Allyshah Allahdina, M.D., DAB CR6845 (2026)

DECISION

I affirm the determination of the Centers for Medicare & Medicaid Services (CMS) that the effective date of enrollment in the Medicare program for Petitioner, Allyshah Allahdina, M.D., is January 19, 2024, with a retrospective billing period starting December 20, 2023.  I also conclude that the effective date for Petitioner’s reassignment of Medicare benefits to Glaucoma Consultants of Washington, Inc. (Glaucoma Consultants) is December 20, 2023.

I. Background and Procedural History

On June 29, 2024, Petitioner requested a hearing before an administrative law judge seeking an earlier effective date of enrollment in the Medicare program and reassignment of Medicare benefits to Glaucoma Consultants.

On July 8, 2024, the Civil Remedies Division acknowledged receipt of the hearing request, assigned an administrative law judge (ALJ) to this case, and issued that ALJ’s Standing Order and the Civil Remedies Division Procedures (CRDP).  On August 8, 2024, CMS filed a brief/motion for summary judgment (CMS Br.) and 12 proposed

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exhibits.  On August 9, 2024, Petitioner filed a brief (P. Br.), which included a copy of an October 3, 2023 email from CMS.  P. Br. at 2-3.  On August 9, 2024, CMS filed a reply brief (CMS Reply), and on August 20, 2024, Petitioner filed a sur-reply (P. Sur-Reply).  On December 30, 2025, the Civil Remedies Division transferred this case to me for adjudication.

II. Admission of Evidence

Absent objection, I admit CMS’s proposed exhibits.

I exclude the October 3, 2023 email submitted with Petitioner’s brief.  P. Br. at 2-3.  The email is not properly marked as an exhibit and Petitioner filed no exhibit list, making this document subject to exclusion.  Standing Order ¶¶ 5(e)(ii), (6); CRDP §§ 13(a)(i)-(ii), 14(b)-(d).  Further, Petitioner did not provide a statement of good cause why Petitioner did not file this document with the reconsideration request.  The letter approving Petitioner’s enrollment and reassignment applications stated that evidence needed to be filed with the reconsideration request if it was to be considered by an ALJ, and the Standing Order explained that Petitioner would need to provide a statement of good cause for any newly submitted documentary evidence.  CMS Ex. 10 at 2; Standing Order ¶ 7.  Therefore, I exclude the October 3, 2023 email from the record.  42 C.F.R. § 498.56(e).

III. Decision on the Written Record

The previously assigned ALJ directed the parties to submit a list of witnesses along with a summary of the witness’s expected testimony.  Standing Order ¶ 5(e)(iv).  Further, the previously assigned ALJ permitted the parties to submit affidavits or declarations from witnesses in lieu of oral testimony.  Standing Order ¶ 5(e)(v).  Finally, the previously assigned ALJ informed the parties that, “[u]nless a hearing is required, the record will be closed and the case will be ready for a decision after all the deadlines have passed.”  Standing Order ¶ 14.

Neither party submitted a witness list or affidavits/declarations in lieu of testimony, and all submission deadlines have passed.  Therefore, I decide this case based on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 11-12 (2022); CRDP § 19(d).

IV. Issue

Whether CMS established the correct effective date for Petitioner’s enrollment in the Medicare program and reassignment of Medicare benefits to Glaucoma Consultants.

V. Jurisdiction

I have jurisdiction to decide the issue in this case.  42 C.F.R. § 498.3(b)(15).

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VI. Findings of Fact

1. Petitioner electronically submitted to CMS a CMS-855I Medicare initial enrollment application and a CMS-855R reassignment of benefits application on September 18, 2023.  CMS Ex. 1.
2. Palmetto GBA (Palmetto), a Medicare Administrative Contractor (MAC), returned the applications to Petitioner on October 2, 2023, because the practice location listed on the application was within a jurisdiction covered by Novitas Solutions, another MAC.  CMS Ex. 2.
3. On October 3, 2023, Petitioner electronically resubmitted CMS-855I and CMS-855R applications to CMS with an updated practice location in Winchester, Virginia.  CMS Ex. 3.
4. On October 17, 2023, Palmetto notified Petitioner that the CMS-855R application was incomplete because it did not include an authorized official’s signature.  CMS Ex. 4; see also CMS Ex. 3 at 2.  Citing 42 C.F.R. § 424.525, Palmetto advised that Petitioner had 30 days to correct the application with the authorized official’s signature or else Palmetto may reject Petitioner’s applications.  CMS Ex. 4.
5. On November 17, 2023, Palmetto rejected Petitioner’s applications because Petitioner did not provide the required signature within 30 days.  CMS Ex. 5 at 1.
6. On November 27, 2023, Petitioner electronically submitted a new CMS-855I application to CMS.  CMS Ex. 6.
7. On December 6, 2023, Palmetto notified Petitioner that it had not received a CMS-855R application form Petitioner.  Citing 42 C.F.R. § 424.525, Palmetto advised that Petitioner had 30 days to submit the CMS-855R or else Palmetto may reject the CMS-855I application.  CMS Ex. 7.
8. On January 10, 2024, Palmetto rejected Petitioner’s CMS-855I application because Petitioner did not submit a CMS-855R application.  CMS Ex. 8 at 1.
9. On January 19, 2024, Petitioner electronically submitted CMS-855I and CMS-855R applications to CMS.  CMS Ex. 9.  Palmetto received the applications on January 19, 2024.  CMS Ex. 9 at 1.
10. On February 2, 2024, Palmetto approved Petitioner’s enrollment and reassignment applications with an effective date of December 20, 2023.  CMS Ex. 10 at 1.

