James Grieme, M.D., DAB CR6636 (2025)

DECISION

Petitioner, James Grieme, M.D., is a Texas physician who participated in the Medicare program until March 28, 2022, when the Centers for Medicare & Medicaid Services (CMS) revoked his enrollment, citing 42 C.F.R. § 424.535(a)(1) and 424.535(a)(9).  CMS took this action because Petitioner had a suspended medical license and he failed to notify CMS of the suspension of his medical license within 30 days. 

Petitioner now appeals the revocation. 

I find that, pursuant to 42 C.F.R. § 424.535(a)(1) and 424.535(a)(9), CMS appropriately revoked Petitioner Grieme’s Medicare enrollment because he did not comply with the Medicare requirement that he be licensed and because he did not notify the contractor that his medical license had been suspended. 

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Background

In a revocation notice, dated March 28, 2022, the Medicare contractor, Novitas Solutions, advised Petitioner Grieme that it revoked his Medicare enrollment, effective December 29, 2021.  As the notice letter explains, the contractor acted pursuant to 42 C.F.R. § 424.535(a)(1) because Petitioner did not comply with the Medicare requirement that he be properly licensed.  The contractor also acted pursuant to 42 C.F.R. § 424.535(a)(9) because Petitioner did not report the license suspension within 30 days.  CMS Ex. 2. 

Petitioner requested reconsideration.  CMS Exs. 1, 3.  In a reconsidered determination, dated July 7, 2022, a contractor hearing specialist affirmed the revocation, noting that Petitioner’s medical license was suspended and that he did not report that event as required.  CMS Ex. 1 at 3. 

Petitioner again appealed. 

Summary judgment.  Although CMS has moved for summary judgment, I find that this matter may be decided on the written record, without considering whether the standards for summary judgment are satisfied.  In Administrative Law Judge Bill Thomas’ initial order, he instructed each party to submit the written direct testimony of any proposed witnesses and, if it wished to cross-examine an opposing witness, to state so affirmatively.  Acknowledgment and Standing Order at 7 (¶¶ 11, 12) (August 31, 2022).  CMS listed no witnesses.  Petitioner listed one witness, himself, and provided his written direct testimony (P. Ex. 4).  However, CMS has not asked to cross-examine Petitioner; an in-person hearing would therefore serve no purpose, and I may decide this case based on the written record.  See Standing Order at 7-8 (¶ 13). 

CMS has filed a prehearing brief and motion for summary judgment (CMS Br.), with six exhibits (CMS Exs. 1-6).  Petitioner filed his own pre-hearing brief and response to CMS’s motion (P. Br.), with four exhibits (P. Exs. 1-4).  In the absence of any objections, I admit into evidence CMS Exhibits 1-6 and Petitioner Exhibits 1-4. 

This case was transferred to me on February 28, 2025. 

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Discussion

• Because Petitioner Grieme had no license to practice and he failed to report that he had no license, CMS properly revoked his Medicare enrollment.  42 C.F.R. § 424.535(a)(1) and 42 C.F.R. § 424.535(a)(9).1  

CMS regulates the Medicare enrollment of providers and suppliers.  Social Security Act (Act) § 1866(j)(1)(A).  It may revoke a supplier’s enrollment in the program if the supplier no longer meets the Medicare enrollment requirements for a supplier of its type.  42 C.F.R. § 424.535(a)(1).  These requirements include complying with federal and state licensing requirements.  42 C.F.R. § 424.516(a)(2); see 42 C.F.R. § 410.20(b) (requiring that a physician be legally authorized to practice by the state in which he functions in order to receive Medicare payments). 

Regulations also allow CMS to revoke a supplier’s enrollment if he does not comply with reporting requirements, including that he report, within 30 days, any adverse legal action or change in enrollment.  42 C.F.R. § 424.535(a)(9); 42 C.F.R. § 424.516(d). 

Here, the parties agree that, effective December 21, 2021, the Texas Medical Board suspended Petitioner’s license to practice medicine in the State of Texas.  CMS Ex. 1; P. Br. at 1-2.  The suspension was related to substance abuse issues.  P. Ex. 4 at 1-2.  Petitioner argues that he has lawfully returned to the practice of medicine in Texas and, therefore, his revocation should be reconsidered.  P. Br. at 2-3; P. Ex. 4.  He also points out that the Texas Medical Board restored his license to active status with supervision on June 10, 2022.  P Ex. 4 at 2 (¶ 10).  Petitioner further states that the supervision requirement was terminated on August 22, 2022.  Id. (¶ 11).  

The reasons underlying Petitioner’s license suspension are irrelevant.  I applaud Petitioner’s efforts to address his substance abuse issues and achieve sobriety.  However, without a medical license, Petitioner had no legal authority to practice medicine.  He no longer met Medicare requirements, and CMS properly revoked his enrollment.  Angela R. Styles, M.D., DAB No. 2882 at 6 (2018).  Nor does it matter that his license was eventually reinstated.  The suspension triggers noncompliance with Medicare enrollment requirements and provides a valid basis for revocation of Medicare billing privileges, regardless of when the license is reinstated.  Id. at 6-7; Meindert Niemeyer, M.D., DAB No. 2865 at 9 (2018); Akram A. Ismail, M.D., DAB No. 2429 at 8 (2011). 

That Petitioner did not report the license suspension provides CMS an alternative justification for revoking his Medicare enrollment.  42 C.F.R. § 424.535(a)(9); Styles, DAB No. 2882 at 9. 

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Conclusion

I affirm CMS’s determination.  CMS may revoke Petitioner Grieme’s Medicare enrollment because his medical license was suspended and because he did not report the license suspension to the Medicare contractor.  42 C.F.R. § 424.535(a)(1) and (9).