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Related Case Results

Obtain a Registration for an Excluded Physician

A physician was excluded from participation with Medicare and Medicaid for committing health care fraud. After the reinstatement of his medical license, he applied for a certificate of registration with the DEA. They were considering rejecting his application solely due to the exclusion issue, even though his license had been reinstated.

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Case Result: Reduction of a Medicare and Medicaid Exclusion Period

Area of Law:
Medicare and Medicaid


Primary Issue:
A pharmacist was convicted of a controlled substance violation. As a result, he was excluded from participation in Medicare and Medicaid by the Office of Inspector General (“OIG”). His exclusion period was increased beyond the mandatory minimum time period of five years.

We argued to the OIG that exclusion for the prescribed time period was unreasonable under the OIG regulations and that most of the factors that lead to a greater exclusion period were inapplicable. The aggravating factors that were considered were whether petitioner’s acts resulted in a financial loss of $50,000 or more; whether the acts had a significant adverse physical, mental or financial impact on beneficiaries, and whether the acts resulted in incarceration. In mitigation, we argued that the financial loss was less than $5,000, that petitioner’s mental, emotional or physical commission was found to lessen his criminal culpability, and that the petitioner has been substantially cooperating. Further, we argued that the exclusion period should be reduced when these mitigating factors are considered. After considering the relevant factors, the administrative law judge determined that the period of exclusion was unreasonable and reduced the exclusion period.

This information is a sample of our past results. Prospective clients may not obtain the same or similar results. Every case is different and each case must be evaluated and handled on its own merits. The circumstances of your case may differ from the results provided. The information provided has not been reviewed or approved by the State Bar.

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