Health Law Daily Wrap Up, ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: DAB denies reconsideration request in controlled substance conviction exclusion case, (Aug 19, 2025)

By WK Editorial Staff

The Department of Health and Human Services' Departmental Appeals Board recently denied a physician’s request for reconsideration, upholding his exclusion from federal health care programs due to a felony conviction related to controlled substances.

In a recent ruling by the Department of Health and Human Services' Departmental Appeals Board (DAB), a request for reconsideration by a physician, has been unequivocally denied. The crux of this decision rests on the firm application of Section 1128(a)(4) of the Social Security Act, which mandates exclusion from federal health care programs for individuals convicted of felonies related to controlled substances post-August 1996 (Milad Ishak Shaker, M.D., DAB No. 3182, Docket No. A-25-53 (May 16, 2025)).

The physician’s initial exclusion was upheld by an Administrative Law Judge (ALJ) and later affirmed by the DAB, due to his federal felony conviction involving controlled substances. The DAB's decision, which the physician sought to challenge, was rooted in a rigorous interpretation of the law, emphasizing the seriousness of offenses involving the unlawful handling of controlled substances within the healthcare system.

In his plea for reconsideration, the physician presented a two-pronged argument. First, he revisited his federal felony conviction, attempting to challenge its validity and relevance to his exclusion. Second, he pointed out alleged errors in the DAB’s initial decision. However, the DAB found that the physician’s motion neither identified any factual nor legal errors that would necessitate a reopening of the case. Furthermore, the Board noted that the petition for reconsideration was improperly used as a platform to reiterate previously rejected arguments and to introduce issues that could have been raised earlier in the appeals process but were not.

The DAB clarified that a request for reconsideration is not an opportunity for appellants to recycle old arguments or introduce new ones that should have been presented earlier. In conclusion, the DAB’s ruling in denying the physician’s request for reconsideration not only upholds the initial exclusion decision but also reinforces the procedural and substantive standards that govern the exclusion process under federal health care programs.

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