Care One Rehabilitation Services Inc., DAB CR6803 (2026)

DECISION

Wisconsin Physicians Service Insurance Corporation (WPS), an administrative contractor for Respondent, the Centers for Medicare and Medicaid Services (CMS), revoked Petitioner’s Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(3) (felony conviction) and 42 C.F.R. § 424.535(a)(9) (failure to report) effective November 8, 2023.  Petitioner was also barred from re-enrolling in Medicare for a period of 10 years, through November 9, 2033.  Additionally, Petitioner was added to the CMS Preclusion List.  For the reasons set forth below, I affirm CMS’s decision to revoke Petitioner’s Medicare enrollment and billing privileges, with a modified effective date of May 8, 2024, and to add Petitioner to the CMS Preclusion List.  

I. Background and Procedural History

Care One Rehabilitation Services Inc. (CORS or Petitioner), is a physical/occupational therapy group, owned by Mr. Virendra Gaidhane, doing business in Troy, Michigan.  CMS Ex. 2.  Petitioner participated in the Medicare program as a supplier.  Id.  Due to Mr. Virendra Gaidhane’s, Petitioner’s owner, felony conviction, CMS revoked Petitioner’s Medicare enrollment, and established a 10-year re-enrollment bar, pursuant

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to 42 C.F.R. § 424.535(a)(3) and § 424.535 (a)(9).  Civil Remedies Division (CRD) Dkt. Entry No. 1a.

Mr. Gaidhane pleaded guilty to one count of Conspiracy to Possess with Intent to Distribute and to Distribute Controlled Substances in violation of 21 U.S.C. §§ 841(a)(1), 846.  CMS Ex. 4.  Mr. Gaidhane’s guilty plea was accepted by the United States District Court for the Eastern District of Michigan (District Court) on May 8, 2024.  CMS Ex. 6 at 10.  

On July 2, 2024, WPS issued a notice letter revoking Petitioner’s enrollment pursuant to 42 C.F.R. § 424.535(a)(3) and 42 C.F.R. § 424.535(a)(9) because Petitioner’s sole owner and managing employee, Mr. Gaidhane, was convicted of a felony.  CMS Ex. 1.  WPS also barred Petitioner from re-enrolling in the Medicare program for 10 years from the date of Mr. Gaidhane’s conviction.  Id.  The re-enrollment bar expires on November 9, 2033.  Id. 

On July 25, 2024, Petitioner requested reconsideration of WPS’s decision to revoke its Medicare billing privileges.  CMS Ex. 7.  The reconsideration request, was submitted by Mr. Gaidhane and explained that he was a physical therapist and that while he owned three pharmacies,1 a pharmacist was in charge of handling prescriptions, and he was only responsible for the “payroll and financials.”  Id.  

A CMS hearing officer issued a reconsidered determination on March 28, 2025, upholding the revocation of Petitioner’s enrollment and billing privileges, the corresponding 10-year re-enrollment bar, and the inclusion of CORS on the preclusion list.  CRD Dkt. Entry No. 1a.  The hearing officer stated:

CMS finds that CORS’s owner and managing employee, Mr. Gaidhane’s November 8, 2023 felony conviction to be detrimental to the best interests of [the] Medicare program and its beneficiaries. Additionally, CMS finds that CORS failed to report the felony conviction to its Medicare contractor within 30 days as required under § 424.516(d). Therefore, CMS upholds CORS’s Medicare enrollment revocation pursuant to §§ 424.535(a)(3) and (a)(9). CMS also upholds the duration of the re-enrollment bar established

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under § 414.535(c). The revocation of CORS’s Medicare enrollment and re-enrollment bar form appropriate bases to include it on the CMS Preclusion List.

Id. at 7.

