Vandalia Physical Therapy, Ltd., DAB CR6875 (2026)

DECISION

Petitioner, Vandalia Physical Therapy, Ltd., is a physical/occupational therapy practice, located in Vandalia, Illinois, that participated in the Medicare program as a supplier of services.  The Centers for Medicare & Medicaid Services (CMS) has revoked its Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(9) because the practice did not timely report its change of ownership.  CMS has also imposed a three-year reenrollment bar.

Petitioner appeals the revocation.

I find that, pursuant to 42 C.F.R. § 424.535(a)(9), CMS appropriately revoked Petitioner Vandalia’s Medicare enrollment because the practice did not timely notify the contractor that its ownership had changed.  I have no authority to review the length of the reenrollment bar.

Background

By letter dated August 7, 2025, the Medicare contractor, National Government Services, advised Petitioner Vandalia that it revoked the practice’s Medicare enrollment, effective

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September 6, 2025.  The letter explains that the contractor revoked the Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(9) because, although the practice had changed ownership, Petitioner did not, within 30 calendar days, notify CMS of a “change of information” as required by 42 C.F.R. § 424.516.  CMS Ex. 37 at 1.  The contractor also imposed a three-year enrollment bar, effective 30 days from the postmark date of the notice letter.  Id.

Petitioner requested reconsideration.  CMS Exs. 5, 24.

In a reconsidered determination, dated December 1, 2025, a provider enrollment specialist concluded that Petitioner did not, within 30 days, report a “change of ownership” by submitting the required “change of information” application (CMS Form 855).  Citing 42 C.F.R. §§ 424.535(a)(9) and 424.535(c), she affirmed the revocation.  E-file # 1a at 4-6.

Petitioner appealed.

Decision based on the written record.  CMS has moved for summary judgment.  I agree that this case turns on one undisputed fact – that Petitioner did not, within 30 days, report that the practice had changed ownership.  I also agree that CMS is entitled to judgment as a matter of law.  42 C.F.R. § 424.535(a)(9).  However, even though summary judgment is available, I am not required to decide a case on summary judgment.  Emery County Care and Rehab. Ctr., DAB No. 3006 at 6 (2020).

I find that this matter may be decided based on the written record, without considering whether the standards for summary judgment are satisfied.  In my initial order, I instructed the parties to submit a list of all proposed witnesses (if any), along with their complete written direct testimony, submitted in the form of an affidavit made under oath or as a written declaration signed under penalty of perjury.  Acknowledgment and Prehearing Order at 4, 5 (¶¶ 4.c.iv, 8) (December 8, 2025) (E-file # 2); CRDP (Civil Remedies Division Procedures) § 16(b).

CMS lists no witnesses.  Petitioner lists three witnesses but, without explanation and contrary to my order, it did not submit their written direct testimony.  CMS objected, and Petitioner did not respond to the objections.  I would therefore not have allowed these witnesses to testify at an in-person hearing.  CRDP § 16(c); see Life Care of Tullahoma, DAB No. 2304 at 25 (2010) (characterizing as “sound” the ALJ’s refusal to allow a witness to testify about matters that could have been included in a written declaration).  Because there are no witnesses to be examined or cross-examined, I decide this case based on the written record, without considering whether the standards for summary judgment are met.  See George Yaplee Medical Ctr. d/b/a Triangle Eye Institute, DAB No. 3003 at 5 (2020) (acknowledging that the Board “has long held that convening a

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hearing would be pointless, where no witness testimony is offered or all witness testimony is completed in writing and no cross-examination is sought.”).1

Submissions.  With its motion and brief (CMS Br.), CMS submitted 39 exhibits (CMS Exs. 1-39).  Petitioner submitted a response (P. Br.), with six exhibits (P. Exs. 1-6).

In the absence of any objections, I admit into evidence CMS Exs. 1-39 and P. Exs. 1-6.

Issue.  The sole issue before me is whether CMS had the authority to revoke Petitioner’s Medicare enrollment.  I have no authority to review the length of the reenrollment bar.

Discussion

1. CMS had the authority to revoke Petitioner’s Medicare enrollment because the physical/occupational therapy practice did not report timely that it had changed ownership.  42 C.F.R. § 424.535(a)(9).2

Statutory and Regulatory Background.  The Medicare program is administered by CMS, acting on behalf of the Secretary of Health and Human Services.  Among other responsibilities, CMS regulates the Medicare enrollment of providers and suppliers.  Social Security Act (Act) § 1866(j)(1)(A).  CMS contracts with Medicare administrative contractors, who pay claims to “providers” (Part A) and “suppliers” (Part B).  Act § 1842 (42 U.S.C. § 1395u).  A non-physician practice organization that furnishes healthcare services (such as Petitioner) may participate in the program as a “supplier” of services; however, it must enroll in the program in order to receive Medicare payments.  Act § 1861(d), (q), (r) (42 U.S.C. § 1395x(d), (q), (r)); 42 C.F.R. §§ 400.202, 424.505.

