Notice2025-18362
Rachel Kientcha-Tita, M.D.; Decision and Order
Primary source
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Published
September 23, 2025
Issuing agencies
Justice DepartmentDrug Enforcement Administration
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<title>Federal Register, Volume 90 Issue 182 (Tuesday, September 23, 2025)</title>
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[Federal Register Volume 90, Number 182 (Tuesday, September 23, 2025)]
[Notices]
[Pages 45811-45813]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-18362]
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DEPARTMENT OF JUSTICE
Drug Enforcement Administration
[Docket No. 25-20]
Rachel Kientcha-Tita, M.D.; Decision and Order
On November 13, 2024, the Drug Enforcement Administration (DEA or
Government) issued an Order to Show Cause (OSC) to Rachel Kientcha-
Tita, M.D. (Respondent), of Houston, Texas. OSC, at 1, 3. The OSC
proposed the revocation of Respondent's DEA Certificate of Registration
(registration), No. FK0843462, and denial of her renewal application
for the same, alleging that Respondent has been, and continues to be,
mandatorily excluded from participation in Medicare, Medicaid, and all
federal health care programs pursuant to 42 U.S.C. 1320a-7(a). Id., at
2 (citing 21 U.S.C. 824(a)(5)).
A hearing was held before DEA Chief Administrative Law Judge (ALJ)
John J. Mulrooney, II, who, on May 19, 2025, issued his Recommended
Rulings, Findings of Fact, Conclusions of Law, and Decision of the
Administrative Law Judge (RD). The RD recommended that Respondent's
registration be revoked and her application for renewal be denied. RD,
at 19. The Government filed exceptions to the RD.<SUP>1 2</SUP> Having
reviewed the entire record, the Agency adopts and hereby incorporates
by reference the entirety of the Chief ALJ's rulings, credibility
findings,\3\ findings of fact, conclusions of law, sanctions analysis,
and recommended sanctions in the RD, and clarifies and expands upon
portions thereof herein.
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\1\ In the Government's first exception to the RD, the
Government contends that Respondent consented by implication to
litigate a public interest issue that was not properly noticed in
the OSC. Throughout the DEA hearing, testimony and evidence were
presented relating to this public interest allegation. Tr. 84-103,
119-40; Government Exhibit (GX) 13-15. However, the Agency agrees
with the Chief ALJ that Respondent did not consent to litigating the
public interest issue by express or implied consent. RD, at 7 n.15;
ALJ Exhibit 22, at 1; see also Bradley H. Chesler, M.D., 87 FR 4917,
4931 (2022). Accordingly, the Agency rejects the Government's first
exception to the RD; none of the introduced public interest
testimony or evidence was considered in reaching this decision.
\2\ The Government's second exception is a technical correction
to the Chief ALJ's reference to GX 12 as Respondent's ``renewal
application.'' RD, at 17. The Government correctly points out that
GX 12 is actually Respondent's original application for registration
which was filed and granted in 2021.
\3\ The Agency adopts the Chief ALJ's summary of the witnesses'
testimonies as well as the Chief ALJ's assessment of the witnesses'
credibility. RD, at 4-10. The Agency agrees with the Chief ALJ that
the testimony from the DEA Diversion Investigator, which was
primarily focused on the introduction of the Government's
documentary evidence, was ``sufficiently plausible, internally
consistent, and detailed to be afforded full credibility.'' Id., at
7.
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I. Applicable Law
Pursuant to 21 U.S.C. 824(a)(5), the Agency \4\ is authorized to
suspend or revoke a registration upon finding that the registrant ``has
been excluded (or directed to be excluded) from participation in a
program pursuant to section 1320a-7(a) of Title 42.'' The Agency has
consistently held that it may also deny an application upon finding
that an applicant has been excluded from a federal health care program.
Mark Agresti, M.D., 90 FR 30098, 30099 (2025); Samirkumar Shah, M.D.,
89 FR 71931, 71933 (2024); Arvinder Singh, M.D., 81 FR 8247, 8248
(2016).
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\4\ The Controlled Substances Act (CSA) delegates power to the
Attorney General, who has delegated it to the Administrator of the
DEA (the Agency) by 28 CFR 0.100.
