Richard Caesar, DAB CR6821 (2026)

DECISION

Petitioner, Richard Caesar, is a physician, licensed in Maine and Florida, who participated in the Medicare program as a supplier of services.  The Centers for Medicare & Medicaid Services (CMS) has revoked his Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(9) because he did not timely report to the Medicare Contractor that the Florida Medical Board had suspended his medical license.  CMS has imposed a five-year reenrollment bar. 

Petitioner appeals the revocation. 

CMS moves for summary judgment, which Petitioner opposes.  I agree that no material facts are in dispute but, for the reasons discussed below, I decline to enter summary judgment and instead issue a decision based on the written record. 

I find that, pursuant to 42 C.F.R. § 424.535(a)(9), CMS appropriately revoked Petitioner Caesar’s Medicare enrollment because he did not timely notify the contractor that his Florida medical license had been suspended. 

I have no authority to review the reenrollment bar. 

Page 2

Background

In a revocation notice, dated August 10, 2022, the Medicare contractor, First Coast Service Options, Inc., advised Petitioner Caesar that it revoked his Medicare enrollment, effective June 24, 2022.  The letter explains that the contractor revoked Petitioner’s Medicare enrollment for two reasons: 

1. 1) pursuant to 42 C.F.R. § 424.535(a)(1) because the Florida Board of Medicine had suspended his medical license, effective June 24, 2022; and
2. 2) pursuant to 42 C.F.R. § 424.535(a)(9) because Petitioner did not, within 30 calendar days, notify CMS of this adverse legal action as required by 42 C.F.R. § 424.516(d)(1).

CMS Ex. 5 at 1.  The contractor also imposed a five-year enrollment bar, effective 30 days from the postmark date of the notice letter.  CMS Ex. 5 at 3.1 

Petitioner submitted a Corrective Action Plan and requested reconsideration.  CMS Ex. 6. 

In a reconsidered determination, dated July 23, 2025, a CMS hearing officer affirmed the revocation under section 424.535(a)(9) but overturned the revocation based on section 424.535(a)(1).  She determined that Petitioner’s Corrective Action Plan established that Petitioner’s medical license had been reinstated, which corrected that problem.  CMS Ex. 1 at 3, 5.  Nevertheless, because Petitioner did not timely report the license suspension, as required by 42 C.F.R. § 424.516(d), the hearing officer upheld the revocation under section 424.535(a)(9).  She also upheld the reenrollment bar under section 424.535(c).  CMS Ex. 1 at 3-5. 

Petitioner appealed. 

Decision based on the written record.  Although CMS has moved for summary judgment, I find that this matter may be decided based on the written record, without considering whether the standards for summary judgment are satisfied.  In my initial order, I instructed the parties to submit a list of all proposed witnesses (if any), along with their complete written direct testimony, submitted in the form of an affidavit made under oath or as a written declaration signed under penalty of perjury.  Acknowledgment and Prehearing Order at 4, 5 (¶¶ 4.c.iv, 8).  CMS lists no witnesses.  Petitioner lists one 

Page 3

witness, himself, and submits his written declaration.  Although CMS maintains that no material facts are in dispute (and I agree), it has asked to cross-examine the witness.  Because the sole witness’s direct testimony is in the record, and CMS prevails without cross-examining him, an in-person hearing would serve no purpose. 

Submissions.  CMS has filed a prehearing brief and motion for summary judgment (CMS Br.) with six exhibits (CMS Exs. 1-6).  Petitioner filed his own pre-hearing brief and response to CMS’s motion (P. Br.), with two exhibits (P. Exs. 1-2).  In the absence of any objections, I admit into evidence CMS Exs. 1-6 and P. Exs. 1-2. 

Discussion

1. 1. Because Petitioner Caesar failed to report timely that his Florida medical license had been suspended, CMS properly revoked his Medicare enrollment. 42 C.F.R. § 424.535(a)(9).2 

CMS regulates the Medicare enrollment of providers and suppliers.  Social Security Act (Act) § 1866(j)(1)(A).  It may revoke a supplier’s enrollment in the program if the supplier does not comply with reporting requirements, including that he report, within 30 days, any adverse legal action or change in enrollment.  42 C.F.R. § 424.535(a)(9); 42 C.F.R. § 424.516(d). 

License suspension.  Here, the parties agree that, effective June 24, 2022, the Florida Board of Medicine suspended Petitioner’s license to practice medicine and imposed an administrative fine of $2,500.  CMS Ex. 6 at 6-7; P. Ex. 1 (Caesar Decl. ¶ 2).  Following a June 3, 2022 hearing, which Petitioner attended, the Florida Board of Medicine explained that the State of Maine Board of Licensure found that Petitioner had “engaged in conduct that violates a standard of professional behavior that has been established for the practice of medicine.”  CMS Ex. 6 at 6, 12.3 

The Administrative Complaint, whose allegations were incorporated into the final order, explained that Florida law “subjects a licensee to discipline for having a license or the authority to practice medicine revoked, suspended, or otherwise acted against, including denial of licensure[] by the licensing authority of any jurisdiction, including its agencies or subdivisions.”  CMS Ex. 6 at 12.  

