Department of Health and Human Services DEPARTMENTAL APPEALS BOARD Civil Remedies Division |
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IN THE CASE OF | |
Helmy Qurtom, M.D., |
DATE: October 10, 2001 |
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Centers for Medicare & Medicaid
Services.
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Docket No.C-01-769
Decision No. CR822 |
DECISION | |
DECISION
I sustain the Inspector General's (I.G.) determination
to exclude Helmy Qurtom, M.D., Petitioner, from participation in Medicare,
Medicaid, and other federal health care programs for an indefinite period
pursuant to section 1128(b)(4)of the Social Security Act (Act). I. Background By letter dated May 31, 2001, the I.G. notified Petitioner that he was being excluded, pursuant to section 1128(b)(4) of the Act, from participation in Medicare and other federally funded health care programs because his license to practice medicine in the State of Maryland had been revoked for reasons bearing on his professional competence, professional performance, or financial integrity. Petitioner requested a hearing and the case was assigned to me. I held a prehearing conference by telephone at which the parties agreed that the case could be heard and decided based on written submissions. Both parties submitted briefs (I.G. or P. Br.) accompanied by documentary evidence. The I.G. filed three exhibits (I.G. Exs. 1 - 3) as part of her submission. Petitioner filed no exhibits. In the absence of objection, I receive into evidence I.G. Exs. 1 - 3. Petitioner rests his case on arguments presented in his appeal request and his reply to the I.G.'s brief. Petitioner was a physician licensed in the State of Maryland. I.G. Ex. 3, at 1. On or about November 17, 1999, Petitioner was charged by the United States Attorney for the District of Maryland with stealing and converting to his own use student assistance benefits totaling $7,220, in violation of 18 U.S.C. �� 2 and 641. I.G. Ex. 1. Thereafter, he entered a plea of guilty to one count of
theft of government property: aiding and abetting, and, on March 4, 1999,
judgement was entered against him. I.G. Ex 2. He was sentenced to five
months imprisonment, and was required to pay a $15,000 fine and restitution
totaling $118,932.26. Id. Based on this conviction, the Board of
Physician Quality Assurance of Maryland (State Board) suspended Petitioner's
medical license. The State Board noted that, under Maryland law, a crime
involving fraud and deceit is a crime of moral turpitude. The State Board
therefore concluded that Petitioner had been convicted of a crime involving
moral turpitude. I.G. Ex. 3. II. Issue The sole issue before me is whether the I.G. had a basis
on which to exclude Petitioner based on the loss of his Maryland license
to practice medicine. III. Findings of Fact and Conclusions of Law I make findings of fact and conclusions of law (Findings) to support my decision in this case. I set forth each Finding below, in italics and bold, as a separately numbered heading. I discuss each Finding in detail.
The Act authorizes the Secretary to exclude from participation
in any federal health care program(1) an
individual whose license to provide health care has been revoked or suspended
for reasons bearing on the individual's professional competence, professional
performance\ or financial integrity. Act, section 1128(b)(4)(A). The I.G.'s
implementing regulations reiterate the Act's grant of authority, and provide
that the I.G. may exclude an individual whose license has been suspended
or revoked for reasons "bearing on the individual's . . . professional
competence, professional performance or financial integrity." 42 C.F.R.
� 1001.501. Both parties agree that the State Board revoked Petitioner's
medical license following his theft conviction. I.G. Ex. 2, at 1. Petitioner
argues that his conviction should not result in an exclusion because his
crime, which involved theft of federal student loan money, relates to
neither his profession nor to his financial integrity. The statutory and
regulatory language, however, do not require a nexus between license revocation
based on financial integrity and the individual's profession. This is
in stark contrast to license revocation based on competence or performance.
In those cases, the statute and regulation explicitly require that the
license revocation be based on "professional competence" or "professional
performance." Significantly, the adjective "professional" does not
modify "financial integrity," an omission that demonstrates Congress'
intent to include exclusions for a broad range of financial irregularities. I also reject Petitioner's claim that his conviction for
theft from a government program does not bear on his financial integrity.
An exclusion is imposed to protect the health care program from those
who have demonstrated themselves to be untrustworthy. See Manocchio
v. Kusserow, 961 F. 2d 1539 (11th Cir. 1992); Douglas
Schram, R. Ph., DAB No. 838 (1992). Congress has determined that providers
who lose their licenses for reasons bearing on their financial integrity
are untrustworthy, and a threat to the integrity of federal health care
programs. Theft of federal monies, no matter which program, must be considered
a crime relating to the individual's financial integrity, and certainly
raises significant concerns about the individual's trustworthiness. Petitioner raises some additional arguments: 1) in applying to become a Medicare/Medicaid provider, he disclosed his conviction and was nevertheless approved to participate, and, in a related argument, he points out that Washington, D.C. renewed his medical license; 2) he has a unique immigration history, having rendered significant services to the United States during the Gulf War; and 3) he has paid his debt and is fully rehabilitated. The factors I may consider in this proceeding, however, are very limited. I am bound by the requirements of the statute and regulations and I may not review the exercise of the I.G.'s discretion to exclude an individual under section 1128(b) of the Act. Because I find that Petitioner's medical license was revoked for reasons bearing on his financial integrity, I must sustain the exclusion without regard to Petitioner's equitable arguments.
For a person excluded under section 1128(b)(4), the statute
also requires that the period of exclusion "shall not be less than the
period during which the individual's or entity's license . . . is . .
. revoked." Act, section 1128(b)(4). I therefore have no authority to
shorten the length of the exclusion period. IV. Conclusion For the reasons stated above, I conclude that the revocation of Petitioner's medical license related to his financial integrity. I therefore affirm the I.G.'s determination and find that the I.G. had a basis to exclude Petitioner from participation in Medicare, Medicaid, and other federal health care programs for an indefinite period pursuant to section 1128(b)(4) of the Act. |
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JUDGE | |
Carolyn Cozad Hughes Administrative Law Judge |
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FOOTNOTES | |
1. The Act defines a "Federal health care program" in this context to mean "(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government . . . ; or (2) any State health care program, as defined in section 1128(h). Act, section 1128B(f); see Act, section 1128(b). | |