On April 3, 2025, Petitioner timely filed a request for hearing (RFH) before an administrative law judge (ALJ).  Petitioner disputed the allegations related to his criminal conviction, explained that he is not a pharmacist and cannot prescribe substances, and argued that his conviction was not related to his work as a physical therapist.  RFH. 
On April 4, 2025, the CRD issued a letter acknowledging Petitioner’s RFH and my Standing Order.  In compliance with my Standing Order, CMS timely filed a prehearing brief and motion for summary judgment (CMS Br.) along with 7 exhibits (CMS Exs. 1-7).  Petitioner failed to timely file its prehearing exchange, and an Order to Show Cause was issued.  CRD Dkt. Entry No. 5.  Petitioner responded to the Order to Show Cause by filing a letter explaining its failure to file a brief and including arguments contesting the revocation and attached several documents to the filing.  CRD Dkt. Entry No. 6.  I construed Petitioner’s response to be its prehearing exchange (P. Br.) and consequently, the Show Cause Order was discharged.  CRD Dkt. Entry No. 9.  Finally, CMS filed a rebuttal statement (CMS R.).

I. Admission of Evidence and Decision on the Record

According to the applicable hearing procedures, I am to admit evidence into the record that is relevant and material.  42 C.F.R. § 498.60(b); see 5 U.S.C. § 556(d).  Further, the regulations specifically require suppliers to submit all evidence with the reconsideration request.  42 C.F.R. § 405.803(e).  Suppliers must show good cause to submit new evidence to an ALJ.   42 C.F.R. § 498.56(e). 

Petitioner did not object to any of CMS’s proposed exhibits.  I therefore admit CMS Exs. 1-7 into the record.  Standing Prehearing Order ¶ 10; CRD Procedures § 14(e).  By failing to mark, identify, and designate the documents filed with its prehearing brief and after, Petitioner did not file its exhibits in accordance with the requirements of ¶ 8 of the Standing Order.  The documents that Petitioner uploaded as CRD Dkt. Entry Nos. 6a, 6b, and 6c were filed with the reconsideration request.  CMS Ex. 7.  CMS also submitted them as part of CMS Ex. 7.  Therefore, I have admitted these documents into the record.  

Petitioner filed documents a day after it filed its untimely prehearing brief, uploaded as CRD Dkt. Entry Nos. 7 and 8.  Docket Entry No. 8 contains additional arguments from Petitioner regarding the revocation and other legal proceedings that have affected Mr. Gaidhane.  Docket Entry No. 7 appears to be an exhibit to Docket Entry No. 8.  Mr. Gaidhane is not legally trained; therefore, I will construe Docket Entry No. 7 as part of Petitioner’s prehearing exchange.  I also find good cause to admit Docket Entry No. 8

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into the record as Petitioner’s Ex. 1, as this document did not exist at the time that Petitioner filed its reconsideration request.

Subsequent to these filings, Petitioner filed additional documents.  For the purpose of clarifying the record, I will address these filings.  On July 5, 2025, Petitioner electronically filed (e-filed) two documents at CRD Dkt. Entry Nos. 10 and 10a.  Docket Entry No. 10 is a request from Petitioner for the appointment of counsel and Docket Entry No. 10a is an order granting Mr. Gaidhane’s motion to proceed in forma papueris for his appeal of his federal conviction and is attached as an exhibit.  On July 14, 2025, Petitioner e-filed two documents at CRD Dkt. Entry Nos. 12 and 12a.  Docket Entry No. 12 is a copy of the document Petitioner previously filed as CRD Dkt. Entry No. 10a.  Docket Entry No. 12a is another letter requesting the appointment of counsel.  Docket Entry Nos. 10, 10a, 12, and 12a are construed together as Petitioner’s request for appointment of counsel.  This request was denied by my Order, found at CRD Dkt. Entry No. 15.

