Alexander J. Acevedo, DAB CR6979 (2026)

DECISION

Petitioner, Alexander J. Acevedo, is a nurse practitioner, who practiced in Michigan and participated in the Medicare program as a supplier of services.  For two years (2016 and 2018), he willingly underreported his income to the Internal Revenue Service.  Because of this, in July 2023, he was convicted on two felony counts of fraud and making false statements.  He did not subsequently report his felony conviction to the Medicare contractor.

Based on his felony conviction and his failure to report the adverse legal action, the Centers for Medicare & Medicaid Services (CMS) revoked Petitioner’s Medicare enrollment and billing privileges, pursuant to 42 C.F.R. §§ 424.535(a)(3) and 424.535(a)(9).  CMS also imposed a ten-year reenrollment bar and added Petitioner’s name to the Medicare preclusion list.

Petitioner appealed.

I affirm CMS’s determinations.  I find that CMS is authorized to revoke Petitioner’s Medicare privileges and to add his name to the Medicare preclusion list because:  1) within the ten years preceding this action, Petitioner Acevedo was convicted of a

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felony that CMS reasonably determined is detrimental to the best interests of the Medicare program and its beneficiaries (42 C.F.R. § 424.535(a)(3)); and 2) Petitioner failed to report the conviction to the Medicare contractor (42 C.F.R. § 424.535(a)(9)).

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, 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.

Section 424.535(a) authorizes CMS to revoke a supplier’s Medicare enrollment and billing privileges on one or more of the grounds set forth under that subsection.  So long as CMS shows that one of the regulatory bases exists, I must uphold the revocation.  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) (citing Patrick Brueggeman, D.P.M., DAB No. 2725 at 15 (2016)).

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Procedural Background.  Here, by letter dated October 17, 2024, the Medicare contractor, National Government Services, advised Petitioner that his Medicare privileges were revoked, effective July 17, 2023.  The letter explained that the contractor revoked Petitioner’s Medicare privileges for two reasons:

1) pursuant to 42 C.F.R. § 424.535(a)(3), because Petitioner Acevedo was convicted of a felony, as defined in 42 C.F.R. § 1001.2, for Fraud and False Statements; and

2) pursuant to 42 C.F.R. § 424.535(a)(9), because Petitioner did not notify CMS, within 30 days, of the felony conviction, as required by 42 C.F.R. § 424.516(d)(1).

CMS Ex. 4 at1.  The contractor imposed a ten-year reenrollment bar (until July 18, 2033), 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, 423.100, and 423.120(c)(6).  It explained that, if Petitioner requested reconsideration, this action would become effective on the date the reconsidered determination was issued.  CMS Ex. 4 at 1-2.

Petitioner requested reconsideration.  CMS Ex. 5.  In a reconsidered determination, dated April 23, 2026, a CMS hearing officer upheld the revocation under sections 424.535(a)(3) and 424.535(a)(9).  Specifically, she found that:  1) Petitioner had been convicted on two counts of fraud and false statements, in violation of 26 U.S.C. § 7206(1), a felony offense that is detrimental to the best interests of the Medicare program; and 2) Petitioner did not report his felony convictions to the Medicare contractor or CMS.  CMS Ex. 7 at 8.

The hearing officer also upheld the duration of the re-enrollment bar and found that Petitioner’s felony conviction formed an appropriate basis for including him on the Medicare Preclusion List.  Id.

Petitioner appealed, and the matter is now before me.

CMS moves for summary judgment.  However, because neither party proposes any witnesses, an in-person hearing would serve no purpose.  See Acknowledgment and Pre-Hearing Order at 4, 5, 6 (¶¶ 4(c)(iv), 8, 9, 10) (June 26, 2026).  I may therefore decide this case based on the written record, without considering whether the standards for summary judgment are satisfied.  See CRDP ¶ 19b.1

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Submissions.  CMS submits its motion and brief (CMS Br.) with seven exhibits (CMS Exs. 1-7).  In the absence of any objections, I admit into evidence CMS Exs. 1-7.

Although directed to do so, Petitioner did not file a brief or any other documents in response to CMS’s submissions.  Pre-Hearing Order at 3-4 (¶ 4).  In deciding this appeal, I consider the arguments made in Petitioner’s Request for Reconsideration, the document titled “Additional Information” (CMS Exs. 5, 6), and his hearing request.  See Anil Hanuman, D.O., DAB No. 3080 at 12 (2022).

Discussion

1. CMS properly revoked Petitioner Acevedo’s Medicare enrollment and billing privileges under 42 C.F.R. §§ 424.535(a)(3) and 424.535(a)(9) because, within ten years preceding the revocation, he was convicted of a felony that CMS reasonably finds detrimental to the best interests of the Medicare program; and because he failed to report his conviction to the Medicare Contractor.2

Revocation of enrollment.  CMS may revoke a supplier’s Medicare enrollment and billing privileges if, within the preceding ten years, the supplier was convicted 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); see also Act §§ 1842 (h)(8), 1866(b)(2)(D).  Offenses for which billing privileges may be terminated include – but are not limited to – financial crimes such as extortion, embezzlement, income tax evasion, insurance fraud, and similar crimes.  42 C.F.R. § 424.535(a)(3)(ii)(B).

CMS may also revoke Medicare privileges if a supplier does not comply with the reporting requirements specified in section 424.516(d).  42 C.F.R. § 424.535(a)(9).  Under section 424.516(d), nonphysician practitioners must report to their Medicare Contractor, within 30 days, “any adverse legal action.”