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II. Findings of Fact
In 2015, Respondent pled guilty to one count of conspiracy to
commit health care fraud in violation of 18 U.S.C. 1349.\5\ RD, at 5;
GX 9, 10. As a result of Respondent's criminal conviction based on her
guilty plea, the U.S. Department of Health and Human Services, Office
of Inspector General (HHS/OIG), excluded Respondent, effective August
20, 2017, from participation in Medicare, Medicaid, and all federal
health care programs pursuant to 42 U.S.C. 1320a-7(a) for a period of
fifteen years.\6\ RD, at 5; GX 2. Accordingly, the Agency finds
substantial record evidence \7\ that Respondent has been, and continues
to be, excluded from participation in federal health care programs.
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\5\ Respondent stipulated to this fact. See ALJ Exhibit 9, at 3
(Stipulation 4).
\6\ Respondent stipulated to this fact. See ALJ Exhibit 9, at 3
(Stipulation 6).
\7\ Where the Respondent has stipulated to a fact, the Agency
exceeds the ``substantial record evidence'' standard.
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III. Discussion
The Agency agrees with the Chief ALJ and finds substantial record
evidence that Respondent has been, and remains, mandatorily excluded
from federal health care programs pursuant to 42 U.S.C. 1320a-7(a),\8\
and Respondent has admitted to the same. RD, at 5, 11; GX 2; ALJ
Exhibit 9, at 3. Accordingly, the Agency finds that substantial record
evidence establishes the Government's prima facie case for revoking
Respondent's registration under 21 U.S.C. 824(a)(5), that Respondent
did not rebut that prima facie case, and that there is substantial
record evidence supporting the revocation of Respondent's registration
and denial of her application.
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\8\ The Agency has consistently held that it may revoke a
registration under 21 U.S.C. 824(a)(5) even if the conviction
underlying the exclusion does not relate to controlled substances.
See, e.g., Phong H. Tran, M.D., 90 FR 14383, 14384 n.10 (2025)
(collecting cases).
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Additionally, the Agency finds it is expedient to discuss an
underlying issue in this case: that in 2021, Respondent applied for and
was granted a registration by DEA while being mandatorily excluded.\9\
GX 1 and 12. The Agency rejects Respondent's arguments that by granting
her the 2021 registration, DEA ``tacitly accept[ed]'' her
qualifications, see ALJ Exhibit 8, at 3, or that the Agency may not now
revoke her registration due to her mandatory exclusion because it
previously granted it while she was similarly excluded.\10\ See ALJ
Exhibits 12 and 16. The Agency may suspend, revoke, or deny a
registration if it finds that an applicant or registrant ``has been
excluded'' from Medicare, Medicaid, or another federal health care
program mandated by 42 U.S.C 1302a-7(a). 21 U.S.C. 824(a)(5) (emphasis
added). This plain language entails that the Agency has discretion \11\
in choosing to suspend,
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revoke, or deny a registration for any person who currently is
mandatorily excluded or who has been mandatorily excluded in the past
but is not currently.\12\
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\9\ There is also a counter issue raised by the Government and
addressed in the RD regarding whether Respondent provided proper
notice to DEA that she was mandatorily excluded when she applied for
a registration in 2021. See GX 12, at 1-2; ALJ Exhibit 13, at 4-5;
RD, at 17. However, the Agency declines to address this issue at
this time because it is not material to the disposition of this
case.
\10\ Prior to her DEA hearing, Respondent argued in a motion to
dismiss that DEA was precluded from now revoking her registration
under the doctrine of laches, a sub-doctrine of equitable estoppel.
ALJ Exhibit 12, at 3-4. The Agency agrees with the reasons provided
by the originally assigned ALJ in denying Respondent's motion to
dismiss. ALJ Exhibit 17, at 5-7. These arguments were briefly
reraised in the DEA hearing, see Tr. 12-13, 22-25, and briefly
addressed in the RD. RD, at 6. The Agency agrees with the ALJ and
Chief ALJ that Respondent's argument has no merit. The United States
Supreme Court has consistently determined that no doctrine of
equitable estoppel may be invoked against the Government where it
would operate to defeat the effective operation of a policy adopted
to protect the public. See Office of Personnel Management v.
