CASE | DECISION | JUDGE | FOOTNOTES

Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Civil Remedies Division
IN THE CASE OF  


SUBJECT:

Helmy Qurtom, M.D.,

Petitioner,

DATE: October 10, 2001
                                          
             - v -

 

Centers for Medicare & Medicaid Services.

 

Docket No.C-01-769
Decision No. CR822
DECISION
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DECISION



I sustain the Inspector General's (I.G.) determination to exclude Helmy Qurtom, M.D., Petitioner, from participation in Medicare, Medicaid, and other federal health care programs for an indefinite period pursuant to section 1128(b)(4)of the Social Security Act (Act).

I. Background

By letter dated May 31, 2001, the I.G. notified Petitioner that he was being excluded, pursuant to section 1128(b)(4) of the Act, from participation in Medicare and other federally funded health care programs because his license to practice medicine in the State of Maryland had been revoked for reasons bearing on his professional competence, professional performance, or financial integrity. Petitioner requested a hearing and the case was assigned to me. I held a prehearing conference by telephone at which the parties agreed that the case could be heard and decided based on written submissions. Both parties submitted briefs (I.G. or P. Br.) accompanied by documentary evidence. The I.G. filed three exhibits (I.G. Exs. 1 - 3) as part of her submission. Petitioner filed no exhibits. In the absence of objection, I receive into evidence I.G. Exs. 1 - 3. Petitioner rests his case on arguments presented in his appeal request and his reply to the I.G.'s brief.

Petitioner was a physician licensed in the State of Maryland. I.G. Ex. 3, at 1. On or about November 17, 1999, Petitioner was charged by the United States Attorney for the District of Maryland with stealing and converting to his own use student assistance benefits totaling $7,220, in violation of 18 U.S.C. §§ 2 and 641. I.G. Ex. 1.

Thereafter, he entered a plea of guilty to one count of theft of government property: aiding and abetting, and, on March 4, 1999, judgement was entered against him. I.G. Ex 2. He was sentenced to five months imprisonment, and was required to pay a $15,000 fine and restitution totaling $118,932.26. Id. Based on this conviction, the Board of Physician Quality Assurance of Maryland (State Board) suspended Petitioner's medical license. The State Board noted that, under Maryland law, a crime involving fraud and deceit is a crime of moral turpitude. The State Board therefore concluded that Petitioner had been convicted of a crime involving moral turpitude. I.G. Ex. 3.

II. Issue

The sole issue before me is whether the I.G. had a basis on which to exclude Petitioner based on the loss of his Maryland license to practice medicine.

III. Findings of Fact and Conclusions of Law

I make findings of fact and conclusions of law (Findings) to support my decision in this case. I set forth each Finding below, in italics and bold, as a separately numbered heading. I discuss each Finding in detail.

1. The I.G. has a basis on which to exclude Petitioner based on the loss of his Maryland medical license, as the loss of his license relates to his financial integrity.

The Act authorizes the Secretary to exclude from participation in any federal health care program(1) an individual whose license to provide health care has been revoked or suspended for reasons bearing on the individual's professional competence, professional performance\ or financial integrity. Act, section 1128(b)(4)(A). The I.G.'s implementing regulations reiterate the Act's grant of authority, and provide that the I.G. may exclude an individual whose license has been suspended or revoked for reasons "bearing on the individual's . . . professional competence, professional performance or financial integrity." 42 C.F.R. § 1001.501.

Both parties agree that the State Board revoked Petitioner's medical license following his theft conviction. I.G. Ex. 2, at 1. Petitioner argues that his conviction should not result in an exclusion because his crime, which involved theft of federal student loan money, relates to neither his profession nor to his financial integrity. The statutory and regulatory language, however, do not require a nexus between license revocation based on financial integrity and the individual's profession. This is in stark contrast to license revocation based on competence or performance. In those cases, the statute and regulation explicitly require that the license revocation be based on "professional competence" or "professional performance." Significantly, the adjective "professional" does not modify "financial integrity," an omission that demonstrates Congress' intent to include exclusions for a broad range of financial irregularities.

I also reject Petitioner's claim that his conviction for theft from a government program does not bear on his financial integrity. An exclusion is imposed to protect the health care program from those who have demonstrated themselves to be untrustworthy. See Manocchio v. Kusserow, 961 F. 2d 1539 (11th Cir. 1992); Douglas Schram, R. Ph., DAB No. 838 (1992). Congress has determined that providers who lose their licenses for reasons bearing on their financial integrity are untrustworthy, and a threat to the integrity of federal health care programs. Theft of federal monies, no matter which program, must be considered a crime relating to the individual's financial integrity, and certainly raises significant concerns about the individual's trustworthiness.

Petitioner raises some additional arguments: 1) in applying to become a Medicare/Medicaid provider, he disclosed his conviction and was nevertheless approved to participate, and, in a related argument, he points out that Washington, D.C. renewed his medical license; 2) he has a unique immigration history, having rendered significant services to the United States during the Gulf War; and 3) he has paid his debt and is fully rehabilitated. The factors I may consider in this proceeding, however, are very limited. I am bound by the requirements of the statute and regulations and I may not review the exercise of the I.G.'s discretion to exclude an individual under section 1128(b) of the Act. Because I find that Petitioner's medical license was revoked for reasons bearing on his financial integrity, I must sustain the exclusion without regard to Petitioner's equitable arguments.

2. The exclusion period may not be less than the period during which Petitioner's medical license is revoked.

For a person excluded under section 1128(b)(4), the statute also requires that the period of exclusion "shall not be less than the period during which the individual's or entity's license . . . is . . . revoked." Act, section 1128(b)(4). I therefore have no authority to shorten the length of the exclusion period.

IV. Conclusion

For the reasons stated above, I conclude that the revocation of Petitioner's medical license related to his financial integrity. I therefore affirm the I.G.'s determination and find that the I.G. had a basis to exclude Petitioner from participation in Medicare, Medicaid, and other federal health care programs for an indefinite period pursuant to section 1128(b)(4) of the Act.

JUDGE
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Carolyn Cozad Hughes

Administrative Law Judge

FOOTNOTES
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1. The Act defines a "Federal health care program" in this context to mean

"(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government . . . ; or (2) any State health care program, as defined in section 1128(h). Act, section 1128B(f); see Act, section 1128(b).

CASE | DECISION | JUDGE | FOOTNOTES