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Petitioner Acevedo’s felony convictions.  For tax years 2016 and 2018, Petitioner Acevedo underreported his income to the Internal Revenue Service.  In an indictment, filed on February 24, 2021, he was charged on two counts of willfully failing to report tens of thousands of dollars in income, in violation of 26 U.S.C. § 7206(1).  CMS Ex. 1 at 1-2.  Under section 7206(1), any person who “[w]illfully makes and subscribes” any return, statement, or other document, which is “verified by a written declaration that it is made under penalties of perjury, and which he does not believe to be true and correct” is guilty of a felony.

Although Petitioner pleaded not guilty to both counts, and on July 11, 2023, the Federal District Court for the Northern District of Illinois noted that Petitioner was found guilty on both counts and sentenced him to two months in prison, followed by four months of supervised release.  CMS Ex. 3 at 2-3.

Petitioner did not report his conviction to the Medicare Contractor.

Legal basis for revocation.  The Departmental Appeals 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).  William Garner, M.D., DAB No. 3026 at 16 (2020); 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.  Johnson, DAB No. 2779 at 11 (citing Care Pro Home Health, Inc., DAB No. 2723 at 9 n.8 (2016)). I may not substitute my discretion for that of CMS in determining whether the revocation is appropriate.  Norman Johnson, DAB No. 2779 at 11; Abdul Razzaque Ahmed, M.D., DAB No. 2261 at 19 (2009), aff’d, Ahmed v. Sebelius, 710 F. Supp. 2d 167 (D. Mass. 2010).

Petitioner argues that, because his crimes did not involve patient care, billing fraud, false claims, misuse of beneficiary information, or “any conduct arising from the provision of healthcare services,” they do not constitute a felony offense “that is sufficiently ‘detrimental to the best interests of the Medicare program and its beneficiaries’ to warrant revocation under 42 C.F.R. § 424.535(a)(3).”  Hr’g Req. at 1-2.

Section 424.535(a)(3) does not require that a financial crime be related to the Medicare program or patient care.  The drafters of that regulation intended to protect the Medicare program and its beneficiaries from fraudulent and abusive providers and suppliers and they singled out, as threats to the program, those convicted of felonious financial crimes.  71 Fed. Reg. 20,754, 20,768 (Apr. 1, 2006).  The regulation is explicit: income tax evasion is a financial crime that is detrimental to the best interests of the Medicare program and its beneficiaries.  Francis J. Cinelli, Sr., D.O., DAB No. 2834 at 8-9 (2017)

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(finding that CMS may revoke Medicare billing privileges under section 424.535(a)(3) based on any financial crime); Letantia Bussell, M.D., DAB No. 2196 at 9 (2008).

Petitioner presents additional arguments:  that, since his conviction, he has maintained a clean record; that he is committed to reform; that, in the future, he will continue to comply with all CMS requirements and ethical standards.  I have no authority to review Petitioner’s equitable claims.  Wendell Foo, M.D., DAB No. 2904 at 3, 25 (2018) (citing Foot Specialists of Northridge, DAB No. 2773 at 18 (2017)); Wassim Younes, M.D., & Wassim Younes, M.D., P.L.C., DAB No. 2861 at 8 (2018).

Because CMS has grounds for revoking Petitioner’s Medicare enrollment under either section 424.535(a)(3) or section 424.535(a)(9), I must sustain the revocation.

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

When a supplier’s billing privileges are revoked, he 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, M.D., 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 Petitioner to its preclusion list because his Medicare billing privileges were revoked for conduct detrimental to the best interests of the Medicare program, and he is under a reenrollment bar.  In the alternative, CMS may add him to its preclusion list because, within the previous ten years, he was convicted of a felony that CMS deems detrimental to the best interests of the Medicare program.  I have no authority to review CMS’s determination as to the length of time he 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,” particularly with respect to prescription drug abuse.3   Pursuant to 42 C.F.R. § 422.2 (Part

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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, for reasons other than that stated under 42 C.F.R. § 424.535(a)(3); 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;
• 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;
• regardless of whether they are or were enrolled in Medicare, have been convicted of a felony under federal or state law within the previous ten years that CMS deems 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. 16,642-43 (Apr. 16, 2018) (explaining that appeals are limited to the individual’s inclusion on the preclusion list).

As discussed above, Petitioner meets two of the criteria for inclusion on the list:  he is currently revoked from Medicare, is under a re-enrollment bar, and CMS determined that his underlying conduct is detrimental to the best interests of the Medicare program; and he was convicted of a felony within the previous ten years that CMS reasonably determined is detrimental to the best interests of the Medicare program and its beneficiaries.  CMS was therefore authorized to add his name to the Medicare preclusion list.  42 C.F.R. §§ 422.2 (preclusion list definition (1), (3)), 423.100 (preclusion list definition (1), (3)).  Because CMS was authorized to take this action, I must uphold its determination to do so.  See Wendell Foo, M.D., DAB No. 2904 at 3; Wassim Younes, M.D., P.L.C., DAB No. 2861 at 8 (citing Patrick Brueggeman, D.P.M., DAB No. 2725 at 15 (2016)).

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

CMS justifiably determined that Petitioner Acevedo was convicted of a felony detrimental to the best interests of the Medicare program and its beneficiaries; it may therefore revoke his Medicare enrollment and billing privileges and impose a reenrollment bar.  In the alternative, CMS may revoke Petitioner’s Medicare enrollment because he did not timely report the adverse legal action to the Medicare contractor.

CMS was authorized to include Petitioner on the preclusion list because:  1) within the previous ten years, he was convicted of a felony that CMS deems detrimental to the best interests of the Medicare program; and 2) he is currently revoked from Medicare, is under a re-enrollment bar, and CMS determined that his underlying conduct is detrimental to the best interests of the Medicare program.

I have no authority to review the length of the reenrollment bar nor his time on the preclusion list.

For these reasons, I affirm CMS’s determinations.