Kaveh Parvaresh, M.D., P.C., DAB CR6808 (2026)

DECISION

I sustain the determination of a Medicare administrative contractor to reactivate the Medicare billing privileges of Petitioner, Kaveh Parvaresh, M.D., P.C., effective February 24, 2025. 

I. Background

Petitioner requested a hearing to challenge the effective date of reactivation of its Medicare billing privileges.  The Centers for Medicare & Medicaid Services (CMS) moved for summary judgment, filing a brief and 17 proposed exhibits that it identified as CMS Exhibits 1-17.  (CMS Exs. 1-17)  Petitioner filed a brief in opposition to the motion for summary judgment (P. Opp’n) and one exhibit (P. Ex. 1). 

There is no need for me to consider whether the criteria for issuing summary judgment are present.  Nor is there a need for me to convene an in-person hearing.  Neither party objected to the other party’s exhibits.  Neither CMS nor Petitioner provided the written direct testimony of a proposed witness.  Consequently, this 

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case is ripe for a decision based on the parties’ written submissions.  See Standing Order at 9. 

I receive CMS Exs. 1-17 into the record.  I also receive Petitioner Ex. 1 into the record. 

II. Issue, Findings of Fact and Conclusions of Law

1. A. Issue

The issue is whether the Medicare administrative contractor properly established February 24, 2025 to be the effective date of reactivation of Petitioner’s Medicare billing privileges. 

1. B. Findings of Fact and Conclusions of Law

On July 31, 2024, Novitas Solutions, a CMS Medicare administrative contractor, sent a letter notifying Petitioner that it must revalidate its Medicare enrollment by October 31, 2024.  CMS Ex. 1.  Petitioner filed its revalidation application on October 21, 2024.  CMS Ex. 2.  A development letter was sent to Petitioner on November 1, 2024, requesting a “certification statement via faxing” and the signature for the authorized official on the application.  CMS Ex. 5 at 1.  The contractor’s letter explicitly stated that Petitioner’s application may be rejected if the requested information was not received within 30 days from the postmarked/emailed date of the letter.  Id. 

Petitioner did not reply to the contractor’s letter.  On December 9, 2024, the contractor deactivated Petitioner’s Medicare billing privileges, effective December 9, 2024.  CMS Ex. 6 at 1.  Deactivation led to recission of Petitioner’s Medicare billing privileges.  As a result, Petitioner could not claim Medicare reimbursement for otherwise reimbursable items or services until the contractor reactivated its billing privileges. 

On January 14, 2025, Petitioner filed a subsequent revalidation application.  CMS Ex. 7.  The contractor sent a development letter via email on January 23, 2025, requesting additional information.  CMS Ex. 8.  On January 28, 2025, Petitioner filed a revised revalidation application.  CMS Ex. 9.  By letter dated February 24, 2025, the contractor notified Petitioner that it was rejecting its January 14, 2025 revalidation application.  CMS Ex. 12. 

On February 24, 2025, Petitioner filed another request with the contractor to reactivate its billing privileges.  CMS Ex. 14.  The contractor accepted Petitioner’s February 24, 2025 application and reactivated its billing privileges.  CMS Ex. 15

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 at 1.  The contractor’s letter notified Petitioner that it would have a billing gap from December 9, 2024 through February 23, 2025.  Id. 

On May 9, 2025, Petitioner requested reconsideration.  CMS Ex. 16.  In its June 10, 2025 reconsidered determination, the contractor affirmed its determination to reactivate Petitioner’s billing privileges with an effective date of February 24, 2025.  CMS Ex. 17. 

Petitioner then requested a hearing. 

