Ralph Thomas Reach, M.D., DAB CR6706 (2025)

DECISION

I affirm the determination of the Centers for Medicare & Medicaid Services (CMS) to revoke the Medicare enrollment and billing privileges of Petitioner, Ralph Thomas Reach, M.D., and to add Petitioner’s name to the CMS Preclusion List. 

I. Background and Procedural History

In notices of initial determination, dated October 10, 2023, and October 11, 2023, a CMS contractor revoked Petitioner’s enrollment in the Medicare program as a supplier based on two different regulatory violations.  The CMS contractor alleged that Petitioner failed to meet enrollment requirements because the Tennessee Board of Medical Examiners revoked Petitioner’s medical license, and the Virginia Department of Health Professions suspended Petitioner’s medical license.  CMS Ex. 4 at 1; CMS Ex. 5 at 1; 42 C.F.R. § 424.535(a)(1).  The CMS contractor also alleged that Petitioner did not timely notify CMS of the revocation and suspension of his medical licenses.  CMS Ex. 4 at 1; CMS Ex. 5 at 1; 42 C.F.R. § 424.535(a)(9).  Finally, the CMS contractor informed Petitioner that CMS would add his name to the CMS Preclusion List.  CMS Ex. 5 at 1.

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Petitioner timely requested reconsideration of the initial determinations and submitted copies of documents to support his appeal.  CMS Exs. 2, 3.  In a May 30, 2024 reconsidered determination, a CMS hearing officer affirmed the initial determinations to revoke Petitioner’s enrollment in the Medicare program and to place Petitioner’s name on the CMS Preclusion List.  CMS Ex. 1.  

On July 31, 2024, Petitioner requested a hearing before an administrative law judge to challenge the reconsidered determination.  On August 5, 2024, the Civil Remedies Division acknowledged receipt of Petitioner’s hearing request, provided the parties with a prehearing submission schedule, and issued my Standing Order. 

On October 9, 2024, CMS filed a prehearing brief and 16 proposed exhibits.  On December 13, 2024, Petitioner filed a prehearing brief (P. Br.) and four proposed exhibits.  On January 2, 2025, CMS filed a rebuttal statement (CMS Rebuttal). 

II. Admission of Evidence

I admit CMS Exhibits 1 through 7 and 9 through 16, and Petitioner Exhibits 1 through 3, into the record, without objection.  See Standing Order ¶ 10.  I exclude CMS Exhibit 8 and Petitioner Exhibit 4 for the reasons stated below. 

Petitioner objects to CMS Exhibit 8, which is an Indictment charging Petitioner with various crimes.  Petitioner asserts that the facts alleged in the Indictment were not the basis for Petitioner’s criminal convictions and those unproven facts are prejudicial.  I exclude CMS Exhibit 8 as irrelevant.  See 42 C.F.R. § 498.60(b)(1).  The Indictment was dismissed, and Petitioner pleaded guilty to different misdemeanor charges.  CMS Ex. 11 at 10-11; CMS Ex. 12 at 4; P. Ex. 1. 

CMS objects to Petitioner Exhibit 4, which is a Corrective Action Plan (CAP) filed with the Drug Enforcement Administration (DEA) on October 13, 2023.  Petitioner asserts that CMS failed to consider this CAP.  P. Br. at 3.  CMS replies that Petitioner did not submit this CAP with the reconsideration request as required by the regulations.  CMS Rebuttal at 1-2; 42 C.F.R. § 405.803(c); see also CMS Ex. 4 at 3; CMS Ex. 5 at 4 (advising Petitioner to file all documents with the reconsideration request).  CMS also argues the CAP was not responsive to the initial determinations.  CMS Rebuttal at 2.  I exclude Petitioner Exhibit 4 as irrelevant and untimely filed without good cause.  See 42 C.F.R. §§ 498.56(e), 498.60(b)(1). 

III. Decision on the Written Record

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

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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).  I also 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. 

Both parties stated on their respective exhibit lists that they do not intend to call any witnesses in this proceeding, and neither party submitted written direct witness testimony.  Therefore, I decide this case based on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 11-12 (2022); Civil Remedies Division Procedures § 19(d). 

