Health Specialties, Inc. d/b/a Ascher Health Care Center, DAB CR6759 (2025)

DECISION

The Medicare enrollment and billing privileges of Petitioner are revoked pursuant to 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(1)1 based on a violation of 42 C.F.R. § 424.57(c)(21) (Supplier Standard 21).  Revocation is effective February 6, 2025, 30 days after the January 7, 2025 notice of the initial determination to revoke.  42 C.F.R. §§ 424.57(e)(1), 424.535(g).

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I.  Procedural History and Undisputed Facts

The material facts are undisputed.  Any reasonable inferences are drawn in favor of Petitioner.

On August 21, 2024, Novitas Solutions, Inc., a durable medical equipment Medicare administrative contractor (MAC) for the Centers for Medicare & Medicaid Services (CMS), notified Petitioner it was not in compliance with Medicare regulations because a five percent or greater owner was deceased and had to be removed from Petitioner's Medicare enrollment record as an owner.  The MAC allowed 90 days for Petitioner to update its Medicare enrollment record online or by sending a paper Medicare enrollment application referred to as a CMS-20134/855, with appropriate sections completed, to the MAC with any required supporting documents.  CMS Exhibit (Ex.) 1 at 67-68.

Petitioner filed a paper CMS-20134 Medicare enrollment application to delete the deceased partner's name from Petitioner's Medicare enrollment.  CMS Ex. 1 at 52.  The first page of the CMS-20134 states it is a Medicare enrollment application for "Medicare Diabetes Prevention Program (MDPP) Suppliers."  CMS Ex. 1 at 34.

The MAC sent Petitioner a letter dated October 8, 2024, advising that Petitioner's application was being returned so that Petitioner could complete the appropriate Medicare application, specifically a CMS-855S described as a Medicare enrollment application "for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers."  The letter advised the "CMS-20314" application filed by Petitioner was for MDDP supplier enrollment and the incorrect form for Petitioner to use.  CMS Ex. 1 at 32.

The MAC advised Petitioner by letter dated November 20, 2024, that Petitioner needed to complete a CMS-855S enrollment application for a DMEPOS supplier.  CMS Ex. 1 at 30.

On November 21, 2024, the MAC sent Petitioner another letter warning that the MAC could reject Petitioner's enrollment application if Petitioner failed to "complete and submit the required sections of the CMS-855S application to update ownership/management changes and any other changes" within 30 days.  CMS Ex. 1 at 27.  The MAC also stated that Petitioner needed to provide proof of comprehensive liability insurance.  CMS Ex. 1 at 27.

On December 31, 2024, the MAC notified Petitioner that the MAC rejected Petitioner's Medicare enrollment application filed on October 3, 2024.  The MAC cited Petitioner's failure to file the required sections of a CMS-855S to update ownership/management changes and proof of comprehensive liability insurance.  CMS Ex. 1 at 25.

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On January 7, 2025, the MAC notified Petitioner of the MAC's initial determination to revoke Petitioner's Medicare enrollment and billing privileges effective 30 days from the postmark date of the notice letter.2  The MAC cited 42 C.F.R. §§ 405.800, 424.57(e), 424.535(a)(1) and (g),3 as authority for the revocation based on violations of 42 C.F.R. § 424.57(c)(10) and (21) (Supplier Standards 10 and 21).  The MAC notified Petitioner that it was subject to a one-year bar to reenrollment pursuant to 42 C.F.R. § 424.535(c), effective 30 days from the postmark date of the January 7, 2025 notice letter.  The MAC advised Petitioner that it had the right to submit a corrective action plan (CAP) and to request a reconsidered determination.  CMS Ex. 1 at 14-18, 20-24.

Petitioner sent the MAC a letter dated January 14, 2025.  Petitioner attached completed sections of a CMS-855S related to comprehensive liability insurance and surety bond information with copies of a certificate of liability insurance and Petitioner's bond attached.  CMS Ex. 1 at 8-13.

