United States Department of Health and Human Services

**DEPARTMENTAL APPEALS BOARD**

Civil Remedies Division

In the Case of: )

)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ) Date:

> )

Petitioner, )

) Docket No. C-XX-XXX

\- v. - )

)

The Inspector General. )

)

)

**INFORMAL BRIEF OF PETITIONER**

The Inspector General (I.G.) argues that he must exclude you from
participating in Medicare, Medicaid, and other federally-funded health
care programs for at least five years, because you were convicted of
crimes that are described at section 1128(a)(1) and/or section
1128(a)(3) of the Social Security Act.

The issue in this case is whether the I.G. is required to exclude you.

**I. Were you convicted of a criminal offense AND/OR of a felony that
was committed after August 21, 1996?**

Yes No

> **A.** Do you agree that you were convicted of a criminal offense that
> was committed after August 21, 1996?

Yes No

> If you **disagree,** explain why you disagree. State which exhibits
> support your argument and explain why they do.
>
> B. Do you agree that you were convicted of a felony that was committed
> after August 21, 1996? \_\_\_\_\_ Yes \_\_\_\_\_ No
>
> If you **disagree,** explain why you disagree. State which exhibits
> support your argument and explain why they do.

**II. Were you convicted of an offense for which exclusion is
required?**

The I.G. argues that he must exclude you, because:

> A. Your conviction was of a criminal offense related to the delivery
> of an item or service under Medicare or a State Medicaid program. Do
> you disagree with the I.G.'s argument? \_\_\_\_\_\_ Yes \_\_\_\_\_ No
>
> If you **disagree,** explain why you disagree. State which exhibits
> support your argument and explain why they do; and/or
>
> B. Your conviction was of a felony relating to fraud, theft,
> embezzlement, breach of fiduciary responsibility or other financial
> misconduct that was committed: in connection with the delivery of a
> health care item or service; **or** with respect to any act or
> omission in a health care program other than Medicare or a State
> Medicaid program operated by, or financed in whole or in part by, any
> federal, State, or local government agency.

Do you disagree with the I.G.'s argument?

\_\_\_\_\_ Yes \_\_\_\_\_ No

> If you **disagree,** explain why you disagree. State which exhibits
> support your argument and explain why they do.

.

**III. Do you believe that an in-person hearing is necessary to decide
your case?**

Yes No

Do you have any testimony that you wish to offer at an in-person
hearing?

Yes No

If you have testimony that you wish to offer, provide the following:

> 1\. The name of each witness whose testimony you want to offer.
>
> 2\. A description of each witness' proposed testimony and an
> explanation of why you believe that the testimony relates to any of
> the arguments you want to offer in connection with items I and II.
>
> 3\. An explanation of why the proposed testimony does not duplicate
> something that is already stated in an exhibit.

**IV. Do you have any other arguments you wish to make?** If so, please
state them here. State which exhibits support your argument(s) and
explain why they do.

Petitioner or Petitioner's Representative

Date: