Stream Health Care, PA, DAB CR6908 (2026)

DECISION

Novitas Solutions (Novitas), an administrative contractor acting on behalf of the Centers for Medicare & Medicaid Services (CMS), revoked the Medicare enrollment and billing privileges of Petitioner, Stream Health Care, PA, effective October 17, 2022, pursuant to 42 C.F.R. §§ 424.535(a)(3), (a)(4), and (a)(9).  CMS also placed Petitioner on its preclusion list pursuant to 42 C.F.R. §§ 422.2 and 423.100.  Petitioner challenges both the revocation action and its placement on the preclusion list.  For the reasons set forth below, I affirm both.

I.      Background and Procedural History

Petitioner is a medical practice located in Texarkana, Texas.  On July 17, 2024, Novitas issued an initial determination revoking Petitioner’s Medicare enrollment and billing privileges effective October 17, 2022, and imposed a ten-year reenrollment bar.  CMS Ex. 3.  Novitas took the action because:  (1) an individual listed by Petitioner as an owner on its enrollment record had been convicted of felony tax fraud; (2) Petitioner provided false or misleading information on its application because it failed to disclose the

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conviction; and (3) Petitioner failed to report the conviction to CMS.  CMS Ex. 6 at 49-50.

Petitioner requested reconsideration of CMS’s initial determination, and specifically requested CMS reverse the revocation pursuant to 42 C.F.R. § 424.535(e).  Id. at 1-3.  CMS issued an unfavorable determination, upholding the revocation and declining to exercise its discretion.  CMS Ex. 1.

Petitioner timely requested review by an administrative law judge (ALJ).  On July 21, 2025, the matter was assigned to me, and the Civil Remedies Division issued a letter acknowledging Petitioner’s request for hearing and my Standing Order.

CMS timely filed its Prehearing Brief and Motion for Summary Judgment (CMS Br.), along with six proposed exhibits (CMS Exs. 1–6).  CMS did not submit written direct testimony from any proposed witnesses.  At the parties’ joint request, I stayed the proceedings to allow for settlement discussions; however, on February 10, 2026, the parties filed a joint status report indicating that settlement would not be reached.  Petitioner then timely filed its combined cross motion for summary judgment, request to remand and brief (P. Br.) but did not submit any exhibits or provide written direct testimony from any proposed witnesses.  Because Petitioner did not object to CMS’s proposed exhibits, I admit CMS Exs. 1–6 into the record.  CMS did not file a reply brief, and the deadline for doing so has passed.

The record is now closed, and the case is ready for decision.  I note, however, Petitioner’s request for a hearing “such that further testimony of Abrar Riaz, owner of the [management services organization], and Dr. Teketel can be given to further disprove the fact of Riaz’s ownership of Stream, which CMS based so much of its decision on.”  P. Br. at 10.  The Standing Order in this case required each party to submit, as a proposed exhibit with its prehearing exchange, the written direct testimony of any proposed witnesses.  Standing Order ¶ 11; see also id. ¶ 7.e.iv.  The Standing Order further explained that an in‑person hearing would be held only if a party submitted admissible written direct testimony and the opposing party requested an opportunity for cross‑examination.  Id. ¶ 13.  Because neither party submitted written direct testimony from any proposed witnesses, an in‑person hearing is not necessary.1 

I therefore decide this case based on the written record, that is, the parties’ submissions and arguments, without applying the summary‑judgment standard.  Civ. Remedies Div. P. § 19(d).  CMS’s motion for summary judgment is denied as moot.

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II.     Issues

The issues I must decide in this case are: 

• Whether CMS had a legal basis to revoke the Medicare enrollment and billing privileges of Petitioner under 42 C.F.R. §§ 424.535(a)(3), (a)(4), and/or (a)(9).
• Whether CMS had a legal basis to place Petitioner on its preclusion list.

III.     Jurisdiction

I have jurisdiction to decide this case.  Social Security Act (Act) § 1866(j)(8), 42 U.S.C. § 1395cc(j)(8); 42 C.F.R. §§ 498.3(b)(17), 498.5(l)(2).

IV.     Discussion

1. Statutory and Regulatory Framework

The Act authorizes the Secretary of Health and Human Services to establish by regulation the enrollment process for providers and suppliers participating in the Medicare program.  Act § 1866(j)(1)(A), 42 U.S.C. § 1395cc(j)(1)(A).  For purposes of the Medicare program, Petitioner is considered a supplier.  Act § 1861(d), 42 U.S.C. § 1395x(d); 42 C.F.R. § 400.202 (definition of supplier).  To participate in the Medicare program as a supplier, individuals must meet certain criteria to enroll and receive billing privileges.  42 C.F.R. §§ 424.505, 424.510, 424.516.

