Larry Woods, D.O. and Dr. Larry Woods, Inc., DAB, CR6899 (2026)

DECISION

The effective date of enrollment in the Medicare program for Petitioners, Larry Woods, D.O. (Dr. Woods) and Dr. Larry Woods, Inc. (the practice), is October 1, 2025, with a retrospective billing period starting on September 1, 2025.

I.  Background and Procedural History

On February 13, 2026, Petitioners requested a hearing before an administrative law judge seeking an earlier effective date of enrollment in the Medicare program.  On March 2, 2026, the Civil Remedies Division acknowledged receipt of the hearing request and issued my Standing Order and the Civil Remedies Division Procedures (CRDP).  On April 6, 2026, the Centers for Medicare & Medicaid Services (CMS) filed a brief/motion

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for summary judgment and seven proposed exhibits.  Petitioner did not file a prehearing exchange.

II.  Admission of Evidence

Absent objection, I admit CMS’s proposed exhibits into the record.  See Standing Order ¶ 10; CRDP § 14(e).

III.  Decision on the Written Record

I directed the parties to submit written direct testimony for any witnesses they wanted to offer.  Standing Order ¶ 11; see also CRDP § 16(b).  I also informed the parties as follows:

If the parties either do not file any written direct testimony or the parties do not request to cross-examine any of the witnesses from whom written direct testimony has been submitted, I will consider such actions by the parties to serve as a constructive request for a decision on the written record because there will be no reason to hold an in-person hearing.

Standing Order ¶ 7(g)(iii); see also CRDP § 19(d).  I further advised:  “Unless a hearing is required for cross-examination of a witness or witnesses, the record will be closed and the case will be ready for a decision after all the submission deadlines have passed.”  Standing Order ¶ 14.

Neither party submitted written direct testimony from any witnesses and all submission deadlines have passed.  Therefore, I decide this case on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 11-12 (2022); CRDP § 19(d).

IV.  Issue

Whether CMS assigned the correct effective date for Petitioners’ Medicare enrollment and billing privileges.1

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V.  Jurisdiction

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

VI.  Findings of Fact

1. On October 1, 2025, CMS received an application for Dr. Woods to enroll in the Medicare program as a physician.  CMS Ex. 2.
2. On October 6, 2025, CMS received an application for the practice to enroll in the Medicare program as a Clinic/Group Practice.  CMS Ex. 4.
3. On October 15, 2025, a Medicare Administrative Contractor, acting on CMS’s behalf, issued an initial determination approving the enrollment applications for Dr. Woods and the practice.  The initial determination indicated that the effective date of enrollment for each of the Petitioners was September 1, 2025.  CMS Ex. 5 at 1.
4. On or about October 24, 2025, Petitioners requested reconsideration.  CMS Exs. 6-7.  Petitioners requested an August 1, 2025, effective date of enrollment.  CMS Ex. 6.
5. On December 9, 2025, the Medicare Administrative Contractor issued an unfavorable reconsidered determination.  CMS Ex. 1.  The reconsidered determination clarified that Petitioners’ effective date of enrollment was October 1, 2025, and the period of retrospective billing privileges began on September 1, 2025.  CMS Ex. 1 at 3.

VII.  Conclusions of Law and Analysis

1. The effective date for Medicare enrollment for Dr. Woods and the practice, as a physician and a physician organization respectively, is October 1, 2025, and their retrospective billing period commenced on September 1, 2025.

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 or other practitioner, a facility, or other entity (other than a provider of services) 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 U.S.C. §§ 1395n(a), 1395u(h)(1); 42 C.F.R. § 424.505.  The term “Enroll/Enrollment means the process that Medicare uses to establish eligibility to submit claims for Medicare-covered items and services, and the process that Medicare uses to

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establish eligibility to order or certify Medicare-covered items and services.”  42 C.F.R. § 424.502.  To enroll, the supplier must submit an enrollment application and provide all required information.  42 C.F.R. § 424.510(a).

When CMS enrolls physicians and physician organizations, 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), (iii).  The “date of filing” is the date that the CMS contractor receives an enrollment application that the 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 physicians and physician organizations, 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), (iii).

In this case, Petitioners argue that August 1, 2025, should be the effective date because that is the date on which Petitioners began providing services at a location in Sharon, Pennsylvania.  Hr’g Req.; CMS Ex. 6.  However, the effective date for Medicare billing privileges for a physician and a physician organization is the “later” of the date on which CMS receives an enrollment application that can be processed to approval or the date on which the physician/physician organization begins furnishing services at a new practice location.  42 C.F.R. § 424.520(d)(1), (2)(i), (iii).  In this case, Petitioners’ enrollment applications were filed and received by CMS after the date on which Petitioners began to furnish services at their new practice location.  Therefore, CMS properly set October 1, 2025, as the effective date for Medicare billing privileges rather than August 1, 2025,2  and set September 1, 2025, as the beginning of the retrospective billing period.  42 C.F.R. § 424.521(a)(1)(i), (2)(i), (iii).

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VIII.  Conclusion

The effective date for Petitioners’ Medicare enrollment is October 1, 2025, and the effective date for their retrospective billing period is September 1, 2025.