Chabot Urology Medical Associates, A Professional Corp., DAB CR6933 (2026)

This decision affirms the determination of the Centers for Medicare & Medicaid Services (CMS), that December 16, 2024 is the reactivation effective date of Medicare enrollment and billing privileges for Chabot Urology Medical Associates, A Professional Corp., (hereinafter referred to as “Petitioner”). 

I. Background and Procedural History

On February 13, 2025, Petitioner requested a hearing before an administrative law judge (ALJ) to contest a reactivation effective date determination. 

On February 14, 2025, the Civil Remedies Division acknowledged receipt of the hearing request and issued former Administrative Law Judge Jacinta Alves’ Standing Order1, as well as the Civil Remedies Division Procedures (CRDP). 

On March 21, 2025, CMS filed a combined pre-hearing brief and motion for summary judgment (CMS Br.) along with 9 exhibits (CMS Exs.). 

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On April 29, 2025, Petitioner filed a pre-hearing brief (P. Br.) with three exhibits. 

On December 23, 2025, this case was transferred to me for hearing and decision. 

II. Admission of Exhibits and Decision on the Written Record

Absent objection, CMS Exs. 1-9 are admitted into evidence. 

Petitioner filed three exhibits along with its brief, but the exhibits are not labeled in accordance with the Standing Order.  Standing Order ¶ 5.  However, absent objection, the exhibits will be admitted, as filed, and will be referred to by docket number (Dkt. 5a-5c). 

Neither party proposed witnesses and all filing deadlines have passed.  Therefore, the record is closed.  Because there is no need to conduct a hearing in this case, I will issue a decision based on the written record.  Standing Order ¶ 14; CRDP ¶ 19d. 

I deny CMS’s motion for summary judgment as moot. 

III. Jurisdiction

I have jurisdiction to hear and decide this case.  42 C.F.R. § 498.3(b)(15). 

IV. Issue

Whether Noridian, acting on behalf of CMS, properly established December 16, 2024, as the reactivation effective date for Petitioner’s enrollment in the Medicare program. 

V. Legal Authorities

The Social Security Act (Act) establishes the enrollment process for providers and suppliers participating in Medicare or Medicare related programs.  42 U.S.C. §§ 1302, 1395cc(j). Under the Act, “suppliers” are physicians or other practitioners, 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); see also 42 U.S.C. § 1395x(u). Providers include hospitals, skilled nursing facilities, and home health agencies.  42 U.S.C. § 1395x(u).  Petitioner is a “supplier.”  42 U.S.C. § 1395x(d); 42 C.F.R. § 400.202. 

A provider or supplier must be enrolled in the Medicare program in order to receive payment for covered items or services from either Medicare (in the case of an assigned claim) or a Medicare beneficiary.  42 C.F.R. § 424.505.  If enrolled, the provider or supplier receives billing privileges and is issued a valid billing number effective for the

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date a claim was submitted for an item that was furnished or a service that was rendered. 42 C.F.R. § 424.505. 

To maintain Medicare billing privileges, suppliers must revalidate their enrollment information at least every five years; however, CMS reserves the right to require revalidation at any time.  When CMS notifies suppliers that it is time to revalidate, the suppliers must submit a signed enrollment application, accurate information, and supporting documents within 60 calendar days of CMS’s notification.  42 C.F.R. § 424.515. 

Once enrolled, CMS may deactivate a provider or supplier’s Medicare billing privileges for any of the reasons listed at 42 C.F.R. § 424.540(a).  If CMS deactivates a supplier’s Medicare billing privileges, then the supplier may file a rebuttal to the deactivation. 42 C.F.R. §§ 424.545(b), 424.546(a)(1).  When CMS issues a determination based on a rebuttal, that determination is not an appealable initial determination. 42 C.F.R. § 424.546(f). 

CMS can also deactivate an enrolled supplier’s Medicare billing privileges if the enrollee fails to comply with revalidation requirements.  42 C.F.R. § 424.540(a)(3).  When CMS deactivates a supplier’s Medicare billing privileges, “[n]o payment may be made for otherwise Medicare covered items or services furnished to a Medicare beneficiary.”  42 C.F.R. § 424.555(b).  If CMS deactivates a supplier’s billing privileges due to an untimely response to a revalidation request, the enrolled supplier may apply for CMS to reactivate its Medicare billing privileges by completing a new enrollment application or, if deemed appropriate, recertifying its enrollment information that is on file.  42 C.F.R. § 424.540(b)(1). 

VI. Findings of Fact

Dr. Sourjya P. Misra has been a Medicare provider since 1993 and is the sole owner of Chabot Urology Medical Associates, A Professional Corp.  CMS Ex. 7 at 3; CMS Ex. 1 at 26. 