CMS may revoke the Medicare billing privileges of suppliers for any of the reasons stated in 42 C.F.R. § 424.535(a).  Applicable here, CMS may revoke a supplier when “[t]he . . . .supplier, or any owner, managing employee, managing organization, officer, or director of the . . . supplier was, within the preceding 10 years convicted . . . of a Federal or State felony offense that CMS determines is detrimental to the best interests of the Medicare program and its beneficiaries.”  42 C.F.R. § 424.535(a)(3).  In addition, CMS may revoke a supplier for failing to disclose a legal adverse action to CMS under 42 C.F.R. § 424.535(a)(9), and for submitting false or misleading information on its enrollment application under 42 C.F.R. § 424.535(a)(4).

When CMS revokes a supplier’s Medicare billing privileges, CMS establishes a reenrollment bar for a period ranging from one to ten years.  42 C.F.R. § 424.535(c).  Generally, a revocation becomes effective 30 days after CMS mails its initial determination revoking Medicare billing privileges, but if the revocation is based on a felony conviction, the revocation is effective with the date of the conviction.  42 C.F.R. § 424.535(g).  Finally, CMS may reverse a revocation due to a felony conviction of an owner, managing employee or managing organization if the supplier terminates the

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business relationship with that party and submits proof thereof within 15 days of the revocation notice.  42 C.F.R. § 424.535(e).

2. Findings of Fact, Conclusions of Law, and Analysis

My findings of fact and conclusions of law, set forth in italics, follow.

1. CMS had a legal basis to revoke Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.535(a)(3) because an owner listed on Petitioner’s enrollment application was convicted of a felony offense that CMS has determined to be per se detrimental to the best interests of the Medicare program and its beneficiaries. 

CMS may revoke a supplier’s enrollment in the Medicare program if, within the preceding ten years, the supplier or any owner, managing employee, managing organization, officer, or director has been convicted, as defined in 42 C.F.R. § 1001.2, of a felony offense that CMS determines is detrimental to the best interests of the Medicare program and its beneficiaries.  42 C.F.R. § 424.535(a)(3)(i); Act § 1842(h)(8), 42 U.S.C. § 1395u(h)(8) (authorizing the Secretary to deny enrollment to a supplier that has been convicted of a felony that the Secretary has determined it detrimental to the best interests of the program or program beneficiaries, and Act § 1866(b)(2)(D), 42 U.S.C. § 1395cc(b)(2)(D) (authorizing the Secretary to deny or terminate enrollment after the Secretary ascertains that a supplier has been convicted of a felony that is determined to be detrimental to the best interests of the program or its beneficiaries).  Under 42 C.F.R. § 1001.2, a “conviction” includes acceptance of a plea of nolo contendere, as well as participation in deferred adjudication or similar programs in which judgment is withheld.  Finally, the regulation identifies financial crimes, such as extortion, embezzlement, income tax evasion, insurance fraud, and similar offenses, as per se detrimental to the Medicare program.  42 C.F.R. § 424.535(a)(3)(ii)(B).

On April 25, 2023, Petitioner submitted an enrollment application to update its Medicare enrollment information.  CMS Ex. 2 at 1, 9-10.  In Section 6 of that application, Petitioner listed Mr. Abrar Riaz as holding ownership and managing control interests.  Id. at 6.  Petitioner identified Mr. Riaz as a “Board of Trustee/Director” and reported that, effective October 4, 2016, he was a “5% or greater direct/indirect owner,” a “director/officer,” and an “authorized official.”  Id. at 7.

On October 17, 2022, a Florida state court accepted Mr. Riaz’s plea of nolo contendere to Tax Fraud-$20,000 or more/less than $100,000, in violation of Florida State Statute 212.15(2C).  CMS Ex. 4 at 9.  The court withheld adjudication, placed him on five years’ probation, and ordered him to pay restitution of $45,679.39.  Id. at 11-12.  On November 29, 2023, the court terminated his probation and closed the felony matter.  CMS Ex. 6 at 48.

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Petitioner does not dispute that Mr. Riaz was “convicted” within the meaning of 42 C.F.R. §§ 424.535(a)(3) and 1001.2.  Nor does Petitioner dispute that Mr. Riaz’s offense was a felony or one that CMS considers detrimental to Medicare or its beneficiaries.

