SUBJECT:

Brent Woodfield, M.D.,

Petitioner,

The Inspector General

I sustain the determination of the Inspector General (I.G.) to exclude Petitioner, Brent Woodfield, M.D., from participating in the Medicare, Medicaid, and all federal health care programs as defined in section 1128B(f) of the Social Security Act (Act)⁽¹⁾ until Petitioner's license to practice medicine in the State of Idaho is reinstated.

I. DISCUSSION

On June 30, 2000, the I.G. notified Petitioner that he was being excluded from participating in Medicare and Medicaid. The I.G. advised Petitioner that the exclusion was being imposed pursuant to section 1128(b)(4) of the Act because his license to practice medicine or provide health care in the State of Idaho was revoked, suspended, or otherwise lost or was surrendered while a formal disciplinary hearing was pending before the Idaho State licensing authority for reasons bearing on his professional competence, professional performance, or financial integrity. The I.G. told Petitioner that he would not be eligible to apply for reinstatement to participate in Medicare and Medicaid until he obtained reinstatement of his Idaho license.

By letter dated August 28, 2000, Petitioner requested a hearing and the case was assigned to me for appropriate proceedings. I convened a prehearing conference by telephone on September 28, 2000.

During the conference, Petitioner agreed with the I.G.'s assertion that his license to practice medicine in the State of Idaho had been revoked, suspended, or otherwise lost or surrendered for reasons bearing on his professional competence or performance. He was aware that, under the foregoing circumstances, the law permits the I.G. to continue the exclusion in effect for as long as his State license to practice medicine remains revoked, suspended, or otherwise lost. However, Petitioner explained that he wished to have a hearing before me because he should not have lost his license. He believed the loss was caused by the State licensing authority's misinterpretation of certain medical information. Additionally, he was hoping to review documents which are not in the I.G.'s possession or control, but which have been gathered by other agencies of the United States Department of Health and Human Services. See October 24, 2000 Order and Schedule for Filing Briefs and Documentary Evidence (October 24, 2000 Order) at p. 2.

In view of the fact that Petitioner was appearing pro se, I enclosed with my October 24, 2000 Order copies of regulations codified at 42 C.F.R. § 1001.2007 ("Appeal of exclusions") and 42 C.F.R. § 1001.501 ("License revocation or suspension"). I invited him to review these regulations in order to determine whether he has any legally cognizable defense to raise. I also enclosed a copy of the regulation codified at 42 C.F.R. § 1005.7 ("Discovery"). October 24, 2000 Order at pp. 2 - 3.

Both parties agreed that it would be appropriate to proceed by submitting written arguments supported by appropriate citations and documentary evidence. I established a liberal briefing schedule so that Petitioner would have sufficient time to prepare his response to the I.G.'s initial submission, either on his own or with the help of any attorney he may have been able to retain in the meantime. October 24, 2000 Order at p. 2.

The I.G. timely submitted eight proposed exhibits with her brief which the I.G. identified as I.G. Ex. 1 - 8. Although I directed Petitioner both by oral order and by written order to file a brief in response along with supporting documentary evidence, he has not filed any submission in response to the I.G.'s submission. I note, however, that Petitioner did attach 27 pages of supporting documentation to his hearing request. Petitioner has not characterized these documents as "exhibits." To safeguard Petitioner's interests against prejudice, I have elected to designate this 27-page attachment as an exhibit. I identify it as P. Ex. 1. I receive into evidence I.G. Ex. 1 - 8. Additionally, I receive into evidence P. Ex. 1.

In affirming the I.G.'s determination, I have considered the applicable law, the exhibits, and the statements of the parties. I conclude that no material controversy exists in this case. The I.G. has submitted sufficient reliable evidence to sustain her burden of proving that there is a basis for the exclusion under section 1128(b)(4) of the Act. Petitioner made concessions during the prehearing conference which support the prima facie validity of the I.G.'s action. The regulation at 42 C.F.R. § 1001.2007(d) precludes my allowing Petitioner to collaterally attack the State licensing authority's decision. Nor is he entitled to use the discovery process in these proceedings to obtain documents which may be in the possession of non-party agencies. See 42 C.F.R. § 1005.7.

Although Petitioner has been given ample opportunity to submit other arguments or evidence that may be legally relevant, he has not done so. Petitioner's failure to do so is consistent with his verbal concessions at the prehearing conference that his license to practice medicine in Idaho had been revoked, suspended, or otherwise lost or surrendered for reasons bearing on his professional competence or performance. Petitioner also agreed that, under these circumstances, the law permits the I.G. to continue the exclusion in effect for as long as his State license to practice medicine remains revoked, suspended, or otherwise lost. Petitioner has introduced nothing that casts doubt on the validity of the I.G.'s determination.

II. FINDINGS OF FACT AND CONCLUSIONS OF LAW

For the reasons discussed above, I issue these formal findings and conclusions based on the pleadings and the undisputed evidence that are material under the applicable statutes and regulations:

1. The I.G. is authorized to exclude an individual whose license to provide health care has been revoked by any State licensing authority for reasons bearing on the individual's professional competence, professional performance, or financial integrity. Act, section 1128(b)(4).

2. Where the I.G. determines to exclude an individual pursuant to section 1128(b)(4) of the Act, the duration of the exclusion must coincide, at minimum, with the period during which the individual's State health care license is revoked. Act, section 1128(c)(3)(E).

3. The I.G. is authorized to exclude Petitioner because Petitioner's license to practice medicine in the State of Idaho was revoked by that State's licensing authority for reasons bearing on Petitioner's professional competence or professional performance. I.G. Ex. 3, 5, 6, 8; October 24, 2000 Order.

4. The length of the exclusion imposed by the I.G. is reasonable as a matter of law because it is coterminous with the period for which his license to practice medicine has been revoked by the State of Idaho. Act, section 1128(c)(3)(E).

III. CONCLUSION

I sustain the exclusion imposed by the I.G.

Mimi Hwang Leahy

Administrative Law Judge

1. In this decision, I refer to all programs from which Petitioner has been excluded, other than Medicare, as "Medicaid."