Anna Potoczny-Jones, DAB CR6591 (2024)

DECISION

I affirm the determination of the Centers for Medicare & Medicaid Services (CMS) that the effective date for the reassignment of Medicare benefits from Petitioner, Anna Potoczny-Jones, to KJB Consulting Corporation (KJB) is March 12, 2024.

I.     Procedural History

On August 7, 2024, Petitioner requested a hearing to challenge the March 12, 2024 effective date for the reassignment of Medicare benefits between Petitioner and KJB.  On August 13, 2024, the Civil Remedies Division acknowledged receipt of the hearing request, informed the parties of the due dates for prehearing submissions, and issued a copy of my Standing Order.  On August 28, 2024, Petitioner filed a signed Appointment of Representative form.  On September 16, 2024, CMS filed a brief and three proposed exhibits.  Petitioner did not file a prehearing submission.

II.     Admission of Evidence

I admit all of CMS’s proposed exhibits without objection.  See Standing Order ¶ 10.

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III.     Decision on the Written Record

I directed the parties to submit the written direct testimony for any witnesses they wanted to offer.  Standing Order ¶ 11.  I also informed the parties as follows:

If the parties either do not file any written direct testimony or the parties do not request to cross-examine any of the witnesses from whom written direct testimony has been submitted, I will consider such actions by the parties to serve as a constructive request for a decision on the written record because there will be no reason to hold an in-person hearing. 

Standing Order ¶ 7(g)(iii).  Finally, I stated:  “Unless a hearing is required for cross-examination of a witness or witnesses, the record will be closed and the case will be ready for a decision after all the submission deadlines have passed.”  Standing Order ¶ 14.

Because neither party submitted written direct testimony from any witnesses and all submission deadlines have passed, I decide this case on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 11-12 (2022).

IV.     Issue

Whether March 12, 2024, is the correct effective date for the reassignment of Medicare benefits from Petitioner to KJB.

V.     Jurisdiction

I have jurisdiction to decide the issue in this case.  42 C.F.R. § 498.3(b)(15).

VI.     Findings of Fact

1. On April 11, 2024, CMS received an application from Petitioner to reassign her Medicare benefits to KJB.  CMS Ex. 1.
2. On April 29, 2024, a CMS contractor approved Petitioner’s application and set March 12, 2024, as the effective date for Petitioner’s reassignment.  CMS Ex. 3.1
3. On April 29, 2024, Petitioner requested reconsideration of the March 12, 2024 effective date for the reassignment of her Medicare benefits.  CMS Ex. 2.

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4. A July 30, 2024 reconsidered determination affirmed March 12, 2024, as the effective date for Petitioner’s reassignment.  Electronic Filing System (E-File) Doc. No. 1a.

VII.     Conclusion of Law and Analysis

The effective date for Petitioner’s reassignment of Medicare benefits to KJB is March 12, 2024.

Petitioner argues the following in support of an earlier reassignment effective date:

An attempt was made to switch over [Petitioner’s] information to our clinic before she was hired 10/11/2023.  Email Correspondence attached.2  We then began submitting visits as of January 2024.  We were alerted in April from our billing department that there were denials, which led us to investigate further and then submit the required paperwork.  We thought we had 6-12 months to correct the issue.

Hearing Req. at 2; see also CMS Ex. 2.

The Social Security Act (Act) permits beneficiaries to assign their Medicare benefits to an enrolled physician or non-physician supplier.  42 U.S.C. § 1395u(b)(3)(B)(ii).  In certain circumstances, a supplier who has received an assignment of benefits may reassign those benefits to an employer, individual, or entity with which the supplier has a contractual arrangement.  42 U.S.C. § 1395u(b)(6); 42 C.F.R. § 424.80(b)(1)-(2).  When CMS approves the reassignment of Medicare benefits, the reassignment “is effective beginning 30 days before the [reassignment application] is submitted if all applicable requirements during that period were otherwise met.”  42 C.F.R. § 424.522(a).

On April 11, 2024, CMS received Petitioner’s application to reassign Medicare benefits to KJB, which it approved.  Therefore, the reassignment is effective March 12, 2024, which is 30 days before the reassignment application was received by CMS.

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VIII.     Conclusion

The effective date of Petitioner’s reassignment of Medicare benefits to KJB is March 12, 2024.