Chags Health Information Technology, LLC (C-HIT), acting on behalf of the MAC, treated Petitioner's January 14, 2025 letter and attachments as a CAP and request for reconsidered determination.  C-HIT issued a reconsidered determination dated March 18, 2025.  C-HIT concluded that Petitioner had corrected noncompliance with 42 C.F.R. § 424.57(c)(10) (Supplier Standard 10).  But C-HIT concluded that Petitioner failed to correct noncompliance under 42 C.F.R. § 424.57(c)(21) (Supplier Standard 21) because Petitioner failed to file as requested by the MAC a completed CMS-855S Medicare enrollment application removing the deceased partner from Petitioner's Medicare enrollment record.  C-HIT overturned revocation pursuant to 42 C.F.R. § 424.535(a)(1) based on noncompliance with Supplier Standard 10, but upheld revocation pursuant to 42 C.F.R. § 424.535(a)(1) based on noncompliance with Supplier Standard 21 because Petitioner failed to provide CMS information required by the Act and regulations, specifically sections of a CMS-855S completed to remove the deceased partner from

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Petitioner's Medicare enrollment record.  C-HIT also upheld the one-year bar to reenrollment pursuant to 42 C.F.R. § 424.535(c).  CMS Ex. 1 at 1-7.

On May 15, 2025, Petitioner timely requested a hearing before an administrative law judge (ALJ).  The case was assigned to me on May 15, 2025, and my Standing Order was issued.

On June 18, 2025, CMS filed its combined prehearing brief and motion for summary judgment (CMS Br.) with CMS Exs. 1 and 2.  Petitioner filed a response in opposition to the CMS motion for summary judgment and prehearing brief on July 14, 2025, with Petitioner's Exhibits (P. Exs.) 1 and 2.  CMS waived filing a reply brief on July 16, 2025.  The parties have not objected to my consideration of CMS Exs. 1 and 2 and P. Exs. 1 and 2.  Petitioner argues there is good cause for offering P. Exs. 1 and 2 for the first time before me.  In provider and supplier appeals, 42 C.F.R. § 498.56(e) requires that I determine whether good cause exists to admit new documentary evidence not submitted at the time of reconsideration.  If I conclude good cause exists I "must include" the evidence.  42 C.F.R. § 498.56(e)(2)(i).  P. Ex. 1 is an affidavit which may be viewed as testimonial evidence that is not subject to 42 C.F.R. § 498.56(e), rather than documentary evidence that is subject to the good cause requirement.  HeartFlow, Inc., DAB No. 2781 at 19 n.13 (2017).  P. Ex. 2 is a blank CMS-855S, readily available on the CMS website, that is offered as demonstrative evidence rather than substantive evidence and arguably also not subject to 42 C.F.R. § 498.56(e).  Even if one concluded that both P. Exs. 1 and 2 are subject to 42 C.F.R. § 498.56(e), I conclude that there is good cause for submitting both before me for the first time.  P. Br. at 5-7; 42 C.F.R. § 498.56(e)(2)(i).  Accordingly, CMS Exs. 1 and 2 and P. Exs. 1 and 2 are admitted and considered as evidence.

Petitioner does not dispute it did not file sections of a CMS-855S with ownership/management changes prior to the reconsidered determination.  P. Br. at 4.

Petitioner offered as evidence the affidavit of Sheryl C. Berger.  P. Ex. 1.  Ms. Berger testified that she assumed some administrative responsibilities for Petitioner when Petitioner's manager retired in June 2024.  She acknowledged receiving the MAC's letter in August 2024, requesting that Petitioner file a change of information application to remove the deceased partner from Petitioner's enrollment record.  But she was confused about which CMS enrollment application to file.  She filed the CMS-20134, rather than the CMS-855S, thinking either would be acceptable as the same information was required by the forms and all information that she submitted was accurate, complete, and consistent with what CMS requested.  Her misunderstanding about which form to use persisted when the CAP was submitted and that is why no sections of a CMS-855S were filed as part of the CAP.  She indicates that had she understood the problem with using the incorrect form she could have submitted the exact same information using a CMS-855S.  P. Ex. 1.  I accept Ms. Berger's statements as true for purposes of summary judgment.

