Cardiac Diagnostic Associate, LLC, DAB, CR6906 (2026)

DECISION

I affirm the determination of the Centers for Medicare & Medicaid Services (CMS) that the effective date for the reactivation of the Medicare billing privileges for Petitioner, Cardiac Diagnostic Associate, LLC, is September 15, 2025. 

I.  Procedural History

On February 25, 2026, Petitioner requested a hearing to dispute the reactivation effective date for its Medicare billing privileges.  On February 26, 2026, the Civil Remedies Division acknowledged receipt of Petitioner’s hearing request, provided the parties with a prehearing submission schedule, and issued my Standing Order and the Civil Remedies Division Procedures (CRDP).  On April 2, 2026, CMS filed a brief/motion for summary judgment and nine proposed exhibits.  Petitioner did not file an exchange. 

II.  Admission of Evidence

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

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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(b).  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 September 15, 2025, is the correct effective date for the reactivation of Petitioner’s Medicare billing privileges. 

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. Petitioner was enrolled in the Medicare program as a clinic/group practice.  See CMS Ex. 2 at 1.
2. In a March 31, 2025 notice, a Medicare Administrative Contractor, acting for CMS, advised Petitioner that it must revalidate the information in Petitioner’s Medicare enrollment record every five years.  The notice warned Petitioner that a failure to revalidate its enrollment information by June 30, 2025, may result in deactivation of its Medicare billing privileges.  The notice further explained that Petitioner would not be paid for services rendered during the period of deactivation and that this will “cause a gap in your reimbursement.”  CMS Ex. 1. 

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3. On July 17, 2025, CMS received a revalidation enrollment application from Petitioner.  CMS Ex. 2.
4. In a July 23, 2025 email, the Medicare Administrative Contractor requested that Petitioner correct the revalidation enrollment application.  CMS Ex. 3.  The email stated that the Medicare Administrative Contractor may reject Petitioner’s revalidation enrollment application if Petitioner failed to furnish complete information within 30 days.  CMS Ex. 3 at 2.
5. In an August 27, 2025 notice, the Medicare Administrative Contractor informed Petitioner that it rejected Petitioner’s revalidation enrollment application because the contractor had not received a response to the July 23, 2025 email request.  CMS Ex. 4 at 1.
6. In an August 28, 2025 notice, the Medicare Administrative Contractor informed Petitioner that its Medicare billing privileges were being deactivated as of July 1, 2025, “because [Petitioner has] not timely revalidated [Petitioner’s] enrollment record with us, or [Petitioner’s] revalidation application has been rejected because [Petitioner] did not timely respond to our requests for more information.  We will not pay any claims after this date.”  CMS Ex. 5 at 1.  The notice advised Petitioner that it could file a rebuttal if Petitioner believed the deactivation was incorrect.  CMS Ex. 5 at 1-2.  Finally, the notice stated that Petitioner could revalidate its Medicare enrollment record through filing an enrollment application.  CMS Ex. 5 at 2.
7. On September 15, 2025, CMS received a revalidation enrollment application from Petitioner.  CMS Ex. 6.
8. In an October 7, 2025 notice, the Medicare Administrative Contractor approved Petitioner’s enrollment application and reactivated Petitioner’s Medicare billing privileges effective September 15, 2025.  CMS Ex. 7 at 1.
9. On October 27, 2025, Petitioner requested reconsideration of the effective date for reactivation.  CMS Ex. 8.
10. On January 14, 2026, the Medicare Administrative Contractor issued an unfavorable reconsideration determination that affirmed September 14, 2025 as the reactivation effective date.  CMS Ex. 9.  The reconsidered determination concluded that “services rendered during the timeframe of July 01, 2025, through September 14, 2025, are not subject to reimbursement.”  CMS Ex. 9 at 4. 

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VII.    Conclusions of Law and Analysis

1. The effective date for reactivation of Petitioner’s Medicare billing privileges is September 15, 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 in the Medicare program.  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 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). 

To maintain enrollment, a supplier must recertify the accuracy of its enrollment information every five years.  42 C.F.R. § 424.515.  To do this, a supplier “must submit to CMS the applicable enrollment application with complete and accurate information and applicable supporting documentation within 60 calendar days of [CMS’s] notification to resubmit and certify to the accuracy of its enrollment information.”  42 C.F.R. § 424.515(a)(2).  If a supplier fails to submit information required by CMS within 90 days of receiving notice from CMS to revalidate, then CMS may deactivate the supplier’s Medicare billing privileges.  42 C.F.R. § 424.540(a)(3). 

