify the factors to be considered by the Secretary in any imposition of penalties and assessments. As indicated, persons subject to civil monetary penalties and assessments may also be excluded from further participation in federal and state health care programs. 42 U.S.C. § 1320a-7a(a).

Prior to the 1987 amendments to the CMPL, Congress did not set forth a statute of limitations prescribing the time within which the Secretary could initiate an action for civil monetary penalties and assessments against a claimant who made false claims. However, 28 U.S.C. § 2462 provided that, except as otherwise provided by an Act of Congress, a proceeding for enforcement of any civil fine, penalty, or forfeiture be commenced within five years from the date the claim first accrued and the Secretary, by regulation, also imposed a five-year period within which he had to initiate such an action against a false claimant. 42 C.F.R. § 1003.132. 1

*1398 The 1987 amendments to the CMPL contained an express statute of limitations which provides as follows:

“The Secretary may not initiate an action under this section with respect to any claim, request for payment, or other occurrence described in this section later than six years after the date the claim was presented, the request for payment was made, or the occurrence took place.” 42 U.S.C. § 1320a-7a(c)(l).

The background facts concerning Dr. Bernstein are not in dispute and were in fact stipulated to and adopted by the Administrative Law Judge. While practicing chiropractic medicine in Coral Springs, Florida, Dr. Bernstein participated in the Medicare program as a provider of medical services. From March through May, 1982, Dr. Bernstein submitted 210 claims for Medicare reimbursement to Blue Cross and Blue Shield of Florida, the designated Medicare carrier for Florida, claiming that he had performed 210 “manipulations of the spine” on ten different Medicare beneficiaries. At least 164 of these claims were false because Dr. Bernstein had not, in fact, performed the services of which he made claims. With respect to those 164 claims, Dr. Bernstein sought, and obtained, $2,460 as reimbursement from Blue Cross and Blue Shield.

On August 15, 1984, Dr. Bernstein was charged in a 20-eount criminal indictment under 18 U.S.C. §§ 1001, 1341 and 1342 with the submission of false claims for Medicare reimbursement. He later entered into a plea agreement wherein on May 10, 1985, he pled guilty to one count in the indictment and was sentenced by the United States District Court for the District of Colorado to three years probation, fined $1,000 and ordered to serve 30 days in a jail-type institution on weekends. 2 Three months later, in September of 1985, Dr. Bernstein was suspended from participation in the Medicare and Medicaid programs for ten years pursuant to 42 U.S.C.

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914 F.2d 1395, 1990 U.S. App. LEXIS 16355, 1990 WL 132894, Counsel Stack Legal Research, https://law.counselstack.com/opinion/donald-o-bernstein-petitioner-v-louis-w-sullivan-secretary-ca10-1990.