DA & AR Hospice Care Inc., DAB CR6984 (2026)

DECISION

The Centers for Medicare & Medicaid Services (CMS) upheld a determination by National Government Services (NGS), a Medicare administrative contractor, revoking the Medicare enrollment and billing privileges of Petitioner, DA & AR Hospice Care Inc., effective September 14, 2025, pursuant to 42 C.F.R. § 424.535(a)(4) and (a)(9).  CMS also upheld Petitioner’s placement on its Preclusion List as well as NGS’s imposition of a ten-year reenrollment bar.  I affirm the revocation of Petitioner’s Medicare enrollment and billing privileges and placement on CMS’s Preclusion List.  Although Petitioner also disputes the ten‑year bar to reenrollment, that challenge falls outside my scope of review because the duration of the bar is not an appealable initial determination. 

I. BACKGROUND AND PROCEDURAL HISTORY

Petitioner is a hospice provider located in Van Nuys, California.  On August 15, 2025, NGS issued an initial determination revoking Petitioner’s Medicare enrollment and billing privileges effective September 14, 2025, and imposing a ten-year reenrollment bar.  CMS Ex. 1 at 1-2.  NGS took the action because:  (1) Petitioner provided false or

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misleading information on its July 5, 2024 revalidation application by failing to disclose its Medical Director, in violation of 42 C.F.R. § 424.535(a)(4); and (2) Petitioner failed to report its Administrator/Director of Patient Care Services as well as its Administrator/Director of Patient Care Services Designee and Medical Director Designee to CMS, in violation of 42 C.F.R. § 424.535(a)(9).  Id. at 1.  NGS also advised Petitioner that it would be placed on CMS’s Preclusion List pursuant to 42 C.F.R. §§ 422.2, 422.222, 423.100, 423.120(c)(6).  Id. at 2. 

On September 16, 2025, Petitioner requested reconsideration of CMS’s initial determination and, on January 7, 2026, submitted a supplemental filing in support of that request.  CMS Exs. 2, 9.  In sum, Petitioner proffered that its failure to report its Medical Director on its revalidation application was inadvertent and resulted in an incomplete rather than false or misleading submission.  CMS Ex. 2 at 4; see also CMS Ex. 9 at 1-2.  Similarly, Petitioner stated that its failure to report its other managing employee, i.e., its Administrator/Director of Patient Care Services, was unintentional but argued that it was not required to report its “designees” because they do not exercise operational control or direct the daily operations of the provider.  CMS Ex. 2 at 4.  Petitioner noted that the hospice’s Administrator, who is the owner, ultimately handles the day-to-day operations and that she has been consistently reported as such in the Provider, Enrollment, Chain, and Ownership System (PECOS).  Id.  In support of its argument that its failure to report was unintentional, Petitioner explained that, at the time it filed its revalidation application, CMS had only recently clarified which hospice administrators qualify as “managing employees” requiring disclosure and asserted that CMS’s own contractor appeared unaware of these changes, as it did not identify the missing Medical Director information either in the application review or in its development request.  CMS Ex. 9 at 1-2.  Petitioner stated that it had no reason to conceal the individuals because none of the unreported individuals had prior adverse legal actions or other sanctions.  CMS Ex. 2 at 5.  For these reasons, Petitioner argued that Medicare funds were never at risk by its inadvertent failures to report and that the ten-year reenrollment bar was excessive.  Id. at 5-6. 

On April 6, 2026, a CMS hearing officer issued a reconsidered determination upholding the revocation of Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.535(a)(4) and (a)(9).  DAB E-File Entry No. 1a (Reconsidered Determination).  The hearing officer also upheld the ten-year reenrollment bar and adding Petitioner to CMS’s Preclusion List.  Id. 

Petitioner timely requested review by an administrative law judge (ALJ).  On April 27, 2026, the matter was assigned to ALJ Benjamin Zeitlin, and the Civil Remedies Division issued a letter acknowledging Petitioner’s request for hearing and issued ALJ Zeitlin’s Standing Order.  On May 6, 2026, upon ALJ Zeitlin’s resignation, the case was reassigned to the undersigned ALJ. 