Instead, Petitioner contends “Mr. Riaz was erroneously reflected as an owner on various of Stream’s 855B enrollment records.”  P. Br. at 2.  Petitioner explains that although Mr. Riaz owned the management services organization, Starling Medical, LLC, which contracted with Petitioner, he was never an owner of Petitioner itself.  Id. at 2, 5; see also CMS Ex. 6 at 17 (Declaration of Mr. Riaz stating he never owned Stream Health Care PA).  Petitioner therefore contends that the revocation, which was based on Mr. Riaz’s felony conviction and his reported ownership interest, should be rescinded.  P. Br. at 2.

However, Petitioner’s April 25, 2023 application identified Mr. Riaz as an owner, director, and authorized official, effective October 4, 2016.  CMS Ex. 2 at 6-7.  Even in its July 31, 2024 application, Petitioner stated that “Mr. Riaz has been removed from all positions and ownership of Stream Health Care as of [July 30, 2024],” which again confirms that Petitioner itself represented that he held ownership in addition to other management positions.  CMS Ex. 5 at 43 (emphasis added).  Even assuming Petitioner now believes this information was submitted in error, Petitioner cites no authority excusing a supplier from responsibility for inaccuracies in its own enrollment record.  To the contrary, the Board held in Meadowmere Emergency Physicians, PLLC that CMS had “properly relied” on information in the supplier’s enrollment record about the identity of a managing employee in order to revoke the supplier’s billing privileges based on that employee’s felony conviction.  DAB No. 2881, at 10-13 (2018).  The Board explained that such reliance was proper because suppliers are legally obligated to provide complete and truthful enrollment information to CMS to “ensure . . . that CMS may rely on the accuracy of the information in administering the Medicare program.”  Id. at 11.  Thus, regardless of whether Petitioner listed Mr. Riaz as an owner intentionally or by mistake, CMS properly relied on the information Petitioner provided about Mr. Riaz’s employment status on its enrollment applications in determining that an owner was convicted of a felony offense.

Moreover, regardless of whether Mr. Riaz was an owner, Petitioner does not dispute that he was a managing official.  P. Br. at 5 (stating Mr. Riaz owned the management service organization that managed back-office functions for Petitioner).  Managing employees, organizations, officers, and directors fall squarely within the categories covered by 42 C.F.R. § 424.535(a)(3).  See also 42 C.F.R. § 424.535(a)(3)(iv) (individuals and organizations include, but are not limited to, W-2 employees and contracted individuals and organizations of the supplier).  To the extent Petitioner argues that “CMS relies heavily on the allegation that Riaz owned Stream” rather than on his status as a managing employee, that argument is unpersuasive.  P. Br. at 6 n.1.  In its reconsidered determination, CMS expressly concluded that Mr. Riaz’s role as a manager and board trustee was sufficient to trigger the regulatory requirements.  CMS Ex. 1 at 4.

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Because Mr. Riaz was listed as an owner, director/officer, and authorized official at the time of his state felony conviction for tax fraud, I find CMS had a legitimate basis to revoke Petitioner’s Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(3).

2. I have no authority to reverse revocation pursuant to 42 C.F.R. § 424.535(e). 

Pursuant to 42 C.F.R. § 424.535(e): 

Reversal of revocation. If the revocation was due to adverse activity (sanction, exclusion, or felony) against the [ ] owner, managing employee, authorized or delegated official, medical director, supervising physician, or other [ ] personnel furnishing services payable by a Federal health care program, the revocation may be reversed if the provider or supplier terminates and submits proof that it has terminated its business relationship with that party within 15 days of the revocation notification.

Upon notice of its revocation, and learning of Mr. Riaz’s felony conviction, Petitioner contends that it acted promptly to notify CMS that steps were taken to terminate its business relationship with Mr. Riaz and the revocation should therefore be reversed.  The record supports Petitioner’s contentions.  CMS Ex. 5 at 13-71.

However, as Petitioner acknowledges, the authority to reverse a revocation is an action within the discretion of CMS, and I have no authority to review that exercise of discretion.  P. Br. at 8; see also Main Street Pharmacy, LLC, DAB No. 2349 at 8 (2010) (stating that use of the term “may” implies CMS’s authority to reverse a revocation is discretionary, even when a supplier terminates its business relationship with the convicted individual).

Petitioner alternatively requests that this matter be remanded to CMS for further consideration of whether the revocation should be reversed.  P. Br. at 8.  Petitioner, however, raised each of these arguments before CMS, and CMS declined to exercise its discretion and reverse the revocation.  A remand for CMS to consider the same facts and arguments would therefore serve no purpose.

