Patrick Trentalange, LCSW-C, DAB CR6643 (2025)

DECISION

Petitioner, Patrick Trentalange, is a licensed certified social worker, practicing in Maryland, who opted out of the Medicare program.  He now seeks to end his opt-out status.  However, because he missed the deadline for canceling his opt-out status, the Centers for Medicare & Medicaid Services (CMS) denied his request.  Petitioner appeals that determination.

Because he missed the regulatory deadline, CMS properly denied Petitioner's request to cancel his Medicare opt-out status.  42 C.F.R. § 405.445(a).

Background

In an affidavit, dated August 26, 2019, and submitted to the Medicare administrative contractor, Novitas Solutions (Novitas), Petitioner opted out of the Medicare program.  CMS Ex. 2.  Among other assurances, he agreed that, during the opt-out period, he would not submit a claim to Medicare for any service furnished to a Medicare beneficiary.  He recognized that the opt-out was for a period of two years and would automatically renew unless cancelled.  He also acknowledged that, to cancel the automatic extension, he had to notify the Medicare contractor in writing at least 30 days prior to the start of the next opt-out period.  CMS Ex. 2 at 1-2.  By letter dated September 30, 2019, Novitas informed Petitioner that the effective date of his opt-out status was September 16, 2019, and informed Petitioner that his opt-out status was effective for two years and would

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automatically renew at the end of the initial two-year period.  CMS Ex. 3 at 1.  Novitas also informed him that in the event Petitioner wanted to cancel his opt-out status, he had to notify Novitas of the cancellation in writing at least 30 days prior to the start of the next two-year opt-out period.  Id.

In a letter dated May 25, 2021, Novitas informed Petitioner that his opt-out status would be automatically renewed for another two-year period on September 16, 2021.  CMS Ex. 4 at 1.  The letter also informed Petitioner that he could cancel his opt-out status by notifying Novitas at least 30 days prior to the end of the opt-out period.  Id.

On May 18, 2023, Novitas sent another letter to Petitioner stating that his opt-out status would be automatically renewed for another two-year period on September 16, 2023.  CMS Ex. 5 at 1.  The letter again informed Petitioner that he could cancel his opt-out status by notifying Novitas at least 30 days prior to the end of the opt-out period.  Id.

In a letter dated September 11, 2023, Petitioner requested cancellation of his opt-out status set to renew on September 16, 2023.  CMS Ex. 6.  On September 19, 2023, Novitas sent Petitioner a letter informing him that his cancellation request was denied because it was submitted after the 30-day deadline.  CMS. Ex. 7.

In a reconsideration request, Petitioner requested that CMS reconsider the decision to reject his request to cancel his opt-out from Medicare.  CMS Ex. 1.

In a reconsidered determination, dated February 28, 2024, the contractor hearing officer determined that, because Petitioner did not meet the deadline for cancelling his Medicare opt-out status, he would remain opted-out until at least September 16, 2025.  CMS Ex. 8 at 2-3.

Petitioner appealed, and the matter was initially before Administrative Law Judge (ALJ) Tannisha D. Bell.  The Civil Remedies Division issued ALJ Bell's standing prehearing order (Standing Order) on April 2, 2024.  The case was transferred to me on March 5, 2025.  Consistent with that order, CMS filed a motion for summary judgment and brief (CMS Br.) with eight exhibits (CMS Exs. 1-8).  In the absence of any objections, I admit into evidence CMS Exhibits 1-8.

Petitioner submitted no additional arguments but did file a copy of his email exchange with CMS requesting status on his case and a copy of his curriculum vitae.  Electronic Filing System (E-File) Doc. Nos. 8, 9.

Judge Bell issued an order dated June 25, 2024, giving Petitioner time to file additional documents, but Petitioner filed nothing else.

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Decision on the written record.  CMS has moved for summary judgment.  However, because neither party proposes any witnesses, an in-person hearing would serve no purpose.  See Standing Order at 5-7 (April 2, 2024).  I may therefore decide this case based on the written record, without considering whether the standards for summary judgment are satisfied.  See Anil Hanuman, D.O., DAB No. 3080 at 12 (2022) (citing cases).

Issue

Whether CMS had a legitimate basis to deny Petitioner cancellation of his opt-out status.

Jurisdiction

I have jurisdiction to hear and decide this case.  42 C.F.R. §§ 405.450(a), 498.3(b)(19).

Discussion

1. Because Petitioner's request to cancel was untimely, CMS properly denied his request for cancellation of his opt-out status.  42 C.F.R. § 405.445.1

A physician or other practitioner may participate in the Medicare program as a supplier of services.  Social Security Act (Act) § 1861(d); 42 C.F.R. § 498.2.  A practitioner may also enter into one or more private contracts with Medicare beneficiaries "for the purpose of furnishing items or services that would otherwise be covered by Medicare" if certain conditions are met.  42 C.F.R. § 405.405(a).  Among those conditions, the practitioner must submit one or more affidavits opting out of the Medicare program.  42 C.F.R. § 405.405; see Act § 1802(b)(3).

If a practitioner opts out, Medicare will not pay for the services he provides to beneficiaries (except in emergency or urgent care circumstances).  42 C.F.R. §§ 405.405, 405.440.  To opt out, the practitioner must sign an affidavit declaring that, during the two-year opt-out period, the practitioner will provide services to Medicare beneficiaries only through private contracts and will not submit claims for payment to Medicare or allow any entity to submit a Medicare claim on his behalf.  42 C.F.R. § 405.420.  The opt-out period is for two years, beginning on the effective date of the affidavit, in this case September 16, 2019.  42 C.F.R. § 405.400.

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A practitioner may cancel his opt-out status if:

A physician or practitioner may cancel opt-out by submitting a written notice to each Medicare Administrative Contractor to which he or she would file claims absent the opt-out, not later than 30 days before the end of the current 2-year opt-out period, indicating that the physician or practitioner does not want to extend the application of the opt-out affidavit for a subsequent 2-year period.

42 C.F.R. § 405.445(a).

Petitioner does not contest that he signed the original opt-out affidavit on August 26, 2019, nor does he contest that the September 11, 2023 request to cancel his opt-out status was untimely.  He thus did not meet the requirements of section 405.445(a) and is bound by the terms of his opt-out affidavit.

Petitioner instead offers as an explanation for the untimely filing that, among other things, he had been told by his former employer that the opt-out period would come to an end with no further action on his part.  Request for Hearing at 2.  However, Petitioner was obligated to familiarize himself with the Medicare rules.  Further, in the letters sent to Petitioner after the initial opt-out and the renewals, instructions were included as to the opt-out rules for proper cancellation.  In any event, I am not authorized to disregard the statute and regulations in order to provide Petitioner with the equitable relief that he seeks.  See Parvin Shafa MD, Inc., DAB No. 2846 at 8 (2018); Thomas Macari, D.O., DAB CR3155 at 4 (2014).

Conclusion

Because Petitioner asked to cancel his opt-out status less than 30 days before the end of the two-year opt-out period, CMS properly denied his request for cancellation.  I therefore affirm CMS's determination.