Richmond, 496 U.S. 414, 427-28 (1990); Heckler v. Cmty. Health
Servs. of Crawford County, Inc., 467 U.S. 51, 61-66 (1984); INS v.
Miranda, 459 U.S. 14, 18 (1982). Congress established the CSA to
protect the public. Gonzales v. Raich, 545 U.S. 1, 12-14 (2005).
Therefore, when acting under its CSA prerogative to protect the
public, as here, the Agency is shielded from equitable estoppel. See
Pettigrew Rexall Drugs, 64 FR 8855, 8859 (1999) (finding that laches
could not be invoked against the Agency).
\11\ The CSA gives the Agency discretionary authority for
suspending, revoking, or denying a registration. See, e.g., Gonzales
v. Oregon, 546 U.S. 243, 251 (2006). Because this authority is
discretionary, the Agency may make a decision that is contrary to
its previous decisions, so long as that decision is permitted under
statute and is not ``arbitrary and capricious.'' F.C.C. v. Fox
Television Stations, Inc., 556 U.S. 502, 515 (2009); see also Frank
Joseph Stirlacci, M.D., 85 FR 45229, 45236 n.20 (2020). Therefore,
in this case, the Agency may revoke Respondent's registration,
despite previously granting it, in light of a ``renewed focus on
enforcement.'' Terrance C. Cole Sworn in as Administrator of the
U.S. Drug Enforcement Administration, DEA Public Affairs (July 25,
2025), <a href="https://www.dea.gov/press-releases/2025/07/25/terrance-c-cole-sworn-administrator-us-drug-enforcement-administration">https://www.dea.gov/press-releases/2025/07/25/terrance-c-cole-sworn-administrator-us-drug-enforcement-administration</a>.
Accordingly, whether Respondent's 2021 registration was granted
intentionally or by mistake is irrelevant to the Agency's present
and perpetuous discretionary authority to impose the sanction it
deems appropriate at this time. See RD, at 6.
\12\ The phrase ``has been'' is used here in the present perfect
tense, ``denoting `an act, state, or condition that is now completed
or continues up to the present.' '' Meija-Castanon v. Att'y General
of the United States, 931 F.3d 224, 233 n.10 (3rd Cir. 2019)
(quoting Chicago Manual of Style Sec. 5.132, at 268 (17th ed.
2017)); see also United States v. Hernandez, 107 F.4th 965, 969
(11th Cir. 2024) (same, relating to ``has not been''). ``It is used
to refer either to time in the indefinite past, or past action that
continues until the present.'' Meija-Castanon, 931 F.3d at 233 n.10.
In this case, by adding the word ``excluded,'' the phrase refers to
anyone who is currently excluded from any of the enumerated programs
or who has been excluded in the past but is not currently. Because
Respondent's mandatory exclusion is encompassed by the plain
language of the statute, the Agency may revoke her registration.
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IV. Sanction
Where, as here, the Government has met its prima facie burden of
showing that Respondent's registration should be revoked and her
application denied, the burden shifts to Respondent to show why she can
be entrusted with a registration. Morall v. Drug Enf't Admin., 412
F.3d. 165, 174 (D.C. Cir. 2005); Jones Total Health Care Pharmacy, LLC
v. Drug Enf't Admin., 881 F.3d 823, 830 (11th Cir. 2018); Garrett
Howard Smith, M.D., 83 FR 18,882, 18,904 (2018). The issue of trust is
necessarily a fact-dependent determination based on the circumstances
presented by the individual respondent. Jeffrey Stein, M.D., 84 FR
46968, 46972 (2019); see also Jones Total Health Care Pharmacy, 881
F.3d at 833. Moreover, as past performance is the best predictor of
future performance, the Agency has required that a registrant who has
committed acts inconsistent with the public interest must accept
responsibility for those acts and demonstrate that they will not engage
in future misconduct. Jones Total Health Care Pharmacy, 881 F.3d at
833; ALRA Labs, Inc. v. Drug Enf't Admin., 54 F.3d 450, 452 (7th Cir.