Finally, on July 14, 2025, Petitioner e-filed a letter at CRD Dkt. Entry No. 13 with the subject of “Request for Clarification and Reconsideration Regarding My Conspiracy Conviction.”  Petitioner also e-filed a screenshot that appears to be from a live television program at CRD Dkt. Entry No. 13a.  As Mr. Gaidhane is not legally trained, I construe Dkt. Entry Nos. 13 and 13a to be an attempt by Petitioner to file a reply to CMS’s rebuttal statement.  However, Petitioner must show good cause for filing a reply.  Standing Order ¶ 7.  I construe the screenshot found at Dkt. Entry No. 13a, to be an attempt by Petitioner to offer new evidence into the record.  I do not find good cause to allow Petitioner’s reply at Dkt. Entry No. 13 nor to admit the screenshot at Dkt. Entry No. 13a into evidence.  The letter Petitioner filed at Dkt. Entry No. 13 is an attempt to collaterally attack Mr. Gaidhane’s conviction and Petitioner has not made any attempt to demonstrate good cause.  The document found at Dkt. Entry No. 13a is a screenshot from a live television program that is completely unrelated to CORS or Mr. Gaidhane’s felony conviction and has no bearing on the facts and applicable law of the instant case.  Because this document is neither relevant nor material and Petitioner did not provide good cause for submitting this document for the first time with the reply, I exclude it from the record.   See Standing Order ¶ 9; CMS Ex. 1 at 3 (notifying Petitioner that all evidence must be filed with the reconsideration request and that there must be good cause to file new documents with an ALJ).

The Standing Order advised the parties that an in-person hearing would only be held if a party submitted the written direct testimony of a proposed witness and the opposing party requested an opportunity to cross-examine a witness.  Standing Order ¶¶ 11-14; CRD Procedures §§ 16(b), 19(b); see Vandalia Park, DAB No. 1940 (2004); Pac. Regency Arvin, DAB No. 1823 at 8 (2002) (holding that the use of written direct testimony for witnesses is permissible so long as the opposing party has the opportunity to cross-examine those witnesses).

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Neither party has submitted written direct testimony.  Therefore, an in-person hearing is not required. Standing Order ¶ 14; CRD Procedures § 19(d).  There is also no need for me to address the legal criteria for summary judgment; I find that this case is ripe for adjudication based on the written record.

I. Issue

1. Whether there is a legitimate basis for revoking Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R. §§ 424.535(a)(3) and/or 424.535(a)(9).
2. Whether CMS had a legitimate basis to include Petitioner on the CMS Preclusion List under 42 C.F.R. §§ 422.2, 422.222, 423.100, 423.120(c)(6).

II. Jurisdiction

I have jurisdiction to decide the issues in this case. 42 C.F.R. § 424.535(a)(3); see also 42 U.S.C. §§ 1395cc(j)(8); 42 C.F.R. §§ 424.545(a), 498.1(g).

III. Legal Framework

The Social Security Act (Act) authorizes the Secretary of Health and Human Services (Secretary) to promulgate regulations governing the enrollment of providers and suppliers in the Medicare program.2  42 U.S.C. § 1395cc(j).  Suppliers 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.

The Secretary has delegated the authority to revoke Medicare enrollment and billing privileges to CMS.  42 C.F.R. § 424.535.  CMS may revoke an enrolled supplier’s Medicare billing privileges for any of the reasons specified in section 424.535(a).  Under paragraph (3) of section 424.535(a), CMS can revoke a supplier’s billing privileges if its “owner or managing employee . . . was within the preceding 10 years, convicted (as that

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term is defined in 42 C.F.R. § 1001.2) of a Federal or State felony offense that CMS determines is detrimental to the best interests of the Medicare program and its beneficiaries.  42 C.F.R. § 424.535(a)(3)(i).  Paragraph (3) specifies general categories of offenses that CMS has determined by rulemaking to be detrimental per se to Medicare and its beneficiaries.  Id. at § 424.535(a)(3)(ii)(A-D).

