United States Court of Appeals, Eleventh Circuit

961 F.
2d 1539
37 Soc.Sec.Rep.Ser. 161, Medicare & Medicaid Guide

P 40,295
Dr. Val MANOCCHIO, Plaintiff-Appellant,
v.
Richard P. KUSSEROW, Louis W. Sullivan, M.D., Secretary,
Department of Health and Human Services,
Defendants-Appellees.
No. 91-5665.
United States Court of Appeals,

Eleventh Circuit.
June 2, 1992.
Richard G. Garrett, Greenberg, Traurig, Hoffman, Lipoff, Rosen &

Quentel, P.A., Holly R. Skolnick, Miami, Fla., for plaintiff-appellant.
Christine N. Kohl, Appellate Staff, Civil Div., Dept. of Justice, Douglas
N. Letter, Washington, D.C., for defendants-appellees.
Appeal from the United States District Court for the Southern District of
Florida.
Before HATCHETT, Circuit Judge, JOHNSON* and HENDERSON,
Senior Circuit Judges.
HATCHETT, Circuit Judge:
We affirm the district court's ruling that 42 U.S.C. 1320a-7, a mandatory

exclusionary provision, is not punitive in nature thereby violating the Double
Jeopardy and Ex Post Facto Clauses of the United States Constitution. 768
F.Supp. 814.
I. FACTS AND PROCEDURAL HISTORY

2
Val Manocchio, a medical doctor, is licensed to practice medicine in the state
of Florida. For approximately ten weeks in 1984, Manocchio worked on a parttime basis at a facility known as Florida Medical Consultants. During his
employment, Manocchio supervised particular tests and medical procedures and
signed health insurance claims as required by the Medicare program.
3
In August, 1985, Federal Bureau of Investigation (FBI) and Department of

Health and Human Services (HHS) agents told Manocchio that he and Florida
Medical Consultants were being investigated for Medicare fraud. Subsequently,
in October, 1988, the United States Attorney's Office for the Southern District
of Florida filed an information against Manocchio charging him with making a
fraudulent demand against the United States, in violation of 18 U.S.C. 1003.
Specifically, the government alleged that on June 11, 1984, Manocchio
submitted a fraudulent Medicare claim in the amount of $62.40. Manocchio
pleaded guilty to the misdemeanor, and on March 17, 1989, the district court
sentenced him to three years probation, and ordered him to pay restitution and a
fine of $1,000.
As a result of Manocchio's Medicare fraud, the Office of the Inspector General

of HHS notified Manocchio that HHS would exclude him from participation in
Medicare programs for a period of not less than five years, pursuant to section
1128(a)(1) of the Social Security Act (42 U.S.C. 1320a-7).** While the
penalty of exclusion from Medicare participation was mandatory at the time of
Manocchio's offense in 1984, the period of exclusion remained within the
discretion of the HHS Secretary. In 1987, Congress amended the law to
implement a mandatory Medicare exclusion period of at least five years.
Manocchio's exclusion period began in January 1990.
Manocchio brought suit against Richard P. Kusserow, Inspector General of

HHS and Dr. Louis W. Sullivan, Secretary of HHS (hereinafter referred to
collectively as HHS) alleging that section 1320a-7, as applied to him, was
unconstitutional because it was punitive in nature, violating both the Double
Jeopardy and Ex Post Facto Clauses of the United States Constitution. HHS
moved to dismiss the lawsuit on the grounds that Manocchio's action failed to
state a claim upon which relief could be granted. The district court granted
HHS's motion to dismiss, finding that section 1320a-7 was constitutional as
applied to Manocchio. Specifically, the district court found that section 1320a-7
was not punitive, but rather remedial, and therefore did not violate either the
Double Jeopardy Clause or the Ex Post Facto Clause.
II. ISSUE
6
Whether 42 U.S.C. 1320a-7, a mandatory exclusionary provision, is punitive
in nature and violates the Double Jeopardy and Ex Post Facto Clauses of the
United States Constitution.
III. DISCUSSION
7
The threshold determination this court must make is whether 42 U.S.C.