IV. Issues

1. Whether CMS had a legitimate basis to revoke Petitioner’s enrollment in the Medicare program under 42 C.F.R. § 424.535(a)(1) and/or (a)(9).
2. Whether CMS had a legitimate basis to include Petitioner’s name on the CMS Preclusion List under 42 C.F.R. §§ 422.2 and 423.100. 

V. Jurisdiction

I have jurisdiction to 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. §§ 424.545(a), 498.1(g).  

VI. Findings of Fact

1. Petitioner is a physician who was first licensed to practice medicine in Virginia on July 1, 1987, and in Tennessee on August 22, 2006.  CMS Exs. 13-14.
2. Petitioner enrolled in the Medicare program as a physician/supplier in 2005 (Virginia) and 2006 (Tennessee).  CMS Exs. 15-16.  
3. On April 28, 2021, a grand jury empaneled by the United States District Court for the Western District of Virginia (District Court) returned an Indictment charging Petitioner with a number of criminal offenses.  CMS Ex. 11 at 4. 

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4. On March 29, 2023, the government filed in the District Court both a single count Information (Information No. 1) and a two-count Information (Information No. 2) charging Petitioner with a total of three misdemeanor violations.  CMS Ex. 11 at 10; CMS Ex. 12 at 4.  All three counts alleged violations of 21 U.S.C. §§ 331(k), 333(a)(1), and 353(b)(1).  All three counts also alleged that Petitioner was an owner of and practiced as a physician at Watauga Recovery Centers located in both Virginia and Tennessee.  Count 1 in both Information Nos. 1 and 2 alleged that Petitioner induced a Schedule III controlled substance (Suboxone) to be dispensed multiple times in 2016 and 2017, without valid prescriptions, by the actions of health care providers at Watauga Recovery Centers.  Count 2 in Information No. 2 alleged that Petitioner induced a Schedule IV controlled substance (Clonazepam), as well as another substance called Gabapentin, to be dispensed, without valid prescriptions, by the actions of health care providers at Watauga Recovery Centers.  All of the counts alleged that Petitioner’s actions resulted “in the drugs being misbranded while held for sale after shipment in interstate commerce.”  P. Ex. 1 at 1, 3, 4.
5. On March 29, 2023, Petitioner signed a Plea Agreement in which he agreed to plead guilty to all of the charges in Information Nos. 1 and 2.  CMS Ex. 9 at 1-2.  In the Plea Agreement, Petitioner stated:  “I willingly stipulate there is a sufficient factual basis to support each and every material factual allegation contained within the charging document(s) to which I am pleading guilty.”  CMS Ex. 9 at 14.  As part of the Plea Agreement, the government agreed to move for the dismissal of the original Indictment.  CMS Ex. 9 at 3.
6. On June 6, 2023, and June 7, 2023, the District Court issued a separate Judgment in a Criminal Case for Information No. 1 and Information No. 2.  CMS Ex. 7 at 5-14.  The District Court indicated that Petitioner pleaded guilty to the charges in Information No. 1 and Information No. 2 and was adjudicated guilty of those offenses.  CMS Ex. 7 at 5, 9.  The District Court characterized the violations of 21 U.S.C. §§ 331(k), 333(a)(1), and 353(b)(1) to be “Causing Drugs to be Misbranded While Held for Sale After Shipment in Interstate Commerce.”  CMS Ex. 7 at 5, 9.  The District Court sentenced Petitioner to six months of imprisonment based on Information No. 1 and to five years of probation based on Information No. 2.  CMS Ex. 7 at 6, 10.
7. On June 7, 2023, the District Court dismissed the Indictment.  CMS Ex. 11 at 11; CMS Ex. 12 at 4.
8. In a June 30, 2023 letter, the President of the Tennessee Board of Medical Examiners informed Petitioner that his medical license was automatically revoked

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due to his conviction involving a controlled substance.  The revocation was effective on the date of the letter.  CMS Ex. 6; see also CMS Ex. 2 at 8-9.

9. In a July 6, 2023 Order of Mandatory Suspension, the Virginia Department of Health Professions suspended Petitioner’s medical license based on the revocation of Petitioner’s Tennessee medical license.   CMS Ex. 7 at 2.
10. On July 14, 2023, the District Court issued an Amended Judgment in a Criminal Case related to Information No. 1 and a second for Information No. 2.  These amended judgments modified the description of the criminal offenses as “Inducing” rather than “Causing” drugs to be misbranded.  CMS Ex. 2 at 4; CMS Ex. 10 at 1; CMS Ex. 11 at 11; CMS Ex. 12 at 4.
11. As of May 2024, Petitioner’s Tennessee and Virginia medical licenses were still revoked and suspended, respectively.  CMS Exs. 13-14.  