This case is governed by regulations.  Petitioner is a “supplier” for purposes of the Medicare program.  See CMS Ex. 4 at 1; see also 42 U.S.C. § 1395x(d); 42 C.F.R. §§ 400.202 (definition of supplier), 498.2.  A “supplier” furnishes items or services under Medicare and the term applies to physicians or other practitioners who are not included within the definition of the phrase “provider of services.”  42 U.S.C. § 1395x(d).  A supplier must enroll in the Medicare program to receive payment for covered Medicare items or services.  42 C.F.R. § 424.505.  The regulations at 42 C.F.R. Part 424, subpart P, establish the requirements for a supplier to enroll in the Medicare program.  42 C.F.R. §§ 424.510‑424.516; see also 42 U.S.C. § 1395cc(j)(1)(A) (authorizing the Secretary of the U.S. Department of Health and Human Services to establish regulations addressing the enrollment of providers and suppliers in the Medicare program).  A supplier that seeks billing privileges under Medicare “must submit enrollment information on the applicable enrollment application.”  42 C.F.R. § 424.510(a)(1).  “Once the provider or supplier successfully completes the enrollment process . . . CMS enrolls the provider or supplier into the Medicare program.”  Id.; see also 42 C.F.R. § 424.510(d) (listing enrollment requirements).  Thereafter, “[t]o maintain Medicare billing privileges, a . . . supplier . . . must resubmit and recertify the accuracy of its enrollment information every 5 years.”  42 C.F.R. § 424.515.  Further, a supplier “may be required to revalidate [its] enrollment outside the routine 5-year revalidation cycle.”  42 C.F.R. § 424.515(e). 

CMS is authorized to deactivate an enrolled supplier’s Medicare billing privileges if the enrollee does not provide complete and accurate information within 90 days of “receipt of notification” to revalidate enrollment.  42 C.F.R. § 424.540(a)(3).  If CMS deactivates a supplier’s Medicare billing privileges, “[n]o payment may be made for otherwise Medicare covered items or services furnished to a Medicare beneficiary . . . .”  42 C.F.R. § 424.555(b); Urology Grp. of NJ, LLC, DAB No. 2860 at 10 (2018) (“The regulations, taken together, clearly establish that a deactivated provider or supplier was not intended to be entitled to Medicare reimbursement for services rendered during the period of deactivation.”).  Further, and quite significantly, the Departmental Appeals Board (DAB) has 

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unambiguously stated that “[i]t is certainly true that [the petitioner] may not receive payment for claims for services during any period when his billing privileges were deactivated.”  Willie Goffney, Jr., M.D., DAB No. 2763 at 6 (2017); see Urology Grp., DAB No. 2860 at 11 (“Taking [the] unique effects of revocation into consideration, it is reasonable to conclude that CMS intended for revocations and deactivations to share the feature of precluding a provider or supplier from collecting reimbursement for services rendered during the period of inactive Medicare billing privileges, while simultaneously intending for revocations to have more severe consequences on a provider’s or supplier’s ability to participate.”); Frederick Brodeur, M.D., DAB No. 2857 at 16 (2018) (“Allowing a deactivated supplier to bill for services furnished during a period of deactivation would conflict with section 424.555(b) of the regulations . . . .”).  

A contractor’s decision to deactivate a provider’s reimbursement privileges is not a determination that gives hearing rights to the affected individual or entity.  See 42 C.F.R. § 498.3(b), (d).  Consequently, a provider or supplier whose Medicare billing privileges are deactivated may not challenge the Medicare contractor’s decision to deactivate.  I have no authority to decide that challenge.  Howard M. Sokoloff, DPM, MS, Inc., DAB No. 2972 at 6 (2019); Wishon Radiological Med. Grp., Inc., DAB No. 2941 (2019). 

CMS has published guidance to its contractors concerning the effective participation date to assign to a supplier or provider that seeks to reactivate its participation.  That date shall be the date when the contractor receives a re-enrollment application that it processes to completion.  Medicare Program Integrity Manual (MPIM), § 15.27.1.2.  That guidance is consistent with regulatory requirements governing the effective date of participation of newly participating suppliers and providers.  42 C.F.R. § 424.520(d); Willie Goffney, Jr., M.D., DAB No. 2763 (2017). 