1995). The Agency requires a registrant's unequivocal acceptance of
responsibility. Janet S. Pettyjohn, D.O., 89 FR 82639, 82641 (2024);
Mohammed Asgar, M.D., 83 FR 29569, 29573 (2018); see also Jones Total
Health Care Pharmacy, 881 F.3d at 830-31. In addition, a registrant's
candor during the investigation and hearing is an important factor in
determining acceptance of responsibility and the appropriate sanction.
See Jones Total Health Care Pharmacy, 881 F.3d at 830-31; Hoxie v. Drug
Enf't Admin., 419 F.3d 477, 483-84 (6th Cir. 2005). Further, the Agency
has found that the egregiousness and extent of the misconduct are
significant factors in determining the appropriate sanction. See Jones
Total Health Care Pharmacy, 881 F.3d at 833 n.4, 834. The Agency also
considers the need to deter similar acts by a respondent and by the
community of registrants. Jeffrey Stein, M.D., 84 FR at 46972-73.
While Respondent testified that she ``really regretted'' her
criminal conduct, the Agency agrees with the Chief ALJ that Respondent
failed to unequivocally accept responsibility for her misconduct. Tr.
62; RD, at 14-15. Respondent's testimony continually downplayed her
role in the criminal conduct to which she pled guilty. ``Throughout the
hearing, Respondent remained steadfast in her view that she acted
appropriately based on her subjective belief that no fraud was
occurring.'' RD, at 8; Tr. 59-61, 67-69. Despite pleading guilty to
conspiracy to commit health care fraud, Respondent was unable to
describe what she actually pled to doing. RD, at 8; Tr. 67-70. Instead,
Respondent stated that her guilty plea was the product of her criminal
defense attorney's advice and her own ``exhaust[ion] with the
[criminal] process.'' Tr. 69-70, 81. This culminated in Respondent
passing blame to others, specifically her coconspirators, and stating
that she actually did not have any direct responsibility in the crime
that occurred. Tr. 72-82.
The Agency agrees with the Chief ALJ that ``the conspiracy that
formed the basis of the misconduct was complex, lengthy in duration,
and targeted many patients who labored under profound mental
impairments.'' RD, at 13; see also Tr. 72-80, 116-19; GX 10. During the
hearing, Respondent ``essentially disavowed any understanding of the
details of the actions that formed the basis of her conviction.'' RD,
at 9; see Bernadette U. Iguh, M.D., 87 FR 56709, 56711 (2022)
(``Respondent's emphasis on her ignorance as the cause of her
misconduct, in tandem with Respondent's lack of emphasis on the damages
she caused, both serve to downplay the extent to which her own actions
and decisions were harmful.''). Respondent's attempts to minimize this
egregious misconduct undermine any purported acceptance of
responsibility. Michael A. White v. Drug Enf't Admin., 626 F. App'x
493, 496-97 (5th Cir. 2015); see also Phong H. Tran, M.D., 90 FR at
14385. Accordingly, the Agency finds that Respondent did not
unequivocally accept responsibility for her actions.
When a registrant fails to make the threshold showing of acceptance
of responsibility, the Agency need not address the registrant's
remedial measures. Ajay S. Ahuja, M.D., 84 FR 5479, 5498 n.33 (2019)
(citing Jones Total Health Care Pharmacy, L.L.C., & SND Health Care,
L.L.C., 81 FR 79188, 79202-03 (2016)); Daniel A. Glick, D.D.S., 80 FR
74800, 74801, 74810 (2015).\13\
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\13\ Respondent did provide examples of certain remedial
measures. First, Respondent noted that her state medical license has
been fully restored. GX 8. The Agency agrees with the Chief ALJ that
the mere existence of state authority to handle controlled
substances does not entitle a person to a DEA registration. RD, at
18-19; see Robert A. Leslie, M.D., 68 FR 15227, 15230 (2003) (noting
that a ``state license is a necessary, but not a sufficient
condition for registration''). Respondent further explained that she
is trying to repay her debt to society by educating other medical
providers to not make the same mistakes she made, by taking steps to
ensure her own compliance with the law, and by undertaking two
medical missions to Cameroon to render medical assistance during the
civil crisis there. Tr. 56-57, 62-63. However, without an
unequivocal acceptance of responsibility, Respondent's remedial
measures are insufficient for the Agency to determine that
Respondent can be trusted with a registration. See Lewisville
Medical Pharmacy, 87 FR 59456, 59460 n.16 (2022); Brenton D. Wynn,
M.D., 87 FR 24228, 24261 (2022); Michael T. Harris, M.D.,87 FR
30276, 30278-79 (2022).