VII. Conclusions of Law and Analysis

1. CMS had a legitimate basis to revoke Petitioner’s enrollment as a physician/supplier in the Medicare program because Petitioner’s licenses to practice medicine in the states in which Petitioner practices were revoked/suspended. 

The Social Security Act (Act) authorizes the Secretary of Health and Human Services (Secretary) to establish regulations governing the enrollment of providers and suppliers in the Medicare program.  42 U.S.C. § 1395cc(j).  Physicians are “suppliers” for Medicare program purposes.  42 U.S.C. § 1395x(d) (defining “supplier” to include physicians and other entities that are not considered to be a “provider of services”). 

To receive payment for covered Medicare items or services provided to beneficiaries, a supplier must enroll in the Medicare program.  42 U.S.C. §§ 1395n(a), 1395u(h)(1); 42 C.F.R. § 424.505.  To enroll, a supplier must complete and file an enrollment application with CMS and meet all of the requirements to be a supplier.  42 C.F.R. §§ 424.510, 424.530; see also 42 U.S.C. § 1395cc(j).  If CMS determines that an applicant does not meet the requirements for enrollment, CMS may deny enrollment.  42 C.F.R. § 424.530.  Once enrolled, CMS may revoke a supplier’s enrollment for any of the reasons stated in 42 C.F.R. § 424.535(a). 

To enroll and maintain active enrollment, a supplier must comply with federal and state licensure requirements for the relevant supplier type.  42 C.F.R. § 424.516(a)(2); see also 42 C.F.R. § 424.510(d)(2)(iii)(A) (requiring submission of applicable licenses with the enrollment application).  For a physician, this means he or she must be “a doctor of

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medicine . . . legally authorized to practice medicine and surgery by the State in which he performs such function or action. . . .”  42 U.S.C. § 1395x(r)(1); 42 C.F.R. § 410.20(b).  CMS may revoke the enrollment of a supplier in the Medicare program when the supplier is not in compliance with enrollment requirements.  42 C.F.R. § 424.535(a)(1). 

As stated in Findings of Fact Numbers 1-2, 4, 8-9, and 11 above, Petitioner was licensed and practiced medicine in Tennessee and Virginia, lost authorization to practice medicine in those states through the revocation and suspension of his licenses, and is still not authorized to practice medicine in those states.  Therefore, CMS had a legitimate basis to revoke Petitioner’s enrollment in the Medicare program.  Akram A. Ismail, M.D., DAB No. 2429 at 8 (2011) (“Dr. Ismail’s inability to practice medicine for any length of time due to the disciplinary actions imposed against him triggered his noncompliance with the Medicare enrollment requirements and authorized revocation of his billing privileges.”). 

Petitioner asserts that the revocation of his medical license was done “without proper regard to his procedural and substantive due process rights,” which resulted in the suspension of his Virginia license, and that he is in the process of seeking judicial review.  P. Br. at 2; see also Hr’g Req. at 3; CMS Ex. 2 at 8-11.  Petitioner also asserts that he has an active license in North Carolina.  P. Br. at 3; Hr’g Req. at 2. 

Petitioner’s arguments and assertions do not call into question the legitimacy of CMS’s determination to revoke his enrollment.  Petitioner’s argument that the Tennessee Board of Medical Examiners deprived him of due process is an impermissible collateral attack on that revocation.  Cheryl Ackerman, M.D., DAB No. 3050 at 17 (2021).  Further, that argument supports CMS’s position that Petitioner’s medical license in Tennessee was and is revoked.  Further, Petitioner submitted no direct evidence that he is licensed to practice medicine in North Carolina and that he practices in that state.  Petitioner only submitted a DEA Controlled Substance Registration Certificate issued on March 14, 2022, which is a year before he pleaded guilty to the criminal charges.  See P. Ex. 3.  If Petitioner wanted to assert that he should be eligible to maintain Medicare enrollment based on licensure in North Carolina, Petitioner needed to submit evidence supporting that argument with his reconsideration request.  42 C.F.R. § 405.803(c).  

