Paul Sucgang, D.O., Inc. and Paul S. Sucgang, D.O., DAB CR6962 (2026)

DECISION

Petitioner, Paul Sucgang (Dr. Sucgang), is a physician, licensed to practice in California, who participated in the Medicare program as a supplier of services.  Petitioner, Paul Sucgang, D.O., Inc. (Sucgang, Inc.), is a medical practice in California.  As of 2010, Dr. Sucgang was listed as the sole owner of Sucgang, Inc.  Beginning on December 14, 2023, Dr. Sucgang was also listed as the contracted managing employee and medical director of Noble Care Hospice (Noble). 

On June 5, 2024, Noble was notified that its Medicare enrollment was revoked pursuant to 42 C.F.R. § 424.535(a)(8)(ii) and 42 C.F.R. § 424.535(a)(10), effective June 5, 2024.  Thereafter, on August 13, 2024, Dr. Sucgang and Sucgang, Inc. (referred to collectively as Petitioners) were notified that their Medicare enrollments were being revoked pursuant to 42 C.F.R. § 424.535(a)(19).  Petitioners were additionally notified of a 10-year reenrollment bar, and that they were being added to the Medicare preclusion list. 

Petitioners now appeal. 

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I affirm the Centers for Medicare and Medicaid Services’ (CMS) determinations.  I find that CMS is authorized to revoke Petitioners’ Medicare billing privileges and to add their names to the Medicare preclusion list because Petitioners’ affiliation with the revoked Noble posed undue risk of fraud, waste or abuse. 

I have no authority to review the length of the reenrollment bar. 

Statutory and Regulatory Background.  The Medicare program, Title XVIII of the Social Security Act (Act), is a federally-subsidized insurance program that provides health care benefits to the elderly, disabled, and those suffering from end stage renal disease.  Medicare is divided into four parts: 

• Part A is the hospital insurance program.  It covers hospital services, post-hospital extended care, home health, and hospice care.  Act § 1811 (42 U.S.C. § 1395c);
• Part B, which is voluntary, is the supplementary medical insurance program, covering physician, outpatient, home health,1 and other services.  Act § 1832 (42 U.S.C. § 1395k);
• Part C is the Medicare Advantage program, which allows its participants to enroll in “Medicare + Choice” plans, managed by organizations, such as health maintenance organizations, that receive a fixed payment for each enrollee.  Act § 1851 (42 U.S.C. § 1395w-21); and
• Part D is the voluntary prescription drug benefit program.  Act § 1860D (42 U.S.C. § 1395w-101). 

The Medicare program is administered by CMS, acting on behalf of the Secretary of Health and Human Services.  CMS contracts with Medicare administrative contractors, who process and pay reimbursement claims and perform other duties necessary to carry out program purposes.  Act § 1842 (42 U.S.C. § 1395u).  Contractors pay claims to “providers” (Part A) and “suppliers” (Part B).  Physicians and other practitioners who furnish healthcare services may participate in the program as “suppliers” of services; however, they 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. 

CMS may revoke a supplier’s Medicare enrollment and billing privileges on one or more of the grounds set forth under 42 C.F.R. § 424.535(a).  So long as CMS shows that one of the regulatory bases exists, I must uphold the revocation.  Devine Sols. Grp., LLC, DAB

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No. 3159 at 12 (2024); Thomas Falls, M.D., DAB No. 3056 at 8 (2022); William Garner, M.D., DAB No. 3026 at 16 (2020); Eva 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); Norman Johnson, M.D., DAB No. 2779 at 11 (2017), and cases cited therein.  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.  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). 

Procedural Background

On August 13, 2024, the Medicare administrative contractor, Noridian Healthcare Solutions, notified Petitioners that their Medicare billing privileges would be revoked, effective September 12, 2024.  CMS Ex. 2.  The notices advised that Petitioners’ billing privileges were being revoked pursuant to 42 C.F.R. § 424.535(a)(19) for an affiliation with Noble that poses undue risk.  Id.  The contractor imposed a 10-year reenrollment bar.  Id.  Petitioners were also added to CMS’s preclusion list, as authorized by 42 C.F.R. §§ 422.2, 422.222, 423.100, and 423.120(c)(6).  Id.  Finally, the notice explained that, if Petitioners requested reconsideration, inclusion on the CMS preclusion list would become effective on the date the reconsidered determination was issued.  Id. 