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CMS timely filed a Motion for Summary Judgment (CMS Br.), along with ten proposed exhibits (CMS Exs. 1–10).  CMS did not identify any proposed witnesses nor submit written direct testimony.  Petitioner timely filed its Combined Motion and Memorandum of Law in Opposition to Respondent’s Motion for Summary Judgment, Motion and Memorandum of Law in Support of Summary Judgment and Pre-Hearing Brief (P. Br.).  Petitioner also filed two proposed exhibits (P. Exs. 1-2), which were not previously submitted, and identified two proposed witnesses but did not submit written direct testimony from the proposed witnesses.  DAB E-File Entry No. 13 at 22 (Petitioner’s Proposed Exhibits and Witness List).  On August 26, 2026, CMS filed a Reply in Support of its Motion for Summary Judgment and in Opposition to Petitioner’s Cross-Motion for Summary Judgment (CMS Reply).  CMS did not object to Petitioner’s proposed exhibits or request to cross-examine or otherwise address Petitioner’s proposed witnesses. 

II. ADMISSION OF NEW EVIDENCE AND DECISION ON THE RECORD

Petitioner did not object to CMS’s proposed exhibits.  I admit CMS’s proposed exhibits 1–9 into the record as CMS Exs. 1–9.  However, I exclude CMS’s proposed exhibit 10 due to concerns regarding its authenticity.  Exhibit 10 purports to be a copy of the reconsidered determination in this matter, but it is dated June 29, 2026, rather than April 6, 2026.  Compare CMS Ex. 10 at 1 with Reconsidered Determination at 1; see also CMS’s Proposed Exhibit List at 2 (identifying exhibit 10 as “Reconsideration request decision dated April 6, 2026.”).  CMS offers no explanation for this discrepancy, and none is apparent from the documents.  The two versions appear identical aside from the issuance date.  Seemingly, CMS inadvertently altered the date when preparing its exchange, which was filed on June 30, 2026.  Any alteration, even minor, raises a question regarding the authenticity of CMS’s proposed version.  Accordingly, I exclude CMS Ex. 10 and rely on the unaltered Reconsidered Determination submitted by Petitioner. 

CMS did not object to Petitioner’s submissions of new evidence; however, the governing regulation requires me to examine any new documentary evidence offered for the first time at the ALJ level and to determine whether Petitioner had good cause for not submitting it earlier.  42 C.F.R. § 498.56(e); see also Standing Order ¶ 9 (explaining that “Petitioner may not offer new documentary evidence absent a showing of good cause for failing to present that evidence previously to CMS.”). 

Petitioner’s proposed exhibit 1 is the 2024 paper version of CMS-855A, and proposed exhibit 2 is the 2023 paper version; both are official, publicly available CMS forms.  Although Petitioner offered no explanation for failing to submit these documents earlier, because they are official CMS documents that are publicly available, and in the interest of developing a complete record, I find good cause to admit Petitioner’s exhibits 1 and 2 into the record as P. Exs. 1–2. 

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Neither party submitted written direct testimony; however, Petitioner identified two proposed witnesses.  The Standing Order in this case required each party to include the written direct testimony for all witnesses with its prehearing exchange and explained that a hearing would be necessary only if written direct testimony was submitted and a party requested to cross-examine at least one witness.  Standing Order ¶¶ 11-13; Civil Remedies Division Procedures (CRDP) §§ 16(a), (b), 19(d) (incorporated by reference at Standing Order ¶ 1).  Because neither party submitted written direct testimony, a hearing is not necessary and I decide this case based on the written record before me.  The parties’ motions for summary judgment are therefore denied as moot. 

III.  ISSUES

The issues I must decide in this case are: 

• Whether CMS had a legal basis to revoke the Medicare enrollment and billing privileges of Petitioner under 42 C.F.R. § 424.535(a)(4), and/or (a)(9).
• If so, whether the length of a reenrollment bar is reviewable.
• Whether CMS had a legal basis to place Petitioner on its Preclusion List. 

IV.  JURISDICTION

I have jurisdiction to decide this case.  Social Security Act (Act) § 1866(j)(8), 42 U.S.C. § 1395cc(j)(8); 42 C.F.R. §§ 498.3(b)(17), 498.5(l)(2). 

V.  DISCUSSION

A.  Statutory and Regulatory Framework

The Social Security Act authorizes the Secretary of Health and Human Services to establish by regulation the enrollment process for providers and suppliers participating in the Medicare program.  Act § 1866(j)(1)(A), 42 U.S.C. § 1395cc(j)(1)(A).  For purposes of the Medicare program, Petitioner is considered a provider.  Act § 1861(u), 42 U.S.C. § 1395x(u); 42 C.F.R. § 400.202 (definition of provider).  To participate in the Medicare program as a provider, entities must meet certain criteria to enroll and receive billing privileges.  42 C.F.R. §§ 424.505, 424.510, 424.516. 