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11. On February 27, 2024, Petitioner submitted a reconsideration request to CMS seeking an earlier effective date.  CMS Ex. 11.
12. On May 1, 2024, the CMS contractor issued a reconsidered determination stating that December 20, 2023, is the correct effective date for Petitioner’s enrollment and the reassignment of Medicare benefits.  The reconsidered determination also stated that Petitioner’s previously filed and rejected applications could not serve as the basis for assigning an earlier effective date.  CMS Ex. 12 at 4.

VII. Conclusions of Law and Analysis

1. The effective date for Petitioner’s enrollment in the Medicare program as a physician is January 19, 2024, and Petitioner’s retrospective billing period commenced on December 20, 2023.

The Social Security Act (Act) authorizes the Secretary of Health and Human Services (Secretary) to promulgate regulations governing the enrollment process for providers and suppliers.  42 U.S.C. §§ 1302, 1395cc(j).  A “supplier” includes “a physician . . . that furnishes items or services” under the Medicare provisions of the Act.  42 U.S.C. § 1395x(d).  A supplier must enroll in the Medicare program to receive payment for covered items or services.  42 C.F.R. § 424.505.  To enroll, the supplier must submit an enrollment application and provide all required information.  42 C.F.R. § 424.510(a).

When CMS enrolls as a physician, CMS sets an effective date for billing privileges that is the later of the “date of filing” or the date the supplier began furnishing services at a new practice location.  42 C.F.R. § 424.520(d)(1), (2)(i).  The “date of filing” is the date that the Medicare contractor receives an enrollment application that the Medicare contractor processes to approval.  73 Fed. Reg. 69,726, 69,769 (Nov. 19, 2008); Donald Dolce, M.D., DAB No. 2685 at 8 (2016).

When CMS assigns an effective date for a physician, CMS may permit a retrospective billing period of up to 30 days, except in circumstances not applicable to this case.  42 C.F.R. § 424.521(a)(1)(i), (2)(i).

In this case, Petitioner primarily argues for an earlier effective date based on the enrollment and reassignment applications that Palmetto returned/rejected.  Petitioner alleges timely compliance with the requests from Palmetto.  Hr’g Req. at 2.  Petitioner also asserts that Palmetto personnel assured Petitioner of an earlier effective date.  Hr’g Req. at 1.  Petitioner further asserts that CMS indicated, in an October 2023 email, that Petitioner’s applications were complete and met all requirements for processing.  P. Br. at 1.  Finally, Petitioner appears to request that CMS process one of Petitioner’s earlier CMS-855I applications for enrollment separately from the CMS-855R application so that

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Petitioner may bill Medicare individually for services Petitioner provided to beneficiaries.  P. Sur-Reply at 1.

There are no exceptions to the requirement that the effective date for a physician’s enrollment in the Medicare program is the date that CMS receives an enrollment application that CMS processes to approval.  CMS only processed Petitioner’s applications received on January 19, 2024, to approval.  In addition, CMS, through Palmetto, formally returned/rejected all of the previously filed applications.  The decision to return or reject an application is not subject to appeal; therefore, I cannot consider whether those applications were properly returned or rejected.  42 C.F.R. §§ 424.525(d), 424.526(b).  My role in this case is limited to determining whether CMS assigned Petitioner the correct effective date.  See 42 C.F.R. § 498.3(b)(15).

CMS received an enrollment application from Petitioner on January 19, 2024, which CMS processed to approval; therefore, January 19, 2024, is the effective date of Petitioner’s enrollment in the Medicare program.  42 C.F.R. § 424.520(d)(1)(i).  CMS provided Petitioner with a 30-day period of retrospective billing privileges, i.e., from December 20, 2023, which is the longest period CMS could provide.  42 C.F.R. § 424.521(a)(1)(i).

2. The effective date for Petitioner’s reassignment of Medicare benefits to Glaucoma Consultants is December 20, 2023.

The Act permits beneficiaries to assign their Medicare benefits to an enrolled physician or non-physician supplier.  42 U.S.C. § 1395u(b)(3)(B)(ii).  In certain circumstances, a supplier who has received an assignment of benefits may reassign those benefits to an employer, individual, or entity with which the supplier has a contractual arrangement.  42 U.S.C. § 1395u(b)(6); 42 C.F.R. § 424.80(b)(1)-(2).  When CMS approves the reassignment of Medicare benefits, the reassignment “is effective beginning 30 days before the [reassignment application] is submitted if all applicable requirements during that period were otherwise met.”1  42 C.F.R. § 424.522(a) (2023).

On January 19, 2024, CMS received Petitioner’s application to reassign Medicare benefits to Glaucoma Consultants.  Therefore, the reassignment is effective December 20, 2023.

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VIII. Conclusion

The effective date for Petitioner’s enrollment in the Medicare program as a physician/supplier is January 19, 2024.  Petitioner’s retrospective billing period commenced on December 20, 2023.  The effective date of Petitioner’s reassignment of Medicare benefits to Glaucoma Consultants is December 20, 2023.