1320a-7 is punitive in nature and effect because both the Double Jeopardy
Clause and the Ex Post Facto Clause apply only to punitive sanctions. See
United States v. Halper, 490 U.S. 435, 448-49, 109 S.Ct. 1892, 1901-02, 104
L.Ed.2d 487 (1989) (holding that Double Jeopardy Clause is violated when a
defendant, punished in a criminal prosecution, is penalized by a subsequent
punitive civil sanction); Flemming v. Nestor, 363 U.S. 603, 613, 80 S.Ct. 1367,
1374, 4 L.Ed.2d 1435 (1960) (holding that an ex post facto claim can only be
successful if the law can be characterized "as 'punishment' in the constitutional
sense").
We begin by noting that we exercise de novo review. Our standard of review is:
assuming the allegations of the complaint to be true, whether it appears beyond
doubt that the plaintiff can prove no set of facts in support of his claim that
would entitle him to relief. Matthews v. United States, 456 F.2d 395, 397 (5th
Cir.1972).
In order to determine whether the exclusionary period is punitive or remedial,

the court must look at the congressional intent at the time of passage of the
statute. An examination of the legislative history of the five-year minimum
mandatory exclusion period in section 1320a-7 establishes that the sanction is
civil and remedial. The Senate Finance Committee report states,
10 basic purpose of the Medicare and Medicaid Patient and Program Protection Act
the
is to improve the ability of the Secretary and the Inspector General of [HHS] to
protect Medicare, Medicaid, [and other social services programs] from fraud and
abuse, and to protect the beneficiaries of those programs from incompetent
practitioners and from inappropriate or inadequate care.
11
S.Rep. No. 109, 100th Cong., 1st Sess. 1-2 (1987) (hereinafter Senate Report),
reprinted in 1987 U.S.C.C.A.N. 682. The committee report also states,
however, that the law "should provide a clear and strong deterrent against the
commission of criminal acts." Senate Report at 5, 1987 U.S.C.C.A.N. at 686.
While the desire to provide a deterrent is a punitive goal, we find that the
legislative history, taken as a whole, demonstrates that the primary goal of the
legislation is to protect present and future Medicare beneficiaries from the
abusers of these programs. Therefore, since the legislative intent of the
exclusionary period is to protect the public, the sanction is remedial, not

punitive.
12
Manocchio urges us to perform a "particularized assessment" to determine

whether the sanction "as applied in the individual case serves the goals of
punishment" pursuant to the rule in Halper. 490 U.S. at 448, 109 S.Ct. at 1902.
The rule in Halper, however, does not apply to the facts of this case. Halper
concerned a defendant's conviction and punishment for making false Medicare
claims totalling $585. In a subsequent False Claims Act (FCA) suit, the
government sought $130,000 in damages. The Court held that the civil sanction
in the FCA action constituted punishment and violated double jeopardy
principles because it was not rationally related to the actual loss the government
sustained.
13
In this case, because HHS did not assess monetary damages Halper's analysis
contrasting the amount of money damages with the amount the government lost
does not apply. See United States v. Reed, 937 F.2d 575, 578 (11th Cir.1991)
(holding that Halper does not apply when a monetary damage award has not
been imposed). Nevertheless, as we stated in Reed, Halper is "helpful in
framing our analysis." Reed, 937 F.2d at 577. In Halper, the Court stated
14 the defendant even remedial sanctions carry the sting of punishment. (citations
for
omitted) Rather, we hold merely that in determining whether a particular civil
sanction constitutes criminal punishment, it is the purposes actually served by the
sanction in question, not the underlying nature of the proceeding giving rise to the
sanction, that must be evaluated.
15
490 U.S. 447 n. 7, 109 S.Ct. at 1901 n. 7.
16
In this case, Manocchio pleaded guilty to Medicare fraud. While his exclusion
from the Medicare system for five years undoubtedly carries the "sting of
punishment," the purpose his exclusion serves is still remedial. The purpose of
the exclusionary provision "is to enable the [HHS] inspector general to keep
[those who defraud the programs] out of the Medicare and Medicaid Programs.
They deprive patients of needed services or supplies, and they divert taxpayer
funds from their intended purposes." 133 Cong.Rec. 14,177 (statement of Rep.
Waxman, Chairman, House Subcommittee on Health and the Environment).
Further, the mandatory exclusionary period "strengthens the ability of the
Secretary of [HHS] to exclude from Medicare and Medicaid those health care
providers and practitioners who fail to provide quality health services or who
have engaged in fraud involving health care programs." 133 Cong.Rec. 20,922
(statement of Sen. Bentsen).
17
Thus, while Manocchio's exclusion from Medicare due to making a $62.40