CMS may revoke the Medicare billing privileges of providers or suppliers for any of the reasons stated in 42 C.F.R. § 424.535(a), including: 

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(4) False or misleading information.  The provider or supplier certified as “true” misleading or false information on the enrollment application to be enrolled or maintain enrollment in the Medicare program. 

* * * *

(9) Failure to report.  The provider or supplier did not comply with the reporting requirements specified in § 424.516(d) or (e), § 410.33(g)(2) of this chapter, or § 424.57(c)(2). 

42 C.F.R. § 424.535(a)(4), (a)(9).  CMS must consider the following factors before revoking pursuant to 42 C.F.R. § 424.535(a)(9): 

(i) Whether the data in question was reported.
(ii) If the data was reported, how belatedly.
(iii) The materiality of the data in question.
(iv) Any other information that CMS deems relevant to its determination. 

When CMS revokes a provider’s Medicare billing privileges, CMS establishes a reenrollment bar for a period ranging from one to ten years.  42 C.F.R. § 424.535(c).  Finally, individuals and entities whose enrollment have been revoked and who are under a reenrollment bar may also, in certain circumstances, be placed on CMS’s Preclusion List.  Medicare Advantage organizations and Medicare Part D plan sponsors may not provide reimbursement for any items or services furnished by an individual or entity on CMS’s Preclusion List or for prescriptions those individuals write.  42 C.F.R. §§ 422.2, 422.222, 422.224, 423.100, 423.120(c)(6). 

A provider whose Medicare enrollment and billing privileges have been revoked may seek reconsideration and further review under the procedures set forth in 42 C.F.R. part 498.  42 C.F.R. §§ 498.3(b)(17), 498.5(l), 498.22(a).  Likewise, a provider added to the Preclusion List may request reconsideration and review.  42 C.F.R. §§ 422.222(a)(2), 423.120(c)(6)(v)(A), 498.3(b)(2), 498.5(n)(1)(i).  A request for reconsideration must be submitted to CMS or its contractor.  42 C.F.R. § 498.22(a).  CMS or its contractor must then issue a reconsidered determination that explains the reasons for the decision and, if adverse, identifies the requirements the provider failed to meet and advises the provider of the right to an ALJ hearing.  42 C.F.R. § 498.25. 

If the reconsidered determination remains unfavorable, the provider may request a hearing before an ALJ and seek further review by the Departmental Appeals Board (the Board).  See Act § 1866(j)(8), 42 U.S.C. § 1395cc(j)(8); 42 C.F.R. §§ 424.545, 498.3(b)(17), (20).  The provider bears the burden to show that it meets all enrollment requirements.  42 C.F.R. § 424.545(c).  Review relating to placement on the Preclusion

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List is limited to whether CMS had a basis to add the individual or entity to the list.  42 C.F.R. §§ 498.3(b)(20), 498.5(n). 

B.  Findings of Fact, Conclusions of Law, and Analysis

My findings of fact and conclusions of law, set forth in italics, follow. 

1.  CMS had a legal basis to revoke Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.535(a)(4) because Petitioner did not report a managing employee on its revalidation application and thereby provided incomplete, inaccurate and misleading information in the application. 

CMS may revoke a currently enrolled provider’s billing privileges when the provider certifies as “true” information on an enrollment application that is misleading or false.  42 C.F.R. § 424.535(a)(4).  The regulations require each enrollment application to contain “complete, accurate and truthful responses” to all requested information applicable to the provider or supplier type.  42 C.F.R. § 424.510(d)(2)(i) (emphasis added).  The application includes ownership and management information, and for hospice providers, “managing employees” specifically include administrators and medical directors.  42 C.F.R. § 424.502; see also id. § 424.510(d)(2)(iii)(C); P. Ex. 1 at 35; P. Ex. 2 at 35. 

Enrollment applications must also be signed.  42 C.F.R. § 424.510(d)(3).  The certification statement must be signed by an individual with legal and financial authority to bind the provider to Medicare’s regulatory requirements.  Id.  By signing, the authorized official certifies that the information submitted is “true, correct, and complete” and authorizes the MAC to verify that information.  P. Ex. 1 at 49. 

