Queens Optometric Care PLLC, DAB CR6681 (2025)

DECISION

This decision grants the Centers for Medicare & Medicaid Services’ (CMS’s) Motion for Summary Judgment and affirms the determination to revoke the Medicare enrollment and billing privileges of Petitioner, Queens Optometric Care PLLC, and to place Petitioner on the CMS preclusion list. 

I.    Background and Procedural History

Queens Optometric Care PLLC (Petitioner) is a New York-based supplier of optometric services and procedures.  Petitioner was enrolled as a supplier in the Medicare program.

By letter dated September 25, 2023, CMS, through its contractor, National Government Services, Inc. (NGS), notified Petitioner that its Medicare billing privileges were being revoked under 42 C.F.R. § 424.535(a)(8)(ii), effective October 25, 2023, due to its abuse of billing privileges.  CMS Ex. 18.  The letter also noted that due to the revocation,

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Petitioner was placed on the CMS preclusion list pursuant to 42 C.F.R. §§ 422.2 and 422.222.  Id.  

On November 28, 2023, Petitioner filed a Request for Reconsideration of the revocation of its billing privileges and placement on the CMS preclusion list.  CMS Ex. 19. 

CMS issued a Reconsideration Decision on May 28, 2024.  The Hearing Officer determined that no error was made in the revocation of Petitioner’s billing privileges or in placing Petitioner on the preclusion list and upheld CMS’s determination.  CMS Ex. 1.  The Reconsideration Decision also found that, contrary to one of Petitioner’s arguments in its Request for Reconsideration, there was a suitable number of similar providers in Petitioner’s area.  Id. at 10. 

Petitioner timely requested a hearing before an administrative law judge (ALJ) on July 23, 2024.  CMS filed a motion for summary judgment (CMS Br.) along with 21 proposed supporting exhibits (CMS Exs. 1-21).  Petitioner filed an opposition to CMS’s motion for summary judgment (P. Br.) along with four proposed supporting exhibits (P. Exs. 1-4). 

II.     Issues

1. Whether CMS has a legitimate basis to revoke Petitioner’s Medicare enrollment and billing privileges under 42 C.F.R. § 424.535(a)(8)(ii); and
2. Whether CMS has a legal basis to place Petitioner on the CMS preclusion list, as defined at 42 C.F.R. §§ 422.2 and 422.222.

III.     Jurisdiction

I have jurisdiction to hear and decide the issues in this case.  42 C.F.R. §§ 498.3(b)(17), (20); 498.5(l)(2), (n)(2); see also 42 U.S.C. § 1395cc(j)(8); 42 C.F.R. §§ 405.803(a); 424.545(a); 498.1(g). 

III.    Summary Judgment

CMS requested summary judgment, arguing that there are no material facts in dispute.  Petitioner opposes CMS’s motion.  CMS’s motion is granted because the undisputed material facts show that CMS had a legitimate basis to revoke Petitioner’s Medicare enrollment and billing privileges under 42 C.F.R. § 424.535(a)(8)(ii) and to place Petitioner on CMS’s preclusion list. 

Summary judgment is appropriate if a case presents no genuine issue of material fact, and the moving party is entitled to judgment as a matter of law.  Bartley Healthcare Nursing & Rehab., DAB No. 2539 at 3 (2013) (citing Celotex Corp. v. Catrett, 477 U.S. 317,

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322‑25 (1986)); Ill. Knights Templar Home, DAB No. 2274 at 3-4 (2009).  The moving party may show the absence of a genuine factual dispute by presenting evidence so one-sided that it must prevail as a matter of law or by showing that the non-moving party has presented no evidence “sufficient to establish the existence of an element essential to [that party’s] case, and on which [that party] will bear the burden of proof at trial.”  Livingston Care Ctr. v. U.S. Dep’t of Health & Human Servs., 388 F.3d 168, 173 (6th Cir. 2004) (quoting Celotex, 477 U.S. at 322).  To avoid summary judgment, the non-moving party must then act affirmatively by tendering evidence of specific facts showing that a dispute exists.  Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 n.11 (1986); see also Vandalia Park, DAB No. 1939 (2004); Lebanon Nursing & Rehab. Ctr., DAB No. 1918 (2004).  The non-moving party may not simply rely on denials but must furnish admissible evidence of a dispute concerning a material fact.  Ill. Knights Templar, DAB No. 2274 at 4; Livingston Care Ctr., DAB No. 1871 at 5 (2003).  In doing so, the non-moving party must show more than “some metaphysical doubt as to the material facts.”  W. Tex. LTC Partners, Inc., d/b/a Cedar Manor, DAB No. 2652 at 6 (2015), aff’d, 843 F.3d 1043 (5th Cir. 2016); 1866ICPayday.com, L.L.C., DAB No. 2289 at 3 (2009) (quoting Matsushita, 475 U.S. at 587). 