To summarize, the elements necessary for revocation pursuant to 42 C.F.R. § 424.535(a)(3) are:  (1) the owner, manager, or officer was convicted of a federal or state felony offense; (2) the conviction occurred within the 10 years preceding the revocation action; and (3) the Secretary has specified that the conviction is per se detrimental in 42 C.F.R. § 424.535(a)(3)(ii) or CMS has determined on a case-by-case basis under 42 C.F.R. § 424.535(a)(3)(i) that the felony offense is detrimental to the best interests of the Medicare program and its beneficiaries.  See Fady Fayad, M.D., DAB No. 2266 at 7-8 (2009).

CMS may revoke a supplier’s Medicare enrollment under 42 C.F.R. § 424.535(a)(9) when a supplier does not comply with the reporting requirements laid out in 42 C.F.R. § 424.516(d).  That regulation requires nonphysician practitioner organizations to meet the following reporting requirement:

Physicians, nonphysician practitioners, and physician and nonphysician practitioner organizations must report the following reportable events to their Medicare contractor within the specified timeframes:

(1) Within 30 days—

(i) A change of ownership;

(ii) Any adverse legal action; or

(iii) A change, addition, or deletion of a practice location.

(2) All other changes in enrollment must be reported within 90 days.

42 C.F.R. § 424.516(d) (emphasis added).

When CMS revokes enrollment, it will establish a re-enrollment bar from one to ten year(s) in duration.  42 C.F.R. § 424.535(c).  If CMS revokes a supplier’s enrollment and establishes a re-enrollment bar, CMS may also add the supplier’s name to the CMS

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Preclusion List if CMS determines that the basis for revocation is detrimental to the best interests of the Medicare program.  42 C.F.R. §§ 422.2, 423.100.

A supplier may request a hearing before an ALJ to dispute a revocation or being added to the CMS Preclusion List.  42 C.F.R. §§ 498.3(b)(17), (20), 498.5(l)(2), (n)(2).  However, “the right to review of CMS’s determination by an ALJ serves to determine whether CMS had the authority to revoke [the supplier’s] Medicare billing privileges, not to substitute the ALJ’s discretion about whether to revoke.”  Letantia Bussell, M.D., DAB No. 2196 at 13 (2008) (emphasis omitted).  A supplier may request administrative review of an ALJ’s decision concerning revocation or being added to the CMS Preclusion List.  42 C.F.R. §§ 498.5(l)(3), (n)(3), 498.80.

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

In the instant case, CMS has satisfied all the required elements to revoke Petitioner’s Medicare enrollment.

1. Petitioner was enrolled in the Medicare program as a supplier and, at the time of revocation, Petitioner’s Medicare enrollment record identified Mr. Gaidhane as the owner and managing employee.3

It is undisputed that, at the time of the revocation, Mr. Gaidhane was listed on CORS’s Medicare enrollment record4 as Petitioner’s sole owner and managing employee.  CMS Ex. 1 at 1.  Petitioner, through Mr. Gaidhane, does not contest this fact and has not presented any evidence to show that Mr. Gaidhane was not the owner at the time of the revocation.  Therefore, because CORS’s Medicare records reflected that Mr. Gaidhane was CORS’s sole owner, Petitioner’s enrollment and billing privileges were subject to revocation based on his conduct that violated the standards for Medicare suppliers.  Accordingly, Petitioner was subject to revocation based on Mr. Gaidhane’s felony conviction.

2. On May 8, 2024, Mr. Gaidhane was convicted of the felony offense of conspiracy to possess with intent to distribute and to distribute controlled substances.

Section 424.535(a)(3) adopts the definition of “convicted” found at 42 C.F.R. § 1001.2.  That section and the statute itself provide that a person is “convicted” when:  1) “a

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judgment of conviction has been entered regardless of whether that judgment has been (or could be) expunged; 2) there has been a finding of guilt; 3) a plea of guilty or nolo contendere has been accepted by the court; or 4) the individual has entered into participation in a first offender, deferred adjudication, or other arrangement or program where the judgment of conviction has been withheld.”  Act § 1128(i); 42 C.F.R. § 1001.2(a) (emphasis added).

