Linda J. Hanna-Trad, MD, DAB CR6981 (2026)

DECISION

National Government Services (NGS), a Medicare administrative contractor for the Centers for Medicare & Medicaid Services (CMS), approved the enrollment application of Linda J. Hanna-Trad, MD (Petitioner) effective September 5, 2025, a date which was also upheld in a reconsidered determination.  Petitioner requests a hearing before an administrative law judge (ALJ) because she does not want a gap in billing privileges from June 6, 2024, through September 4, 2025. 

My jurisdiction in this matter is limited to determining whether NGS assigned the correct date for reactivation under the law.  I do not have jurisdiction to review NGS’s decision to deactivate Petitioner’s billing privileges or to issue equitable relief.  As to the issue before me, I affirm NGS’s determination that Petitioner’s effective date for reactivation of Medicare billing privileges is September 5, 2025, because that is the date NGS received Petitioner’s reactivation application that it processed to approval. 

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I.  Background

1. Procedural History

On February 2, 2026, NGS issued a reconsidered determination, finding that September 5, 2025, was the effective date of reactivation of Petitioner’s Medicare billing privileges.  On April 2, 2026, Petitioner timely filed a request for hearing (RFH) to dispute the reconsidered determination.  On April 6, 2026, the Civil Remedies Division (CRD) assigned the case to me, acknowledged the hearing request and issued my Standing Prehearing Order (Prehearing Order). 

On May 12, 2026, CMS timely filed a prehearing exchange, which included a Motion for Summary Judgment, and 11 proposed exhibits (CMS Exs. 1-11).  On August 14, 2026, Petitioner filed an additional statement supporting her appeal, which I treat as Petitioner’s prehearing exchange (P. Br.).  Petitioner did not object to any of CMS’s proposed exhibits.  Therefore, CMS exhibits 1 through 11 are admitted into the record.  Prehearing Order ¶ 10; Civ. Remedies Div. P. § 14(e).  CMS did not file a rebuttal, and the deadline to do so has passed.  Prehearing Order ¶ 7(c).  The record is now closed. 

Because neither party has proffered any witnesses, a hearing is not necessary.  I decide this case on the written record, meaning the parties’ written submissions and arguments, and without considering whether the standard for summary judgment is met.  Prehearing Order ¶ 13; Civ. Remedies Div. P. § 19(d).  Therefore, I deny the CMS’s motion for summary judgment as moot. 

II.  Issue

Whether NGS, acting on CMS’s behalf, had a legitimate basis to assign September 5, 2025, as the effective date for the reactivation of Petitioner’s Medicare billing privileges. 

III.  Jurisdiction

I have jurisdiction to hear and decide this case.  42 C.F.R §§ 498.3(b)(15), 498.5(l)(2); see also 42 U.S.C. § 1395cc(j)(8). 

IV.  Findings of Fact

1. Petitioner is a physician, whose NPI is 1629148986, and PTAN is U400305550.  CMS Ex. 9 at 1.
2. On May 30, 2025, NGS mailed a notice to Petitioner stating that her Medicare billing privileges were being deactivated because she had not had an active

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reassignment in the Provider Enrollment, Chain and Ownership System (PECOS) for at least 90 days.  CMS Ex. 4 at 1. 

3. Petitioner is the sole owner of Linda J. Hanna-Trad, M.D., Inc., a clinic/group practice (practice) whose NPI is 1316300064, and PTAN is U100305538.  Id.
4. On December 29, 2023, NGS mailed a revalidation letter to Petitioner stating that the practice was required to revalidate its Medicare enrollment record by March 31, 2024.  CMS Ex. 2.
5. On April 15, 2024, NGS notified Petitioner that it was withholding all payments on Medicare claims because Petitioner’s practice had not revalidated its enrollment.  CMS Ex. 3 at 1.
6. On June 11, 2024, NGS notified Petitioner that her practice’s billing privileges were being deactivated effective June 6, 2024, because it did not timely revalidate its enrollment records.  CMS Ex. 6.
7. Petitioner submitted an 855I to reactivate her Medicare enrollment on September 5, 2025, and an 855B to reactivate her practice’s enrollment on September 16, 2025.  CMS Exs. 7 and 8.
8. On September 27, 2025, NGS notified Petitioner that her and her practice’s reactivation enrollment applications were approved effective September 5, 2025.  CMS Ex. 9 at 1, 4.  The notice stated Petitioner would have a gap in billing privileges from June 6, 2024, to September 4, 2025, for failing to fully revalidate during the previous revalidation cycle.  Id.
9. On November 28, 2025, Petitioner filed a reconsideration request.  CMS Ex. 10.  Petitioner requested reimbursement for services rendered from June 6, 2024, through September 4, 2025.  Id. at 2.  Petitioner stated that she did not receive any notice to revalidate the practice’s enrollment.  Id. at 3.  Petitioner further explained that she provided continuous service to Medicare beneficiaries during this time and the denial of reimbursement had caused significant financial strain.  Id.  Petitioner further noted that she took immediate action when made aware of the revalidation issue and has taken steps to ensure the issue does not reoccur.  Id.
10. On February 2, 2026, NGS issued an unfavorable reconsidered determination.  CMS Ex. 11.  NGS explained that the practice’s enrollment was correctly deactivated effective June 6, 2024, due to a non-response to revalidation.  Id. at 2-3.  NGS further found Petitioner’s enrollment was correctly deactivated effective May 31, 2025, because Petitioner was not in compliance with enrollment requirements because she did not have an active assignment or practice location

