Lasher v. Dep't of Health & Human Servs.

369 F. Supp. 3d 243
CourtCourt of Appeals for the D.C. Circuit
DecidedMarch 27, 2019
DocketCivil Action No. 17-1746 (ABJ)
StatusPublished
Cited by1 cases

This text of 369 F. Supp. 3d 243 (Lasher v. Dep't of Health & Human Servs.) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lasher v. Dep't of Health & Human Servs., 369 F. Supp. 3d 243 (D.C. Cir. 2019).

Opinion

AMY BERMAN JACKSON, United States District Judge

Plaintiff Lena Lasher ("Lasher") has brought this action under 42 U.S.C. § 405(g) challenging the decision of the Secretary of Health and Human Services ("DHHS") to exclude her from participation in federal health care programs for *245a period of 10 years.1 This matter is before the Court on the Defendants' Motion to Dismiss or, in the Alternative, for Summary Judgment. [Dkt. 14.] For the reasons discussed below, the Court will grant the motion. In light of Lasher's conviction of multiple counts involving fraud in health care related federal programs, the sentence she received, and all of the factors considered by the agency, her exclusion for the ten year period was reasonable, supported by substantial evidence, and consistent with the applicable law. Lasher's efforts to challenge her underlying conviction in this proceeding are misplaced, and none of the constitutional violations she has alleged provide a basis to alter the agency's decision.

I. BACKGROUND

A. Exclusion from Federal Health Care Programs

There are "certain bases upon which individuals ... must[ ] be excluded from participation in Medicare, Medicaid and all other Federal health care programs." 42 C.F.R. § 1001.1(a). One such basis is an individual's conviction of a program-related offense:

The Secretary shall exclude ... from participation in any Federal health care program ... [a]ny individual or entity that has been convicted for an offense which occurred after August 21, 1996, under Federal or State law, in connection with the delivery of a health care item or service or with respect to any act or omission in a health care program ... operated by or financed in whole or in part by any Federal, State, or local government agency, of a criminal offense consisting of a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct.

42 U.S.C. § 1320a-7(a)(3) ; see 42 C.F.R. § 1001.101. An individual is deemed "convicted of a criminal offense ... when a judgment of conviction has been entered against [her] by a Federal, State, or local court, regardless of whether there is an appeal pending or whether the judgment of conviction or other record relating to criminal conduct has been expunged." 42 U.S.C. § 1320a-7(i)(1).

This exclusion authority is delegated to DHHS' Inspector General ("IG"). See 48 Fed. Reg. 21662 (May 13, 1983). The IG issues a notice of exclusion which specifies the period of exclusion and its effective date. See 42 U.S.C. § 1320a-7(c), (f)(1).

The mandatory exclusion period lasts a minimum of five years. 42 U.S.C. § 1320a-7(c)(3)(B) ; 42 C.F.R. § 1001.102(a). However, if aggravating factors are found, the IG may extend the mandatory exclusion period. See 42 C.F.R. § 1001.102(b). Aggravating factors include "acts that resulted in conviction ... committed over a period of one year or more," 42 C.F.R. § 1001.102(b)(2), and a sentence including incarceration, 42 C.F.R. § 1001.102(b)(5). If aggravating factors are found to exist, the IG may consider "mitigating factors ... as a basis for reducing the period of exclusion to no less than 5 years." 42 C.F.R. § 1001.102(c). For example, the IG may consider a sentencing court's "determin[ation] that the individual had a mental, emotional or physical condition before or during the commission of the offense that reduced the individual's culpability," 42 C.F.R. § 1001.102(c)(2), as a mitigating *246factor. An individual who has been excluded may apply for termination of the exclusion. See 42 U.S.C. § 1320a-7(g).

An individual whom the IG has excluded may request a hearing before an administrative law judge ("ALJ") of the Civil Remedies Division ("CRD") of DHHS' Departmental Appeals Board ("DAB"), see 42 U.S.C. § 1320a-7(f)(1) ; 42 C.F.R. § 1005.2(a), "on the issues of whether: (i) [t]he basis for the imposition of the sanction exists, and (ii) [t]he length of exclusion is unreasonable." 42 C.F.R. § 1001.2007(a)(1). The parties to this proceeding are the petitioner and the IG. 42 C.F.R.

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369 F. Supp. 3d 243, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lasher-v-dept-of-health-human-servs-cadc-2019.