Section 424.535(a) authorizes CMS to revoke a supplier’s Medicare enrollment and billing privileges on one or more of the grounds set forth under that subsection.  So long as CMS shows that one of the regulatory bases exists, I must uphold the revocation.  William Garner, MD, DAB No. 3026 at 16 (2020); Eva

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Orticio Villamor-Goubeaux, DAB No. 2997 at 13 (2020); Wassim Younes, M.D. & Wassim Younes, M.D., P.L.C., DAB No. 2861 at 8 (2018) (citing Patrick Brueggeman, D.P.M., DAB No. 2725 at 15 (2016)).  Although CMS itself has the discretion to consider “unique or mitigating circumstances in deciding whether, or how, to exercise its revocation authority,” I do not.  I may not substitute my discretion for that of CMS in determining whether the revocation is appropriate.  Norman Johnson, DAB No. 2779  at 11, citing Care Pro Home Health, Inc., DAB No. 2723 at 9 n.8 (2016); Abdul Razzaque Ahmed, M.D., DAB No. 2261 at 19 (2009), aff’d., Ahmed v. Sebelius, 710 F. Supp. 2d 167 (D. Mass. 2010).

The grounds listed under section 424.535(a) include a supplier’s failing to report a change of ownership within 30 days.  42 C.F.R. § 424.535(a)(9); 42 C.F.R. § 424.516(d)(i)(i).

The change of ownership.  The following facts are not in dispute:

• In a submission dated October 31, 2023, Julie Gordon updated Petitioner’s Medicare enrollment information, listing herself as the practice’s sole owner.  CMS Ex. 38 at 1, 2, 6.
• On January 1, 2024, Mattie Carter purchased the practice from Julie Gordon.  CMS Ex. P. Exs. 3 at 9, 12; P. Ex. 6; see CMS Ex. 35 at 3.  CMS Ex. 36.
• As of August 7, 2025, when the Medicare contractor advised Petitioner that its Medicare enrollment was revoked, Petitioner had not advised the Medicare contractor of the change of ownership.  See CMS Exs. 35, 36; P. Ex. 2.

Thus, because CMS has grounds for revoking Petitioner’s Medicare enrollment under section 424.535(a)(9), I must sustain the revocation.

Petitioner concedes that it did not report the change of ownership to the Medicare contractor but asserts that its new owner relied on Seller Gordon’s representation that the required change-of-ownership process “had been completed.”  P. Br. at 1, citing P. Ex. 2.  Petitioner also points out that, as soon as it received the contractor’s revocation notice, it cured the deficiency by promptly reporting the change.  P. Br. at 2, citing P. Ex. 2.  No fraud or abuse occurred, and, in Petitioner’s view, the practice should not be barred from program participation based on an “honest misunderstanding.”  P. Br. at 2.

Petitioner’s defenses cannot change the outcome of this case.  The regulation is unambiguous:  within 30 days, non-physician practitioner organizations must report a change of ownership to their Medicare contractor.  42 C.F.R. § 424.516(d)(1)(i).

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Reporting a change a year and a half after the deadline does not satisfy the regulatory requirement.

Moreover, Petitioner may not rely on its purported ignorance to justify its failing to report.  It is long settled that those who participate in the Medicare program are responsible for knowing its rules.  See Heckler v. Cmty. Health Servs. of Crawford Cnty, 467 U.S. 51, 63 (1984); New Grove Manor, DAB No. 3090 at 15 (2023); Francis J. Cinelli, Sr., D.O., DAB No. 2834 at 10 (2017); Hartford HealthCare at Home, Inc., DAB No. 2787 at 8-9 (2017).

2. I have no authority to review CMS’s determination to impose a three-year reenrollment bar.

When a supplier’s billing privileges are revoked, it may not participate in the Medicare program until the end of its reenrollment bar, which must be for a minimum of one year but no more than ten years (except under circumstances that don’t apply here), depending on the severity of the underlying offense.  42 C.F.R. § 424.535(c)(1).  Here, CMS imposed a three-year reenrollment bar.  Because the length of a reenrollment bar is not listed as an appealable determination, I have no authority to review it.  42 C.F.R. § 498.3(b); Linda Silva, P.A., DAB No. 2966 at 11 (2019); Vijendra Dave, M.D., DAB No. 2672 at 9-12 (2016); accord, William Garner, MD, DAB No. 3026 at 16 (2020), Lilia Gorovits, MD, DAB No. 2985 at 15-16 (2020).

Conclusion

I affirm CMS’s determination.  CMS may revoke Petitioner Vandalia’s Medicare enrollment because it did not report its change of ownership within 30 days.  42 C.F.R. § 424.535(a)(9).