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The Agency further agrees with the Chief ALJ that Respondent's
actions in the underlying criminal conduct are egregious such that
revocation of her registration and denial of her application are
appropriate.\14\ RD, at 12-13. In addition to acceptance of
responsibility, the Agency considers both specific and general
deterrence
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when determining an appropriate sanction. Daniel A. Glick, D.D.S., 80
FR at 74810. Regarding specific deterrence, the Agency agrees with the
Chief ALJ that based on Respondent's inconsistent testimony, ``it would
be objectively unreasonable to conclude that she would avoid similar
mistake[s] in the future.'' \15\ RD, at 17. Regarding general
deterrence, the Agency agrees with the Chief ALJ that the interests of
general deterrence also support revocation of Respondent's registration
and denial of her application, as a lack of sanction in the current
matter would send a message to the registrant community that a
registrant can commit similar misconduct without consequences. RD, at
17-18.
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\14\ The Agency has found that ``defrauding health care programs
is egregious,'' in and of itself. RD, at 13; Gilbert Y. Kim, D.D.S.,
87 FR 21139, 21145 (2022); Samirkumar Shah, M.D., 89 FR at 71934.
Furthermore, Respondent's mandatory exclusion period was set at
fifteen years. GX 2, at 1. This is ten years in excess of the
mandatory minimum prescribed by statute. See 42 U.S.C. 1320a-
7(c)(3)(B); see also Michael Jones, M.D., 86 FR 20728, 20732 (2021)
(an exclusion period in excess of the statutory minimum can be
considered on the issue of egregiousness). Additionally, the Texas
Medical Board requested that Respondent's punishment be ``more
severe and restrictive'' that normal due to the egregiousness of the
underlying offense. RD, at 14 n.34; GX 5, at 5. Accordingly, the
Agency agrees with the Chief ALJ's egregiousness assessment.
However, the Agency does note that Respondent received a reduced
criminal sentence due to her cooperation with the underlying
criminal investigation. GX 10, at 2, 7.
\15\ Concerning the Chief ALJ's continued specific deterrence
assessment, RD, at 17, it is not necessary to evaluate the candor of
Respondent's 2021 application for DEA registration, GX 12, at 1-2,
because the Agency already finds Respondent's testimony to be
inconsistent. See supra n.9.
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In sum, the Agency agrees with the Chief ALJ that Respondent has
not offered any credible evidence on the record to rebut the
Government's prima facie case for revocation of her registration or
denial of her application, and Respondent has not met her burden to
demonstrate that she can be entrusted with the responsibility of
registration. RD, at 19. Accordingly, the Agency will order that
Respondent's registration be revoked and her renewal application be
denied.
Order
Pursuant to 28 CFR 0.100(b) and the authority vested in me by 21
U.S.C. 823 and 824(a)(5), I hereby revoke DEA Certificate of
Registration No. FK0843462 issued to Rachel Kientcha-Tita, M.D., as
well as deny any other pending application of Rachel Kientcha-Tita,
M.D., to renew or modify this registration. I further, pursuant to the
same, deny any other pending application of Rachel Kientcha-Tita, M.D.,
for registration in Texas. This Order is effective October 23, 2025.
Signing Authority
This document of the Drug Enforcement Administration was signed on
September 17, 2025, by Administrator Terrance Cole. That document with
the original signature and date is maintained by DEA. For
administrative purposes only, and in compliance with requirements of
the Office of the Federal Register, the undersigned DEA Federal
Register Liaison Officer has been authorized to sign and submit the
document in electronic format for publication, as an official document
of DEA. This administrative process in no way alters the legal effect
of this document upon publication in the Federal Register.
Heather Achbach,
Federal Register Liaison Officer, Drug Enforcement Administration.
[FR Doc. 2025-18362 Filed 9-22-25; 8:45 am]
BILLING CODE 4410-09-P
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