Florida Atlantic University, DAB CR6853 (2026)

DECISION

I affirm the June 14, 2024 effective date of enrollment in the Medicare program for Petitioner’s Federally Qualified Health Center (FQHC) location at 720 8th Street, West Palm Beach, Florida (8th Street Location).

I.  Procedural History

On January 24, 2025, Petitioner filed a request for hearing to dispute the effective date of Medicare enrollment for Petitioner’s FQHC 8th Street Location.  On January 27, 2025, 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 March 10, 2025, the Centers for Medicare & Medicaid Services (CMS) filed a brief/motion for summary judgment (CMS Br.) and 14 proposed exhibits.  On April 11, 2025, Petitioner filed a brief/cross-motion for summary judgment (P. Br.) and four proposed exhibits.  On April 23, 2025, CMS filed a reply brief (CMS Reply).  On December 30, 2025, the Civil Remedies Division transferred this case to me for adjudication.

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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 and Petitioner Exhibit 2.

CMS objected to Petitioner Exhibits 1, 3, and 4 as redundant exhibits to the ones submitted by CMS.  CMS Reply at 4-5.  CMS is correct that Petitioner should not have submitted proposed exhibits that another party already submitted.  Standing Order ¶ 5(e)(iii); CRDP § 14(a).  Therefore, I sustain the objection and exclude Petitioner Exhibits 1, 3 and 4 from the 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); CRDP § 16(a).  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).

III.  Issue

Whether June 14, 2024, is the correct effective date for enrollment of Petitioner’s 8th Street Location as a FQHC.

IV.  Jurisdiction

I have jurisdiction to decide the issue in this case.  42 C.F.R. § 498.3(b)(15); see also 42 C.F.R. § 405.2430(c).

V.  Findings of Fact

1. Petitioner was enrolled in the Medicare program as a FQHC effective July 15, 2021, at the following location:  1650 Osceola Drive, West Palm Beach, Florida (Osceola Drive Location).  CMS Ex. 11 at 1.
2. On January 10, 2024, a CMS contractor received an enrollment application (CMS-855A) from Petitioner to enroll its 8th Street Location in the Medicare program as a FQHC location.  CMS Ex. 12.  Petitioner noted on the enrollment application

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that it was enrolled in Medicare Part B and as a FQHC, but Petitioner wanted to enroll a second location (i.e., the 8th Street Location) as part of the FQHC in addition to its Osceola Drive Location.  CMS Ex. 12 at 7, 8.  Petitioner indicated that the CMS contractor erred when it failed to enroll the 8th Street Location at the time it enrolled the Osceola Drive Location in July 2021.  CMS Ex. 12 at 7-8, 13.

3. In a January 31, 2024 letter, the CMS contractor requested that Petitioner provide a variety of necessary information missing from the enrollment application.  CMS Ex. 13 at 1-2.  The CMS contractor stated that it may reject the enrollment application if Petitioner did not provide the requested information within 30 days.  CMS Ex. 13 at 1.
4. In a March 5, 2024 letter, the CMS contractor rejected Petitioner’s enrollment application because Petitioner did not provide the information that the contractor requested.  CMS Ex. 14.
5. On April 8, 2024, a CMS contractor received an enrollment application (CMS-855A) from Petitioner to enroll its 8th Street Location in the Medicare program.  CMS Ex. 4 at 174.  Petitioner noted on the enrollment application that it was enrolled in Medicare Part B and as a FQHC, but Petitioner wanted to enroll a second location (i.e., the 8th Street Location) as part of the FQHC in addition to its Osceola Drive Location.  CMS Ex. 4 at 18.  Petitioner indicated that the CMS contractor erred when it failed to enroll the 8th Street Location when it enrolled the Osceola Drive Location.  CMS Ex. 4 at 18, 20, 30, 150.
6. In a May 2, 2024 letter, the CMS contractor stated that Petitioner failed to provide payment for the enrollment fee and that it had 30 days to make payment.  CMS Ex. 5 at 1.
7. On June 14, 2024, a CMS official accepted an Attestation Statement for Federally Qualified Health Center (Attestation) for Petitioner’s 8th Street Location.  Petitioner signed the Attestation on April 1, 2024.  CMS Ex. 6.
8. In a July 24, 2024 notice, the CMS contractor informed Petitioner that the effective date for enrollment of the 8th Street Location was June 14, 2024.  CMS Ex. 2 at 1.
9. Petitioner requested reconsideration seeking an earlier effective date of enrollment for the 8th Street Location based on its enrollment application for the Osceola Drive Location.  CMS Ex. 1 at 2.  The December 11, 2024 reconsidered determination upheld the June 14, 2024, effective date for enrollment because that is the date on which CMS accepted the Attestation.  CMS Ex. 1 at 2-3.