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associated with enrollment in PECOS for at least 90 days.  Id. at 3.  NGS affirmed the effective date of reactivation, September 5, 2025, explaining that was the date of receipt of the application that was processed to approval, and that there was no error in the resulting gap in billing privileges from June 6, 2024, through September 4, 2025.  Id. at 3-4. 

V.  Conclusions of Law

1. Based on the reactivation enrollment application that NGS approved in this case, the effective date for reactivation of Medicare billing privileges is the date the approved application was received by NGS, i.e., September 5, 2025.  42 C.F.R. § 424.540(d)(2). 

VI.  Analysis

The Social Security Act (Act) authorizes the Secretary to promulgate regulations governing the enrollment process for providers and suppliers.  42 U.S.C. §§ 1302, 1395cc(j).  Pertinent here, a “supplier” is “a physician or other practitioner, 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). 

A supplier must enroll in the Medicare program to receive payment for covered Medicare items or services.  42 C.F.R. § 424.505.  The term “Enroll/Enrollment means the process that Medicare uses to establish eligibility to submit claims for Medicare-covered items and services, and the process that Medicare uses to establish eligibility to order or certify Medicare-covered items and services.”  42 C.F.R. § 424.502.  A supplier seeking Medicare billing privileges must “submit enrollment information on the applicable enrollment application.”  42 C.F.R. § 424.510(a)(1). 

To maintain Medicare billing privileges, suppliers must revalidate their enrollment information at least every five years.  42 C.F.R. § 424.515.  However, CMS reserves the right to perform revalidations at any time.  42 C.F.R. § 424.515(d), (e).  When CMS notifies a supplier that it is time to revalidate, the supplier must submit the appropriate enrollment application, accurate information, and supporting documentation within 60 calendar days of CMS’s notification.  42 C.F.R. § 424.515(a)(2).  CMS can 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 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). 

In this case, NGS deactivated Petitioner’s practice’s billing privileges for failing to timely revalidate its enrollment record, effective June 6, 2024.  CMS Ex. 6.  I acknowledge Petitioner’s assertion that she did not receive NGS’s December 29, 2023 notice to

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Petitioner to revalidate or its April 25, 2024 notice of withholding payments.  RFH, P. Br., CMS Ex. 10 at 2-3.  However, the regulations are unequivocal that I do not have authority to review CMS’s decision to deactivate, because deactivation is not an initial determination subject to appeal.  42 C.F.R. §§ 424.545(b) (providing rebuttal rights pursuant to sections 424.546) and 498.3(b); see also Urology Group of New Jersey, LLC, DAB No. 2860 at 6 (2018). 

Instead, my authority extends only to determining whether NGS assigned the correct reactivation date under the applicable law. After reviewing the record, I find no error in NGS’s determination. 

If CMS deactivates a supplier’s billing privileges due to a failure to timely revalidate its enrollment record, the enrolled supplier may apply for CMS to reactivate its Medicare billing privileges by recertifying its enrollment information that is on file or, if deemed appropriate by CMS, complete a new enrollment application.  42 C.F.R. § 424.540(b)(1), (2).  The effective date of reactivation is the date on which the Medicare contractor received the supplier’s reactivation submission that was processed to approval.  42 C.F.R. § 424.540(d)(2). 

The record reflects that Petitioner submitted her reactivation application of September 5, 2025.  CMS Ex. 7 at 1.  This application was processed to approval.  CMS Ex. 9.  Accordingly, the effective date of reactivation is September 5, 2025.  42 C.F.R. § 424.540(d)(2). 

I recognize Petitioner does not want a gap in Medicare billing privileges, and I have no reason to doubt the significant financial impact the lack of reimbursement for services rendered has had on Petitioner, a solo practitioner.  However, the reactivation regulation simply does not permit retrospective billing privileges under any circumstances.  42 C.F.R. § 424.540(e).  To the extent Petitioner seeks equitable relief, I am not authorized to grant it no matter how compelling the circumstances.  An ALJ may not provide equitable relief by reimbursing or enrolling a supplier that does not meet statutory or regulatory requirements.  US Ultrasound, DAB No. 2302 at 8 (2010). 

VII.  Conclusion

For the reasons explained above, the reactivation effective date for Petitioner’s Medicare billing privileges is September 5, 2025.