fraudulent demand against the Government may constitute "rough remedial
justice" (Halper, 490 U.S. at 446, 109 S.Ct. at 1900), the purpose of his
exclusion is to protect the public, a legitimate nonpunitive goal. See also
Greene v. Sullivan, 731 F.Supp. 838, 840 (E.D.Tenn.1990) (holding that
exclusion from participation in Medicare and Medicaid programs serves
remedial goals and does not violate the Double Jeopardy Clause). Since we
find that the five year mandatory exclusion from Medicare programs detailed in
section 1320a-7 is not punitive, the provision does not violate either the Double
Jeopardy or Ex Post Facto Clauses of the United States Constitution.
18
Our decision today is clearly consistent with precedent concerning similar

disqualification or exclusionary provisions. See, e.g., Reed, 937 F.2d 575
(suspension of mail carrier after criminal punishment does not violate the
Double Jeopardy Clause).IV. CONCLUSION
19
For the foregoing reasons, we find that the mandatory exclusionary provision of
42 U.S.C. 1320a-7 is not punitive, but rather remedial in nature and purpose.
Therefore, we affirm the district court's dismissal of Manocchio's constitutional
challenges to the statute based on the Double Jeopardy Clause and the Ex Post
Facto Clause of the United States Constitution.
20
AFFIRMED.
See Rule 34-2(b), Rules of the U.S. Court of Appeals for the Eleventh Circuit
**
Title 42 U.S.C. 1320a-7 in relevant part provides:

(a) The Secretary shall exclude the following individuals and entities from
participation in any program under subchapter XVIII of this chapter and shall
direct that the following individuals and entities be excluded from participation
in any State health care program (as defined in subsection (h) of this section):
(1) Any individual or entity that has been convicted of a criminal offense
related to the delivery of an item or service under subchapter XVIII of this
chapter or under any State health care program.
....
(c)(3)(B) In the case of an exclusion under subsection (a) of this section, the
minimum period of exclusion shall be not less than five years....

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961 F.

37 Soc.Sec.Rep.Ser. 161, Medicare & Medicaid Guide

United States Court of Appeals,

Richard G. Garrett, Greenberg, Traurig, Hoffman, Lipoff, Rosen &

We affirm the district court's ruling that 42 U.S.C. 1320a-7, a mandatory

I. FACTS AND PROCEDURAL HISTORY

Val Manocchio, a medical doctor, is licensed to practice medicine in the state

In August, 1985, Federal Bureau of Investigation (FBI) and Department of

As a result of Manocchio's Medicare fraud, the Office of the Inspector General

Manocchio brought suit against Richard P. Kusserow, Inspector General of

Whether 42 U.S.C. 1320a-7, a mandatory exclusionary provision, is punitive

The threshold determination this court must make is whether 42 U.S.C.

In order to determine whether the exclusionary period is punitive or remedial,

exclusionary period is to protect the public, the sanction is remedial, not

Manocchio urges us to perform a "particularized assessment" to determine

490 U.S. 447 n. 7, 109 S.Ct. at 1901 n. 7.

Thus, while Manocchio's exclusion from Medicare due to making a $62.40

Our decision today is clearly consistent with precedent concerning similar

Title 42 U.S.C. 1320a-7 in relevant part provides:

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