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VI.  Conclusion of Law and Analysis

1. The effective date for enrollment as a FQHC is “the date on which CMS accepts a signed agreement which assures that the . . . FQHC meets all Federal requirements.”  42 C.F.R. §§ 424.520(a), 489.13.  In the present case, June 14, 2024, is the date on which CMS accepted Petitioner’s Attestation; therefore, that is the effective date of enrollment for the 8th Street Location.

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).  The Act sets requirements that an entity must meet to qualify as a FQHC, and the Act delineates the types of services that FQHCs provide.  42 U.S.C. § 1395x(aa)(3)-(4); see also 42 C.F.R. § 405.2401(b) (definition of “Federally qualified health center”).

When an entity wants to participate in the Medicare program as a FQHC, the entity must receive approval from the Health Resources and Services Administration (HRSA), assure CMS that it meets the requirements specified in 42 C.F.R. Part 491, and terminate other provider agreements or make certain assurances concerning the use of its staff and space.  42 C.F.R § 405.2430(a).  If the entity meets these requirements, CMS will enter into an agreement with the entity, and CMS will specify the effective date in a notice stating that it has accepted the agreement.  42 C.F.R. § 405.2430(a)(1), (3), (4).  The effective date of the agreement “is the date on which CMS accepts a signed agreement which assures that the . . . FQHC meets all Federal requirements.”  42 C.F.R. §§ 405.2434(b), 489.13(a)(2)(i).  This is also the effective date of enrollment/Medicare billing privileges.  42 C.F.R. § 424.520(a).

In the present case, the record shows that CMS approved the Attestation for the 8th Street Location on June 14, 2024, and set the effective date of enrollment as June 14, 2024.  CMS Exs. 2, 6.  This is the correct effective date.

Petitioner asserts that the 8th Street Location ought to have the same effective date as its Osceola Drive Location because Petitioner applied for both locations at the same time in 2021.  Petitioner states that CMS contractor personnel told Petitioner that both locations would have the same effective date.  However, later, Petitioner learned that the Medicare program was not going to pay Petitioner for services rendered at the 8th Street Location.  P. Br. at 1, 3-4.  In 2024, CMS contractor personnel allegedly told Petitioner to submit a new enrollment application.  P. Br. at 2.

The record reflects that Petitioner filed an enrollment application in 2021 that included both the Osceola Drive and 8th Street Locations.  CMS Ex. 7 at 24-25.  Further, in April

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2021, Petitioner secured HRSA approval for both locations.  P. Ex. 2 at 2.  However, in a July 7, 2021 notice, the CMS contractor informed Petitioner of the following:

Please remove the Medicare ID listed and provide only one location in the Practice Location section 4A of your application.  Any additional locations would need to be submitted as a separate initial enrollment request.

CMS Ex. 8 at 2.  Petitioner complied with this request.  CMS Ex. 9 (emphasis added).

On July 15, 2021, CMS accepted Petitioner’s Attestation for the Osceola Drive Location.  CMS Ex. 10.  In a July 30, 2021 notice, the CMS contractor informed Petitioner that it was enrolled in the Medicare program effective July 15, 2021, at its Osceola Drive Location.  CMS Ex. 11 at 1.

The CMS contractor’s action to limit Petitioner’s enrollment application to a single location was consistent with the regulations.  If a FQHC’s “services are furnished at permanent units in more than one location, each unit is independently considered for approval . . . as an FQHC.”  42 C.F.R. § 491.5(a)(3)(iii).

Petitioner’s argument, which is contrary to the record and regulations summarized above, is based solely on alleged conversations with CMS contractor staff.  Petitioner provided no evidence to support the existence of these conversations, such as a witness.  However, even if Petitioner had, I could not override the regulations based on equitable estoppel.  Fam. Health Servs. of Darke Cnty., Inc., DAB No. 2269 at 18-20 (2009).

VII.  Conclusion

I affirm CMS’s determination that the effective date for enrollment of Petitioner’s 8th Street Location as a FQHC location is June 14, 2024.