[Source: Health Lawyers Weekly, Vol. 6, Iss. 25, June 27, 2008 - AHLA]
The Department of Health and Human Services Secretary correctly determined that a physician who pled nolo contendere on charges of attempting to defraud TennCare, Tennessee’s Medicaid managed care program, was “convicted” of a criminal offense under applicable federal statutes and therefore subject to a mandatory five-year exclusion from participation in Medicare, Medicaid, and all other federal healthcare programs, a federal district court ruled June18.
. . . .
Physician excluded under 42 U.S.C. § 1320a-7: Among other categories enumerated in that statute, the Secretary is authorized to exclude for a period of not less than five years, “any individual or entity that have been convicted of a criminal offense related to the delivery of an item or service under any state health care program.”
Under another provision of the statute, “convicted,” is further defined as a “judgment of conviction . . . regardless of whether there is an appeal pending or whether the judgment . . . relating to criminal conduct has been expunged,” as well as a “plea of guilty or nolo contendere” accepted by a court, or evidence that an individual or entity has entered into participation in a first offender, deferred adjudication, or other program where judgment of conviction has been withheld.
Continue reading
Gupton v. Leavitt, No. 3:07-cv-185 (E.D. Tenn. June 18, 2008).