3. CMS had a legal basis to revoke Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.535(a)(4) because Petitioner did not disclose the felony conviction on its enrollment application and thereby provided false or misleading information in the application. 

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CMS may revoke a currently enrolled supplier’s billing privileges in the following circumstance: 

The . . . supplier certified as “true” misleading or false information on the enrollment application to be enrolled . . . in the Medicare program.

42 C.F.R. § 424.535(a)(4).

On April 25, 2023, Petitioner submitted an 855B enrollment application.  CMS Ex. 2.  Mr. Riaz is identified in “Section 6:  Ownership Interest & Managing Control Info (Individuals)” of the application.  Id. at 6-7.  Petitioner responds “no” to the question of whether Mr. Riaz “ever had a final adverse legal action imposed against him . . . .”  Id. at 7.  However, as explained above, the Florida state court accepted Mr. Riaz’s plea of nolo contendere to tax fraud on October 17, 2022.  CMS Ex. 4 at 9-10.

Petitioner does not dispute the underlying facts.  Instead, it argues that its reporting obligation arises only after it is notified of the conviction.  P. Br. at 7.  Petitioner asserts that because Mr. Riaz failed to inform it of his conviction, it had nothing to report.  Id. at 7-8.  This argument is unpersuasive.  As a supplier enrolled in the Medicare program, Petitioner had the responsibility for ensuring that its enrollment information was complete, accurate, and current.  Meadowmere Emergency Physicians, PLLC, DAB No. 2881 at 10 (2018).  At a minimum, Petitioner could have asked the individuals it identified as having an ownership interest or managing control whether any adverse legal action had been imposed before submitting and certifying an application stating otherwise.  Yet, Petitioner does not assert that it undertook even this basic level of due diligence before certifying its application as true.

In any event, the regulation does not require an intent to deceive.  It is enough that false or misleading information was certified as true.  Mark Koch, D.O., DAB No. 2610 at 4-5 (2014) (“section 424.535(a)(4) does not require proof that [the petitioner] subjectively intended to provide false information, only proof that he in fact provided misleading or false information that he certified as true”); see also Sandra E. Johnson, CRNA, DAB No. 2708 at 15 (2016).  Petitioner certified that its Medicare enrollment application was accurate and complete, yet it failed to disclose Mr. Riaz’s felony conviction.  That omission rendered the certification false and misleading.  Therefore, CMS had a legal basis to revoke Petitioner’s enrollment and billing privileges under 42 C.F.R. § 424.535(a)(4).

4. CMS had a legal basis to revoke Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.535(a)(9) because Petitioner did not report Mr. Riaz’s felony conviction as an adverse action within 30 days. 

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CMS may revoke a currently enrolled supplier’s billing privileges if the supplier fails to comply with the reporting requirements in 42 C.F.R. § 424.516(d)(1)(i)–(iii).  42 C.F.R. § 424.535(a)(9).  Under 42 C.F.R. § 424.516(d)(1)(ii), a physician organization must report any adverse legal action within 30 days of the reportable event.  See also 42 C.F.R. § 424.502 (definition of final adverse action includes conviction of a Federal or State felony offense (as defined in § 424.535(a)(3)(i)) within the last 10 years preceding enrollment, revalidation, or re-enrollment).

Petitioner does not dispute that Mr. Riaz’s conviction is a reportable event or that it failed to report it to CMS.  Rather, Petitioner asserts that it could not report the conviction because it was unaware of it.  Even assuming Petitioner did not know about the conviction, ignorance does not excuse the reporting obligation.  “ALJs and the Board are ‘bound by applicable statutes and regulations and [have] no authority to make exceptions to their applicability.’”  Meadowmere Emergency Physicians, PLLC, DAB No. 2881 at 11-12 (quoting Vijendra Dave, M.D., DAB No. 2672 at 8 (2016)).   In this instance, the regulation requires physicians to report final adverse actions within 30 days of the reportable event, without exception.  42 C.F.R. § 424.516(d)(1)(ii).  Because Petitioner listed Mr. Riaz as an owner and managing employee on its enrollment record, it was required to report his conviction to CMS within 30 days of the conviction.  Petitioner failed to do so, and CMS therefore had a legitimate basis to revoke Petitioner’s Medicare billing privileges under 42 C.F.R. § 424.535(a)(9).

