Patel v. Shalala, 3:97CV-312-M.
| Court | United States District Courts. 6th Circuit. United States District Court of Western District of Kentucky |
| Citation | 17 F.Supp.2d 662 |
| Docket Number | No. 3:97CV-312-M.,3:97CV-312-M. |
| Parties | Sharad C. PATEL, M.D., Plaintiff, v. Donna E. SHALALA, Secretary of the Department of Health and Human Services, Defendant. |
| Decision Date | 24 June 1998 |
v.
Donna E. SHALALA, Secretary of the Department of Health and Human Services, Defendant.
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James H. Barr, III, Asst. U.S. Atty., John E. Kuhn, Jr., Asst. U.S. Atty., U.S. Attorney's Office, Louisville, KY, for defendant Secretary of the Department of Health and Human Services.
Denise Malone Helline, Ruck, Wilson & Helline, Louisville, KY, for plaintiff Sharad C. Patel, M.D.
MOYER, United States Magistrate Judge.
This is an appeal from an administrative decision of the Secretary of the Department of Health and Human Services excluding plaintiff from participation in the Medicare program and specified state health care programs for ten years. The exclusion was imposed as a consequence of plaintiff's conviction on charges of Medicare billing fraud and related crimes. All administrative appeals regarding the exclusion have been exhausted. Plaintiff has filed a motion for summary judgment, (Docket No. 14), and defendant has responded. (Docket No. 17). Plaintiff has replied, (Docket Nos. 18, 19), and the parties have consented to proceed before the Magistrate Judge pursuant to 28 U.S.C. § 636(b)(1)(C). (Docket No. 28).
In the pending motion, the plaintiff requests the court to either reduce the period of exclusion or remand the case to the Secretary for additional proof and a determination as to an appropriate reduction in the period of exclusion. In support of his motion, plaintiff argues that he was under a mental, emotional, or physical condition at the time he committed his crimes and that this mitigating factor should have been considered in determining the length of his exclusion. The condition that he states he was suffering from was an advanced state of drug and alcohol dependence.
Plaintiff was a licensed psychiatrist practicing in Kentucky and was eligible to receive reimbursement from Medicare, Medicaid, and CHAMPUS. Between October 1, 1989 and December 21, 1991, plaintiff conspired with his employees to submit false claims to the United States to defraud these three health care programs. Fraudulent claims for reimbursement during this time period were submitted to Medicare in the amount of $26,110, to Medicaid in the amount of $36,149, and to CHAMPUS in the amount of $58,232. On August 3, 1992, a grand jury in the Western District of Kentucky returned an indictment against plaintiff charging him with 55 felony counts, including violations of the False Claims Act and mail fraud statutes. A civil action was also filed for the false claims violations. On December 6, 1993, plaintiff executed a plea agreement with the United States and pleaded guilty to all 55 felony counts. Pursuant to the plea, plaintiff's sentence included four months of incarceration and four months of home detention. Plaintiff also agreed to pay the United States $200,000 in settlement of the civil False Claims action.
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In November of 1995, the Inspector General of the Department of Health and Human Services [I.G.], informed plaintiff, by letter, that he would be excluded from the Medicare program for ten years. Plaintiff timely appealed that decision and a hearing was scheduled before Administrative Law Judge Mimi Hwang Leahy. Upon reconsideration, ALJ Leahy canceled the hearing after determining that testimony of plaintiff's witnesses was of questionable relevance given the requirement that the mitigating factors that would support a reduction of the time period of exclusion must be evidenced by a finding of the court on the record of the criminal proceeding. The ALJ issued her decision in November, 1996 based solely on the written record.
The ALJ upheld the I.G.'s proposed ten-year exclusion, finding it reasonable in light of the existence of aggravating factors and the absence of mitigating factors, as reflected in the record of the criminal proceedings. The ALJ specifically found that plaintiff had not established the existence of a judicial determination on the record of his criminal proceeding that he had a "mental, emotional, or physical condition before or during the commission of the offense that reduced [his] culpability."
The plaintiff then sought review of the ALJ's decision before the Departmental Appeals Board of the Department of Health and Human Services [DAB]. Plaintiff attached several new exhibits to his Notice of Appeal, one of which was his personal statement detailing events which transpired between August of 1980 and December of 1993. Plaintiff offered no explanation for his failure to submit the personal statement to the ALJ other than that it "may have been inadvertently omitted" by his former counsel. In March, 1997, the DAB advised plaintiff that it had declined to review the ALJ's decision and also that it had rejected his newly proffered exhibits. The DAB found that there was no basis to consider plaintiff's personal statement material or relevant as it added nothing new to the previously adduced evidence and would not have materially affected the outcome of the case.