Petitioners subsequently requested reconsideration.  CMS Exs. 1, 8.  On February 4, 2025, a CMS hearing officer issued a reconsidered decision in which Petitioners’ revocations were upheld.  CMS Ex. 1.  The hearing officer specifically found that Petitioners had an affiliation with Noble, a provider that had its Medicare billing privileges revoked due to abuse of billing by submitting claims that failed to meet Medicare requirements.  Id. at 6-7, 9.  The hearing officer also upheld the determination to impose the reenrollment bar and to include Petitioners on CMS’s preclusion list.  Id. at 9. 

On February 27, 2026, Petitioners electronically filed a hearing request challenging CMS’s reconsidered determination.  A prior hearing request was dated April 2, 2025 and showed that it had been incorrectly mailed to CMS rather than the Departmental Appeals Board.  On March 23, 2026, CMS filed a motion to dismiss arguing that the hearing request was untimely.  Petitioners objected to the motion to dismiss.  On April 30, 2026, I issued an order denying CMS’s motion to dismiss. 

Decision based on the written record.  CMS has moved for summary judgment.  However, the standing order directed the parties to list all proposed witnesses and to submit, as a proposed exhibit, the complete, written direct testimony of any proposed witness.  Standing Order at 9-10.  The order further stated that a hearing would be necessary only if a party files admissible, written direct testimony, and the opposing party asks to cross-examine.  Id. 

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CMS has not proposed any witnesses.  Petitioners listed Dr. Sucgang as a witness and provided his declaration.  CMS has not requested to cross-examine Dr. Sucgang.  As there are no witnesses to be cross-examined, an in-person hearing would serve no purpose, and I may decide this case based on the written record, without considering whether the standards for summary judgment have been met.2 

Submissions and Exhibits.  CMS submits its brief (CMS Br.) with 10 exhibits (CMS Exs. 1-10).  Petitioners did not object to CMS’s exhibits.  In the absence of any objections, I admit into evidence CMS Exs. 1-10. 

Petitioners submit their brief (P. Br.) with 1 exhibit (P. Ex. 1), Dr. Sucgang’s declaration.  CMS did not object to Petitioner’s exhibit.  As a result, I admit into evidence P. Ex. 1. 

Issues

1. Did CMS have the authority to revoke Petitioners’ Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(19)?
2. Did CMS have the authority to include Petitioners on the CMS’s Preclusion List pursuant to 42 C.F.R. §§ 422.2, 422.222, 423.100, and 423.120(c)(6)?

I have no authority to review the length of the reenrollment bar.  Brian O’Connor, DAB No. 3140 at 18 (2024). 

Discussion

1. CMS properly revoked Petitioners’ Medicare enrollment under 42 C.F.R. § 424.535(a)(19) because Petitioners’ affiliation with Noble poses an undue risk of fraud, waste and abuse.3 

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1. Legal Background

Revocation of enrollment.  CMS may revoke Petitioners’ Medicare enrollment and billing privileges if Petitioners had an affiliation under 42 C.F.R. § 424.535(a)(19) that poses an undue risk of fraud, waste or abuse to the Medicare program. 

42 C.F.R. § 424.502 defines the term “affiliation” as including any of the following4: 

(1) A 5 percent or greater direct or indirect ownership interest that an individual or entity has in another organization. 

(2) A general or limited partnership interest (regardless of the percentage) that an individual or entity has in another organization. 

(3) An interest in which an individual or entity exercises operational or managerial control over, or directly or indirectly conducts, the day-to-day operations of another organization (including, for purposes of this paragraph, sole proprietorships), either under contract or through some other arrangement, regardless of whether or not the managing individual or entity is a W–2 employee of the organization. 

(4) An interest in which an individual is acting as an officer or director of a corporation. 

(5) Any reassignment relationship under § 424.80. 

42 C.F.R. § 424.502. 

Undue risk. [If an affiliation is established,] CMS determines whether any of the disclosed affiliations pose an undue risk of fraud, waste, or abuse by considering the following factors: 

(1) The duration of the affiliation. 

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(2) Whether the affiliation still exists and, if not, how long ago it ended. 

(3) The degree and extent of the affiliation. 

(4) If applicable, the reason for the termination of the affiliation. 