In examining the evidence for purposes of determining whether summary judgment is appropriate, I must draw all reasonable inferences in the light most favorable to the non-moving party.  Heritage House of Marshall Health & Rehab., DAB No. 3035 at 8 (2021); Brightview Care Ctr., DAB No. 2132 at 2, 9 (2007); Livingston Care Ctr., 388 F.3d at 172; Guardian Health Care Ctr., DAB No. 1943 at 8 (2004); see also Brightview, DAB No. 2132 at 10 (entry of summary judgment upheld where inferences and views of non-moving party are not reasonable).  However, drawing factual inferences in the light most favorable to the non-moving party does not require that I accept the non-moving party’s legal conclusions.  W. Tex. LTC Partners, DAB No. 2652 at 6-7; cf. Guardian, DAB No. 1943 at 11 (“A dispute over the conclusion to be drawn from applying relevant legal criteria to undisputed facts does not preclude summary judgment if the record is sufficiently developed and there is only one reasonable conclusion that can be drawn from those facts.”); see Green Valley Healthcare & Rehab. Ctr., DAB No. 2947 at 8 (2019) (quoting Johnson v. Perez, 823 F.3d 701, 705 (D.C. Cir. 2016) (noting that a genuine factual dispute does not exist “when a putatively disputed body of evidentiary material could not, even assuming a sympathetic factfinder, reasonably support a finding crucial to the nonmoving party’s legal position”)). 

In relation to administrative proceedings involving Medicare, it is well-established that an ALJ is empowered to decide a case on summary judgment, without an evidentiary hearing.  Shah v. Azar, 920 F.3d 987, 996 (5th Cir. 2019) (citing Cedar Lake Nursing Home v. U.S. Dep’t of Health & Human Servs., 619 F.3d 453, 457 (5th Cir. 2010)); see Fal-Meridian, Inc. v. U.S. Dep’t of Health & Human Servs., 604 F.3d 445, 449 (7th Cir. 2010) (“All it means for a decision to be based on a grant of summary judgment is that

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there are no issues that would benefit from being resolved in an evidentiary hearing.”) (emphasis added). 

Finally, deciding a case on summary judgment does not mean that it is decided without a hearing.  In reviewing administrative appeals decided on summary judgment, courts describe the case as having been decided without an “oral hearing” or without an “evidentiary hearing.”  They recognize that, by considering the evidence and applying the law, the ALJ has granted the petitioner a hearing.  See CNG Transmission Corp. v. FERC, 40 F.3d 1289, 1293 (D.C. Cir. 1994) (holding that a “paper hearing” satisfies statutory requirements for “notice and opportunity for hearing”). 

V.     Admission of Evidence

Absent objection, CMS’s Exhibits (CMS Exs. 1-21) are admitted into the record.  

CMS objected to Petitioner’s Exhibits 3 and 4.  Petitioner’s Exhibit 3 is a declaration of Petitioner’s counsel conducting research into the community that Petitioner services.  The declaration explains counsel’s research method and lays the foundation for Petitioner’s Exhibit 4.  Petitioner’s Exhibit 4 is a chart compiling the research into whether other offices in Petitioner’s community provide the same services.  

Any new documentary evidence offered by Petitioner at the ALJ level must be examined to determine whether any good cause exists for failure to previously present the evidence.  42 C.F.R. § 498.56(e).  Any new evidence must be excluded if there is a failure to show good cause.  Id.  While “good cause” is not defined in the regulations, the term has been interpreted to mean an event beyond a party’s control that prevents the party from offering the evidence timely.  City Crown Home Health Agency, Inc., DAB CR3130 at 4 (2014).  Here, Petitioner did not offer its proposed Exhibits 3 and 4 during the reconsideration phase of the case. 

