MEMORANDUM AND ORDER Before the Court is a truly exceptional case. The plaintiff, Vincent Richard Leddy, a bilingual medical doctor who diligently works in an underserved, low-income community, seeks a temporary restraining order staying a directive by the Department of Health and Human Services (HHS) excluding him from participation in all federal health programs. Docket Entry (“DE”) 2. This administrative order, issued without a hearing, sounds the death knell for his medical practice, a critical resource for 5,000 patients, many of whom are vulnerable, impoverished and otherwise without access to health care. The proposed exclusion is based upon Dr. Leddy’s conviction of a criminal offense stemming from a potential Medicare audit. Sadly, that a medical doctor was prosecuted in federal court does not make this case exceptional. In a society riddled with illegal prescription drug addiction and health care fraud, the prosecution of medical doctors has become a shockingly common, if not routine, event in federal court, sometimes involving medical providers inflicting harm upon the very patients they have sworn to heal. Rather, what makes this case extraordinary are the aberrational circumstances surrounding the prosecution, the highly attenuated nature of the underlying conduct, the otherwise exemplary professional life of the plaintiff and, most notably, the virtually1 unprecedented, detailed determinations by an experienced trial judge at the sentencing hearing in that criminal case urging relevant authorities not to exclude Dr. Leddy from continued participation in health care programs. In her findings, Judge Azrack expressly found that suspending the plaintiff from the Medicare program would not only represent a substantial injustice but would constitute an unwarranted harm to the underserved community to which he attends. Notwithstanding these findings, HHS proceeded to commence exclusion proceedings based on a misreading of the applicable law. Judge Azrack’s findings, along with the other evidence submitted, and HHS’s misguided interpretation of statutory provisions, require that the instant application be carefully weighed, and on balance, the Court finds that the issuance of a temporary restraining order is warranted. BACKGROUND The plaintiff, Dr. Leddy, operates a medical practice in Brentwood, New York, which he describes, under oath, as follows: I am a physician duly licensed to practice medicine in the State of New York. I have practiced for decades in Brentwood, New York. I am bilingual which is essential for effective communication in the Spanish speaking community. I have treated multiple generations of patients and am a trusted and valued provider of medical services in the community. The area in which I practice is recognized as being underserved, meaning that there too many patients in the area for the limited number of physicians to treat. DE 2-1 at 2. Yet we need not rely on Dr. Leddy’s description alone. New York State Senator Phil Boyle, the legislator for the relevant community, makes the following observations: Dr. Leddy has practiced in Brentwood for more than thirty years. Based on my knowledge of his practice, Dr. Leddy treats countless individuals, many of whom reside in underserved communities. He is very well regarded in the Brentwood community, not only because of his medical expertise, but also because of his willingness to go above and beyond the minimal requirements of a medical professional. For example, I would like to note that during the COVID-19 Pandemic, when many healthcare facilities were shut down, Dr. Leddy’s clinic remained open to the community. This, of course, incurs a risk for the health and safety of him and his staff. Dr. Leddy and his staff were willing to put themselves at risk of contracting the virus in order to care for people in some of the hardest-hit areas. DE 2-4. Indeed, even his sentencing judge reached similar conclusions: As I have learned through reading all of the submissions in this case, including the over 220 letters, Dr. Leddy is an extraordinary person and an extraordinary doctor who has served an underserved community in Long Island for years. I was particularly moved by a letter from Steven Schwartz, who has known Dr. Leddy for over 20 years. Mr. Schwartz describes Dr. Leddy as a man who has dedicated himself not only to his medical practice, but to a community where the help he provides is priceless. Mr. Schwartz stated, quote, in this world, we need more Dr. Leddys, not less. I also note that Dr. Leddy provides physicals to incoming firefighters, he provides medical care to the sisters at St. Joseph, and he treats all clergy on a gratis basis. The letters from his patients are also compelling evidence of his devotion to a needy segment of the population. DE 2-2 at 16. The Criminal Case In late 2014, the doctor made a terrible mistake in judgment and violated the law. Having learned that a Medicare audit had been initiated relating to certain tests performed by his office, in his words, On retrieving the records and having them reviewed, I learned that the testing results were useless and did not reflect proper test results. I paid someone to produc[e] fictitious testing results that I mailed to Medicare from Brentwood, New York. See United States v. Leddy, 15-CR-0004(JMA), DE 9 at 22. Dr. Leddy acted promptly to accept responsibility for his actions, entering a guilty plea in January 2015 to a one-count information charging obstruction of a Medicare audit. DE 2-1 at 4. Judge Azrack observed that Dr. Leddy “has never made excuses for his aberrational criminal conduct, and readily acknowledged his grave mistake.” DE 2-2 at 17. Paradoxically, the feared audit never occurred. DE 2-2 at 15. Beyond immediately accepting responsibility, in an effort to make amends for this transgression, Dr. Leddy performed services that directly and substantially benefitted the Medicare program. DE 2-2. For seven years, he assisted the agency with numerous investigations and, according to one investigator, “was one of the best cooperating witnesses with whom he ever worked.” DE 2-2 at 15. At the direction of federal investigators and prosecutors, he worked on a dozen investigations, made recorded telephone calls and wore a wire to various meetings. Id. He was “proactive and frequently brought potential leads to the attention of government agents.” Id. at 15-16. Dr. Leddy’s efforts prompted a federal prosecutor to describe him as “a valuable resource for many health care investigations that we have been conducting.” DE 2-2 at 14. Based on this record, unsurprisingly, at his sentencing in December 2021, Judge Azrack imposed no incarceration, limiting his sentence to a statutorily-mandated special assessment of $100. DE 2-2 at 17. The Exclusion Notice By letter dated June 30, 2022, HHS advised Dr. Leddy that “[e]ffective 20 days from the date of this letter, the Office of Inspector General (OIG) of the Department of Health and Human Services is excluding you from participation in all Federal health care programs…for the minimum statutory period of 5 years.” DE 7-2. The sole basis for this determination, the letter continues, was his “conviction…of a criminal offense related to the delivery of an item or service under Medicare or a State health care program.” Id., citing 42 U.S.C. 1320a-7(a)(l). Dr. Leddy filed an administrative appeal, which will not be heard for weeks, and, it is estimated, will not be decided for many months. DE 2 at