On July 5, 2024, Petitioner submitted, and certified an 855A revalidation application.  CMS Ex. 3 at 1.  Petitioner identified three owners, and their respective roles, in “Section 6:  Ownership Interest & Managing Control Info (Individuals)” of the application.  Id. at 3-5.  Petitioner did not identify Dr. H.L., its Medical Director, since November 1, 2021, on its application.  See CMS Ex. 6; CMS Ex. 4 at 7; CMS Ex. 5 at 1-9.  Petitioner does not dispute these material facts.  Petitioner also does not dispute that the definition of managing employees specifically includes medical directors, and that it was therefore required to report its medical director on its revalidation application.  P. Br. at 3. 

Instead, Petitioner first argues that CMS has not established a prima facie basis for revocation under 42 C.F.R. § 424.535(a)(4).  Id. at 8.  Petitioner contends that the enrollment application CMS relies on is merely a printout of an online data report reflecting the status of information in PECOS on August 3, 2024, and not the actual revalidation application it submitted.  According to Petitioner, this printout “contains no language of certification.”  Id.  I disagree. 

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As CMS notes, Petitioner acknowledges the existence and contents of its July 2024 revalidation application, including that it was submitted electronically.  CMS Reply at 2 (citing P. Br. at 4).  Moreover, the Application Data Report submitted by CMS bears sufficient indicia of authenticity to establish that it is the application Petitioner electronically submitted on July 5, 2024.  It includes the same Tracking Identifier that Petitioner previously stated had been reviewed by NGS.  Compare CMS Ex. 3 at 1 (“Tracking ID: T070520240001874”), with CMS Ex. 9 at 2, 7–8 (Request for Corrections for Medical Enrollment Application (Tracking ID: T070520240001874), which Petitioner submitted with its First Supplement to Request for Reconsideration).  The Application Data Report further shows that the application was electronically signed by A.R., an authorized official, and included an “AUTHORIZED OFFICIAL CERTIFICATION STATEMENT FOR INSTITUTIONAL PROVIDERS.”  CMS Ex. 3 at 1.  Accordingly, I find that the evidence sufficiently demonstrates that Petitioner submitted, signed, and certified its revalidation application. 

Petitioner’s second argument is that section 424.535(a)(4) requires a provider to have deliberately submitted false or misleading information, and CMS has not shown that Petitioner intended to conceal any information.  P. Br. at 8.  Petitioner maintains that when it submitted its revalidation application, CMS had only recently clarified that hospice medical directors must be reported as managing employees and was still in the process of issuing guidance.  Id. at 3-5; see also CMS Ex. 2 at 2-4; CMS Ex. 9 at 1-2.  Moreover, according to Petitioner, it had no reason to conceal these individuals because “none of the individuals it failed to report had prior adverse legal action or other known sanctions that would motivate a desire to hide them.”  P. Br. at 11. 

Petitioner’s assertions regarding the timing of its submission and CMS’s guidance appear accurate.  The record contains no indication that Petitioner intended to conceal the identity of its managing employees, and the evidence instead supports that its failure to report its Medical Director was an oversight. 

However, Petitioner’s arguments that the regulation requires intent are unavailing.  The plain language of section 424.535(a)(4) does not require any intent to deceive; it states simply that CMS may revoke when a provider “certified as ‘true’ misleading or false information on the enrollment application.”  42 C.F.R. § 424.535(a)(4).  The Board has likewise been clear that the regulation requires only proof that false or misleading information was certified as true.  Mark Koch, D.O., DAB No. 2610 at 4–5 (2014) (“[S]ection 424.535(a)(4) does not require proof that [the petitioner] subjectively intended to provide false information, only proof that he in fact provided misleading or false information that he certified as true”); see also Sandra E. Johnson, CRNA, DAB No. 2708 at 15 (2016). 

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Nor are Petitioner’s assertions that it was unaware of reporting changes persuasive.  Medicare-enrolled providers are responsible for ensuring their enrollment information is complete, accurate, and current, and must familiarize themselves with applicable Medicare requirements.  Meadowmere Emergency Physicians, PLLC, DAB No. 2881 at 11 (2018).  And these responsibilities are not to be taken lightly.  As the Board explained, adherence to the regulatory requirements ensures that CMS can rely on the accuracy and completeness of enrollment information to effectively and efficiently administer the vast Medicare program.  Id. 

Here, Petitioner certified that its application was accurate and complete but failed to disclose Dr. H.L. as its Medical Director.  That omission rendered the certification misleading because CMS was not informed of an individual with managing control of the provider and was therefore deprived of the opportunity to evaluate Petitioner’s continued suitability as an enrolled provider.  See Reconsidered Determination at 6.  CMS thus had a legal basis to revoke Petitioner’s enrollment and billing privileges under 42 C.F.R. § 424.535(a)(4). 