Petitioner alleges that good cause exists for submitting this evidence into the record because the documentation was created in response to an issue first raised in the reconsideration decision.  P. Ex. 3 at ¶ 8.  However, the record does not support this argument.  Petitioner raised the issue of its unique services in its request for reconsideration.  CMS Ex. 1 at 10; CMS Ex. 19.  It was likely this argument raised by Petitioner resulted in the hearing officer addressing access to care and determining that there was an ample number of similar providers in the area.  CMS Ex. 1 at 10.  Therefore, I find that Petitioner has not alleged good cause as for why it did not submit Exhibits 3 and 4 earlier. 

As a result, I sustain CMS’s objections and do not admit Petitioner’s Exhibits 3 and 4 into evidence.

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VI.    Legal Authorities

The Social Security Act (Act) authorizes the Secretary of Health and Human Services to establish regulations for enrolling providers and suppliers in the Medicare program.  42 U.S.C. § 1395cc(j)(1)(A).  Providers must enroll in the Medicare program and receive a billing number to obtain payment for services rendered to Medicare beneficiaries.  42 C.F.R. § 424.505. 

CMS or a Medicare contractor may revoke a provider or supplier’s Medicare enrollment and billing privileges for any of the reasons listed in 42 C.F.R. § 424.535(a).  42 C.F.R. §§ 405.800(b)(1), 424.535(a).  If CMS revokes a provider or supplier’s Medicare enrollment and billing privileges, the revocation becomes effective 30 days after CMS or one of its contractors mails the revocation notice to the provider or supplier, subject to some exceptions not applicable in this case.  42 C.F.R. §§ 405.800(b)(2), 424.535(g).  After CMS revokes a provider or supplier’s enrollment and billing privileges, CMS bars the provider or supplier from reenrolling in the Medicare program for a minimum of one year, but no more than 10 years.  42 C.F.R. § 424.535(c).  

CMS may revoke the enrollment of a provider or supplier who engages in abuse of billing privileges.  42 C.F.R. § 424.535(a)(8).  CMS may determine that there has been an abuse of billing privileges if a provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements.  42 C.F.R. § 424.535(a)(8)(ii).  In making that determination, CMS will consider any or all of the four factors specified in the regulations, as applicable or appropriate in an individual case.  42 C.F.R. § 424.535(a)(8)(ii)(A)-(D).  

When evaluating a challenge to a revocation, the Departmental Appeals Board (DAB) has adopted an evidentiary structure that includes burden shifting.  CMS must make a prima facie showing that the provider or supplier failed to comply with the regulations.  If this occurs, the provider or supplier must prove, by a preponderance of the evidence, that it was in compliance.  Hillman Rehab. Ctr., DAB No. 1611 (1997), aff’d, Hillman Rehab. Ctr. v. U.S. Dep’t of Health & Human Servs., No. 98-3789 (GEB) (D.N.J. May 13, 1999); see Adora Healthcare Services, Inc., DAB No. 2714 at 4-5 (2016); Medisource Corp., DAB No. 2011 at 2-3 (2006) (applying Hillman to all cases adjudicated under 42 C.F.R. Part 498.). 

VII.    Undisputed Facts

Petitioner provides optometric services in Bronx, New York.  P. Br. at 2.  

Petitioner was enrolled as a Medicare Part B supplier.  CMS Br. at 6.

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SafeGuard Services PLLC (SGS) conducted three rounds of medical reviews between 2019 and 2023.  CMS Br. at 6. 

2019 Post-Payment Review

The first review was conducted on services billed between February 16, 2018 and September 18, 2019.  CMS Ex. 3 at 3.  SGS selected a probe sample of 25 claims for services provided to five beneficiaries.  CMS Ex. 2 at 2.  The investigation began based on a data analysis that showed potential overutilization and high frequency of claims submitted under procedure code 68761, closure of tear duct opening using a punctum plug.  CMS Ex. 3 at 2-3.  The notable findings from the medical records review included that the documentation submitted did not support the services billed, the documentation was insufficient to support the service that was completed as billed, and the required documentation was not provided.  Id. at 3.  The records review resulted in 89 of the 110 services or 80.9% being denied and all 25 claims being denied.  Id. 

As a result of the post-payment review, NGS issued two demand letters for repayment of an $8,047.68 overpayment from Medicare.  CMS Ex. 6.  Petitioner did not appeal the overpayment demand and the overpayment was recouped.  CMS Ex. 6. 