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II.  Discussion

A.  Applicable Law

Section 1831 of the Social Security Act (Act) (42 U.S.C. § 1395j) establishes the supplementary medical insurance benefits program for the aged and disabled known as Medicare Part B.  Administration of the Part B program is through the MACs.  Act § 1842(a) (42 U.S.C. § 1395u(a)).  Only eligible providers of services and suppliers may enroll in Medicare to receive payments for services rendered to Medicare-eligible beneficiaries.4  Act §§ 1834(j)(1) (42 U.S.C. § 1395m(j)(1)), 1835(a) (42 U.S.C. § 1395n(a)), 1842(h)(1) (42 U.S.C. § 1395u(h)(1)).  Petitioner was a DMEPOS supplier.

The Act requires the Secretary of Health and Human Services (Secretary) to issue regulations that establish a process for the enrollment in Medicare of providers and suppliers, including the right to a hearing and judicial review of certain enrollment determinations such as revocation of enrollment and billing privileges.  Act §§ 1866(j) (42 U.S.C. § 1395cc(j)), 1871 (42 U.S.C. § 1395hh).

Pursuant to 42 C.F.R. §§ 424.57(b) and 424.505, a DMEPOS supplier such as Petitioner must be enrolled in the Medicare program to be reimbursed for DMEPOS sold or rented to Medicare beneficiaries.  The regulations establish detailed requirements that suppliers must meet and maintain to enroll in Medicare and to receive and maintain Medicare billing privileges.  42 C.F.R. pt. 424, subpt. P.  DMEPOS suppliers have additional requirements imposed by 42 C.F.R. § 424.57(b) and (c).  To receive direct-billing privileges, a DMEPOS supplier must meet and maintain the Medicare application certification standards set forth in 42 C.F.R. § 424.57(c), which established 30 supplier standards.

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The Secretary has delegated authority to CMS or its MACs to revoke an enrolled supplier's Medicare enrollment and billing privileges and any supplier agreement for any of the reasons listed in 42 C.F.R. § 424.535.  Pursuant to 42 C.F.R. § 424.57(e)(1), the Secretary requires that CMS and its MACs revoke Medicare enrollment and billing privileges of DMEPOS suppliers for violation of any of the requirements of 42 C.F.R. § 424.57(b) and (c).  When Medicare enrollment and billing privileges are revoked pursuant to 42 C.F.R. § 424.57(e)(1), revocation is effective 30 days after the DMEPOS supplier is sent notice of the revocation.  If a supplier's Medicare enrollment and billing privileges are revoked, the supplier is barred from reenrolling in the Medicare program for one to 10 years, with an exception that is relevant in this case for reasons discussed at the end of this decision.  42 C.F.R. § 424.535(c).

A supplier whose enrollment and billing privileges have been revoked may request reconsideration and review as provided by 42 C.F.R. pt. 498.  42 C.F.R. §§ 405.803, 424.545(a).  A supplier submits a written request for reconsideration to CMS or its contractor.  42 C.F.R. § 498.22(a).  CMS or its contractor must give notice of its reconsidered determination to the supplier, giving the reasons for its determination and specifying the conditions or requirements the supplier failed to meet, and advising the supplier of its right to an ALJ hearing.  42 C.F.R. § 498.25(a).