Given that, the only question I may consider in a case involving reactivation of previously deactivated billing privileges is whether the contractor properly assigned an effective reactivation date to a provider or a supplier.  The propriety of the contractor’s action in determining to reactivate is governed by 42 C.F.R. § 424.520(d).  The regulation states that: 

• (1)    The effective date for billing privileges for the provider and supplier types identified in paragraph (d)(2) of this section is the later of—
  • i.    The date of filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor; or  

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• ii.    The date that the provider or supplier first began furnishing services at a new practice location.   

The earliest possible effective reactivation date that a contractor may assign to a provider or supplier whose billing privileges are deactivated is the date that the provider or supplier files a new enrollment application with the contractor that the contractor subsequently approves.  42 C.F.R. § 424.540(d)(2).  The contractor has no authority to assign a retroactive reactivation date to a provider or a supplier whose billing privileges were deactivated on a date prior to the date when the provider or supplier submits a new enrollment application for the purpose of reactivating his or her billing privileges.  Moreover, I do not have authority to order a contractor to assign a retroactive reactivation date. 

1. 1. An effective date earlier than February 24, 2025, is not warranted for the reactivation of Petitioner’s Medicare enrollment and billing privileges.

The regulations and the undisputed facts mandate the outcome of this case.  Petitioner may not challenge the contractor’s determination to deactivate its billing privileges.  The only question that I may consider is whether the reactivation date of February 24, 2025, determined by the contractor is consistent with regulatory requirements.  I find that it is, because February 24, 2025 is the date that the contractor received Petitioner’s reactivation application that was subsequently approved.  42 C.F.R. § 424.540(d)(2).  February 24, 2025, is the earliest date on which Petitioner’s billing privileges may be reactivated.  I may not assign Petitioner a reactivation date that is retroactive to a date that is earlier than February 24, 2025.  42 C.F.R. § 424.540(e).  

Petitioner’s arguments are based in equity and assert that Petitioner timely filed its revalidation application and received confirmation that all documents and signatures were received.  P. Opp’n at 2.  Petitioner supports its argument with the submission of an October 21, 2024 email from the contractor stating that all documents and signatures have been received.  P. Ex. 1.  Petitioner also asserts that representatives from the contractor assured it that its billing privileges would be retroactive.  P. Opp’n at 2.  However, Petitioner was made aware by a letter from the contractor that an original signature was required for its revalidation application to be processed and it failed to respond.  CMS Ex. 5.  The CMS-855B submitted by Petitioner on October 21, 2024, provided explicit instructions just below the signature line that all signatures must be original and in ink.  CMS Ex. 3 at 4.  As a result, it is clear that Petitioner failed to follow CMS and the contractor’s instructions.  

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Petitioner also argues that missing out on close to three months of payment for submitted claims would cause significant hardship.  P. Opp’n at 3.  To the extent that Petitioner’s request for relief is based on principles of equitable relief, I cannot grant such relief.  US Ultrasound, DAB No. 2302 at 8 (2010) (“Neither the ALJ nor the [DAB] is authorized to provide equitable relief by reimbursing or enrolling a supplier who does not meet statutory or regulatory requirements.”).  Petitioner points to no authority by which I may grant it relief from the applicable regulatory requirements, and I have no authority to declare statutes or regulations invalid or ultra vires.  1866ICPayday.com, L.L.C., DAB No. 2289 at 14 (2009) (“An ALJ is bound by applicable laws and regulations and may not invalidate either a law or regulation on any ground . . . .”). 

I lack authority to hear and decide this argument for two reasons.  First, it constitutes a challenge to the contractor’s decision to deactivate Petitioner’s billing privileges, a challenge that I have no authority to hear and decide.  Michael B. Zafrani, M.D., DAB NO. 3075 at 3 (2022). Second, it is an equitable argument that I also lack authority to hear and decide.  Effectively, Petitioner contends that it has been treated unfairly by the contractor.  As a general rule, equitable challenges to CMS’s determinations are not appealable.  U.S. Ultrasound, DAB No. 2302 at 8 (2010).  I may not use equitable principles to override or ignore regulatory requirements. 

III. Conclusion

For the foregoing reasons, I uphold the February 24, 2025 effective date of Petitioner’s reactivated Medicare billing privileges.