2021 Post-Payment Review

As part of its efforts to investigate potential fraud, waste, and abuse, SGS performed a second post-payment review of Petitioner’s records from June 8, 2020 to August 12, 2021, reviewing a random sample of 42 claims for services provided to 41 beneficiaries paid between August 10, 2020 and September 8, 2021.  CMS Ex. 7 at 2.  

Petitioner was informed of the audit results by notice letter dated February 11, 2022.  Following the review, 92.3% or 120 out of 130 audited services were denied and all 42 claims were denied because the documentation did not support the medical necessity for the services billed.  CMS Ex. 8.  The audit revealed the following issues:  

• Documentation submitted does not support service / item billed;
• Documentation submitted does not support medical necessity of the service provided;
• Medicare signature requirements do not follow Medicare guidelines; and
• Documentation submitted does not clearly indicate beneficiary’s informed consent was obtained prior to the procedure.

CMS Ex. 8 at 3. 

The notice stated that documentation of all services rendered is absolutely necessary for a claim to be properly evaluated.  CMS Ex. 8 at 7 (emphasis added).  The notice also

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stated, “[t]he documentation should be of such content and clarity as to make it abundantly clear to any third-party reviewer, the patients’ symptoms, history, physical findings, and plan of treatment.  Services that are not proven to be reasonable or medically necessary are denied under the authority of section 1862(a)(1)(A) of the Social Security Act.”  Id.  The notice also informed Petitioner of CMS’s authorization to revoke billing privileges.  Id. at 8. 

As a result of the second post-payment review, CMS identified an overpayment of $105,484.48.  CMS Exs. 10, 11.  Petitioner was notified of the overpayment, along with its appeal rights, by letter dated February 23, 2022.  CMS Ex. 10.  Petitioner filed an appeal and the Qualified Independent Contractor (QIC) issued an unfavorable decision affirming the finding that all of the claims and services did not meet the documentation requirements to support the medical necessity.  CMS Exs. 13, 14.  Petitioner did not file any additional appeals. 

2023 Pre-Payment Review

SGS conducted a pre-payment audit because an analysis of their billing data indicated that there may be anomalies in Petitioner’s billing.  CMS Ex. 15.  The pre-payment review was limited to CPT codes 68761, and 92012 and 92014 with Modifier 25.  CMS Ex. 20 at ¶ 38.  By letter dated February 1, 2024, Petitioner was notified that the review resulted in 90% of claims reviewed being denied.  CMS Ex. 15 at 2. 

To date, Petitioner has not appealed the pre-payment denials. 

CMS’s revocation and preclusion determination

On September 25, 2023, CMS, through its contractor, NGS, issued a notice informing Petitioner that its Medicare billing privileges were revoked effective October 25, 2023.  CMS Ex. 18.  CMS imposed the revocation after determining that Petitioner engaged in a pattern or practice of submitting claims that failed to meet Medicare requirements.  Id.; 42 C.F.R. § 424.535(a)(8)(ii). 

CMS also added Petitioner to the CMS Preclusion List pursuant to 42 C.F.R. §§ 422.2 and 422.222 for providers/suppliers, and pursuant to 42 C.F.R. §§ 423.100 and 423.120(c)(6) for physicians and non-physician practitioners.  CMS Ex. 18 at 2-3. 

Lastly, CMS established a reenrollment bar for 10 years pursuant to 42 C.F.R. § 424.535(c).  CMS Ex. 18 at 2.

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VIII.   Analysis and Conclusions of Law

1. The undisputed evidence shows that the determinations from the 2019, 2021, and 2023 audits are final and binding. 

It is undisputed that Petitioner did not contest the results of the 2019 audit and remitted payment to CMS for the overpayment.  Petitioner filed an initial appeal of the 2021 audit but did not pursue the appeal further after the QIC’s unfavorable decision.  Therefore, both of those audits are administratively final under the regulations.1

There has been no evidence that Petitioner appealed the results of the 2023 pre-payment audit.  Because Petitioner did not appeal the results of the pre-payment audit, and the deadline for the appeal has passed, it is considered finally and fully adjudicated.  Furthermore, I do not have jurisdiction over the claim denials in the third audit.  Claim denials are subject to a separate administrative appeal process, which permits ultimate review by the Medicare Appeals Council and judicial review.  See 42 U.S.C. § 1395ff; 42 C.F.R. Part 405, Subpart I.  Each level of review, from initial determination onward, is final and binding on all parties unless further appealed per regulation.  42 C.F.R. §§ 405.928(b), 405.958, 405.978; Devine Solutions Group, LLC d/b/a Quick Response EMS, DAB CR5981 at 14 (2021).  