If the decision on reconsideration is unfavorable to the supplier, the supplier has the right to request a hearing by an ALJ and further review by the Departmental Appeals Board (the Board).  Act § 1866(j)(8) (42 U.S.C. § 1395cc(j)(8)); 42 C.F.R. §§ 424.545(a), 498.3(b)(17), 498.5(l)(1).  CMS is also granted the right to request ALJ review of a reconsidered determination with which it is dissatisfied.  42 C.F.R. § 498.5(l)(2).  A hearing on the record, also known as an oral hearing, is required under the Act.  Crestview Parke Care Ctr. v. Thompson, 373 F.3d 743, 748-51 (6th Cir. 2004).  The DMEPOS supplier bears the burden to demonstrate that it meets enrollment requirements with documents and records.  42 C.F.R. § 424.545(c).  The only determination subject to my review in a provider and supplier enrollment case such as this is the reconsidered determination.  Neb Grp. of Ariz. LLC, DAB No. 2573 at 9.

B.  Issue

Whether there was a basis for the revocation of Petitioner's billing privileges and Medicare enrollment.

C.  Findings of Fact, Conclusions of Law, and Analysis

My conclusions of law are set forth in bold followed by the undisputed facts and analysis.

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1.  Summary judgment is appropriate.

CMS filed a motion for summary judgment that Petitioner opposes.  A provider or supplier denied enrollment in Medicare or whose enrollment has been revoked has a right to a hearing and judicial review pursuant to sections 1866(h)(1) and (j)(8) of the Act and 42 C.F.R. §§ 498.3(b)(17) and 498.5(l).  A hearing on the record, also known as an oral hearing, is required under the Act.  Act §§ 205(b), 1866(h)(1), (j)(8); Crestview, 373 F.3d at 748-51.  A party may waive appearance at an oral hearing but must do so affirmatively in writing.  42 C.F.R. § 498.66.  In this case, Petitioner has not waived the right to oral hearing or otherwise consented to a decision based only upon the documentary evidence or pleadings.  Accordingly, disposition on the written record alone is not permissible, unless the CMS motion for summary judgment has merit.

Summary judgment is not automatic upon request but is limited to certain specific conditions.  The Secretary's regulations that establish the procedure to be followed in adjudicating Petitioner's case are at 42 C.F.R. pt. 498.  42 C.F.R. §§ 405.800, 405.803(a), 424.545(a), 498.3(b)(17)(i).  The regulations do not establish a summary judgment procedure or recognize such a procedure.  However, the Board has long accepted that summary judgment is an acceptable procedural device in cases adjudicated pursuant to 42 C.F.R. pt. 498.  See, e.g., Ill. Knights Templar Home, DAB No. 2274 at 3‑4 (2009); Garden City Med. Clinic, DAB No. 1763 (2001); Everett Rehab. & Med. Ctr., DAB No. 1628 at 3 (1997).  The Board also has recognized that the Federal Rules of Civil Procedure (Fed. R. Civ. Pro.) do not apply in administrative adjudications such as this.  However, the Board has accepted that Fed. R. Civ. Pro. 56 and related cases provide useful guidance for determining whether summary judgment is appropriate.  A summary judgment procedure was also adopted as a matter of judicial economy within my authority to regulate the course of proceedings and made available to the parties in the litigation of this case by my Standing Order.  The parties were given notice by the Standing Order that summary judgment is an available procedural device and that the law as it has developed related to Fed. R. Civ. Pro. 56 will be applied.  Standing Order ¶¶ D, G.

Summary judgment is appropriate when there is no genuine dispute as to any issue of material fact for adjudication and/or the moving party is entitled to judgment as a matter of law.  The party requesting summary judgment bears the burden of showing that there are no genuine issues of material fact for trial and/or that it is entitled to judgment as a matter of law.  In determining whether there are genuine issues of material fact for trial, the reviewer must view the evidence in the light most favorable to the non-moving party, drawing all reasonable inferences in that party's favor.  Generally, the non-movant may not defeat an adequately supported summary judgment motion by relying upon the denials in its pleadings or briefs but must furnish evidence of a dispute concerning a material fact, i.e., a fact that would affect the outcome of the case if proven.  Mission Hosp. Reg'l Med. Ctr., DAB No. 2459 at 5-6 (2012) (and cases cited therein); Experts

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Are Us, Inc., DAB No. 2452 at 5-6 (2012) (and cases cited therein); Senior Rehab. & Skilled Nursing Ctr., DAB No. 2300 at 3 (2010) (and cases cited therein); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).

