Skip to main content


U.S. flag
      An official website of the United States government
              Here’s how you know
        Here’s how you knowDot gov**Official websites use .gov**
                 A **.gov** website belongs to an official government organization in the United States.
                  HTTPS**Secure .gov websites use HTTPS**
                 A **lock** (A locked padlock) or **https://** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites. 
  Menu Close
          HHS Search block
    Search
        








  
  
    

  
      

                                      About HHS
    
                        
                              
      
      
      Programs & Services
    
                        
                              
      
      
      Grants & Contracts
    
                        
                              
      
      
      Laws & Regulations Breadcrumb
    Home
                              About
                              Agencies
                              DAB
                              Decisions
                              ALJ Decisions
                              2023 ALJ Decisions
                              Oduah Daniel Osaro, M.D., DAB CR6385 (2023)
 Navigate to:
  Departmental Appeals Board (DAB)
    
                                                  
                                                    
            
      
      
      
      About DAB
                                            
            
            Organizational Overview
    
                                                  
                              
            
      
      
      
      Who are the Judges?
    
                                                  
                              
            
      
      
      
      DAB Divisions
    
                                                  
                              
            
      
      
      
      Contact DAB
    
                                                  
                                                    
            
      
      
      
      Filing an Appeal Online
                                            
            
            DAB E-File
    
                                                  
                              
            
      
      
      
      Medicare Operations Division (MOD) E-File
    
                                                  
                                                    
            
      
      
      
      Different Appeals at DAB
                                            
            
            Appeals to DAB Administrative Law Judges (ALJs)
                          
            
            Forms
    
                                                  
                              
            
      
      
      
      Procedures
    
                                                                
                                                    
            
      
      
      
      Appeals to Board
                          
            
            Practice Manual
    
                                                  
                              
            
      
      
      
      Guidelines
    
                                                  
                              
            
      
      
      
      Regulations
    
                                                  
                              
            
      
      
      
      National Coverage Determination Complaints
    
                                                                
                                                    
            
      
      
      
      Appeals to the Medicare Appeals Council (Council)
                          
            
            Forms
    
                                                  
                              
            
      
      
      
      Fully Integrated Duals Advantage (FIDA) Demonstration Project
    
                                                  
                                                    
            
      
      
      
      Alternative Dispute Resolution Services
                                            
            
            Sharing Neutrals
    
                                                  
                              
            
      
      
      
      ADR Training
    
                                                  
                              
            
      
      
      
      Other ADR Services
    
                                                  
                                                    
            
      
      
      
      DAB Decisions
                                            
            
            Board Decisions
    
                                                  
                              
            
      
      
      
      DAB Administrative Law Judge (ALJ) Decisions
    
                                                  
                              
            
      
      
      
      Medicare Appeals Council (Council) Decisions
    
                                    
                              
            
      
      
      
      Stakeholder Feedback
    
                                                  
                                                    
            
      
      
      
      Careers
                                            
            
            Open Career Opportunities
    
                                                  
                              
            
      
      
      
      Internships & ExternshipsText resize icon

                    




Oduah Daniel Osaro, M.D., DAB CR6385 (2023)








  
  
    

  
      
Department of Health and Human Services 
    DEPARTMENTAL APPEALS BOARD
          Civil Remedies Division





Oduah Daniel Osaro, M.D.,
(PTAN: 1B3721001, NPI No.: 1821095787),
Petitioner,

v.

Centers for Medicare & Medicaid Services.
Docket No. C-23-317Decision No. CR6385November 1, 2023

        
              
    

      DECISION

I sustain the determination of the Centers for Medicare & Medicaid Services (CMS) to revoke the Medicare participation of Petitioner, Oduah Daniel Osaro, and to place him on the Preclusion List.

I.    Background

This case was reassigned to me recently.  I have reviewed the record and find that the parties have completed their pre-hearing exchanges.

CMS moved for summary judgment, contending that there are no disputed issues of material fact.  Although I agree with CMS that there are no material facts in dispute, it is unnecessary that I decide whether all the criteria for summary judgment are met.  That is because neither CMS nor Petitioner offered witness testimony.  Consequently, there is no need for an in-person evidentiary hearing.  This case is ripe for decision based on the parties’ written exchanges of arguments and evidence.

Page 2

With its exchange CMS filed exhibits that are identified as CMS Ex. 1 – CMS Ex. 15.  Petitioner filed exhibits that are identified as P. Ex. 1 – P. Ex. 12.1  I receive these exhibits into the record.

