Nomo-Ongolo v. Secretary of the U.S. Department of Health and Human Services

Background

Sirri A. Nomo-Ongolo, M.D., was a licensed physician who worked for Addiction Care Practitioners, PA, a clinic specializing in opiate-dependency treatment. She was an employee and did not own or manage the clinic. Nomo-Ongolo claimed that she was not involved in patient billing and did not request or receive payments from clinic patients.

The Minnesota Department of Human Services issued a notice stating that Nomo-Ongolo could no longer participate in the Minnesota Health Care Program because she had violated program rules by requesting and receiving 46 direct cash payments from clinic patients. Nomo-Ongolo appealed and denied responsibility for the alleged billing errors. She also said that the clinic’s office manager and owner accepted responsibility for them.

Shortly before a scheduled administrative prehearing conference, Nomo-Ongolo’s attorney withdrew. Nomo-Ongolo claimed that she and Assistant Minnesota Attorney General Heather N. Kjos agreed that she would voluntarily opt out of the state program, the state would drop its case, and the only consequence would be dismissal of her appeal and an end to her treatment of state-program patients. The administrative law judge then dismissed the appeal without making findings about the alleged cash payments. The state later terminated Nomo-Ongolo’s participation and advised her that she could apply for reinstatement in 2020.

The federal Department of Health and Human Services Office of Inspector General later excluded Nomo-Ongolo from all federal health programs under a Social Security Act provision allowing exclusion of a person who has been excluded, suspended, or otherwise sanctioned by a state health care program for reasons related to professional competence, professional performance, or financial integrity. A federal administrative law judge affirmed the exclusion, and the Department’s Appeals Board also affirmed, although it characterized the state action as an exclusion rather than an “otherwise sanctioned” action.

Nomo-Ongolo sought judicial review. The parties filed cross-motions for summary judgment, a procedure used when the court concludes that no genuine dispute of material fact requires a trial and decides which party is entitled to judgment under the law.

Court’s Analysis

The court stated that it had to determine whether substantial evidence supported the agency’s conclusion that Nomo-Ongolo’s state exclusion was based on reasons bearing on her financial integrity. “Substantial evidence” means relevant evidence that a reasonable person could accept as adequate to support a conclusion.

The court found that the record contained no state adjudicative findings about the alleged payments or Nomo-Ongolo’s conduct. The administrative law judge had dismissed her appeal without specific factual findings. The court also found no evidence that Nomo-Ongolo withdrew her appeal as an admission of guilt or wrongdoing, and no evidence contradicting her account that she withdrew it pursuant to an agreement that the state would drop her case.

The court concluded that the only evidence bearing adversely on Nomo-Ongolo’s financial integrity consisted of the Minnesota Department of Human Services’ vague and unsubstantiated investigative allegations. The court noted that much of the record supported Nomo-Ongolo’s position that she was not involved in the clinic’s billing and that the clinic acknowledged responsibility for the billing errors. The termination notice alone was not substantial evidence of wrongdoing bearing on her financial integrity. The court also stated that permissive exclusion was not warranted under the statute’s “otherwise sanctioned” language.

Disposition

Judge David S. Doty concluded that the Secretary’s final decision was not supported by substantial evidence in the record as a whole. The court denied the Secretary’s motion for summary judgment, granted Nomo-Ongolo’s motion for summary judgment, reversed the Secretary’s final decision, and held that Nomo-Ongolo was eligible for reinstatement as a participant in all federal health programs. The court directed that judgment be entered accordingly.