The standard for deciding a case on summary judgment and an ALJ's decision-making in deciding a summary judgment motion differs from that used in resolving a case on the merits after a hearing or when a hearing is waived.  On summary judgment, the ALJ does not make credibility determinations, weigh the evidence, or decide which inferences to draw from the evidence, as would be done when finding facts after a hearing on the record.  Rather, on summary judgment, the ALJ construes the evidence in a light most favorable to the non-movant and avoids deciding which version of the facts is more likely true.  Holy Cross Vill. at Notre Dame, Inc., DAB No. 2291 at 5 (2009).  The Board also has recognized that on summary judgment it is appropriate for the ALJ to consider whether a rational trier of fact could find that the party's evidence would be sufficient to meet that party's evidentiary burden.  Dumas Nursing & Rehab., L.P., DAB No. 2347 at 5 (2010).  The Secretary has not provided in 42 C.F.R. pt. 498 for the allocation of the burden of persuasion or the quantum of evidence required to satisfy the burden.  However, the Board has provided some persuasive analysis regarding the allocation of the burden of persuasion in cases subject to 42 C.F.R. pt. 498.  Batavia Nursing & Conv. Ctr., DAB No. 1904 (2004), aff'd, Batavia Nursing & Conv. Ctr. v. Thompson, 129 F. App'x 181 (6th Cir. 2005).

There is no genuine dispute as to any material fact pertinent to revocation under 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(1) based on violation of 42 C.F.R. § 424.57(c)(21) (Supplier Standard 21) that requires a trial in this case.  This case is resolved based on application of the regulations to the undisputed facts as discussed hereafter.  Petitioner does not dispute that the MAC asked Petitioner to file a Medicare enrollment application to remove a deceased partner's information from Petitioner's Medicare enrollment record.  Petitioner filed the required information but on the wrong form.  Petitioner argues that the information reported would be the same on the correct form and requests that the revocation be reversed because Petitioner did respond to the MAC's request for information with accurate and true information.  Petitioner's argument that its use of an incorrect form should be overlooked must be resolved against Petitioner as a matter of law.  Although CMS or the MAC could arguably excuse the error, I have no authority to do so.  Accordingly, summary judgment is appropriate.

2.  There was a basis to revoke Petitioner's Medicare enrollment and billing privileges pursuant to 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(1) for a violation of 42 C.F.R. § 424.57(c)(21) (Supplier Standard 21).

3.  The effective date of revocation of Petitioner's Medicare enrollment and billing privileges based on a violation of 42 C.F.R. § 424.57(c)(21)

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(Supplier Standard 21) is February 6, 2025, 30 days after January 7, 2025, the date on which notice of the initial determination to revoke was mailed to Petitioner.

4.  No bar to reenrollment may be imposed against Petitioner in this case because revocation is based on failure to timely respond to a request for information.  42 C.F.R. § 424.535(c)(1)(ii).

It is well established that even a single violation of a supplier standard is a sufficient basis for revocation of Medicare enrollment and billing privileges under 42 C.F.R. § 424.57(e)(1).  1866ICPayday.com, L.L.C., DAB No. 2289 at 13 (2009).  Pursuant to 42 C.F.R. § 424.57(e)(1), CMS or the MAC revokes a DMEPOS supplier's enrollment and billing privileges if it is determined that the supplier does not meet the Supplier Standards established by 42 C.F.R. § 424.57(c).  Revocation is effective 30 days after the supplier is sent notice of the revocation.  42 C.F.R. § 424.57(e)(1).  CMS and the MAC also have authority to revoke under 42 C.F.R. § 424.535(a)(1) after permitting a provider or supplier the opportunity to submit a CAP.  Revocation under 42 C.F.R. § 424.535(a)(1) is effective 30 days after the date of the initial determination to revoke.  42 C.F.R. § 424.535(g)(1).