5. I cannot review the length of the reenrollment bar. 

Petitioner disputes the duration of the ten-year bar to reenrollment.  However, the Board has unambiguously explained that such a matter is beyond the scope of an ALJ’s review, stating: 

A decision by CMS or its contractor about how long to bar a revoked supplier from re-enrolling in Medicare, unlike the determination to revoke the supplier’s billing privileges, is not an appealable “initial determination” under 42 C.F.R. Part 498.  Blossomwood Medical, P.C., et al., DAB No. 2914, at 11 (2018); Vijendra Dave, M.D. [DAB No. 2672] at 8-11 [ [(2016)] (stating that the authority of an ALJ or the Board in a revocation appeal “does not extend to reviewing the length of the reenrollment bar imposed by CMS”).  We therefore cannot consider or act upon Petitioner’s contention that the three-year re-enrollment bar was excessive in her circumstances.

Linda Silva, P.A., DAB No. 2966 at 11 (2019); see also Vijendra Dave, M.D., DAB No. 2672 at 11 (“CMS’s determination regarding the duration of the re-enrollment bar is not reviewable.”).

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Petitioner has not identified any legal error in CMS’s imposition of the reenrollment bar, and I find none.  Pursuant to 42 C.F.R. § 424.535(c), CMS is authorized to impose a bar to reenrollment of up to ten years when it has revoked a supplier’s enrollment.  Here, CMS upheld a ten-year bar to reenrollment, which is within the timeframes established by regulation.  I may not otherwise review the issue and do not disturb the ten-year reenrollment bar.

6. There is a basis for adding Petitioner to the CMS preclusion list. 

My review is limited to whether CMS had a legitimate basis to add Petitioner to the preclusion list.  To place a provider or supplier on its preclusion list, CMS must establish the following elements: 

1. The individual or entity is currently revoked from Medicare for a reason other than that stated in § 424.535(a)(3);
2. The individual or entity is currently under a reenrollment bar under § 424.535(c); and
3. CMS determines that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program. 

42 C.F.R. §§ 422.2; 423.100.

There is no dispute that the first two elements are met here.  While CMS revoked Petitioner’s Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(3), it also revoked Petitioner pursuant to 42 C.F.R. §§ 424.535(a)(4), and (a)(9).  CMS Ex. 1 at 5-6.  In addition, CMS imposed a ten-year reenrollment bar under § 424.535(c).  Id. at 6.

As to the third element, CMS must consider the following factors to determine whether the conduct that resulted in revocation is detrimental to the best interests of the Medicare program:

1. The seriousness of the conduct underlying the individual’s or entity’s revocation;
2. The degree to which the individual’s or entity’s conduct could affect the integrity of the Medicare program; and
3. Any other evidence that CMS deems relevant to its determination.

42 C.F.R. §§ 422.2; 423.100.

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Where the regulations have granted CMS discretion to determine whether a provider or supplier’s underlying conduct is detrimental to the Medicare program, I may not substitute my own judgment as to whether CMS properly exercised that discretion.  Brian K. Ellefsen, DO, DAB No. 2626 at 7 (2015).

Here, CMS satisfied its regulatory obligation to consider whether the conduct underlying Petitioner’s revocation was detrimental to the best interests of the Medicare program by evaluating both the seriousness of the conduct and its potential impact on program integrity.  42 C.F.R. § 422.2, Preclusion list.  In its reconsideration decision, CMS expressly addressed these factors, stating that Petitioner submitted false information by failing to disclose Mr. Riaz’s felony conviction and that CMS found this conduct to be serious and a significant program integrity risk.  CMS Ex. 1 at 7–8.  CMS explained that the Medicare program relies on its partners to accurately self-report information on enrollment applications, and that inaccurate or outdated information jeopardizes the Medicare Trust Funds.  Id. at 7.  CMS also considered Petitioner’s argument that it was unaware of Mr. Riaz’s conviction, noting that Petitioner was “at best, ignorant of its responsibility to keep CMS appropriately informed,” which CMS likewise viewed as an integrity concern.  Id.

This discussion reflects that CMS thoroughly evaluated the seriousness of Petitioner’s conduct and its implications for the integrity of the Medicare program.  42 C.F.R. § 422.2, Preclusion list; see also 42 C.F.R. § 423.100.  CMS’s analysis was clearly articulated and free of factual errors or misstatements.  CMS therefore established that the conduct leading to revocation was detrimental to the best interests of the Medicare program.  For these reasons, I find CMS had a legitimate basis to place Petitioner on its Preclusion List.

V.     Conclusion

I affirm CMS’s determination to revoke Petitioner’s Medicare enrollment and billing privileges and Petitioner’s placement on the preclusion list.