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 INSPECTOR GENERAL**

The Inspector General (I.G.) determined to exclude Petitioner, , from
participating in Medicare, Medicaid, and other federally-funded health
care programs. The statutory basis given for the exclusion is section(s)
of the Social Security Act (Act). The duration of the exclusion is for
at least years, or, in the case of an exclusion imposed pursuant to
sections 1128(b)(4), 1128(b)(5), or 1128(b)(14) of the Act, until .

The issues in this case are whether:

> 1\. The I.G. has the authority to exclude Petitioner; and
>
> 2\. The length of the exclusion is reasonable, in the case of any
> exclusion that is not for a minimum mandatory period.

**I. Authority for the exclusion.** Describe each fact that supports the
I.G.'s determination that Petitioner may or must be excluded pursuant to
section(s) of the Act and explain why these facts support your argument
that an exclusion is authorized or mandated.

In doing so, cite to each exhibit that supports your statement of facts
and explain why it does.

**II. Whether the length of the exclusion is reasonable.**

> A. Is the exclusion for a minimum mandatory period of five years
> (applicable only in cases where the exclusion is imposed pursuant to
> section 1128(a) of the Act)?

Yes No

> Is it for a minimum mandatory period of three years (applicable only
> in cases where the exclusion is imposed pursuant to section 1128(b) of
> the Act)?

Yes No

> B. If the exclusion is for other than a minimum mandatory period,
> state each regulatory aggravating factor that you contend is present
> in the case. Cite the relevant regulatory section that states each
> aggravating factor that you contend is present. Describe the facts
> that support the presence of each aggravating factor or factors. Cite
> to each exhibit that supports your contentions and explain why it
> does.
>
> C. If there are mitigating factors present in this case, state each
> mitigating factor that you contend is present. Cite the relevant
> regulatory section that states each mitigating factor that you contend
> is present. Describe the facts that support the presence of each
> mitigating factor or factors. Cite to each exhibit that supports your
> contentions and explain why it does.
>
> D. Explain why the facts that relate to the aggravating and, if any,
> mitigating factors that you contend are present support a finding that
> the length of the exclusion is reasonable.

**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, II, and
> III.
>
> 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?**

Yes No

If so, please state them here. State which exhibits support your
argument(s) and explain why they do.

Counsel for the I.G.

Date: