Michelle Bahrain, D.O., DAB CR6827 (2026)

DECISION

The Centers for Medicare & Medicaid Services (CMS) revoked the Medicare enrollment of Petitioner, Michelle Bahrain, D.O., and established a one-year reenrollment bar commencing 30 days after June 20, 2025.  Petitioner appeals and requests an earlier effective date for the reenrollment bar.  I affirm the effective date CMS established for the reenrollment bar because it is the effective date required by the regulations. 

I.       Procedural History

On October 27, 2025, Petitioner filed a request for an administrative law judge hearing to dispute the effective date of a one-year reenrollment bar that CMS imposed on her.  On October 29, 2025, the Civil Remedies Division acknowledged receipt of the hearing request, provided the parties with the dates for prehearing submissions, and issued my Standing Order.  On December 3, 2025, CMS filed a prehearing brief (CMS Br.), which included a motion for summary judgment, and six proposed exhibits.  On January 7, 2026, Petitioner filed a brief, which included a cross-motion for summary judgment and an opposition to CMS’s motion for summary judgment.  Petitioner did not submit any proposed exhibits.

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II.      Admission of Evidence and Decision on the Written Record

Absent objection, I admit all of CMS’s proposed exhibits into the record. 

I decide this case based on the written record.  Although the parties filed motions for summary judgment, I will decide this case based on the written record because neither party submitted written direct testimony from any witnesses.  Standing Order ¶¶ 7(g)(iii), 11-14; Civil Remedies Division Procedures §§ 16(b), 19(b), (d); Anil Hanuman, D.O., DAB No. 3080 at 11-12 (2022); EI Med., Inc., DAB No. 3117 at 15 (2023); Vandalia Park, DAB No. 1940 (2004).  

III.     Issue

Whether July 20, 2025, is the correct effective date for Petitioner’s reenrollment bar.  

IV.     Legal Framework

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).  A physician is considered a “supplier” in the Medicare program.  42 U.S.C. § 1395x(d). 

To receive payment for covered Medicare items or services provided to beneficiaries under Medicare Part B, 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 meet all enrollment requirements and file an enrollment application.  42 C.F.R. §§ 424.510, 424.530.  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 enrollment for any of the reasons stated in 42 C.F.R. § 424.535(a).  When CMS revokes a supplier’s enrollment, CMS must establish a reenrollment bar that lasts at least one year.  42 C.F.R. § 424.535(c)(1)(i). 

V.       Findings of Fact

1. Petitioner was enrolled in the Medicare program as a physician.  CMS Ex. 1.
2. In a June 20, 2025 notice, a CMS contractor revoked Petitioner’s enrollment in the Medicare program based on the suspension of Petitioner’s medical license in Maryland (effective February 26, 2025) and Petitioner’s failure to report the suspension of her medical license to CMS within 30 days.  42 C.F.R. §§ 424.516(d)(1), 424.535(a)(1), (9).  The revocation was effective February 26, 2025.  CMS Ex. 4 at 1.

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3. The June 20, 2025 notice also stated that Petitioner was barred from reenrollment in the Medicare program for one year and that the reenrollment bar was to “begin 30 days after the postmark date of this letter.”  CMS Ex. 4 at 1.
4. In a June 25, 2025 letter, Petitioner requested reconsideration.  CMS Ex. 5 at 13.
5. On reconsideration, the CMS contractor affirmed the revocation and the effective date for the reenrollment bar.  CMS Ex. 6 at 3-4.

VI.   Conclusion of Law

1. The effective date for a reenrollment bar is 30 days after CMS or a CMS contractor mails notice of a revocation to an enrolled provider or supplier.  42 C.F.R. § 424.535(c)(1)(i).

VII.  Analysis

Petitioner only disputes the effective date for the reenrollment bar.  P. Br. at 1. 

When CMS revokes enrollment, the effective date of revocation is generally 30 days following the mailing of the revocation notice; however, the date of revocation can be retroactive in some situations.  42 C.F.R. § 424.535(g)(1)-(2).  When CMS revokes enrollment, CMS must establish a reenrollment bar for at least one year.  42 C.F.R. § 424.535(c)(1)(i).  Like many revocations, this reenrollment bar “[b]egins 30 days after CMS or its contractor mails notice of the revocation.”  42 C.F.R. § 424.535(c)(1)(i). 

Petitioner argues that it is inconsistent for her revocation to be retroactively effective on February 26, 2025 (see 42 C.F.R. § 424.535(g)(2)(iii)), while the one-year reenrollment bar commenced on July 20, 2025.  P. Br. at 3-4.  Petitioner states that, once her medical license suspension took effect on February 26, 2025, she could neither provide nor bill for Medicare covered services; therefore, the “application of a reenrollment bar that effectively delays its commencement until months after the license suspension serves no regulatory purpose.”  P. Br. at 4. 

A plain reading of the regulations does not support Petitioner’s position.  A revoked provider or supplier is “barred from participating in the Medicare program from the effective date of the revocation until the end of the reenrollment bar.”  42 C.F.R. § 424.535(c)(1).  Therefore, when the effective date for a retroactive revocation precedes the reenrollment bar’s effective date, there is an additional period (i.e., the period between the retroactive effective date of revocation until the effective date of the reenrollment bar) where the revoked provider or supplier is barred from reenrollment.

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Petitioner appears to assert that the regulations concerning the effective date for revocations and the effective date for reenrollment bars do not align properly with each other.  However, the preamble to the final rule shows that the Secretary intentionally changed the regulations to ensure that all reenrollment bars would commence 30 days after the revocation notice, even when a revocation became effective at an earlier date: 

We proposed to revise § 424.535(c) to specify that all re-enrollment bars begin 30 days after CMS or the CMS contractor mails notice of the revocation determination to the provider or supplier.  The rationale for this change was to address situations where the revocation is based on a federal exclusion or debarment, felony conviction, license revocation or suspension, or non-operational status.  Due to potential delays in the updating of databases with criminal conviction and licensure information, the revocation effective dates for these actions can be months prior to the date the contractor mails the revocation letter, and it is from these retroactive effective dates that the re-enrollment bar runs.  By starting the re-enrollment bar period after the revocation letter is sent, the full period can be imposed. 

79 Fed. Reg. 72,500, 72,522 (Dec. 5, 2014) (emphasis added).  

While Petitioner’s position was correct prior to 2015, the Secretary specifically amended the regulations so that the effective date for the reenrollment bar would not commence with the effective date for retroactive revocations. 

VIII.  Conclusion

I affirm CMS’s determination that Petitioner’s reenrollment bar must commence 30 days after the June 20, 2025 revocation notice was mailed to Petitioner.