City of Hope Hospice, DAB CR6968 (2026)

DECISION

Petitioner, City of Hope Hospice, is a California hospice, who participated in the Medicare program as a provider of services.  Finding that it had been affiliated with another hospice provider that posed an undue risk of fraud, waste, or abuse to the Medicare program, the Centers for Medicare & Medicaid Services (CMS) has revoked its Medicare enrollment, imposed a ten-year re-enrollment bar, and added its name to the Medicare preclusion list.  42 C.F.R. § 424.535(a)(19); see 42 C.F.R. § 424.519.

Petitioner appealed.

I affirm CMS’s determination.  I find that CMS is authorized to revoke Petitioner’s Medicare enrollment, pursuant to section 1866(j)(5)(B) of the Social Security Act (Act) and 42 C.F.R. § 424.535(a)(19) because, based on its affiliation with the provider, Recovery Hospice, through a shared medical director, its enrollment in the Medicare program poses an undue risk of fraud, waste, and abuse.  For the same reason, CMS may add Petitioner’s name to the Medicare preclusion list.

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

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Background

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.  Salman M. Akbar, DAB No. 3227 at 9 (2025); Devine Solutions Group, LLC, d/b/a/ Quick Response EMS, DAB No. 3159 at 12 (2024); Thomas Falls, M.D., DAB No. 3056 at 8 (2022); William Garner, MD, DAB No. 3026 at 16 (2020); Eva Orticio Villamor-Goubeaux, DAB No. 2997 at 13 (2020); Wassim Younes, M.D. and 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.

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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 a legally-sound revocation is appropriate.  Norman Johnson 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.  Here, by letter dated December 23, 2024, the Medicare contractor, National Government Services, advised Petitioner that its Medicare privileges were revoked, effective January 22, 2025.  The letter explained that the contractor revoked Petitioner’s Medicare privileges because he had an affiliation with Recovery Hospice, Inc., an entity previously enrolled in the Medicare program through Dr. Hoang Chuong Vu (Dr. Vu), a shared medical director.  Recovery Hospice’s Medicare billing privileges were revoked pursuant to 42 C.F.R. § 424.535(a)(8)(ii) – abuse of billing privileges and 42 C.F.R. § 424.535(a)(10).  The contractor determined that Petitioner’s affiliation with Recovery Hospice through its shared medical director posed an undue risk of fraud, waste, or abuse to the Medicare program and that Petitioner’s participation in Medicare should therefore be revoked.  CMS Ex. 4 at 1; see 42 C.F.R. §§ 424.519(i); 424.535(a)(19).

The contractor imposed a ten-year reenrollment bar, effective 30 days after the postmark date of the notice, pursuant to 42 C.F.R. § 424.535(c).  Id.

The letter also advised Petitioner that the contractor added him to CMS’s preclusion list, as authorized by 42 C.F.R. §§ 422.2, 422.222 (Part C), 423.100, and 423.120(c)(6) (Part D).  It explained that, if Petitioner requested reconsideration, this action would become effective on the date the reconsidered determination was issued.  Id. at 1-2.

The reconsidered determination.  In a reconsidered determination, dated March 6, 2026, a CMS hearing officer upheld the revocation under sections 424.519 and 424.535(a)(19).  Citing section 424.519, she found that Petitioner’s affiliation with Recovery Hospice posed an undue risk of fraud, waste, or abuse to the Medicare program.  CMS Ex. 2 at 11-12.

The hearing officer also upheld the ten-year reenrollment bar and the determination to include Petitioner’s name on CMS’s preclusion list.  Id.

Exhibits and witnesses.  CMS submitted its motion and brief (CMS Br.) with six exhibits (CMS Exs. 1-6).  CMS also filed a Reply brief (CMS Reply).  In the absence of any objections, I admit into evidence CMS Exs. 1-6.

CMS listed no witnesses.

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Petitioner submitted his own brief and opposition to summary judgment (P. Br.) with five exhibits (P. Exs. 1-5).

Petitioner also submitted a declaration for one witness:  Anna Boyrazyan, Petitioner’s Chief Executive Office.  P. Exs. 10, 11.