On November 8, 2023, Mr. Gaidhane pleaded guilty to one count for conspiracy to possess with intent to distribute and to distribute controlled substances in violation of 21 U.S.C. §§ 841(a)(1), 846.  CMS Ex. 6 at 10; CMS Ex. 4.  That same day, the District Court took the plea agreement under advisement and later, on May 8, 2024, the Court accepted the plea agreement.  CMS Ex. 6 at 10.  Consequently, on May 8, 2024, within 10 years of the revocation action, Mr. Gaidhane was convicted of a felony, as defined by 42 C.F.R. § 1001.2.  On May 8, 2024, the District Court sentenced Mr. Gaidhane to 12 months and one day of imprisonment and ordered him to pay a $10,000 fine and entered a forfeiture money judgment against him in the amount of $400,000.  CMS Ex. 5.

Mr. Gaidhane’s felony conviction arises from his participation in an illegal scheme that involved the “unlawful acquiring and distribution of prescription drug controlled substances,” including Oxycodone HCL and Oxymorphone HCL.  CMS Ex. 4 at 3-4. Pharmacies owned by Mr. Gaidhane were used to fulfill unlawfully issued prescriptions issued to recruited patients.  Id.  Various individuals employed by Mr. Gaidhane dispensed medically unnecessary prescriptions in exchange for cash during slot appointments in an effort to “avoid detection of the drug diversion scheme.”  Id. at 5.  Mr. Gaidhane participated in this scheme from about September 2017 to June 2020.  Id.  In pleading guilty, Mr. Gaidhane admitted that he “willfully conspired, with two or more persons, to possess with intent to distribute and to distribute controlled substances.”  Id. at 4.

Petitioner disputes this conviction and asserts that Mr. Gaidhane was unable to dispense or prescribe medication as he was a “non-Pharmacist owner” of the pharmacy that participated in the illegal scheme.  RFH at 1-4.  Petitioner also contests the conviction by asserting several defenses including lack of intent, entrapment, and insufficient evidence.  Id.  CMS argues that the regulations do not require an examination of the circumstances of the underlying conviction or for CMS to “second-guess the judgment of the criminal court.”  CMS Br. at 6.  I reject Petitioner’s arguments as they are irrelevant.  Petitioner’s arguments attack the conviction; however, the regulations do not require that CMS evaluate the criminal proceeding that resulted in the conviction that led to the revocation.  Furthermore, Mr. Gaidhane has pleaded guilty and acknowledged his culpability for the crime for which he was convicted.  Finally, it is of no import that Mr. Gaidhane is not a pharmacist.  His actions included willfully conspiring in the distribution of prescriptions by employing pharmacists to slot appointments for recruited patients.  Mr. Gaidhane was

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convicted, and CORS cannot defeat the revocation by trying to minimize his role in the illegal scheme that led to his conviction.  

3. CMS had a legitimate basis to revoke Petitioner’s enrollment in the Medicare program because Petitioner’s owner was convicted within the last 10 years of a felony offense that CMS reasonably determined to be intrinsically detrimental to the bests interest of the Medicare program and its beneficiaries.

CMS determined that Mr. Gaidhane’s conviction was detrimental to the best interests of the Medicare program because Mr. Gaidhane was convicted of a crime that would result in mandatory exclusion under § 1128(a) of the Act.  CRD Dkt. Entry No. 1a at 4.  Felonies that would result in mandatory exclusion, as enumerated in § 424.535(a)(3)(ii)(D), are intrinsically detrimental to the best interests of the Medicare program and its beneficiaries.  Section 1128(a)(4) requires the mandatory exclusion of “any individual or entity that has been convicted for an offense which occurred after [] August 21, 1996, under Federal or State law, of a criminal offense consisting of a felony relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance.”  CMS properly determined that Mr. Gaidhane’s felony conviction for conspiracy to possess with intent to distribute and to distribute controlled substances qualifies as a felony that would result in mandatory exclusion.  Additionally, CMS noted that Mr. Gaidhane was, in fact, excluded by the Inspector General under this provision of the Act.  CRD Dkt. Entry No. 1a at 4.  CMS’s finding that that Mr. Gaidhane’s felony conviction is per se detrimental, or inherently detrimental, to the Medicare program as a crime that would result in mandatory exclusion is reasonable.