The court's review of the Secretary's final decision is governed by 42 U.S.C. § 1320a-7(f), which incorporates the standard of judicial review found in 42 U.S.C. § 405(g). Under that standard, judicial review is limited to determining whether the decision of the Secretary is supported by substantial evidence. Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971). Substantial evidence is more than a scintilla of evidence, but less than a preponderance. It is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Kirk v. Secretary of Health and Human Services, 667 F.2d 524, 535 (6th Cir.1981) cert. den., 461 U.S. 957, 103 S.Ct. 2428, 77 L.Ed.2d 1315 (1983).
When the decision of the Secretary is supported by substantial evidence, it will be affirmed even if the District Court would have decided matters differently, and even if substantial evidence would have supported the opposite conclusion. Kinsella v. Schweiker, 708 F.2d 1058, 1059 (6th Cir. 1983); Mullen v. Bowen, 800 F.2d 535, 545 (6th Cir.1986)(en banc). The District Court, in fulfilling its duties pursuant to 42 U.S.C. § 405(g), may not try the case de novo, resolve conflicts in the evidence, or decide questions of credibility. Garner v. Heckler, 745 F.2d 383, 387 (6th Cir.1984).
Title 42 U.S.C. § 1320a-7(a)(1) requires the Secretary to exclude from participation in the Medicare program and specified state health care programs "[a]ny individual or entity that has been convicted of a criminal offense related to the delivery of an item or service under" such programs. A "conviction" includes a plea of guilty or nolo contendere which has been accepted by a state, federal, or local court. 42 U.S.C. § 1320a-7(i)(3). The statute expressly requires that in cases involving a program-related crime "the minimum period of exclusion shall not be less than five years." 42 U.S.C. § 1320a-7(c)(3)(B). The Secretary has issued regulations implementing the exclusion state and
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has delegated enforcement of those regulations to the Inspector General. 42 C.F.R. § 1001.1 et seq. When the statute requires the imposition of a minimum five year exclusion due to conviction of a program-related crime, the regulations permit the Secretary to increase the duration of the exclusion if specified aggravating factors are found to exist. 42 C.F.R. § 1001.102(b). If the Secretary increases the duration of the exclusion based upon the existence of one or more aggravating factors, the party challenging the exclusion may prove the existence of one or more specified mitigating factors which would warrant a reduction in the exclusion period to less than five years. 42 C.F.R. § 1001.102(c).
The regulations contain an exclusive list of the aggravating facts which may serve as the basis for the Secretary's decision to impose...
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Friedman v. Sebelius, Civil Action No. 09–2028 (ESH).
...whether that decision is supported by substantial evidence,” citing 42 U.S.C. § 1320a–7(f) and 42 U.S.C. § 405(g).); Patel v. Shalala, 17 F.Supp.2d 662, 665 (W.D.Ky.1998) (“The court's review of the Secretary's final decision is governed by 42 U.S.C. § 1320a–7(f), which incorporates the sta......
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Brennan v. Comm'r of Soc. Sec.
...2017). Even an "inadvertent omission by prior counsel" in submitting evidence is not "good cause" for the failure. Patel v. Shalala, 17 F. Supp. 2d 662, 667 (W.D. Ky. 1998); see also Shuter v. Astrue, 537 F. Supp. 2d 752, 758-59 (E.D. Pa. 2008) (rejecting "good cause" where the administrati......
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Friedman v. Sebelius
...whether that decision is supported by substantial evidence, " citing 42 U.S.C. § 1320a-7(f) and 42 U.S.C. § 405(g).); Patel v. Shalala, 17 F. Supp. 2d 662, 665 (W.D. Ky. 1998) ("The court's review of the Secretary's final decision is governed by 42 U.S.C. § 1320a-7(f), which incorporates th......
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...2017). Even an "inadvertent omission by prior counsel" in submitting evidence is not "good cause" for the failure. Patel v. Shalala, 17 F. Supp. 2d 662, 667 (W.D. Ky. 1998); see also Shuter v. Astrue, 537 F. Supp. 2d 752, 758-59 (E.D. Pa. 2008) (rejecting "good cause" where the administrati......