Therefore, I conclude that Petitioner failed to maintain Medicare enrollment requirements when his license to practice medicine in Tennessee was revoked and his license to practice medicine in Virginia was suspended, and I affirm CMS’s determination to revoke Petitioner’s Medicare enrollment under 42 C.F.R. § 424.535(a)(1). 

2. CMS had a legitimate basis to revoke Petitioner’s enrollment as a supplier in the Medicare program because Petitioner did not report the revocation of his license to practice medicine in Tennessee and the suspension of his license to practice medicine in Virginia to CMS within 30 days of those events. 

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The regulations require that physicians report, within 30 days, “[a]ny adverse legal action” to their Medicare contractor.  42 C.F.R. § 424.516(d)(1)(ii).  An adverse action includes the suspension or revocation of a state license to provide health care.  See 42 C.F.R. § 424.502 (definition of “Final adverse action”).  The failure to timely report an adverse action is a basis to revoke a physician’s Medicare enrollment.  42 C.F.R. § 424.535(a)(9).  When deciding whether to revoke a supplier, CMS will consider the following:  whether the required information was reported; if the information was reported, how untimely was it reported; the materiality of the information; and any other relevant information.  42 C.F.R. § 424.535(a)(9)(i)-(iv). 

As stated in Findings of Fact Numbers 8 and 9, Petitioner’s Tennessee medical license was revoked on June 30, 2023, and his Virginia medical license was suspended on July 6, 2023.  There is no evidence in the record that Petitioner ever informed CMS or a CMS contractor of those adverse actions.  Further, the information about Petitioner’s state license revocation and suspension is highly material because the Act requires a physician to be authorized to practice in the state where the physician is providing services in order to be enrolled in the Medicare program.  42 U.S.C. § 1395x(r)(1).  As discussed above, Petitioner’s enrollment in the Medicare program is revoked based on this failure to meet enrollment requirements.  Therefore, CMS had a legitimate additional basis to revoke Petitioner’s Medicare enrollment under 42 C.F.R. § 424.535(a)(9). 

Petitioner asserts that the Tennessee license revocation is not final because it is under appeal.  Petitioner also explains that, because “his adverse legal actions did not involve felony charges and because his revocation is under appeal, [Petitioner] simply misinterpreted the reporting mandate.”  CMS Ex. 2 at 2.  Although Petitioner has an appeal pending before the Tennessee Supreme Court, this does not mean that his license revocation in that state is not final.  In any event, Petitioner was obligated to report any adverse legal action, which “require[s] the reporting of a license suspension even if an appeal of the suspension is pending.”  Ismail, DAB No. 2429 at 10.  Further, there is no dispute that the Tennessee revocation went into effect, despite Petitioner’s efforts at seeking the intervention of a court.  Petitioner’s Virginia license was also suspended based on the Tennessee revocation.  See CMS Ex. 7 at 2, 4.  It would not have been reasonable for Petitioner to assume that the loss of his licenses to practice medicine did not need to be reported to CMS.  After all, “[a]llowing a doctor of medicine with a suspended medical license to participate in Medicare pending an appeal of the suspension without having to notify a CMS contractor of the suspension would prevent CMS from effectively evaluating whether the supplier should continue to participate in Medicare, and would undercut the regulatory goal of reducing improper payments to unqualified practitioners.”  Ismail, DAB No. 2429 at 11.  Therefore, I reject Petitioner’s arguments as to why his enrollment should not be revoked for failing to timely report the adverse legal actions against his licenses.  

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3. I do not have authority to review the length of the reenrollment bar. 

When CMS revokes enrollment, it will establish a reenrollment bar from one to ten years in duration.  42 C.F.R. § 424.535(c). 

CMS imposed a reenrollment bar on Petitioner for five years.  CMS Ex. 4 at 1; CMS Ex. 5 at 2.  CMS is permitted to impose a reenrollment bar that is at least one year in length and no more than ten years in length, except in certain circumstances that are not present in this case.  42 C.F.R. § 424.535(c)(1)(i).  CMS imposed a reenrollment bar that is within the permitted range.  Therefore, I have no authority to review the five-year length of the reenrollment bar.  Shah v. Azar, 920 F.3d 987, 998 (5th Cir. 2019); Vijendra Dave, M.D., DAB No. 2672 at 9 (2016). 

