Fuentes v. Azar

CourtDistrict Court, District of Columbia
DecidedJune 17, 2020
DocketCivil Action No. 2019-1965
StatusPublished

This text of Fuentes v. Azar (Fuentes v. Azar) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fuentes v. Azar, (D.D.C. 2020).

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA _________________________________________ ) EDWIN L. FUENTES, ) ) Plaintiff, ) ) v. ) Case No. 19-cv-1965 (APM) ) ALEX M. AZAR II et al., ) ) Defendants. ) _________________________________________ )

MEMORANDUM OPINION

I. INTRODUCTION

Plaintiff Edwin L. Fuentes was convicted of health care fraud and attempted tax evasion in

January 2018. As a result of his conviction, the Inspector General of the Department of Health

and Human Services excluded Plaintiff from participating in federal health care programs for

15 years. Plaintiff lodged an administrative appeal of that decision and filed several motions

seeking comprehensive access to hearing records from prior exclusion cases, which the

administrative law judge denied. Before appealing the denial through the ordinary administrative

channels, Plaintiff filed the instant action seeking mandamus relief ordering Defendants to grant

Plaintiff access to “all records of any proceedings” brought under the civil monetary penalty and

exclusion provisions of the Social Security Act, as well as a declaratory judgment that Defendants’

failure to provide such access is contrary to law and unconstitutional. Defendants move to dismiss

Plaintiff’s Complaint, arguing among other things, that Plaintiff has not established the

jurisdictional prerequisites for mandamus relief and has not levied his other challenges through the

required channels. The court agrees, and for the reasons that follow, grants Defendants’ motion. II. BACKGROUND

A. Legal Background

The Inspector General of the United States Department of Health and Human Services

(“HHS”), acting pursuant to authority delegated by the Secretary of HHS, see 53 Fed. Reg. 12,993

(April 20, 1988), is required to exclude individuals from participating in federal healthcare

programs who have been convicted of, among other things, “a criminal offense related to the

delivery of an item or service” under Medicare or a state health care program, 42 U.S.C. § 1320a-

7(a)(1), or a felony related to healthcare fraud, id. § 1320a-7(a)(3). Unless certain exceptions

apply, the minimum period of exclusion for these crimes is five years, id. § 1320a-7(c)(3)(B), and

the Inspector General may lengthen that period based on aggravating factors, see 42 C.F.R. §

1001.102(b).

An individual whom the Inspector General excludes may request a hearing before an

administrative law judge (“ALJ”) in the Civil Remedies Division of HHS’s Departmental Appeals

Board. See 42 U.S.C. § 1320a-7(f)(1); 42 C.F.R. § 1005.2(a). She may challenge “[t]he basis for

the imposition of the sanction,” and, if the term is longer than the five-year minimum, “[t]he length

of exclusion.” See 42 C.F.R. § 1001.2007(a). The parties to such proceeding are the petitioner

and the Inspector General. Id. § 1005.2(b). Either party “may make a request to another party for

production of documents for inspection and copying which are relevant and material to the issues

before the ALJ,” and if the request is refused, she may file a motion to compel discovery. Id.

§ 1005.7(a), (e)(1). The opponent of discovery may, in turn, file a motion for a protective order,

which the ALJ may grant if she finds the requested discovery is irrelevant, unduly costly or

burdensome; will unduly delay the proceedings; or seeks privileged information. Id.

2 § 1005.7(e)(1)–(2); see also id. § 1005.4(b)(6)–(7) (empowering the ALJ to “[r]ule on motions and

other procedural matters” and “[r]egulate the scope and timing of documentary discovery”).

A petitioner may appeal an ALJ’s adverse determination to the Departmental Appeals

Board’s Appellate Division (“Appellate Division”). Id. § 1005.21(a). The Appellate Division’s

decision becomes final and binding 60 days after the parties are served with the decision. Id.

§ 1005.21(j). A party may seek judicial review within that timeframe. Id. § 1005.21(k)(1).

Judicial review is governed by section 405(g) of the Social Security Act (“SSA”). See 42 U.S.C.

§ 1320a-7(f)(1) (providing that “any individual or entity that is excluded (or directed to be

excluded) from participation under this section is entitled to reasonable notice and opportunity for

a hearing thereon by the Secretary . . . , and to judicial review of the Secretary’s final decision after

such hearing as is provided in section 405(g) of this title”).

B. Factual Background

On April 30, 2018, the Inspector General notified Plaintiff that he was being excluded from

participating in Medicare, Medicaid, and all other federal healthcare programs on the basis of two

criminal convictions for healthcare fraud and attempted tax evasion. See Compl., ECF No. 1

[hereinafter Compl.], ¶¶ 82–83; see also id., Exs. A–H, ECF No. 1-2 [hereinafter Compl. Exhibits],

Ex. A; Judgment, ECF No. 28, USA v. Fuentes, No. 4:17-cr-00009-JLK-1 (W.D. Va. Jan. 9, 2018).

The Inspector General increased the exclusionary period from five to 15 years based on three

aggravating factors. Compl. Exhibits, Ex. A; Compl. ¶ 84. Plaintiff requested administrative

review of his exclusion on July 2, 2018. Compl. ¶ 85. Later that month, an ALJ conducted a

prehearing conference and set a briefing and evidentiary schedule. Id. ¶ 86.

Plaintiff’s November 2018 Motion and Request. On November 12, 2018, Plaintiff filed a

motion before the ALJ seeking “full access” to the Departmental Appeals Board’s E-File

3 Database—a non-public electronic filing and document management system, which contains

records associated with exclusion proceedings, as well as certain other matters before the Board.

See Compl. Exhibits, Ex. B [hereinafter Mot. for Access], at 1–2 (PDF pp. 3–4); Compl. ¶¶ 64, 89.

On the same date, Plaintiff filed a “Request for Discovery,” asking that the Inspector General

provide, among other things, “[a]ll final Administrative Law Judge or Departmental Appeals

Board exclusion decisions issued in 2018,” and “[a]ll non-public Administrative Law Judge rulings

interpreting or applying any part, subpart, or regulation found in section 1005, Title 42, Code of

Federal Regulations relating to discovery, evidentiary rulings, hearing procedures, or witness

testimony.” Compl. Exhibits, Ex. C. at 5 ¶¶ 6–7 (PDF p. 17); Compl. ¶ 92. In a November 30,

2018 order, the ALJ concluded that he “had no authority to grant or deny access to case records in

E-File,” denied Plaintiff’s discovery requests because Plaintiff had not explained how the ALJ

opinions and other materials he sought were relevant and material to his appeal, and granted the

Inspector General’s request for a protective order, thereby “relieving [him] of any responsibility

to produce documents responsive” to the discovery requests at issue. See Compl. Exhibits, Ex. E,

at 1–9 (PDF pp. 24–32); Compl. ¶ 96.

Plaintiff’s January 2019 Motion. On January 29, 2019, Plaintiff filed a “Motion to Inspect

Prior Records,” seeking to “inspect and copy” records from various cases before the Departmental

Appeals Board. See Compl.

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