CMS’s objections to exhibit 9.  CMS objects to my admitting P. Ex. 9:

• P. Ex. 9 – Petitioner’s Hospice Medical Director job description and professional services agreement for the medical director.  Petitioner does not dispute that the document was in existence at the time of the reconsideration request.
  
  CMS objects to my admitting P. Ex. 9 because Petitioner did not submit the document at the reconsideration level.  Petitioner argues that the exhibit shows the medical director’s duties and shows that Dr. Vu was terminated by Petitioner.  P. Br. at 5-6.
  
  Petitioner was well aware at the time of the reconsideration, that this case turns on its relationship with Recovery Hospice and Dr. Vu.  Since Petitioner argued that it terminated its relationship with Dr. Vu prior to the receipt of its initial determination revoking its billing privileges, it was foreseeable that it would need to present proof of that termination at the reconsideration level.
  
  Because Petitioner did not submit the proposed exhibit at the reconsideration level and has not shown good cause for failing to do so, I must exclude it from the proceeding and may not consider it in reaching a decision.  42 C.F.R. § 498.56(e)(2).2

Decision based on the written record.  CMS moves for summary judgment, which Petitioner opposes.

The initial order instructed the parties to list any proposed witnesses and to submit their written direct testimony.  Standing Order at 9-10; see CRD Procedures ¶ 16b.  The order

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also directs the parties to indicate which, if any, of the opposing side’s witnesses the party wishes to cross-examine and explains that an in-person hearing is needed only if a party wishes to cross-examine the opposing side’s witnesses.  Id.  CMS lists no witnesses.  CMS has not asked to cross-examine Petitioner’s witness.  Because there are no requests to cross-examine, an in-person hearing would serve no purpose, and I may decide this case based on the written record.  See CRD Procedures ¶ 19b.3 

Issues

The sole questions before me are:

1. Did CMS have the authority to revoke Petitioner’s Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(19)?
2. Did CMS have the authority to include Petitioner on the CMS 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’Conner, DAB No. 3140 at 8 (2024).

Discussion

1. CMS properly revoked Petitioner’s Medicare enrollment under 42 C.F.R. § 424.535(a)(19) because its affiliation with the provider, Recovery Hospice, Inc., poses an undue risk of fraud, waste or abuse.4

Revocation of enrollment: To protect program integrity, it has directed the Secretary of Health and Human Services (and, thus, CMS) to hold accountable those individuals responsible for ensuring that the Medicare rules are followed.  This includes a provider’s medical director.  With this goal in mind, Congress expanded CMS’s authority to revoke the enrollment of those affiliated with entities that have had their billing privileges denied or revoked.

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Section 1866(j)(5) of the Act (42 U.S.C. § 1395cc(j)(5)) increases the disclosure requirements for Medicare providers and suppliers.  That provision requires that providers/suppliers disclose the following information:

any current or previous affiliation (directly or indirectly) with a provider of medical or other items or services or supplier that has uncollected debt, has been or is subject to a payment suspension under a Federal health care program . . . , has been excluded from participation under the program under this title, the Medicaid program under title XIX, or the CHIP [Children’s Health Insurance Program] program under title XXI, or has had its billing privileges denied or revoked.

Act § 1866(j)(5)(A) (Emphasis added).  The Act also authorizes CMS (acting on behalf of the Secretary) to deny Medicare enrollment if it determines that the disclosed affiliation “poses an undue risk of fraud, waste, or abuse.”  Act § 1866(j)(5)(B).

Consistent with the statute, the regulations authorize CMS to revoke a provider’s Medicare enrollment and billing privileges if he has or has had an affiliation, under section 424.519, that “poses an undue risk of fraud, waste, or abuse to the Medicare program.”  42 C.F.R. § 424.535(a)(19). 

Affiliation defined.  For purposes of applying section 424.519 (discussed below), an “affiliation” means any of the following:

1. A five percent or greater direct or indirect ownership interest in another organization.
2. A general or limited partnership interest (regardless of percentage) 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 an organization, either under contract or through some other arrangement, regardless of whether the individual 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 section 424.80.

