Hallie B. Brooks, MD, DAB CR6844 (2026)

DECISION

Petitioner, Hallie B. Brooks, MD, is a New York physician.  On July 30, 2025, she applied to reassign her Medicare benefits to Priority Medical Services, PLLC.  The Centers for Medicare & Medicaid Services (CMS) granted her application, effective July 30, 2025, with a reassignment effective date of May 31, 2025.  Petitioner now challenges that effective date and asks that the effective date be changed to March 27, 2025.

Because Petitioner filed her subsequently-approved application on July 30, 2025, and a reassignment of benefits can be effective 30 days before the application to reassign benefits with a possible additional 30 days for payment services, May 31, 2025 is the correct effective date of reassignment.

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Background

In a notice dated August 19, 2025, the Medicare contractor, National Government Services, advised Petitioner that it approved her change of information Medicare enrollment application, with a retrospective billing date of May 31, 2025.  CMS Ex. 3.  Petitioner requested reconsideration.  CMS Ex. 2.

In a reconsidered determination, dated September 23, 2025, the contractor affirmed the July 30, 2025 effective date.  CMS Ex. 1.  Petitioner appealed.

CMS moves for summary judgment.  However, because CMS did not propose any witnesses and did not request to cross-examine Petitioner’s proposed witness, an in-person hearing would serve no purpose.  See Standing Order at 9-10 (May 6, 2025).  I may therefore decide this case based on the written record, without considering whether the standards for summary judgment are satisfied.

CMS submits its motion and brief (CMS Br.) with five exhibits (CMS Exs. 1-5).  Petitioner submits a brief (P. Br.) and one sworn declaration.  In the absence of any objections, I admit into evidence CMS Exs. 1-5 and the sworn declaration of Jonathan S. Halpert, MD.

Discussion

1. Petitioner filed her subsequently-approved application to reassign benefits on July 30, 2025, and her reassignment of benefits is effective May 31, 2025.  42 C.F.R. § 424.522(a); 42 C.F.R. § 424.521(a)(1)(i).1

Enrollment.  Petitioner participates in the Medicare program as a “supplier” of services.  Social Security Act § 1861(d); 42 C.F.R. § 498.2.  To receive Medicare payments for the services furnished to program beneficiaries, a supplier must enroll in the program.  42 C.F.R. § 424.505.  “Enrollment” is the process by which CMS and its contractors:  1) identify the prospective supplier; 2) validate the supplier’s eligibility to provide items or services to Medicare beneficiaries; 3) identify and confirm a supplier’s owners and practice location; and 4) grant the supplier Medicare billing privileges. 42 C.F.R. § 424.502.

To enroll, a prospective supplier must complete and submit an enrollment application.  42 C.F.R. §§ 424.510(d)(1), 424.515(a).  An enrollment application is either a CMS-approved paper application or an electronic process approved by the Office of

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Management and Budget.  42 C.F.R. § 424.502.2  When CMS determines that a prospective supplier meets the applicable enrollment requirements, it grants Medicare billing privileges, which means that the supplier can submit claims and receive payments from Medicare for covered services provided to program beneficiaries.  For a physician, the effective date for billing privileges “is the later of the date of filing” a subsequently-approved enrollment application or “the date that the supplier first began furnishing services at a new practice location.”  42 C.F.R. § 424.520(d) (emphasis added); Medicare Program Integrity Manual (MPIM) Chapter 10, section 10.6.2(B)(4).

A supplier may reassign her billing privileges under certain circumstances, including where the reassignment is to an employer or to a Medicare-enrolled entity pursuant to a contractual arrangement under which the entity bills for the supplier’s services.  42 C.F.R. § 424.80(b) and (d).

Petitioner’s enrollment.  Here, on July 30, 2025, Petitioner filed her application to reassign her Medicare benefits (CMS-855I), which the contractor subsequently approved.  CMS Ex. 4.  Thus, pursuant to section 424.520(d), the date Petitioner filed her subsequently-approved enrollment application – May 31, 2025 – is the correct effective date of enrollment.  Howard M. Sokoloff, DPM, MS, Inc., DAB No. 2972 (2019); Urology Grp. of NJ, LLC, DAB No. 2860 (2018); Willie Goffney, Jr., M.D., DAB No. 2763 at 7 (2017), aff’d Goffney v. Azar, No. CV 17-8032 MRW (C.D. Cal. Sept. 25, 2019).

Pursuant to section 424.522(a), the reassignment of Petitioner’s benefits is effective beginning 30 days before she submitted Form CMS-855I plus retrospective payment for services for an additional 30 days pursuant to 42 C.F.R. § 424.521(a)(1) – in this case, on May 31, 2025.

Petitioner argues that the practice, Priority Medical Services, PLLC, submitted enrollment documentation for its four staff physicians in early 2025.  P. Br. at 1.  The three other staff physicians were granted effective dates of March 27, 2025.  Id.  However, CMS does not have a record of Petitioner being included in that filing.  Petitioner offers the sworn declaration of Dr. Jonathan Halpert to support Petitioner’s contention that she was included in the practice’s earlier 2025 revalidation application.  However, I have no authority to grant Petitioner the relief she requests.  The question she raises pertains to the deactivation and reactivation of the group’s and other physicians’ billing privileges.  No matter how compelling the circumstances, I have no authority to review a deactivation.  Ark Health Grp., DAB No. 2929 at 7-9 (2019) (and cases cited therein).  Similarly, I have no authority to review the reactivation because Petitioner was not included in the filing and a related appeal was never filed.  Nor may I grant Petitioner relief based on any equitable arguments.  Sokoloff, DAB No. 2972 at 9.

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Conclusion

On July 30, 2025, Petitioner filed her subsequently-approved application to reassign Medicare benefits.  Pursuant to 42 C.F.R. § 424.522(a) and § 424.521(a)(1), the reassignment was effective on May 31, 2025.