(5) Regarding the affiliated provider’s or supplier’s disclosable event under paragraph (b) of this section: 

(i) The type of disclosable event. 

(ii) When the disclosable event occurred or was imposed. 

(iii) Whether the affiliation existed when the disclosable event occurred or was imposed. 

(iv) If the disclosable event is an uncollected debt: 

(A) The amount of the debt. 

(B) Whether the affiliated provider or supplier is repaying the debt. 

(C) To whom the debt is owed. 

(v) If a denial, revocation, termination, exclusion, or payment suspension is involved, the reason for the disclosable event. 

(6) Any other evidence that CMS deems relevant to its determination. 

(g) Determination of undue risk. A determination by CMS that a particular affiliation poses an undue risk of fraud, waste, or abuse will result in, as applicable . . . the revocation of the provider’s or supplier’s Medicare enrollment under § 424.535(a)(19). 

42 C.F.R. § 424.519. 

Disclosable Events: A disclosable event under 42 C.F.R. § 424.519 is defined to include, whether a provider or supplier: 

(4) Has had its Medicare, Medicaid, or CHIP enrollment denied, revoked, or terminated, regardless of—

(i) The reason for the denial, revocation, or termination;

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(ii) Whether the denial, revocation, or termination is currently being appealed;

or

(iii) When the denial, revocation, or termination occurred or was imposed.

42 C.F.R. § 424.502. 

2. Analysis

As of December 14, 2023, Dr. Sucgang was listed in Noble’s Medicare enrollment filings as both a contracted managing employee and medical director.  CMS Ex. 7.  Dr. Sucgang was also the sole owner of Sucgang, Inc. beginning in 2010 with no end date.  CMS Ex. 10. 

Petitioners do note dispute that he was listed as the medical director which would establish an affiliation under 42 C.F.R. § 424.502 with Noble.  See generally P. Br.  I further note that Dr. Sucgang does not deny his affiliation with Sucgang, Inc. or that his affiliation with Noble is also imputed to Sucgang, Inc.  See Id.  Petitioners instead argue that his role was limited to an independent contractor whose responsibilities were limited to providing care to hospice patients.  See Id. 

It is also undisputed that Noble’s Medicare billing privileges were revoked pursuant to 42 C.F.R. § 424.535(a)(8)(ii) for engaging in a pattern or practice of submitting claims that fail to meet Medicare requirements and 42 C.F.R. § 424.535(a)(10) for failure to provide documentation.  CMS Ex. 3.  Further, Dr. Sucgang was Noble’s medical director and contracted managing employee during the time Noble’s billing privileges were revoked – and during the time in which the claims were submitted that failed to meeting Medicare requirements.  CMS Ex. 5. 

In addition, Petitioners do not challenge CMS’s finding that Noble’s Medicare enrollment revocation was a disclosable event under 42 C.F.R. § 424.502.  See generally P. Br. 

Petitioners argue that Dr. Sucgang was an independent contractor with Noble whose involvement was limited to providing medical care to hospice patients.  See generally P. Br; P. Ex. 1.  Dr. Sucgang states that he did not supervise employees, billing personnel or make operational decisions.  Id.  Petitioners argue that although the patient records identify Dr. Sucgang as medical director, those records “reflect Dr. Sucgang's clinical responsibilities as a treating physician and do not demonstrate that he exercised authority over Noble Care Hospice's business operations, Medicare enrollment, billing activities, or corporate management.”  P. Br. at 5.  He further asserts that he had no idea that Noble had issues with its Medicare enrollment or billing practices.  Id. 

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Petitioners also challenge CMS’s position that it has demonstrated that the disclosed affiliations pose an undue risk of fraud, waste, or abuse by considering the regulatory factors listed under 42 C.F.R. § 424.519(f).  P. Br. 5-9.  As noted above, Dr. Sucgang argues that his affiliation was short and limited to treating patients.  Dr. Sucgang adds that he never had any ownership interest, managerial control and or billing control of the Hospice.  P. Ex. 1.  However, Petitioner’s arguments are not supported by the evidence.  As discussed below, Dr. Sucgang was Noble’s medical director at the time of Noble’s noncompliant billing. 