42 C.F.R. § 424.502 (Definition of Affiliation).

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The regulation specifically defines a “managing employee” as:

general manager, business manager, administrator, director, or other individual that exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operation of the provider or supplier, under contract or through some other arrangement, whether or not the individual is a W-2 employee of the provider or supplier.  For purposes of this definition, this includes, but is not limited to, a hospice or skilled nursing facility administrator and a hospice or skilled nursing facility medical director.

42 C.F.R. § 424.502 (Definition of Managing employee (1)).

Disclosable events defined.  Sections 424.519 and 424.502 define “disclosable events.”  A disclosable event (for purposes of section 424.519) includes situations in which a supplier has been subject to payment suspension under a federal health care program or when it has had its Medicare, Medicaid, or CHIP enrollment denied, revoked, or terminated.  42 C.F.R. § 424.502 (Definition of Disclosable event (2), (4)).

When CMS requests it, an enrolling or revalidating provider or supplier must disclose “any and all affiliations” that it or any of its owning or managing employees has or had, within the previous five years, with a currently or formerly enrolled Medicare, Medicaid, or CHIP provider or supplier that has a disclosable event (as defined in section 424.502).  CMS will request such disclosures when it has determined that the provider or supplier may have at least one such affiliation.  42 C.F.R. § 424.519(b).

The regulation then lists the information that the provider/supplier must disclose about each reported affiliation.  These include general identifying information, reasons for the disclosure, data regarding the affiliation relationship (length; type; degree of affiliation; if ended, the reason it ended).  42 C.F.R. § 424.519(c).

When it receives the information, CMS determines whether any of the disclosed affiliations pose an undue risk of fraud, waste, or abuse.  In making this determination, CMS considers:

1) The duration of the affiliation. 
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 disclosable event (section 424.519(b)), CMS considers:  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

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imposed . . . 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.

42 C.F.R. § 424.419(f).

If CMS determines that a particular affiliation poses an undue risk of fraud, waste, or abuse, it denies the provider/supplier’s enrollment application under section 424.530(a)(13), or it revokes the provider’s/supplier’s Medicare enrollment under section 424.535(a)(19).  42 C.F.R. § 424.519(g).

Revocation of Recovery Hospice’s billing privileges.  Recovery Hospice, Inc., was a California hospice that participated in the Medicare program as a provider of services.

On August 22, 2024, a CMS contractor sent a notice letter to Recovery Hospice revoking its Medicare billing privileges based on abuse of billing privileges, 42 C.F.R. § 424.535(a)(8)(ii), and failure to document or provide CMS access to documentation, 42 C.F.R. § 424.535(a)(10).  CMS Ex. 1.  The contractor reviewed 10 claims with dates of service from October 4, 2023 through November 30, 2023 and 9 were denied.  Id.  From May 14, 2024 through May 20, 2024, the contractor requested medical for 10 beneficiaries and Recovery Hospice failed to produce 9 of the 10 records.  Id.  CMS determined that Recovery Hospice has a pattern or practice of submitting claims that fail to meet Medicare requirements.  Recovery Hospice did not file for reconsideration.  CMS  imposed a ten-year re-enrollment bar and added it to the preclusion list.  Id.

The revocation of Recovery Hospice’s Medicare billing privileges was a disclosable event that prompted CMS to review its affiliations and to determine whether those affiliations posed an undue risk of fraud, waste, or abuse to the Medicare program.  42 C.F.R. §§ 424.519, 424.535(a)(19).

Recovery Hospice’s affiliation with Dr. Vu.  In its Medicare enrollment documents, Recovery Hospice listed Dr. Vu as its medical director effective July 10, 2023.  CMS Ex. 3.  Dr. Vu was the medical director during the dates of service CMS based its revocation of Recovery Hospice’s on and there was no evidence he had been terminated at the time of Recovery Hospice’s revocation.

Petitioner’s affiliation with Recovery Hospice, Inc.  In its Medicare enrollment documents, Petitioner listed Dr. Vu as a managing employee and medical director.  CMS Ex. 5.  Petitioner does not dispute that Dr. Vu was its medical director and managing employee beginning on March 18, 2024.  P. Br. at 4.  Dr. Vu was Petitioner’s medical director for an undefined period of time.  However, there is no evidence or argument submitted that Dr. Vu was not Petitioner’s medical director at the time of Recovery Hospice’s revocation.