2. Petitioner engaged in a pattern or practice of submitting claims for services that were not in compliance with Medicare requirements.

CMS may revoke a currently enrolled provider or supplier’s Medicare enrollment and any corresponding provider agreement or supplier agreement if it determines that the provider or supplier has a pattern of submitting claims that fail to meet Medicare requirements.  In making this determination CMS considers:  

• 1)  The percentage of submitted claims that were denied during the period under consideration.
• 2)  Whether the provider or supplier has any history of final adverse actions and the nature of any such actions.  
• 3)  The type of billing non-compliance and the specific facts surrounding said non-compliance (to the extent this can be determined).
• 4)  Any other information regarding the provider or supplier’s specific circumstances that CMS deems relevant to this determination.  

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42 C.F.R. § 424.535(a)(8)(ii).  The hearing officer contemplated each factor in the reconsideration. 

1. Percentage of submitted claims that were denied during the period under consideration

The record shows, and the hearing officer confirmed, that the first post-payment review audited 25 claims submitted under CPT code 68761 with dates of service from February 16, 2018 through September 28, 2019.  It was determined that the documentation did not support the medical necessity of the services billed.  CMS Ex. 1 at 4. This resulted in 100% of the claims being denied.  CMS Ex. 1 at 4; CMS Ex. 3.  

The second post-payment review audited 42 claims from June 8, 2020 through August 12, 2021.  All 42 claims were denied because the documentation did not support the medical necessity of the services billed.  CMS Ex. 1 at 4; CMS Ex. 8. 

The third audit, a pre-payment review, audited 29 claims and denied 26 claims because the documentation did not support the medical necessity of the services billed.  CMS Ex. 1 at 4; CMS Ex. 15.  This time 90% of the audited claims were denied.  Id. 

Petitioner argues that the number of claims that were audited are insignificant in comparison with the number of claims that the practice would have billed Medicare during the time period of the audits.  Req for Hrg. at 3; P. Br. at 2, 7, 11.  While this may be true, a 100% denial rate through two audits followed by a 90% denial rate is high, and it calls into question how many claims would have been denied if more claims were audited.  A weighted averaging of these audit results produces a 97% denial rate.  Additionally, the hearing officer noted that CMS considers the percentage of denied claims for the audits to be “unacceptably high error rates” of noncompliance.  CMS Ex. 1 at 7.  The hearing officer also noted that the claims remained high despite the education provided by CMS.  CMS Ex. 1 at 4-5.  

2. History of adverse actions

Petitioner does not have a history of adverse actions.  CMS Ex. 1 at 8. 

3. Type of billing non-compliance and specific facts

Regarding the third factor, in the 2019 audit all claims were denied because the documentation did not support the medical necessity of the services billed and the documentation was insufficient to support the lab tests billed.  CMS Ex. 1 at 8.  The hearing officer noted that there was no required documentation of less invasive treatments and the beneficiaries often showed no signs of improvement following the procedure and after repeat procedures.  Id.

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Similarly, all claims were denied in the 2021 post-payment audit because the documentation did not support the medical  necessity of the services billed.  CMS Ex. 1 at 9.  Additionally, Petitioner appealed the claims in the second post-payment audit.  Id.  The appeals upheld the claims determinations.  Id. 

In the 2023 pre-payment review, 26 of 29 claims were again denied due to insufficient documentation.  CMS Ex. 1 at 9.  

4. Additional information

Lastly, the hearing officer found that the underlying conduct that led to the revocation was detrimental to the best interests of the Medicare program.  CMS Ex. 1 at 9-11.  CMS expects suppliers enrolled in the Medicare program to be familiar with program requirements.  Id.  

The hearing officer found that Petitioner’s behavior over a period of more than four years was not sporadic but rather routine.  CMS Ex. 1 at 7. 

The hearing officer concluded that a supplier who refuses to properly document the services it provides places both Medicare beneficiaries and Trust Funds at risk.  CMS Ex. 1 at 9-11. 

3. CMS acted within its authority in revoking Petitioner’s Medicare enrollment and billing privileges under 42 C.F.R. § 424.535(a)(8)(ii).