A DMEPOS supplier must meet and certify in its application for Medicare enrollment and billing privileges that it meets and will continue to meet the 30 Supplier Standards established by 42 C.F.R. § 424.57(c).  Pursuant to Supplier Standard 21 (42 C.F.R. § 424.57(c)(21)), a DMEPOS supplier must "[provide] to CMS, upon request, any information required by the Medicare statute and implementing regulations."  Although not cited as a reason for revocation in this case, it is required by Supplier Standard 2 that a DMEPOS supplier ensure that the information in its Medicare enrollment application is complete and accurate and report to CMS or the MAC any changes to its enrollment information within 30 days of the change.  42 C.F.R. §§ 424.57(c)(2), 424.510(d)(2)(ii) (includes owner information).  Enrollment information must be submitted on the applicable enrollment application.  42 C.F.R. § 424.510(a)(1).  The Board has recognized that CMS or the MAC may reject a Medicare enrollment application submitted on the wrong form citing 42 C.F.R. § 424.525(a)(1)(x).  Michael B. Zafrani, M.D., DAB No. 3075 at 2 (2022).

The undisputed material facts show that Petitioner violated Supplier Standard 21 (42 C.F.R. § 424.57(c)(21)) because Petitioner did not file the required CMS-855S to delete the deceased partner from its Medicare enrollment record within 30 days of the request by the MAC that Petitioner do so.  The violation provides a basis for revocation of Petitioner's Medicare enrollment and billing privileges pursuant to 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(1).

CMS and the MAC clearly have the discretion not to revoke a supplier's Medicare

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enrollment and billing privileges under 42 C.F.R. § 424.535(a)(1), which states "CMS may revoke."  However, 42 C.F.R. § 424.57(e)(1), which applies specifically to DMEPOS suppliers, provides that CMS revokes the Medicare enrollment and billing privileges of a DMEPOS supplier for violation of supplier standards.  Therefore, 42 C.F.R. § 424.57(e)(1) seems to grant CMS or the MAC no discretion to not revoke once a Supplier Standard violation is found.  In either case, I have no authority to review the exercise of discretion by CMS to revoke a DMEPOS supplier's Medicare enrollment and billing privileges once I have found that a basis for revocation exists such as, in this case, the violation of Supplier Standard 21.  My authority is limited to determining whether there is a legal basis for revocation of Petitioner's Medicare enrollment and billing privileges.  If I conclude that there is a basis for revocation, I have no authority to review the exercise of discretion by CMS or the MAC to revoke and must uphold the revocation.  Abdul Razzaque Ahmed, M.D., DAB No. 2261 at 19 (2009), aff'd, Ahmed v. Sebelius, 710 F. Supp. 2d 167 (D. Mass. 2010).

Petitioner's arguments that the change in information was provided on the wrong form due to confusion or lack of experience and that the same information would have been provided on a CMS-855S, as was provided by Petitioner on the CMS-20134, are without merit as a matter of law.  CMS and the MAC have authority under the regulations to require the use of a specific form.  42 C.F.R. § 424.510(a)(1).  It is undisputed that Petitioner failed to use the required form, that is, a CMS-855S rather than a CMS-20134.  Pursuant to 42 C.F.R. § 424.510(a)(3), when filing a Medicare enrollment application, the signature on the form attests that the provider or supplier that submitted the application is aware of and abides by the applicable statutes, regulations, and program instructions.  Petitioner has not rebutted the prima facie showing of a basis for revocation pursuant to 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(1) based on violation of 42 C.F.R. § 424.57(c)(21) for failure to submit requested enrollment information on the required form, established an affirmative defense, or shown any other grounds for relief from the revocation.

