Medpro Urgent Care Center, Inc., DAB CR6861 (2026)

DECISION

The Centers for Medicare & Medicaid Services (CMS), through a Medicare administrative contractor, revoked the Medicare enrollment and billing privileges of Medpro Urgent Care Center, Inc. (Petitioner or Medpro) pursuant to 42 C.F.R. § 424.535(a)(1) based on Petitioner’s failure to comply with CMS’s fingerprint-based background check.  42 C.F.R. § 424.518(d).  Because Petitioner failed to file the required fingerprints, I affirm that CMS had a legal basis to revoke Petitioner’s Medicare enrollment and billing privileges.

Background

Prior to the revocation, Petitioner participated in the Medicare program as a supplier of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).  Petitioner is located in Fort Lauderdale, Florida.  CMS Ex. 3 at 1.  On March 5, 2024, Petitioner submitted a Medicare enrollment application to revalidate its Medicare enrollment and billing privileges.  CMS Ex. 3.  In Petitioner’s application, Petitioner listed Aneta Dadasheva (AD), as a five percent (5%) or greater owner of Medpro.  CMS Ex. 3 at 5.

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In a letter, dated January 30, 2025, a Medicare contractor, Novitas Solutions (Novitas), informed Petitioner that AD, as a five percent or more owner of Medpro, was required to complete a fingerprint-based background check within 30 calendar days of the postmark on the letter.  CMS Ex. 4.  Novitas instructed Petitioner to contact Accurate Biometrics, a CMS-approved company, to coordinate its fingerprint background check.  Id.  Petitioner did not comply.

In a revocation notice, dated April 10, 2025, Novitas informed Petitioner that it has revoked its Medicare privileges, effective May 10, 2025.  CMS Ex. 5.  The notice stated the revocation was due to Petitioner’s failure to comply with the Medicare requirement to complete fingerprint-based background checks on all five percent or higher owners within 30 days of filing a Medicare application.  CMS Ex. 5; 42 C.F.R. § 424.535(a)(1); 42 C.F.R. § 424.518(d).

In response to the revocation letter, Petitioner sent an April 15, 2025 email with a copy of AD’s background screening results from Florida’s Agency of Health Care Administration (AHCA) and stated that Medpro is in “complete compliance and up to date” with the “fingerprint-based background check.”  CMS Ex. 6 at 1.

Petitioner requested reconsideration.  The reconsidered determination, dated August 1, 2025, affirmed the revocation, noting that Petitioner failed to comply with filing the fingerprints of its owner.

Petitioner appealed the reconsidered determination, and the matter is now before me.

Decision based on the written record.  CMS moved for summary judgment.  The standing order1 directed the parties to list all proposed witnesses when they filed their briefs.  Standing Order at 3-4 (August 18, 2025).  Neither party offered any witnesses. Because there are no witnesses, an in-person hearing would serve no purpose, and I may decide this case based on the written record, without considering whether the standards for summary judgment have been met.2

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CMS filed its prehearing brief and motion for summary judgment (CMS Br.) with six exhibits (CMS Exs. 1-6).  Petitioner filed its prehearing brief (P. Br.) and four proposed exhibits (P. Exs. 1-4).

CMS exhibits.  In the absence of objections, I admit into evidence CMS Exs. 1-6.

Petitioner’s exhibits. All four of Petitioner’s proposed exhibits were not submitted at the reconsideration level:

• P. Ex. 1:  a copy of Accurate Biometrics fingerprint check containing AD’s fingerprints, an August 14, 2025 Plantation Police Department signed affidavit, and an August 1, 2025 consent form signed by AD.  P. Br.; P. Ex. Att.; CRD Dkt. Entry No. 1c;
• P. Ex. 2:  confirmation of submission for a national background check (referencing the Florida background check).  P. Br.; P. Ex. Att.; CMS Ex. 6;
• P. Ex. 3:  an acknowledgement correspondence confirming receipt of fingerprint processing (referencing the standard acknowledgment letter sent out by the Civil Remedies Division after receiving the request for hearing).  P. Br.; P. Ex. Att.; CRD Dkt. Entry No. 2; and
• P. Ex. 4:  Petitioner’s timeline of events.

Although CMS has not objected to my admitting the documents, I am required to examine any new documentary evidence to determine whether the supplier has good cause for submitting it for the first time at the ALJ level of review.  If I find that good cause does not exist, I must exclude the evidence and may not consider it in reaching a decision.  42 C.F.R. § 498.56(e); see 42 C.F.R. § 405.803(e).