2.  CMS had a legal basis to revoke Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.535(a)(9) because Petitioner did not report its managing employees to CMS. 

CMS may revoke a currently enrolled provider’s billing privileges if the provider fails to comply with the reporting requirements in 42 C.F.R. § 424.516(e).  42 C.F.R. § 424.535(a)(9).  Under 42 C.F.R. § 424.516(e)(1), providers must report, within 30 days, a change in ownership or control, including changes in authorized or delegated officials, adverse legal actions or changes to practice locations.  All other changes must be reported within 90 days.  Id. § 424.535(e)(2).  As previously indicated, the regulations specify managing employees include administrators and medical directors.  42 C.F.R. § 424.502 (“Managing employee” definition).  In determining whether to revoke under (a)(9), CMS considers whether the data was reported; and, if so, how belatedly; the materiality of the data in question; and any other information that CMS deems relevant to its determination.  42 C.F.R. § 424.535(a)(9)(i)-(iv). 

In this case, CMS identified an additional basis for revocation because Petitioner failed to report its Administrator/Director of Patient Care Services and the designee, as well as its Medical Director designee.  Petitioner does not dispute that it failed to report J.T., its Administrator/Director of Patient Care Services, nor does it dispute that the regulations required disclosure of that individual.  P. Br. at 12–13.1  Therefore, the basic elements for

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revocation under 42 C.F.R. § 424.535(a)(9) (the existence of a reporting obligation and a failure to meet that obligation) are satisfied.  Nevertheless, Petitioner contends CMS failed to properly apply the regulatory factors in exercising its discretion to revoke. 

As an initial matter, I note that my authority to review CMS’s determination to revoke Petitioner’s enrollment is limited to determining if there is a legal basis to revoke rather than determining whether I agree with CMS’s discretionary determination to revoke.  See, e.g., Eva Orticio Villamor-Goubeaux, DAB No. 2997 at 10 (2020).  As such, my review requires that I ensure CMS exercised its discretion when it revoked Petitioner’s enrollment, and, for revocation pursuant to 42 C.F.R. § 424.535(a)(9), that means a consideration of the regulatory factors.  Brian K. Ellefsen, D.O., DAB No. 2626 at 9 (2015).  When doing this, I review the reconsidered determination since that is the determination subject to appeal.  Devine Sols. Grp. LLC, DAB No. 3159 at 18 (2024). 

Regarding 42 C.F.R. § 424.535(a)(9)(i) and (ii), that is whether the data was reported and, if so, how belatedly, the CMS hearing officer stated that Petitioner did not dispute failing to report the three identified managing employees and offered no evidence showing these positions were ever reported.  Reconsidered Determination at 7.  CMS also rejected Petitioner’s arguments that the “designees” did not require reporting because the regulations do not require managing employees to be full-time and specifically “includes administrators, directors, or individuals who indirectly conduct day-to-day operations.”  Id. at 7-8.  Petitioner identifies no error in CMS’s statements although it maintains that designees do not require reporting.  P. Br. at 11-12.  Even assuming arguendo that “designees” do not require reporting, the point is immaterial because Petitioner concedes that it was required to report its Administrator/Director of Patient Care Services and failed to do so.  Failure to report even one managing employee is sufficient to establish that Petitioner failed to comply with the regulatory reporting requirements.  Therefore, I find CMS properly considered factors one and two. 

With respect to 42 C.F.R. § 424.535(a)(9)(iii), Petitioner does not dispute that CMS considered this factor but disagrees with its assessment.  CMS determined that the unreported information was material to Petitioner’s continued enrollment in the Medicare program.  Reconsidered Determination at 8.  It rejected Petitioner’s argument that the omissions were inconsequential because none of the unreported individuals had prior violations, adverse actions, or sanctions.  CMS explained that it must have accurate and current information to ensure compliance with Medicare requirements and to ensure payments are made appropriately.  Id.  CMS further noted that Petitioner’s failure to report made proper oversight impossible, particularly given the leadership roles and responsibilities of the unreported individuals.  Id. at 8.  Petitioner asks that I find otherwise; however, whether I would reach the same conclusion is irrelevant because I may not substitute my discretion for CMS’s. 

