Areas of Law:
Medicare and Medicaid Exclusion
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.
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