Petitioner was, or should have been, aware of this requirement, as it uploaded the revocation notice letter which explained it.  In its April 10, 2025 notice letter, advising Petitioner of its right to request reconsideration, Novitas warned:

[I]f you have additional information that you would like a Hearing Officer to consider during the reconsideration or, if necessary, an Administrative Law Judge (ALJ) to consider during a hearing, you must submit that information with your request for reconsideration. This is your only opportunity to submit information during the administrative appeals process unless an ALJ allows additional information to be submitted.

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CMS Ex. 5 at 4.

In the standing order, Petitioner was once again advised of the good cause requirement:

Petitioner may not offer new documentary evidence absent a showing of good cause for failing to present that evidence previously to CMS. 42 C.F.R. §§ 405.803(e), 498.56(e). If Petitioner offers new evidence, the evidence must be specifically identified as new and Petitioner must explain, in a separate filing from its brief, why good cause exists for its submission. Petitioner must file the request when it files its prehearing exchange.

Standing Order at 6 (¶ 7).  Petitioner refers to its Exhibits 1-3 as being “previously submitted and are reflected in CMS’s eDAB system” and that all of its exhibits demonstrate its “good-faith compliance with the fingerprinting requirements.”  P. Ex. Att. at 2.

Petitioner filed its exhibit 1 (CRD Dkt. Entry No. 1c) without providing good cause.  However, the fingerprints and the attached application are dated August 1 and August 14, 2025.  CRD Dkt. Entry No. 1c.  Petitioner’s billing privileges were revoked in a letter dated April 10, 2025 and the reconsideration determination was dated August 1, 2025.  As a result, the fingerprints and attached application were not available at the time Petitioner filed its reconsideration request.  Therefore, I find good cause for Petitioner not submitting the documents earlier and CRD Dkt. Entry No. 1c is admitted into evidence as P. Ex. 1.

I decline to admit P. Exs. 2-3, as they are duplications of CRD Dkt. Entry Nos. 2, 2a and CMS. Ex. 6.

Finally, I find good cause to admit P. Ex. 4 as a continuation of the arguments made in Petitioner’s brief.  Therefore, I admit into evidence P. Ex. 4.

Discussion

1. CMS had a legal basis to revoke Petitioner’s Medicare enrollment and billing privileges because Petitioner did not comply with filing evidence of its owner’s fingerprint-based background check. 

Requirements for a DMEPOS supplier’s Medicare participation.  The Social Security Act (Act) authorizes the Secretary of Health and Human Services (Secretary) to establish regulations for enrolling providers and suppliers in the Medicare program and requirements for DMEPOS suppliers to obtain a supplier number.  42 U.S.C. §§ 1395m(j)(1)(B), 1395cc(j)(1)(A).  DMEPOS suppliers must enroll in the Medicare program and receive a supplier number to obtain payment for items and services provided

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to Medicare beneficiaries.  42 U.S.C. § 1395m(j)(1)(A); 42 C.F.R. §§ 424.57(b)-(c), 424.505.

The Act required the Secretary to “establish procedures under which screening is conducted with respect to providers of medical or other items or services and suppliers under the [Medicare] program. . . .”  42 U.S.C. § 1395cc(j)(2)(A).  Relevant to this case, are orthoses, wheelchairs and accessories, and walkers.  42 U.S.C. § 1395x(s)(8); see also 42 C.F.R. §§ 410.36(a)(1), 410.38.  As part of the screening procedures mandated by the Act, the Secretary must determine the level of screening to be conducted according to the risk of fraud, waste, and abuse.  42 U.S.C. § 1395cc(j)(2)(B).  The Act stated that screening may include “a criminal background check” and “fingerprinting.”  42 U.S.C. § 1395cc(j)(2)(B)(ii)(I)-(II).

The Secretary promulgated regulations for the enrollment and screening of suppliers.  See 42 C.F.R. §§ 424.57, 424.510-424.535.  Those regulations designate DMEPOS suppliers as high‑risk to the Medicare program.  42 C.F.R. § 424.518(c)(1)(ii).  Suppliers in the high-risk category must submit “a set of fingerprints for a national background check from all individuals who maintain a 5 percent or greater direct or indirect ownership interest in the . . . supplier” so that a criminal history record check may be made.  42 C.F.R. § 424.518(c)(2)(ii).  An individual subject to a fingerprint-based background check must submit the fingerprints either with the enrollment application or within 30 days of a CMS contractor’s request for the fingerprints.  42 C.F.R. § 424.518(d)(1).  The CMS contractor may revoke an enrollment application if fingerprints are not submitted in accordance with the regulations.  42 C.F.R. §§ 424.518(d)(2)(ii), 424.535(a)(1).