4. CMS had a legitimate basis to include Petitioner on the CMS Preclusion List. 

CMS may add an individual or entity to the CMS Preclusion List for any of the reasons stated in the regulatory definition of the term “Preclusion List.”  42 C.F.R. §§ 422.2, 423.100.  If this happens, a Medicare Advantage Organization under Medicare Part C may not pay for a health care item, service, or drug provided by the individual or entity on the CMS Preclusion List.  42 C.F.R. § 422.222(a)(1)(i).  Also, a Medicare Part D sponsor must not reimburse a Medicare beneficiary for a drug prescribed by an individual on the CMS Preclusion List.  42 C.F.R. § 423.120(c)(6)(i)-(ii). 

CMS may add an individual to the CMS Preclusion List when:  1) CMS revoked the individual’s Medicare enrollment; 2) the individual is currently under a reenrollment bar; and 3) CMS determines that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program.  42 C.F.R. §§ 422.2 (paragraph (1) of definition of “Preclusion List”), 423.100 (paragraph (1) of definition of “Preclusion List”).  When determining whether the underlying basis for the revocation is detrimental to the best interests of the Medicare program, CMS considers: 

1. The seriousness of the conduct underlying the individual’s or entity’s revocation.  
2. The degree to which the individual’s or entity’s conduct could affect the integrity of the Medicare program.
3. Any other evidence that CMS deems relevant to its determination. 

42 C.F.R. §§ 422.2 (paragraph (1)(iii) of definition of “Preclusion List”), 423.100 (paragraph (1)(iii) of definition of “Preclusion List”).

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There is no dispute that CMS revoked Petitioner’s Medicare enrollment and Petitioner is under a reenrollment bar.  Therefore, the only question is whether the underlying basis for revocation is detrimental to the best interests of the Medicare program. 

In the reconsidered determination, the CMS hearing officer found that the underlying basis for the revocation of Medicare enrollment under 42 C.F.R. § 424.535(a)(1) is detrimental to the best interests of the Medicare program.  The CMS hearing officer considered Petitioner’s criminal conduct as the ultimate underlying basis for his Medicare revocation because it had led to the loss of his Tennessee and Virginia licenses.  The CMS hearing officer concluded that the underlying basis for the revocation involved very serious conduct because, at its heart, it involved the improper prescribing of controlled substances at Petitioner’s clinics.  CMS Ex. 1 at 6. 

The hearing officer was also concerned that Petitioner’s conduct could affect the integrity of the Medicare program: 

The CMS Preclusion List was established to conform with a Congressional mandate (see Comprehensive Addiction and Recovery Act of 2016, P.L. 114-198).  This mandate intended to establish a program to prevent prescription drug abuse under Medicare Parts C and D for Medicare beneficiaries.  Although [Petitioner] is a Medicare supplier and not a Medicare beneficiary, the integrity of the Medicare program is at risk if it allows its Medicare providers and suppliers to engage in improper prescribing of controlled substances while seeking to prevent and prohibit prescription drug abuse by its beneficiaries.  CMS also noted that the Preclusion List “is of particular importance when considering the nationwide opioid crisis” and that “the inclusion of problematic prescribers on the [P]reclusion [L]ist could reduce the amount of opioids that are improperly or unnecessarily prescribed by persons who pose a heightened risk to the Part D program and Medicare beneficiaries” (see 82 Fed Reg. 56,336, 56,444). The conduct which led to the revocation of [Petitioner]’s Medicare enrollment is the precise type of conduct that the CMS Preclusion List was intended to deter within the Medicare program.  

CMS Ex. 1 at 6-7. 

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The CMS hearing officer also considered Petitioner’s revocation under 42 C.F.R. § 424.535(a)(9) for failing to report his license suspension in Virginia as serious.  The hearing officer stated: 

A supplier is ultimately responsible for furnishing complete and accurate information to CMS, as well as understanding the requirements of their on-going participation in the Medicare program.  Failure to understand or comply with program requirements is very serious because CMS relies upon the most recent information reported to CMS by providers and suppliers.  