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Citing 42 C.F.R. § 424.535(e), Petitioner argues that, because it terminated its relationship with Dr. Vu as soon as it became aware of a revocation notice and before it received an initial determination, it should not be subject to exclusion.  Petitioner misreads the regulation.  The regulation provides:

If the revocation was due to adverse activity (sanction, exclusion, or felony) against a provider’s or supplier’s owner, managing employee, managing organization, officer, director, authorized or delegated official, medical director, supervising physician, or other health care or administrative or management services 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 notice.

42 C.F.R. § 424.535(e) (Emphasis added).  Thus, if a provider or supplier faces revocation because one of its employees (or other listed individuals) has been sanctioned (see, e.g., 42 C.F.R. § 424.535(a)(2)), it may avoid revocation by terminating its business relationship with the sanctioned individual.  See Diagnostic Imaging Network Medical Group, DAB No. 3100 at 12 (2023) (explaining that section 424.535(e) applies when the previously sanctioned individual is still employed by, or in a business relationship with the provider/suppler at the time CMS issues a revocation notice, and the provider/supplier timely terminates that relationship).  Petitioner argues that this regulation can be extended to cover its situation where the affiliation is based on its relationship with another provider through a mutually shared medical director.  However, the language of the regulation covers the termination of an employee not another hospice.  Thus, section 424.535(e) does not apply.  Even if it did, Petitioner did not submit proof that it had terminated its business relationship with that party within 15 days of the revocation notice.  Additionally, an ALJ, unlike CMS, is not afforded the discretion pursuant to section 424.535(e) to reverse a revocation based on proof that the hospice terminated its relationship.

Petitioner’s affiliation with Recovery Hospice, Inc.  In its Medicare enrollment documents, Petitioner listed Dr. Vu as a managing employee and medical director.  CMS Ex. 5.  Petitioner does not dispute that Dr. Vu was its medical director and managing employee beginning on March 18, 2024.  P. Br. at 4.  Dr. Vu was Petitioner’s medical director for an undefined period of time.  However, there is no evidence or argument submitted that Dr. Vu was not Petitioner’s medical director at the time of Recovery Hospice’s revocation.

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Although Petitioner concedes that Dr. Vu was the medical director for both Petitioner and Recovery Hospice, Petitioner argues that Dr. Vu had limited roles at both hospices and that Recovery Hospice was owned by a group that has “compliance challenges” that said group had nothing to do with Petitioner.

However, because Dr. Vu was both Petitioner’s and Recovery Hospice’s medical director, Petitioner was, by law, affiliated with Recovery Hospice.  The regulation, on its face, includes the hospice’s medical director in the definition of managing employee.  42 C.F.R. § 424.502 (Definition of Managing employee (1)) (managing employee “includes . . . a hospice . . . medical director.”).

Petitioner’s efforts to distance itself from the Recovery Hospice cannot change the nature of that affiliation.  As medical director, Dr. Vu was responsible for the “medical component of the hospice’s patient care program.”  42 C.F.R. § 418.102(d).  His duties included “review[ing] the clinical information for each hospice patient and provid[ing] written certification that it is anticipated that the patient’s life expectancy is 6 months or less if the illness runs its normal course.”  42 C.F.R. § 418.102(b) (Emphasis added).

Petitioner does not seem to understand what is required of a medical director.  The medical director plays an integral role and, like other provider officers and managers (as listed in the statute and regulation), must protect against fraud, waste, and abuse.  Petitioner’s efforts to distance itself from Recovery Hospice cannot erase Dr. Vu’s disregard for the hospice’s mismanagement and for not fulfilling his obligations as set forth in the hospice regulations.

