Department of Health and Human Services DEPARTMENTAL APPEALS BOARD Civil Remedies Division |
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IN THE CASE OF | |
Brent Woodfield, M.D., |
DATE: February 8, 2001 |
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The
Inspector General
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Docket No.C-00-808
Decision No. CR736 |
DECISION | |
I sustain the determination of the Inspector General (I.G.)
to exclude Petitioner, Brent Woodfield, M.D., from participating in the
Medicare, Medicaid, and all federal health care programs as defined in
section 1128B(f) of the Social Security Act (Act)(1)
until Petitioner's license to practice medicine in the State of Idaho
is reinstated. I. DISCUSSION On June 30, 2000, the I.G. notified Petitioner that he
was being excluded from participating in Medicare and Medicaid. The I.G.
advised Petitioner that the exclusion was being imposed pursuant to section
1128(b)(4) of the Act because his license to practice medicine or provide
health care in the State of Idaho was revoked, suspended, or otherwise
lost or was surrendered while a formal disciplinary hearing was pending
before the Idaho State licensing authority for reasons bearing on his
professional competence, professional performance, or financial integrity.
The I.G. told Petitioner that he would not be eligible to apply for reinstatement
to participate in Medicare and Medicaid until he obtained reinstatement
of his Idaho license. By letter dated August 28, 2000, Petitioner requested
a hearing and the case was assigned to me for appropriate proceedings.
I convened a prehearing conference by telephone on September 28, 2000. During the conference, Petitioner agreed with the I.G.'s
assertion that his license to practice medicine in the State of Idaho
had been revoked, suspended, or otherwise lost or surrendered for reasons
bearing on his professional competence or performance. He was aware that,
under the foregoing circumstances, the law permits the I.G. to continue
the exclusion in effect for as long as his State license to practice medicine
remains revoked, suspended, or otherwise lost. However, Petitioner explained
that he wished to have a hearing before me because he should not have
lost his license. He believed the loss was caused by the State licensing
authority's misinterpretation of certain medical information. Additionally,
he was hoping to review documents which are not in the I.G.'s possession
or control, but which have been gathered by other agencies of the United
States Department of Health and Human Services. See October 24,
2000 Order and Schedule for Filing Briefs and Documentary Evidence (October
24, 2000 Order) at p. 2. In view of the fact that Petitioner was appearing pro
se, I enclosed with my October 24, 2000 Order copies of regulations codified
at 42 C.F.R. � 1001.2007 ("Appeal of exclusions") and 42 C.F.R. � 1001.501
("License revocation or suspension"). I invited him to review these regulations
in order to determine whether he has any legally cognizable defense to
raise. I also enclosed a copy of the regulation codified at 42 C.F.R.
� 1005.7 ("Discovery"). October 24, 2000 Order at pp. 2 - 3. Both parties agreed that it would be appropriate to proceed
by submitting written arguments supported by appropriate citations and
documentary evidence. I established a liberal briefing schedule so that
Petitioner would have sufficient time to prepare his response to the I.G.'s
initial submission, either on his own or with the help of any attorney
he may have been able to retain in the meantime. October 24, 2000 Order
at p. 2. The I.G. timely submitted eight proposed exhibits with
her brief which the I.G. identified as I.G. Ex. 1 - 8. Although I directed
Petitioner both by oral order and by written order to file a brief in
response along with supporting documentary evidence, he has not filed
any submission in response to the I.G.'s submission. I note, however,
that Petitioner did attach 27 pages of supporting documentation to his
hearing request. Petitioner has not characterized these documents as "exhibits."
To safeguard Petitioner's interests against prejudice, I have
elected to designate this 27-page attachment as an exhibit. I identify
it as P. Ex. 1. I receive into evidence I.G. Ex. 1 - 8. Additionally,
I receive into evidence P. Ex. 1. In affirming the I.G.'s determination, I have considered
the applicable law, the exhibits, and the statements of the parties. I
conclude that no material controversy exists in this case. The I.G. has
submitted sufficient reliable evidence to sustain her burden of proving
that there is a basis for the exclusion under section 1128(b)(4) of the
Act. Petitioner made concessions during the prehearing conference which
support the prima facie validity of the I.G.'s action. The
regulation at 42 C.F.R. � 1001.2007(d) precludes my allowing Petitioner
to collaterally attack the State licensing authority's decision. Nor is
he entitled to use the discovery process in these proceedings to obtain
documents which may be in the possession of non-party agencies. See
42 C.F.R. � 1005.7. Although Petitioner has been given ample opportunity to
submit other arguments or evidence that may be legally relevant, he has
not done so. Petitioner's failure to do so is consistent with his verbal
concessions at the prehearing conference that his license to practice
medicine in Idaho had been revoked, suspended, or otherwise lost or surrendered
for reasons bearing on his professional competence or performance. Petitioner
also agreed that, under these circumstances, the law permits the I.G.
to continue the exclusion in effect for as long as his State license to
practice medicine remains revoked, suspended, or otherwise lost. Petitioner
has introduced nothing that casts doubt on the validity of the I.G.'s
determination. II. FINDINGS OF FACT AND CONCLUSIONS OF LAW For the reasons discussed above, I issue these formal
findings and conclusions based on the pleadings and the undisputed evidence
that are material under the applicable statutes and regulations:
III. CONCLUSION I sustain the exclusion imposed by the I.G. |
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JUDGE | |
Mimi Hwang Leahy Administrative Law Judge
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FOOTNOTES | |
1. In this decision, I refer to all programs from which Petitioner has been excluded, other than Medicare, as "Medicaid." | |