4. CMS’s case-specific determination that Mr. Gaidhane’s felony conviction is detrimental to the best interests of the Medicare program and its beneficiaries is reasonable.

In addition to the analysis above, CMS also made a case-specific determination that Mr. Gaidhane’s conviction is detrimental to the best interests of the Medicare program and its beneficiaries.5  While the Secretary has authorized CMS to make the determination as to whether a crime is detrimental, CMS still must “explain[] why the offense is detrimental to the Medicare program and its beneficiaries.”  Michael Scott Edwards, OD, & M. Scott

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Edwards, OD, PA, DAB No. 2975 at 11 (2019).  Additionally, CMS’s determination must be reasonable.  Eva Orticio Villamor-Goubeaux, DAB No. 2997 at 10 (2020).

Petitioner disputes that the conviction is detrimental because it was not related to CORS and CORS was never involved in any “fraudulent billing.”  RFH at 3.  However, there is no requirement for a link between the underlying criminal conviction and CORS delivery of health care services.  See Stephen C. White, M.D., DAB No. 3116 at 14 (2023) (pointing out that the regulations do not require CMS to show that Petitioner’s offense occurred in connection with the practice of medicine or resulted in harm to Medicare beneficiaries).  In the reconsidered determination, CMS found that Mr. Gaidhane’s conduct “indicates… a willingness to knowingly violate the law.”  CRD Dkt. Entry No. 1a at 4.  CMS explained that Mr. Gaidhane’s unlawful actions “reflect[] poorly on the medical profession as a whole and jeopardize[] public confidence in Medicare providers and suppliers.”  Id. at 5.  Overall, CMS found Mr. Gaidhane’s behavior posed a threat to the integrity of the Medicare program.  Id.  CMS’s analysis of the specific facts and circumstances is apt and reasonable.  Therefore, CMS has established that Mr. Gaidhane’s felony conviction is detrimental to the best interests of the Medicare program.

5. Because the effective date of the revocation was not the date of Mr. Gaidhane’s conviction, it must be modified to May 8, 2024.

As previously discussed, the definition of convicted found at 42 C.F.R. § 1001.2 defines convicted as when “a plea of guilty or nolo contendere has been accepted by the court ….”  See supra section b.  Mr. Gaidhane requests that the effective date be modified to May 8, 2024, as that was the date he was sentenced, and he does not have funds to pay back Medicare for the services he provided.  P. Br. at 4-5.  CMS contends that the court accepted Mr. Gaidhane’s plea on November 8, 2023.  CMS Br. at 5.

Although the date of conviction does not affect the applicability of 42 C.F.R. § 424.535(a)(3) as a basis for revocation, Petitioner has properly raised the effective date of revocation as an issue for consideration.  The plain language of 42 C.F.R. § 1001.2 defines conviction such that it requires a plea of guilty to be accepted by the court.  On November 8, 2023, the plea agreement was taken under advisement by the court.  CMS Ex. 6 at 10.  Then, according to the minute entries from the criminal docket, Mr. Gaidhane’s guilty plea was accepted by the court on May 8, 2024.  Id.  Therefore, the effective date of Petitioner’s revocation, as it is based on a felony conviction, is May 8, 2024.  42 C.F.R. § 424.535(g).  See Lilia Gorovits, M.D., P.C., DAB No. 2985 at 13 (2020).

