SUBJECT:

Julie R. Homme,

Petitioner,

The Inspector General.

DECISION

This case is before me pursuant to a request for hearing filed by Julie R. Homme, Petitioner, on November 15, 2004. Social Security Act (Act), section 1128(f); 42 C.F.R. � 1005.2.

By letter dated October 29, 2004, the Inspector General (I.G.) notified Petitioner that she was being excluded from participating in the Medicare, Medicaid, and all federal health care programs as defined in section 1128B(f) of the Act. ALJ Exhibit (Ex.) 1. ⁽¹⁾ The I.G. further informed Petitioner that the exclusion was based on section 1128(b)(4) of the Act, in view of the revocation, suspension, loss, or surrender of her license to practice medicine or provide health care as a counselor in the State of Washington for reasons bearing on her professional competence, professional performance, or financial integrity. The exclusion, the I.G. informed Petitioner, would be in effect as long as her license remained revoked.

The I.G. is represented in this case by the Office of Counsel. Petitioner appears pro se. At a telephone conference held on February 16, 2005, I informed the parties that this matter could be decided based on written arguments and documentary evidence inasmuch as there are no issues requiring an in person hearing. Pursuant to the order to that effect, issued by me on February 18, 2005, the I.G. submitted a memorandum of law, accompanied by two proposed exhibits, on March 15, 2005. These have been identified as I.G. Exs. 1-2, and I admit them into the record without objection. Petitioner submitted a hand-written, six-page letter which I received on May 19, 2005. I consider this to be Petitioner's brief. Attached to Petitioner's letter were two one-page documents. I have marked these as Petitioner's Exs. 1-2, and I admit them without objection.

It is my decision to sustain the determination of the I.G. to exclude Petitioner, Julie R. Homme, from participating in the Medicare, Medicaid, and all other federal health care programs, for a period coterminous with the loss of her license to practice medicine or provide health care in the State of Washington. I base my decision on the documentary evidence, the applicable law and regulations, and the arguments of the parties. It is my finding that Petitioner's license was revoked by the Washington Department of Health, Office of Professional Standards, for reasons bearing on her professional competence, professional performance, or financial integrity. Additionally, I find that when an exclusion imposed by the I.G. runs concurrent with the remedy imposed by the State licensing authority, such exclusion shall not be less than the period during which the individual's license is suspended or revoked.

1. Whether the I.G. had a basis upon which to exclude Petitioner from participating in the Medicare, Medicaid, and all other federal health care programs.

2. Whether the length of the exclusion imposed and directed against Petitioner by the I.G. is unreasonable.

Under section 1128(b) of the Act, the Secretary of Health and Human Services (Secretary) may exclude individuals from receiving payment for services that would otherwise be reimbursable under Medicare, Medicaid, or other federal health care programs.

The Act defines "federal health care program" as any plan or program that provides health care benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government; or any state health care program, as defined in section 1128(h). Act, section 1128B(f).

Section 1128(b)(4) of the Act authorizes the Secretary to exclude an individual whose license has been lost, suspended, revoked, or surrendered while a formal disciplinary proceeding is pending before a state licensing authority, and the proceeding concerns the individual's professional competence, professional performance, or financial integrity. According to section 1128(c)(3)(E) of the Act, the minimum term of exclusion of an individual who is excluded pursuant to section 1128(b)(4) must be coterminous with the term of loss, revocation, suspension, or surrender of that individual's license to provide health care.

The regulations promulgated at 42 C.F.R. �� 1001.501 and 1001.1901(b) mirror the statutory provisions set forth in the Act.

1. Petitioner was licensed as a counselor and as a chemical dependency professional in the State of Washington. I.G. Ex. 1, at 3.

2. Petitioner provided counseling services to Client A from approximately August 26, 2002 through September 23, 2002. ⁽²⁾ I.G. Ex. 1, at 2.

3. In or about September 2002, Petitioner hired Client A to come to her home and clean her house. I.G. Ex. 1, at 2.

4. Because she suspected that Client A stole money from her home, Petitioner wrote her a letter demanding the return of the money. She also threatened Client A with pressing charges if Client A informed Petitioner's boss that she hired her to do house cleaning.

5. Petitioner possessed a counselor's license to provide health care within the meaning of section 1128(b)(4) of the Act. I.G. Ex. 1.

6. The State of Washington Department of Health is a state licensing authority. I.G. Ex 1.

7. Petitioner's medical license was revoked by the State of Washington Department of Health, Office of Professional Standards, for reasons bearing on her professional competence or professional performance. I.G. Ex. 1, at 3, 4

8. Petitioner engaged in unprofessional conduct in violation of RCW 18.130.180(1), (4), (13), and (24). I.G. Ex. 1, at 3.

9. Petitioner's counselor's license was revoked within the meaning of section 1128(b)(4) of the Act. 42 U.S.C. � 1320a-7(b)(4).

10. The I.G. had a legal basis for excluding Petitioner under section 1128(b)(4) of the Act.

11. Petitioner's exclusion is effective until such time as her license to provide counseling is restored and she applies for, and is granted, reinstatement by the I.G. to participate in federal health care programs.

12. There is no legal issue as to the length of Petitioner's exclusion.

Conclusion

It is my decision that the I.G. was authorized to exclude Petitioner pursuant to section 1128(b)(4) of the Act. Additionally, I conclude that the indefinite period of exclusion imposed by the I.G. is the minimum period mandated by section 1128(c)(3)(E) of the Act.

José A. Anglada

Administrative Law Judge

1. The I.G. failed to include the notice of exclusion as an exhibit. I have, therefore, entered that notice into the record motu proprio.

2. The Amended Findings of fact, Conclusions of Law, and Final Order on Default issued by the State of Washington Department of Health, Office of Professional Standards, refers to the client in question as "Client A." I.G. Ex. 1, at 2.