The evidence supports CMS’s conclusion that Petitioner engaged in a pattern or practice of abuse of billing practices.  Three audits were conducted between 2019 and 2023, assessing 96 claims.  The first two audits resulted in 100% of the audited claims being denied and the third resulted in 90% of the audited claims being denied.  Despite two separate post-payment audits, with instructions and education on documentation, Petitioner continued to submit claims that did not comply with Medicare regulations, as revealed during the later pre-payment audit.  In the reconsidered determination, the hearing officer considered all four factors and found a pattern or practice of abusive billing.  CMS Ex. 1.  

4. I do not have the authority to review the 10-year reenrollment bar imposed by CMS.

An ALJ is authorized to review CMS’s initial determination to “revoke a . . . supplier’s Medicare enrollment.”  42 C.F.R § 498.3(b)(17)(i).  However, the determination of the reenrollment bar is not considered an initial determination and is not subject to review by an ALJ.  42 C.F.R. § 498.3(d).  “An appealable determination to revoke a supplier’s

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enrollment, and a decision about how long the revoked supplier must wait before being allowed to apply for reentry to the program, are factually distinct matters governed by different legal requirements.”  Vijendra Dave, M.D., DAB No. 2672 at 10 (2016).

5. CMS has the authority to place Petitioner on its preclusion list.  

The CMS preclusion list is composed of individuals and entities who are precluded from receiving payment for Medicare Advantage items and services or Medicare Part D drugs furnished or prescribed to Medicare beneficiaries.  CMS may place an individual or entity on the preclusion list if:

• (i)      The individual or entity is currently revoked from Medicare for a reason other than that stated in [42 C.F.R.] § 424.535(a)(3).
• (ii)     The individual or entity is currently under a reenrollment bar under [42 C.F.R.] § 424.535(c).
• (iii)    CMS determines that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program.

In determining whether conduct is detrimental to the best interests of the Medicare program, CMS considers: 

• (i)      the seriousness of the conduct underlying the revocation;
• (ii)     the degree to which that conduct could affect the integrity of the Medicare program; and
• (iii)    any other evidence that CMS deems relevant to its determination.

42 C.F.R. §§ 422.2, 423.100, Preclusion list.

When CMS made the decision to add Petitioner to the preclusion list, Petitioner was “revoked from Medicare” under 42 C.F.R. § 424.535(a)(8)(ii) and was under a reenrollment bar pursuant to § 424.535(c).  CMS Ex. 1 at 11.  CMS also determined Petitioner’s pattern of submitting claims that failed to meet Medicare standards to be very serious.  Id. at 11-12.

Next, CMS determined that the conduct underlying Petitioner’s revocation is very serious and harmful to the integrity of the Medicare program.  CMS noted that it calls on its partners to only submit claims that comply with Medicare requirements.  CMS Ex. 1 at 11.

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Lastly, the hearing officer noted that Petitioner’s continued “abusive” billing after multiple education efforts questions whether Petitioner is willing or able to submit claims that meet requirements.  Id.  Petitioner argues that it took action to correct the billing issues in response to the CMS audits.  P. Ex. 1 at ¶¶ 16-19.  However, the record shows that these changes did not do much to reduce the rate of claims denied by CMS.

CMS next determined that the conduct underlying Petitioner’s revocation was detrimental to the best interests of the Medicare program and therefore warranted placing Petitioner on the preclusion list for the duration of the reenrollment bar.  CMS Ex. 1 at 11-12.

Petitioner argues that should the preclusion stand, there will be a dangerous shortage of available doctors providing specialty optometry services in their geographic area.  Req. for Hearing; P. Br. at 19-20.  Based on the information provided, CMS conducted a review of providers in the area and determined that this is not the case.  CMS Ex. 1 at 10.

Here, CMS met its regulatory obligation to consider whether the conduct underlying Petitioner’s revocation was detrimental to the best interests of the Medicare program by assessing the seriousness of that conduct, the degree to which that conduct could affect the integrity of the Medicare program, and any other information CMS deemed relevant to its determination.  42 C.F.R. § 422.2, Preclusion list.

IX.    Conclusion

For the foregoing reasons, CMS’s motion for summary judgment is granted.  I affirm CMS’s revocation of Petitioner’s Medicare enrollment and billing privileges under 42 C.F.R. § 424.535(a)(8)(ii) and uphold Petitioner’s inclusion on the CMS preclusion list.