II.    Issues, Findings of Fact and Conclusions of Law

**A.    Issues**

The issues are whether CMS may revoke Petitioner’s participation in Medicare and place him on the Preclusion List.

**B.    Findings of Fact and Conclusions of Law**

Petitioner is a physician and has been enrolled as a supplier of Medicare services.  CMS revoked Petitioner’s Medicare participation on the authority of 42 C.F.R. § 424.535(a)(12).  This section authorizes revocation of a supplier’s participation where that supplier’s participation in a State Medicaid program has been revoked, terminated, or otherwise barred.

Additionally, CMS put Petitioner on its Preclusion List, an action that effectively bars him from receiving reimbursement for services provided for or on behalf of any federally funded healthcare program.  In doing so, CMS relied on 42 C.F.R. § 422.2.  This section authorizes placing an individual on the Preclusion List, with exceptions that do not on their face apply here, if that individual’s Medicare participation is currently revoked, if the individual is currently under a reenrollment bar, and if CMS determines that the underlying conduct that led to revocation of that individual’s participation is detrimental to the best interests of the Medicare program.2

The evidence unequivocally supports CMS’s determinations.

Petitioner is the sole owner, authorized official, and managing employee of an entity known as Clinton Urgent Care PLC (Clinton).  CMS Ex. 1 at 3-4; CMS Ex. 12 at 2; CMS Ex. 13; CMS Ex. 14.  In May 2013, the Iowa Department of Human Services (State agency) terminated Petitioner’s participation in the Iowa Medicaid program, finding that Petitioner had violated both state requirements and federal law.  CMS Ex. 1 at 3; CMS Ex. 8.  The basis for termination of participation was that Petitioner had unlawfully taken cash payments from Medicaid recipients.  *Id*.  Subsequently, CMS revoked Petitioner’s Medicare participation.  CMS Ex. 1 at 3.3

Page 3

On November 9, 2021, the State agency terminated Clinton’s participation in the Iowa Medicaid program, effective immediately.  CMS Ex. 9.  The reason for termination was that Clinton had received $76,111.03 as reimbursement for claims for Medicaid services, services that in fact had been provided by Petitioner.  *Id*.  The State agency found that Petitioner had been billing for his services under Clinton’s provider number as a means of circumventing his termination from participation in the Iowa Medicaid program.  *Id*.

Clinton no longer has appeal rights from the Iowa State agency’s determination and that determination now is administratively final.

On June 4, 2022, CMS revoked Petitioner’s Medicare participation.  CMS Ex. 3 at 2.  Additionally, CMS imposed a five-year reenrollment bar and placed Petitioner on the Preclusion List.  Petitioner requested reconsideration of CMS’s determination.  The determination was upheld on reconsideration and Petitioner then requested a hearing.

The evidence establishes Petitioner to be an individual whose participation in the Iowa Medicaid program has been revoked, terminated, or otherwise barred, as is described by 42 C.F.R. § 424.535(a)(12).  It is not disputed that Petitioner is Clinton’s sole owner, authorized official, and manager.  No other individual bears responsibility for the services that Clinton provides.  Any services that Clinton purportedly provides are services provided by Respondent under another name.  Therefore, Petitioner is not just Clinton’s proprietor, but he is Clinton for all practical purposes.

CMS may revoke a supplier’s participation on the authority of 42 C.F.R. § 424.535(a)(12) based on factors that include:  (A) the reasons for that supplier’s termination from a State Medicaid program; (B) whether the supplier is currently terminated, revoked or barred from more than one program; and (C) any other information that CMS deems to be relevant.  42 C.F.R. § 424.535(a)(12)(i)(A)-(C).  In this case, evidence relating to factors A and C amply supports CMS’s determination because it establishes Petitioner to be untrustworthy to provide care to Medicaid recipients and Medicare beneficiaries.

The evidence not only establishes that Petitioner unlawfully billed Medicaid recipients for services for which they were not required to pay but also engaged in a subterfuge to continue doing so after he’d been caught in the act.  Petitioner deliberately circumvented the termination of his Medicaid billing privileges by billing for Medicaid services under another name and by continuing to unlawfully extract money from recipients. The amount of his unlawful gains – at least $76 thousand – was substantial.  Moreover, it constitutes money taken unlawfully from Iowa’s poorest residents, individuals who, by

Page 4

definition, were unable to purchase medical services from their own income and resources.