CMS Ex. 6 at 7.  Further, the hearing officer thought that Petitioner’s failure to report the license suspension could negatively impact Medicare program integrity: 

Regarding factor (B), [Petitioner]’s failure to report the suspension of his Virginia medical license presents a risk to the integrity of the Medicare program.  As stated above, Medicare providers and suppliers are responsible for furnishing complete and accurate information to CMS, as well as understanding the requirements of their participation in the Medicare program.  CMS relies on complete and accurate data on each provider and supplier to help confirm that they still meet all Medicare requirements and that Medicare payments are made correctly.  Inaccurate or outdated information puts the Medicare Trust Funds at risk.  It necessarily follows that the submission of false information or the withholding of information relevant to the provider’s or supplier’s enrollment eligibility represents a significant program integrity risk (see 84 Fed. Reg. 47,794, 48,726-30).  

CMS Ex. 1 at 7. 

Petitioner objects to the reconsidered determination because it used information from the original Indictment that was dismissed by the District Court.  Hr’g Req. at 2.  Petitioner argues:  “[He] never caused prescriptions to be issued for other than legitimate medical purposes and within the bounds of medical practice.  He nor his clinics billed Medicaid and TennCare for services not provided.  [He] was actually a TennCare ‘Preferred Provider,’ having performed excellently on the four audits, two personally, conducted by TennCare.”  Hr’g Req. at 2; P. Ex. 2.  Because of the reconsidered determination’s use of the dismissed Indictment, Petitioner argues that the hearing officer’s analysis is entirely incorrect.  Hr’g Req. at 1-2.  Finally, Petitioner asserts that the reconsidered

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determination failed to consider Petitioner’s positive history as a Medicare enrolled supplier and other evidence filed by Petitioner in this case.  Hr’g Req. at 2. 

I agree that the reconsidered determination erroneously considered the charges from a dismissed Indictment.  Despite this, the criminal charges that Petitioner pleaded guilty to committing involve inducing his staff to provide controlled substances to patients without a prescription.  As stated in Finding of Fact Number 4: 

Count 1 in both Information Nos. 1 and 2 alleged that Petitioner induced a Schedule III controlled substance (Suboxone) to be dispensed multiple times in 2016 and 2017, without valid prescriptions, by the actions of health care providers at Watauga Recovery Centers.  Count 2 in Information No. 2 alleged that Petitioner induced a Schedule IV controlled substance (Clonazepam), as well as another substance called Gabapentin, to be dispensed, without valid prescriptions, by the actions of health care providers at Watauga Recovery Centers.  All of the counts alleged that Petitioner’s actions resulted “in the drugs being misbranded while held for sale after shipment in interstate commerce.” 

P. Ex. 1 at 1, 3, 4.  

It is the numerous instances where Petitioner induced his staff to dispense controlled substances to patients without a prescription that underlies the revocation of Petitioner’s license in Tennessee, the suspension of his license in Virginia, and ultimately the revocation of his Medicare enrollment.  Indeed, as stated in Findings of Fact Number 8, it was because Petitioner was convicted of an offense involving controlled substances that the Tennessee Board of Medical Examiners automatically revoked his medical license.  The CMS hearing officer’s concern that Petitioner’s criminal conduct is related to one of the purposes of imposing preclusion, i.e., reducing improper prescription of controlled substances, remains valid even if the CMS hearing officer referenced the wrong charging document.  Petitioner’s actual crime involved inducing staff to provide controlled substances to patients without valid prescriptions, which is also very serious and implicates improper prescribing practices.  Therefore, I agree with the CMS hearing officer, even though the reconsidered determination suffered from error, that Petitioner’s underlying misconduct is both serious and may adversely impact the Medicare program. 

Further, I agree that Petitioner’s failure to report the loss of his Tennessee and Virginia licenses is both serious and may negatively affect the Medicare program.  The CMS hearing officer correctly concluded that the Medicare program relies on suppliers who provide timely and accurate information in relation to the items and services for which

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they bill Medicare.  Cf. Devine Solutions Group, LLC, DAB No. 3159 at 21 (2024) (discussing a supplier’s obligation to provide valid Medicare claim information).  As stated earlier, I concluded that it was unreasonable for Petitioner to determine that he did not need to report the revocation of his Tennessee license and the suspension of his Virginia license. 

Therefore, I conclude that the underlying basis for Petitioner’s revocation of enrollment is detrimental to the best interests of the Medicare program and that CMS’s placement of Petitioner’s name on the CMS Preclusion List is appropriate. 

VIII. Conclusion

I affirm CMS’s revocation of Petitioner’s enrollment in the Medicare program and CMS’s placement of Petitioner’s name on the CMS Preclusion List.