The reasons the contractor denied Recovery Hospice’s claims – because hospice failed to provide records in response to requests from the CMS contractor.  Dr. Vu was responsible for the medical component of the hospice’s patient care program.  42 C.F.R. § 418.102(d).  Dr. Vu was supposed to have reviewed the clinical information and provided written certification regarding the patients.  42 C.F.R. § 418.102(b).  Those were his responsibilities.  That Dr. Vu allegedly did not know that the hospice failed to produce the records resulting in improperly billing for those services just means that he was not paying proper attention and was allowing fraud, waste, and abuse to happen on his watch.  See Adel A. Kallini, M.D., DAB No. 3021 at 20 (2020) (in a related context, finding that a physician’s responsibility to ensure proper billing for the services he provides is “so core” to his role as a physician in the Medicare program “that it is hard to see how any physician oblivious to them . . . could be trusted to participate in the program.”)

In deciding to exclude Petitioner, CMS considered the factors, set forth in 42 C.F.R. § 424.519(f).  Although Petitioner considers the duration of his affiliation with Recovery Hospice inconsequential, a 9-month affiliation is, in fact, significant, particularly considering that the improper billing occurred at that time as well as Recovery Hospice’s

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revocation.  See, e.g., Ritu Khanna, M.D., DAB CR6854 (2026) (upholding revocation based, in part, on a one-year affiliation); Edmond Petrossian and Sterling Physicians Medical Group, DAB CR6758 (2025) (seven-month affiliation); Fernando D. Palacios, Fernando Palacios, M.D., DAB CR6754 (2025) (two-month affiliation).

Further, as discussed above, by law, the degree and extent of the affiliation between a hospice and its medical director are significant.  That Dr. Vu did not appreciate his critical role only underscores the risk Petitioner’s affiliation with Recovery Hospice poses.

During his 9-month affiliation with Recovery Hospice (March 2024, through December 2024), Dr. Vu failed to perform the medical director’s duties to guard against fraud, waste, and abuse.  CMS reasonably found a risk that he 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.  Thus, Petitioner’s affiliation with Recovery Hospice through Dr. Vu poses an undue risk of fraud, waste, or abuse.  42 C.F.R. § 424.519(f).

Because CMS has grounds for revoking Petitioner’s Medicare enrollment under section 424.535(a)(19), I must sustain the revocation.

2. I have no authority to review CMS’s determination to impose a ten-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 ten years (except under circumstance 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 ten-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, MD, DAB No. 2985 at 15-16 (2020).

3. CMS acted within its authority when it added Petitioner to its preclusion list because its Medicare privileges were revoked for conduct detrimental to the best interests of the Medicare program, and he is under a reenrollment bar.  I have no authority to review CMS’s determination as to the length of time it remains on the preclusion list.

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,”

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particularly with respect to prescription drug abuse.5  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:

• are currently revoked from Medicare enrollment, are under an active reenrollment bar, and CMS determines that the underlying conduct leading to the revocation is detrimental to the best interests of the Medicare program; or
• have engaged in behavior for which CMS could have revoked the prescriber, individual, or entity had it been enrolled in the Medicare program, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare program.

Review of Petitioner’s 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. 16,642-16643 (Apr. 16, 2018) (explaining that appeals are limited to the individual’s inclusion on the preclusion list).

As discussed above, CMS revoked Petitioner’s Medicare enrollment because it correctly determined that it had been affiliated with Recovery Hospice, through their mutual medical director, whose Medicare billing privileges were revoked because it had abused its billing privileges.

CMS reasonably determined that, based on its affiliation with Recovery Hospice, Petitioner poses 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 it 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, M.D., P.L.C., DAB No. 2861 at 8 (2018), citing Patrick Brueggeman, D.P.M., DAB No. 2725 at 15 (2016).

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Having determined that CMS properly added Petitioner to the preclusion list, I have no authority to review CMS’s determination as to how long it 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)).

Conclusion

I affirm CMS’s determinations.

CMS justifiably revoked Petitioner’s Medicare enrollment and imposed a reenrollment bar because, based on its affiliation with Recovery Hospice, its enrollment poses an undue risk of fraud, waste, and abuse to the Medicare program.  42 C.F.R. § 424.535(a)(19).

CMS was authorized to include Petitioner on the preclusion list because its Medicare enrollment was revoked for conduct detrimental to the best interests of the Medicare program, and because it is under a reenrollment bar.

I have no authority to review the lengths of the reenrollment bar nor Petitioner’s time on the preclusion list.