Page 4

Legal basis for revocation.  The Departmental Appeals Board has consistently held that an administrative law judge’s review of CMS’s determination to revoke a supplier’s Medicare enrollment is limited to deciding whether CMS has established one or more of the grounds specified in section 424.535(a).  William Garner, M.D., DAB No. 3026 at 16 (2020); Norman Johnson, M.D., DAB No. 2779 at 11 (2017), and cases cited therein.  Although CMS itself has the discretion to consider “unique or mitigating circumstances in deciding whether, or how, to exercise its revocation authority,” I do not.  I may not substitute my discretion for that of CMS in determining whether the revocation is appropriate.  Johnson, DAB No. 2779 at 11 (citing Care Pro Home Health, Inc., DAB No. 2723 at 9 n.8 (2016)); Abdul Razzaque Ahmed, M.D., DAB No. 2261 at 19 (2009), aff’d, Ahmed v. Sebelius, 710 F. Supp. 2d 167 (D. Mass. 2010).  

Here, because CMS has grounds for revoking Petitioner’s Medicare enrollment under section 424.535(a)(9), I must sustain the revocation. 

Petitioner concedes that he did not report his license revocation to the Medicare contractor but excuses himself by claiming that he “did not know that [he] was enrolled in Medicare through the Florida intermediary” until he received the August 10, 2022 notice letter.  P. Ex. 1 (Caesar Decl. ¶ 7).  He claims that he limited his practice to pediatric patients and would have been enrolled only so that he could participate in the Medicaid program.  P. Ex. 1 (Caesar Decl. ¶¶ 9, 10).4 

CMS responds with copies of Petitioner’s 2017 Medicare enrollment applications and points out that he was required to sign the applications himself and could not have delegated the authority to sign to any other person.  CMS Br. at 6; CMS Ex. 2 at 2; CMS Ex. 3 at 2-3.  So, Petitioner should have known that he had enrolled in the Medicare program when he was in Florida. 

CMS also suggests that Petitioner’s purported ignorance regarding his Medicare enrollment in Florida is of recent duration.  In his request for reconsideration, he conceded that he “was at fault” for not notifying the Florida Medicare Contractor about the Florida license suspension.  CMS Ex. 6 at 1.  Before the Medicare hearing officer, he did not dispute that he was required to report the license suspension to CMS and acknowledged that he failed to do so.  CMS Ex. 1 at 3. 

Page 5

Petitioner’s position is puzzling.  He doesn’t deny his Medicare enrollment; he just claims that he did not know that he was enrolled in Florida.  Ultimately, the question is irrelevant.  Petitioner was enrolled in the Medicare program; he was subject to an adverse legal action – the suspension of his Florida medical license; he did not report that adverse legal action to any CMS Medicare contractor within 30 days.  CMS therefore has grounds for revoking Petitioner’s Medicare enrollment under section 424.535(a)(9), and I must sustain the revocation. 

Petitioner also argues that he satisfied the reporting requirement because “sometime in November or December of 2022,” he notified Florida Medicaid that his license had been suspended.  P. Ex. 1 (Caesar Decl. ¶ 4).  Obviously, “November or December” 2022 is not within 30 days of the adverse legal action (June 24, 2022).  Even if Petitioner had reported the action to the appropriate entity (which he did not), he would not have satisfied the regulatory requirement because the reporting was untimely. 

Moreover, the regulation is unambiguous:  within 30 days, physicians must report, to their Medicare contractor, any adverse legal action.  42 C.F.R. § 424.516(d)(1)(ii).  It is long settled that those who participate in the Medicare program are responsible for knowing its rules.  See Heckler v. Cmty. Health Servs. of Crawford Cnty., Inc., 467 U.S. 51, 63 (1984); New Grove Manor, DAB No. 3090 at 15 (2023); Francis J. Cinelli, Sr., D.O., DAB No. 2834 at 10 (2017); Hartford HealthCare at Home, Inc., DAB No. 2787 at 8-9 (2017).  Reporting the adverse legal action to the wrong entity four or five months after the deadline does not satisfy the regulatory requirement. 

2. 2. I have no authority to review CMS’s determination to impose a five-year reenrollment bar nor the length of that reenrollment bar. 

When a supplier’s billing privileges are revoked, he may not participate in the Medicare program until the end of his reenrollment bar, which must be for a minimum period of one year but no more than ten years (except under circumstances that don’t apply here), depending on the severity of the underlying offense.  42 C.F.R. § 424.535(c)(1).  Here, CMS imposed a five-year reenrollment bar.  Because neither the determination to impose a reenrollment bar nor the length of a reenrollment bar is listed as an “initial determination,” which would be appealable, I have no authority to review those determinations.  42 C.F.R. § 498.3(b); Wheelchair City, Inc., DAB No. 3131 at 5 (2024); John O. Dimowo, M.D., DAB No. 3101 at 12-13 (2023); Linda Silva, P.A., DAB No. 2966 at 11 (2019); Vijendra Dave, M.D., DAB No. 2672 at 9-12 (2016); accord, William Garner, M.D., DAB No. 3026 at 16 (2020), Lilia Gorovits, M.D., P.C., DAB No. 2985 at 15-16 (2020). 

Conclusion

I affirm CMS’s determination.  CMS may revoke Petitioner Caesar’s Medicare enrollment because his medical license was suspended and he did not, within 30 days, report that suspension to the Medicare contractor.  42 C.F.R. § 424.535(a)(9).  I have no authority to review the reenrollment bar.