In a notice dated January 30, 2025, Novitas instructed Petitioner to complete fingerprinting background check within 30 calendar days.  AD was specifically listed as being required to submit fingerprints.  The notice stated Petitioner was required to contact Accurate Biometrics to arrange the fingerprinting check.  It also warned Petitioner that a failure to submit its owner’s fingerprints would result in a denial of its Medicare billing privileges.  CMS Ex. 4.

In its request for hearing, Petitioner acknowledges receipt of the January 30, 2025 notice and accepts responsibility for the failure to properly file its owner’s fingerprints with CMS.  P. RFH at 1.  Petitioner believed it was complaint with CMS’s fingerprinting check because it verified that its fingerprinting with Florida’s Agency for Health Care Administration (ACHA) was up to date and valid.  P. RFH; CMS Ex. 6.  As part of its reconsideration submission, Petitioner submitted a screenshot of what appears to be AD’s background check conducted by ACHA as proof of its compliance.  CMS Ex. 6.  After reviewing CMS’s revocation notice, Petitioner acknowledged in its request for hearing, “I now fully understand that CMS requires fingerprints to be submitted through its own designed process, independent of ACHA screenings.”  P. RFH at 1.  Although Petitioner takes accountability for its misunderstanding of the Medicare regulations, Petitioner still

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requests a reversal of its revocation and a reinstatement of its Medicare enrollment and billing privileges.  P. RFH; P. Br.

I acknowledge that Petitioner may have made a good faith effort by submitting what it mistakably thought met the requirements when it filed the ACHA fingerprints.  As I can sympathize with Petitioner’s confusion with the revalidation process, there is still an onus on the Medicare supplier to know the Medicare requirements of the program it is participating in.  Petitioner’s misunderstanding of the Medicare process is not a defense.  See Brenda Lee Jackson, DAB No. 2903 at 10-11 (2018); Heckler v. Cmty. Health Servs. of Crawford Cnty., Inc., 467 U.S. 51, 63 (1984).

After the 30-day period to complete the fingerprint check lapsed, Petitioner no longer met the Medicare enrollment requirements for a DMEPOS supplier.  42 C.F.R. § 424.535(a)(1).  Petitioner had an opportunity to ask for clarification and/or assistance during the 30-day window Novitas provided in its January 30, 2025 letter.  Petitioner had many opportunities to comply with CMS’s request for fingerprints.  The fact remains, at the time of its revalidation, at the time it received a notice letter, and at the time of the revocation, Petitioner did not comply with CMS’s request to complete the owner’s fingerprint background check.  This undisputed fact justifies CMS’s action to revoke Petitioner’s Medicare enrollment and billing privileges.

I will now focus on Petitioner’s request for a reinstatement of its Medicare enrollment and billing privileges.

2. I have no authority to review the reenrollment of Petitioner’s billing privileges and cannot afford it equitable relief.

In its request for hearing, Petitioner stated that it “acknowledge[s] and accept[s] responsibility for the oversight that led to this action.”  P. RFH at 1.  Petitioner states that it wishes to provide uninterrupted services to Medicare patients.  P. RFH.  Petitioner’s submission of its timeline of events was provided to “clarify the sequence of events and demonstrate Petitioner’s good-faith compliance with the fingerprinting requirements” and “in support of Petitioner’s request for reinstatement of Medpro’s Medicare enrollment and billing privileges.”  P. Ex. Att. at 2.

I recognize that Petitioner does not want to incur a gap in its Medicare billing privileges, however, Petitioner’s request and arguments can only be construed as requests for equitable relief.  But I have no authority to grant equitable relief.  U.S. Ultrasound, DAB No. 2302 at 8 (2010).  I may not use equitable principles to ignore or override regulatory requirements.  Petitioner’s requests that I consider its good faith efforts and reinstate its Medicare enrollment and billing privileges are out of my purview.  I can only determine whether the revocation was legitimate under the law and facts, i.e., whether there is a

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legal basis for the revocation.  See Letantia Bussell, M.D., DAB No. 2196 at 12-13 (2008); Neb Group of Arizona LLC, DAB No. 2573 at 5-6 (2014). 

Thus, Petitioner’s presumed good-faith and eagerness to serve its community do not rebut its failure to comply with Novitas’ fingerprinting request and cannot provide a basis for a finding that CMS acted outside of its legal right when reaching its determination to revoke Petitioner’s Medicare privileges.

I. Conclusion

For the foregoing reasons, I conclude that CMS had a legal basis to revoke Petitioner’s Medicare enrollment and billing privileges.  42 C.F.R. § 424.535(a)(1).