There is additional evidence that establishes Petitioner to be untrustworthy.  In 2014 the Iowa State Board of Medicine found that Petitioner had engaged in unprofessional conduct and had violated laws governing the practice of medicine.  CMS Ex. 9.

This evidence also amply supports CMS’s determination to place Petitioner on the Preclusion List.  Petitioner’s Medicare participation is currently revoked.  He is subject to a reenrollment bar.  CMS Ex. 1 at 6.  Finally, the evidence relating to Petitioner’s efforts to continue unlawfully claiming reimbursement for Medicaid services and extract cash payments from program recipients establishes Petitioner to be so untrustworthy that placing him on the Preclusion List would be in the best interests of the Medicare program.  42 C.F.R. § 422.2(1)(i)-(iii)(A)-(C).

I have considered Petitioner’s contentions and arguments.  I find them to be without merit.

Petitioner has not offered evidence that refutes that which I rely on to establish the facts of this case.  Instead, he makes arguments that are equitable in character.  He asserts that he has provided services to drug addicts, disabled veterans, and Medicaid recipients, without receiving complaints from these patients.  He contends that it would be unjust and cruel to deprive these persons of his services.  Motion for Reversal of CMS Revocation of Oduah Osaro/Clinton Urgent Care PLC’s Medicare Enrollment and CMS Preclusion List Dated January 5, 2023 (Petitioner’s brief) at 3.

I have no authority to hear and decide this argument.  I may not overturn on equitable grounds a legally valid determination by CMS.  *Foot Specialists of Northridge*, DAB No. 2773 at 17 (2017).

Petitioner also seems to assert that he was able to contract to provide services for various entities (“Total Care” and “Amerihealth”) even after his Medicaid participation in Iowa was terminated.  Petitioner’s brief at 3.  From this he seems to be contending that these contractual relationships somehow justified his continued billing for Medicaid services via Clinton as well as his continued practice of extracting cash payments from Medicaid recipients.

I fail to see the relevance of Petitioner’s other contractual relationships to the issues before me.  Whatever Petitioner may have done on behalf of other entities it does not gainsay the conduct that justifies CMS’s determination to revoke his Medicare billing privileges and to place him on the Preclusion List.

Page 5

Petitioner also argues that the State of Iowa resolved a fraud investigation against Petitioner without imposing additional sanctions against him.  Petitioner’s brief at 4; *see* P. Ex. 9.  That may be so, but it does not address the basis for Clinton’s termination from participation in the Iowa Medicaid program, nor does it address CMS’s reasons for revoking Petitioner’s Medicare billing privileges or putting him on the Preclusion List.

Endnotes

1  Petitioner filed two copies of P. Ex. 9.  The exhibits are identical.

2  42 C.F.R. § 433.100 restates these criteria.

3  Petitioner challenged CMS’s determination in an administrative hearing.  An administrative law judge sustained the determination.  *Oduah D. Osaro, M.D.*, DAB CR4357 (2015).
  
          /s/
        Steven T. Kessel

                      Administrative Law Judge Back to top
    Contact HHS
    
                        
                                            
      
      
      Careers
    
                        
                                            
      
      
      HHS FAQs
    
                        
                                            
      
      
      Nondiscrimination NoticeHHS Archive
    
                        
                                            
      
      
      Accessibility Statement
    
                        
                                            
      
      
      Privacy Policy
    
                        
                                            
      
      
      Viewers & PlayersBudget/Performance
    
                        
                                            
      
      
      Inspector General
    
                        
                                            
      
      
      Web Site Disclaimers
    
                        
                                            
      
      
      EEO/No Fear ActFOIA
    
                        
                                            
      
      
      The White House
    
                        
                                            
      
      
      USA.gov
    
                        
                                            
      
      
      Vulnerability Disclosure Policy
        Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases.

Sign Up
  HHS Headquarters
          200 Independence Avenue, S.W.
                  Washington, D.C. 20201
                  Toll Free Call Center: 1-877-696-6775​ Disclaimer Policy: Links with this icon () mean that you are leaving the HHS website. The Department of Health and Human Services (HHS) cannot guarantee the accuracy of a non-federal website.
                  Linking to a non-federal website does not mean that HHS or its employees endorse the sponsors, information, or products presented on the website. HHS links outside of itself to provide you with further information.
                  You will be bound by the destination website's privacy policy and/or terms of service when you follow the link.
                  HHS is not responsible for Section 508 compliance (accessibility) on private websites. For more information on HHS's web notification policies, see Website Disclaimers.
 Continue
                  Go back