6. CMS had a legitimate basis to revoke Petitioner’s Medicare enrollment and billing privileges under 42 C.F.R. § 424.535(a)(9) because Petitioner failed to report, within 30 days, an adverse legal action to the relevant Medicare contractor.

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CMS had a legitimate basis to revoke Petitioner’s Medicare enrollment and billing privileges under 42 C.F.R. § 424.535(a)(9) because Petitioner failed to report an adverse legal action against its owner to WPS within 30 days.

CMS may revoke a supplier’s Medicare enrollment under 42 C.F.R. § 424.535(a)(9) when a supplier does not comply with the reporting requirements laid out in 42 C.F.R. § 424.516(d).  That regulation requires a nonphysician practitioner to meet the following reporting requirement:

Physicians, nonphysician practitioners, and physician and nonphysician practitioner organizations must report the following reportable events to their Medicare contractor within the specified timeframes:

(1) Within 30 days—

(i) A change of ownership;

(ii) Any adverse legal action; or

(iii) A change, addition, or deletion of a practice location.

(2) All other changes in enrollment must be reported within 90 days.

42 C.F.R. § 424.516(d) (emphasis added).

There is no doubt that Petitioner failed to timely report Mr. Gaidhane’s felony conviction within the required 30-day timeframe.  In Petitioner’s brief, Petitioner claims to have notified the Board of Physical Therapy and then WPS.  P. Br. at 5.  CMS asserts that the record demonstrates that CORS never notified WPS of Mr. Gaidhane’s conviction.  CMS Br. at 7.  Ultimately, Petitioner has not produced any evidence to support that it notified WPS of the conviction.

As with the analysis of 42 C.F.R. § 424.535(a)(3), I conduct a brief analysis below to determine whether CMS exercised its discretion to impose the revocation based on section 424.535(a)(9).

Once it is clear that a supplier has failed to report an adverse legal action, CMS considers the following factors to determine whether revocation is proper:

(i) Whether the data in question was reported.

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(ii) If the data was reported, how belatedly.

(iii) The materiality of the data in question.

(iv) Any other information that CMS deems relevant to its determination.

42 C.F.R. § 424.535(a)(9).

I conclude that CMS adequately considered all four factors under 42 C.F.R. § 424.535(a)(9).  Because Petitioner has not proven that it reported the conviction, factors (i) and (ii) are significant.  Regarding factor (iii), CMS considered the lack of reporting to be material to Petitioner’s Medicare enrollment because the conviction was a basis for revocation and CMS relies on suppliers to provide data to confirm that they are in compliance with Medicare requirements.  CRD Dkt. Entry No. 1a at 5.  If this data is inaccurate it “puts the Medicare Trust at risk.”  Id.

Regarding factor (iv), CMS found that Petitioner was responsible for the reporting of “complete and accurate information to the applicable Medicare contractor” and that Petitioner was also responsible for understanding the requirements of its participation as a Medicare supplier.  Id. at 6.

While Petitioner does dispute the date of the conviction, this contention is of no consequence as the conviction was never reported, so it cannot be argued that it was reported within 30 days of the later date.  The reconsidered determination is sufficient to meet CMS’s obligation to consider the factors outlined in 42 C.F.R. § 424.535(a)(9) and the record supports a finding that Petitioner violated the reporting requirements in 42 C.F.R. § 424.516(d).  Therefore, CMS had a legitimate basis to revoke Petitioner’s Medicare enrollment based on 42 C.F.R. § 424.535(a)(9).

CMS had a legitimate basis to revoke Petitioner’s Medicare enrollment and billing privileges under 42 C.F.R. § 424.535(a)(9) because Petitioner failed to report an adverse legal action against him to WPS within 30 days.