To reactivate billing privileges, the supplier must recertify that its enrollment information currently on file with CMS is correct and furnish any missing information.  42 C.F.R. § 424.540(b)(1).  When a supplier seeks reactivation, “[t]he effective date of a reactivation of billing privileges under this section is the date on which the Medicare contractor received the . . . supplier’s reactivation submission that was processed to approval by the Medicare contractor.”  42 C.F.R. § 424.540(d)(2). 

Petitioner believes that its deactivation was an error.  Petitioner asserts that CMS records erroneously recorded its name as Cardiac Diagnostic Associates LLC when in fact it is Cardiac Diagnostic Associate LLC (i.e., CMS incorrectly had an “s” at the end of the word “Associate.”).  According to Petitioner, it submitted multiple requests for revalidation starting in May 2025; however, CMS rejected all of them.  Eventually, Petitioner learned from a CMS representative that the revalidation enrollment applications had been rejected due to Petitioner’s name error.  The CMS representative allegedly stated that the reactivation would be backdated to the original revalidation request.  In September 2025, Petitioner was able to amend CMS’s records concerning its

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name through CMS’s Provider Enrollment, Chain, and Ownership System (PECOS).  Petitioner submitted a revalidation enrollment application in September 2025, which was approved but with an effective date that resulted in claims totaling $58,000 being declined because services were provided between July and September 2025.  Petitioner also asserts that it did not receive the March 31, 2025 notice to revalidate, and only received a July 7, 2025 notice of stay of enrollment and the August 28, 2025 notice of deactivation.  Petitioner seeks a reactivation date of July 1, 2025, or July 8, 2025 (i.e., the date of the stay notification), due to CMS’s error concerning Petitioner’s name and the significant financial loss Petitioner will incur due to the deactivation.  Hr’g Req.; CMS Ex. 8 at 1-2. 

My jurisdiction is limited to determining if the date of reactivation established by CMS was factually and legally correct.  See 42 C.F.R. § 498.3(b)(15).  In the present case, CMS received Petitioner’s revalidation/reactivation enrollment application on September 15, 2025, and CMS was able to process that application to completion.  CMS Ex. 6 at 1; CMS Ex. 7 at 1.  Therefore, CMS correctly set September 15, 2025, as the date of reactivation. 42 C.F.R. § 424.540(d)(2). 

Although Petitioner asserts that it submitted multiple revalidation enrollment applications, which CMS rejected, I have no jurisdiction to review CMS’s rejection of  those applications.  See 42 C.F.R. § 424.525(d); Wishon Radiological Medical Group, Inc., DAB No. 2941 at 7 (2019). 

Petitioner asserts that CMS improperly imposed deactivation due to various errors on CMS’s part, including an error in CMS’s records concerning Petitioner’s name and a failure to serve Petitioner with the March 31, 2025 notice to revalidate.  I have no jurisdiction to review a deactivation that CMS imposed.  42 C.F.R. § 424.546(f).  Rather, as stated in the August 28, 2025 deactivation notice, Petitioner had the right to file a rebuttal with CMS to appeal the deactivation.  CMS Ex. 5 at 1-2; 42 C.F.R. § 424.545(b), 424.546.  The right to file a rebuttal is the exclusive administrative appeal right for a deactivation.  See Michael B. Zafrani, M.D., DAB No. 3075 at 3, 8 (2022). 

Petitioner alleges that CMS or Medicare Administrative Contractor staff stated that Petitioner could obtain a backdated effective date.  However, I am unable to provide an earlier effective date based on anything CMS or contractor staff may have said.  See Fam. Health Servs. of Darke Cnty., Inc., DAB No. 2269 at 18-20 (2009). 

Finally, financial hardship is not a legal basis to change the effective date of reactivation because the regulations prohibit CMS from paying Petitioner for any health care items or services provided during the period of deactivation.  42 C.F.R. §§ 424.540(e), 424.555(b); 86 Fed. Reg. 62,240, 62,359-60 (Nov. 9, 2021); see also Goffney v. Becerra, 995 F.3d 737, 743 (9th Cir. 2021). 

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VIII.  Conclusion

The effective date for the reactivation of Petitioner’s Medicare billing privileges is September 15, 2025.