I observe that these arguments were raised below in Petitioners’ request for reconsideration and were rejected by the hearing officer.  CMS Ex. 1.  The hearing officer considered all of the regulatory factors listed in 42 C.F.R. § 424.519(f) and found the evidence supported that Petitioners had an affiliation that posed an undue risk of fraud, waste, or abuse.  Id. 

The hearing officer specifically found that with respect to factor 1 (duration of affiliation with revoked provider Noble), factor 2 (whether the affiliation still exists), and factor 4 (reason for termination of affiliation, if applicable), Dr. Sucgang was Noble’s medical director during the period from December 14, 2023 through at the least of the date of the reconsideration request.  Id. at 6.  Moreover, during that period, in which Dr. Sucgang was medical director, Noble submitted noncompliant claims with dates of service December 1, 2023 through February 29, 2024.  Id. 

The hearing officer also determined that regarding factor (3) (the degree and extent of the affiliation with revoked provider Noble), that Dr. Sucgang was listed by Noble as its medical director on its Medicare enrollment documentation at the time of the submission of noncompliant claims which resulted in the revocation of the Noble’s Medicare enrollment.  CMS Ex. 1 at 6.  CMS also considered that “hospices and their medical directors have an extremely close affiliation” and that “as a condition of Medicare participation, a hospice must have a medical director” that is responsible for certifying that a patient’s life expectancy is six months or less.  Id. (citing § 418.102). 

The hearing officer next considered all the applicable parts of factor (5) (the affiliated provider’s or supplier’s disclosable event)5 and found that Noble’s Medicare enrollment was revoked, during a period in which Dr. Sucgang was its medical director due to its submission of noncompliant claims.  CMS Ex. 1 at 6-7.  Moreover, regarding factor (5)(v), the hearing officer observed that a total of 10 claims with dates of service from December 1, 2023 through February 29, 2024 were denied because Noble did not respond to the contractor’s request for records and CMS determined that Noble engaged in a pattern or practice of submitting claims that fail to meet Medicare requirements.  Id. 

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It was further noted that the revocation became final when CMS issued a reconsidered determination affirming the revocation.  Id. 

Lastly, CMS considered factor (6) (other evidence) and observed that Dr. Sucgang, as medical director during the time the noncompliant billing was submitted “cannot be counted on to own or direct a Medicare enrolled entity in a way that does not compromise the integrity of the Medicare program.  The noncompliant behavior that Noble exhibited could easily be replicated by Dr. Sucgang with him at the helm of [Sucgang, Inc.] and enrolled in the Medicare program.”  Id. 

Based on the above, CMS established a legal basis for Petitioners’ revocation.  The Board has consistently held that an administrative law judge’s review of CMS’s determination to revoke a supplier’s Medicare enrollment is limited to deciding whether CMS has established one or more of the grounds specified in section 424.535(a).  Tammy Dobbin, APN & Ebony Wellness, LLC, DAB No. 3136 at 8 (2024); William Garner, M.D., DAB No. 3026 at 16 (2020); Norman Johnson, M.D., DAB No. 2779 at 11 (2017).  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.  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 regulation required that CMS consider certain factors when determining to revoke enrollment and billing privileges.  The reconsidered determination shows that the CMS hearing officer considered the factors required by 42 C.F.R. § 424.535(a)(19) when it concluded that Petitioners’ affiliation with Noble posed an undue risk of fraud, waste, or abuse.  CMS Ex. 14 at 6-8.  Therefore, I find that CMS acted within its authority when it determined that there was an affiliation between Petitioners and Noble because Dr. Sucgang was listed on the Noble’s Medicare enrollment as a medical director and contracted managing employee. 

CMS has further established that the Petitioners’ affiliations with the revoked Noble posed an undue risk of fraud, waste, or abuse.  Petitioners’ assertions that Dr. Sucgang did not act in the role of medical director are belied by the evidence.  Dr. Sucgang is listed on Noble’s Medicare enrollment forms as the medical director.  CMS Ex. 5.  Dr. Sucgang signed medical records as the medical director.  CMS Ex. 10. And, Dr. Sucgang was Noble’s medical director during the majority of the period that Noble had noncompliant billing.  Additionally, Dr. Sucgang was the medical director of Noble when it was revoked and when the revocation was upheld on reconsideration.  And, as discussed above, although Petitioners do not make a challenge regarding the affiliation between Dr. Sucgang and Sucgang, Inc., Dr. Sucgang was the sole owner of Sucgang, Inc. during this entire period as well. 