Although not specifically mentioned, Petitioner's arguments may be construed to be that CMS should be estopped from revoking Petitioner's Medicare enrollment and billing privileges.  However, estoppel against the federal government, if available at all, is presumably unavailable absent "affirmative misconduct," such as fraud.  See, e.g., Pac. Islander Council of Leaders, DAB No. 2091 at 12 (2007); Off. of Pers. Mgmt. v. Richmond, 496 U.S. 414, 421-22 (1990).  Petitioner points to no evidence of affirmative misconduct such as fraud by the MAC or CMS.

Petitioner's arguments may be construed to be requests for equitable relief.  However, I have no authority to grant equitable relief.  US Ultrasound, DAB No. 2302 at 8 (2010).  I am required to follow the Act and regulations and have no authority to declare statutes or regulations invalid.  1866ICPayday.com, L.L.C., DAB No. 2289 at 14.

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Pursuant to 42 C.F.R. § 424.57(e)(1), revocation for noncompliance with the supplier standards established by 42 C.F.R. § 424.57(c) is effective 30 days after the supplier is sent notice of the revocation.  Therefore, the effective date for revocation of Petitioner's Medicare enrollment and billing privileges is 30 days after the notice of the initial determination to revoke was issued.  Accordingly, I conclude that the effective date of the revocation of Petitioner's Medicare enrollment and billing privileges was February 6, 2025 – 30 days after the January 7, 2025 notice of the initial determination to revoke was mailed.

A provider or supplier whose Medicare enrollment and billing privileges are revoked is generally barred from reenrolling in the Medicare program for one to 10 years.  42 C.F.R. § 424.535(c)(1).  In this case, the MAC imposed, and C-HIT upheld, a one-year reenrollment bar.  CMS Ex. 1 at 15, 21.  There is no statutory or regulatory language establishing a right to review of the duration of the reenrollment bar CMS imposes, when it commences, or when it ends.  Act § 1866(j)(8); 42 C.F.R. §§ 424.535(c), 424.545, 498.3(b), 498.5.  The Board has held that the duration of a revoked supplier's reenrollment bar is not an appealable initial determination listed in 42 C.F.R. § 498.3(b) and is not subject to ALJ review.  Vijendra Dave, M.D., DAB No. 2672 at 11 (2016).  In this case, however, C-HIT erred as a matter of law in imposing a reenrollment bar.  Pursuant to 42 C.F.R. § 424.535(c)(1)(ii), a reenrollment bar does not apply to revocation pursuant to 42 C.F.R. § 424.535(a)(1) based on failure to timely respond to "a revalidation request or other request for information."5  Revocation in this case is required by 42 C.F.R. § 424.57(e)(1), which includes no authority to impose a reenrollment bar, based on Petitioner's violation of 42 C.F.R. § 424.57(c)(21) (Supplier Standard 21) which requires providing information to CMS upon request.  Revocation is also authorized by 42 C.F.R. § 424.535(a)(1), the authority cited in the reconsidered determination.  CMS Ex. 1 at 1.  C-HIT's reconsidered determination upheld revocation based on noncompliance with Supplier Standard 21, because Petitioner failed to provide requested information.  There is authority for imposition of a reenrollment bar granted by 42 C.F.R. § 424.535(c), but not when revocation is pursuant to 42 C.F.R. § 424.535(a)(1)

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based on failure to provide requested information.  Accordingly, the one-year bar to reenrollment approved on reconsideration may not be imposed.

III.  Conclusion

For the foregoing reasons, I conclude that there is a basis to revoke Petitioner's Medicare enrollment and billing privileges pursuant to 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(1) for a violation of 42 C.F.R. § 424.57(c)(21) (Supplier Standard 21).  The effective date of revocation is February 6, 2025.