7. I cannot overturn the revocation for equitable reasons.

Petitioner makes several arguments to challenge the revocation and touch on the unfairness and impact on Mr. Gaidhane.  Petitioner asserts that now that Mr. Gaidhane’s license to practice physical therapy is no longer suspended, he should be allowed to treat Medicare patients.  RFH at 4.  Petitioner also claims that the community that CORS served in Metro Detroit has a critical shortage of physical therapists and that Mr. Gaidhane provides this service to the senior community and has letters from patients that

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he serves.  P. Br. at 2; CMS Ex. 7 at 5-25.  Additionally, Petitioner explains that in the criminal case, the judge found Mr. Gaidhane to be low risk and no harm to the community and allowed him to travel internationally while on probation.  Id. at 3.  Finally, Petitioner also shares that Mr. Gaidhane cannot find a full-time job, which is a requirement of his probation, while his billing privileges are revoked.  Id.  Unfortunately, these arguments amount to a request for equitable relief, which I do not have the authority to grant.  US Ultrasound, DAB No. 2302 at 8 (2010).  I do not have the authority to set aside CMS’s revocation based on the adverse impact it may have on Mr. Gaidhane and CORS.  Blair Allen Nelson, M.D., DAB No. 3024 at 12 (2020).  Because CMS has demonstrated that one of the regulatory bases for revocation exists, I must uphold the revocation.  Wassim Younes, M.D., DAB No. 2861 at 8 (2018).

8. CMS had a legitimate basis to include Petitioner on CMS’s Preclusion List.

Petitioner’s request for hearing and brief do not challenge its placement on the CMS Preclusion List.  Therefore, this determination is administratively final.  However, I note that CMS raises in its brief that preclusion under the definition found in 42 C.F.R. 422.2 paragraph (3) is also warranted.  Under this provision, CMS considers “ (i) the severity of the offense; (ii) When the offense occurred; and (iii) any other information that CMS deems relevant to its determination.”  Counsel for CMS correctly asserts that Mr. Gaidhane’s offense was extremely serious, as demonstrated by his automatic exclusion from Medicare.  CMS Br. at 10; see also DAB Ruling No. 2025-95; DAB Ruling No. 2025-64 (A-25-64, reconsideration request denied in A-25-95).  Furthermore, the offense was recent, as Mr. Gaidhane admitted to participation in the illegal scheme through June 2020 and was convicted in May 2024.  CMS Ex. 1 at 1; CMS Ex. 6 at 10.  Finally, CMS explains that Mr. Gaidhane’s conviction could undermine the public’s confidence in the Medicare program.  CMS Br. at 10.

9. I do not have the authority to review the length of the re-enrollment bar and Petitioner has not raised this issue at any stage in this case.

When CMS revokes the enrollment of a supplier, CMS must also impose a re-enrollment bar that is between one and ten years in length.  42 C.F.R. § 424.535(c)(1)(i).  In this case, CMS imposed a 10-year re-enrollment bar.  CMS Ex. 3 at 3.  Petitioner asserts that because Mr. Gaidhane’s license to practice physical therapy was only suspended for 15 months, a 10-year re-enrollment bar is not appropriate because his conviction was not related to his practice as a physical therapist.  RFH at 4.  Additionally, Petitioner asserts that the 10-year re-enrollment bar has essentially forced Mr. Gaidhane to be unemployed even though he is willing to work.  Id. at 4-5.  Finally, Petitioner requests that the length be modified to 18 months.  P. Br. at 5.  While I understand the challenges Mr. Gaidhane is personally facing, ultimately, I do not have the authority to review the length of the re-

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enrollment bar imposed.  Vijendra Dave, M.D., DAB No. 2672 at 9-12 (2016); see also 42 C.F.R. § 424.535(c)(2)(ii)(B).

II. Conclusion

Based on the foregoing findings of fact and conclusions of law, I conclude that CMS had a legitimate basis to revoke Petitioner’s Medicare enrollment and billing privileges under 42 C.F.R. § 424.535(a)(3) and (a)(9) and to place Petitioner on the CMS Preclusion List.  I affirm CMS’s revocation and placement of Petitioner on the Preclusion List.  I modify the effective date of the revocation to May 8, 2024.