On July 24, 2024, Noridian Healthcare Solutions (Noridian), a Medicare Administrative Contractor, acting on behalf of CMS, issued a notice informing Petitioner that it needed to revalidate its Medicare enrollment record by October 31, 2024.  CMS Ex. 2.  The notice letter warned that failure to respond may result in the deactivation of Medicare billing privileges and a gap in reimbursement.  Id.  The notice was addressed to Chabot Urology Medical Associates and sent to Petitioner’s address at 20055 Lake Chabot Rd, Ste 310, Castro Valley, CA 945465334 (sic).  Id. 

On November 1, 2024, Noridian issued a Stay of Enrollment notice informing Petitioner that all Medicare payments were placed on hold due to Petitioner’s failure to revalidate

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its enrollment record.  CMS Ex. 3.  The notice warned that a failure to respond may result in deactivation of Petitioner’s Medicare enrollment and may cause a gap in reimbursement.  Id.  The second notice letter was also addressed to Petitioner and sent to the same address as the initial notice.2  Id. 

On December 3, 2024, Noridian issued a “Stopping Billing Privileges” notice informing Petitioner that its billing privileges were being deactivated effective November 1, 2024, due to failure to timely revalidate its enrollment record. CMS Ex. 4. The notice stated that claims would not be paid after the deactivation date.  Id.  The notice was again addressed to Petitioner and sent to the same address as the July 24, 2024 and November 1, 2024 notice letters.  Id. 

Dr. Misra was unaware of the deactivation until her billing service informed her that Medicare remits were being returned as “provider not certified/eligible for a specific service/ procedure on certain dates.”  CMS Ex. 1 at 24. 

Petitioner submitted a CMS-855B Medicare enrollment application on December 16, 2024.  CMS Ex. 5. 

On December 24, 2024, Noridian informed Petitioner that the revalidation application was approved.  Id.  The letter also stated that Petitioner’s PTAN and effective date would remain the same, but there would be a gap in billing privileges from November 1, 2024 through December 15, 2024, due to failure to fully revalidate during a previous revalidation cycle and Petitioner would not be reimbursed for services provided to Medicare beneficiaries during those dates.  Id. 

On December 24, 2024, Dr. Misra, on behalf of Petitioner, timely requested reconsideration of the reactivation date decision, requesting that the gap in billing privileges be reinstated because she did not receive the revalidation or stay of enrollment notices.  CMS Ex. 1. 

Noridian issued an unfavorable reconsideration determination on January 31, 2025. CMS Exs. 6, 7. 

VII. Analysis

Petitioner wishes to appeal Noridian’s finding that her enrollment was appropriately deactivated.  P. Br. at 1. However, I do not have the authority to review the deactivation of Petitioner’s Medicare billing privileges.  Ellyn Smith, M.D., DAB No. 3233 at 2 (2026); Ark. Health Grp., DAB No. 2929 at 7-9 (2019).  If Petitioner was dissatisfied

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with the deactivation determination, the remedy was to file a rebuttal with Noridian. CMS Ex. 3.  Neither the deactivation of billing privileges nor the rejection of enrollment applications are “initial determinations” subject to ALJ review under 42 C.F.R. Part 498.  See 42 C.F.R. § 424.525(d); 42 C.F.R. § 498.3(b). Petitioner states that she did not receive the revalidation or stay notices and argues that CMS has not provided proof of mailing or emailing the notices.  P. Br. at  1.  Petitioner also argues that the CMS Medicare Revalidation List – Online Interactive Tool is not accurate and surmises that she may also suffer deactivation if she relies on the tool in the future.  P. Br. at 2.  Though I certainly understand Petitioner’s frustration, this is not the forum to challenge the actual deactivation. 

Once Medicare billing privileges are deactivated, the effective date of the reactivation of billing privileges is the date on which the Medicare contractor received the provider’s or supplier’s reactivation submission that was processed to approval by the Medicare contractor. 42 C.F.R. § 424.540(d)(2).  In this case, Petitioner’s Medicare billing privileges were deactivated effective November 1, 2024, for failure to revalidate enrollment within the specified time period.  CMS Ex. 4.  It is undisputed that Petitioner filed an enrollment application that Noridian was able to subsequently process to approval on December 16, 2024.  CMS Ex. 5.  Based on the evidence provided, I find that the hearing officer did not err in determining that Petitioner’s reactivation effective billing date is December 16, 2024. 

Lastly, Petitioner argues that it will incur substantial financial loss, approximately $19,000, if unable to bill for services provided during the deactivation period.  P. Br. at 1. While I understand Petitioner’s concerns about the financial impacts of the billing gap during the deactivation, the applicable regulation does not provide for a retrospective or retroactive billing period, nor do I have the authority to add a period of retrospective or retroactive billing.  See 42 C.F.R. § 498.3(b)(15).  In addition, the regulations prohibit CMS from paying a supplier for items or services furnished to Medicare beneficiaries during the period of deactivation.  42 C.F.R. §§ 424.540(e), 424.555(b). 

VIII.  Conclusion

For the reasons stated above, I find that Noridian, on behalf of CMS, correctly determined that Petitioner’s reactivation effective date for Medicare enrollment and billing privileges is December 16, 2024.  Therefore, CMS’s determination is AFFIRMED.