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Finally, Petitioners argue that they have suffered substantial financial losses and suffered harm to their reputation.  I do not have authority to reinstate Petitioners’ Medicare enrollment and billing privileges on equitable grounds.  “The Board has consistently held that it (and the ALJs) lack the authority to restore a supplier’s billing privileges on equitable grounds.”  Neb Grp. of Ariz. LLC, DAB No. 2573 at 6 (2014) (citations omitted).  “[O]nce CMS has shown that one of the regulatory bases for revocation exists, the ALJ and the Board may not refuse to apply the regulation and must uphold the revocation.”  Donald W. Hayes, D.P.M., DAB No. 2862 at 15 (2018). 

2. I have no authority to review CMS’s determination to impose a 10-year reenrollment bar.

When a provider’s billing privileges are revoked, it may not participate in the Medicare program until the end of the reenrollment bar, which must be for a minimum of one year but no more than 10 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 10-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, M.D., P.C., DAB No. 2985 at 15-16 (2020). 

3. CMS acted within its authority when it added Petitioners to the preclusion list because Petitioners are currently revoked and under a re-enrollment bar and CMS has determined that the underlying conduct that led to the revocation was detrimental to the best interests of the Medicare program and its beneficiaries.6 

The preclusion list.  Effective January 1, 2019, CMS implemented a “preclusion list” as part of its effort to “prevent fraud, waste, and abuse, and to protect Medicare enrollees.”  See 82 Fed. Reg. 56,336, 56,448 (Nov. 28, 2017); 83 Fed. Reg. 16,440, 16,643 (Apr. 16, 2018).  Pursuant to 42 C.F.R. § 422.2 (Part C) and 42 C.F.R. § 423.100 (Part D), CMS’s “preclusion list” includes individuals and entities that: 

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(i)      The [individual, entity, or prescriber] is currently revoked from Medicare for a reason other than that stated in [42 C.F.R.] § 424.535(a)(3) . . . .

(ii)     The [individual, entity, or prescriber] is currently under a reenrollment bar under [42 C.F.R] § 424.535(c). 

(iii)     CMS determines that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program. In making this determination under this paragraph . . . , CMS considers the following factors:

(A) The seriousness of the conduct underlying the . . . revocation.

(B) The degree to which the . . . conduct could affect the integrity of the [Medicare/Part D] program.

(C) Any other evidence that CMS deems relevant to its determination.

42 C.F.R. §§ 422.2, 423.100. 

Review of Petitioners’ inclusion on the preclusion list.  My review here is limited to whether CMS had the authority to include Petitioner on the preclusion list.  42 C.F.R. § 498.3(b)(20); see 83 Fed. Reg. 16,642-16,643 (Apr. 16, 2018) (explaining that appeals are limited to the individual’s inclusion on the preclusion list). 

As discussed above, CMS revoked Petitioners’ Medicare enrollment because it correctly determined that they had been affiliated with Noble whose Medicare billing privileges were revoked because it had abused those billing privileges.  CMS reasonably determined that, based on that affiliation, Petitioners posed an “undue risk of fraud, waste, or abuse” to the Medicare program and revoked its enrollment.  Posing an “undue risk of fraud, waste, or abuse” is necessarily detrimental to the best interests of the Medicare program and its beneficiaries.  Because its enrollment was revoked for conduct deemed detrimental to the best interests of the Medicare program and its beneficiaries and because it is under a reenrollment bar, CMS is authorized to add them to the Medicare preclusion list.  42 C.F.R. §§ 422.2, 423.100.  I must uphold its determination to do so.  See Wendell Foo, M.D., DAB No. 2904 at 3 (2018), aff’d, 420 F. Supp. 3d 1100 (D. Haw. 2019); Wassim Younes, DAB No. 2861 at 8 (citing Patrick Brueggeman, D.P.M., DAB No. 2725 at 15 (2016)). 

Having determined that CMS properly added Petitioners to the preclusion list, I have no authority to review CMS’s determination as to how long Petitioner remains there.  See 42 C.F.R. § 498.3(b); Vijendra Dave, M.D., DAB No. 2672 at 9-12 (2016) (limiting ALJ review to the determinations in section 498.3(b)). 

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Conclusion

I affirm CMS’s determinations.