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Finally, turning to 42 C.F.R. § 424.535(a)(9)(iv), Petitioner argued that its revocation would have a substantial impact on the availability of services to Medicare beneficiaries and other terminally ill California residents.  CMS Ex. 2 at 6.  In addition, Petitioner explained that Medicare revocation and placement on CMS’s Preclusion List would inevitably lead to Medicaid termination as well as termination of all commercial insurance participation, essentially putting the provider out of business.  Id.  CMS considered Petitioner’s contentions regarding the impact its revocation will have on the availability of services to Medicare beneficiaries and concluded that Petitioner’s revocation would have minimal impact, considering that it serves only 13 patients, of whom only 7 are Medicare beneficiaries.  Reconsidered Determination at 8.  And although CMS did not expressly consider Petitioner’s arguments regarding the broader financial impact of revocation on the provider, the regulations do not require CMS to do so.  Therefore, I find no error in CMS’s exercise of its discretion in considering other information it deemed relevant to its determination. 

As set for the above, the CMS hearing officer sufficiently considered the relevant facts related to the regulatory factors.  Therefore, I find CMS exercised its discretion within the bounds of the regulations and CMS had a legal basis to revoke Petitioner pursuant to 42 C.F.R. § 424.535(a)(9). 

3.  I cannot review the length of the reenrollment bar, nor can I direct the basis on which CMS seeks revocation. 

Pursuant to 42 C.F.R. § 424.535(c), CMS may impose a reenrollment bar lasting no less than one year and no more than ten years following a revocation of a provider’s enrollment.  Here, CMS upheld a ten-year bar to reenrollment, which is within the timeframes established by regulation.  I acknowledge Petitioner’s argument that the ten-year bar is excessive in its case, but I do not have the authority to review the issue.  The Board has unambiguously explained that such a matter is beyond the scope of an ALJ’s review, stating: 

A decision by CMS or its contractor about how long to bar a revoked supplier from re-enrolling in Medicare, unlike the determination to revoke the supplier’s billing privileges, is not an appealable “initial determination” under 42 C.F.R. Part 498.  Blossomwood Medical, P.C., et al., DAB No. 2914, at 11 (2018); Vijendra Dave, M.D. [DAB No. 2672] at 8-11 [(2016)] (stating that the authority of an ALJ or the Board in a revocation appeal “does not extend to reviewing the length of the reenrollment bar imposed by CMS”).  We therefore cannot consider or act upon Petitioner’s contention that the three-year re-enrollment bar was excessive in her circumstances. 

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Linda Silva, P.A., DAB No. 2966 at 11 (2019); see also Vijendra Dave, M.D., DAB No. 2672 at 11 (“CMS’s determination regarding the duration of the re-enrollment bar is not reviewable.”). 

Similarly, I lack authority to dictate the regulatory basis on which CMS elects to pursue revocation.  Petitioner contends, as it did at reconsideration, that any revocation arising from minor reporting omissions should have been pursued under 42 C.F.R. § 424.535(a)(1), with an opportunity for Petitioner to take corrective action.  P. Br. at 19.  As already explained, my review is limited to determining whether a legally sufficient basis for revocation exists.  In this case, exercising its discretion, CMS proceeded under 42 C.F.R. § 424.535(a)(4) and (a)(9).  See 42 C.F.R. § 424.535(a) (CMS “may” revoke for any reason listed in paragraph (a)).  To direct CMS to use a different revocation provision would impermissibly substitute my judgment for CMS’s, which I have no authority to do.  Nor do the regulations confer a right to correct before CMS revokes in these circumstances (and Petitioner identifies none); therefore, I cannot require CMS to give Petitioner an opportunity to correct its enrollment application. 

4.  There is a basis for adding Petitioner to the CMS Preclusion List. 

To place a provider or supplier on its Preclusion List, CMS must establish the following elements: 

1. The individual or entity is currently revoked from Medicare for a reason other than that stated in § 424.535(a)(3);
2. The individual or entity is currently under a reenrollment bar under § 424.535(c); and
3. CMS determines that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program.

42 C.F.R. §§ 422.2, 423.100.  There is no dispute that the first two elements are met here.  CMS revoked Petitioner pursuant to 42 C.F.R. § 424.535(a)(4) and (a)(9).  CMS Ex. 1 at 5-6.  In addition, CMS imposed a ten-year reenrollment bar under § 424.535(c).  Id. at 6. 

As to the third element, CMS must consider the following factors to determine whether the conduct that resulted in revocation is detrimental to the best interests of the Medicare program: 

1. The seriousness of the conduct underlying the individual’s or entity’s revocation;
2. The degree to which the individual’s or entity’s conduct could affect the integrity of the Medicare program; and

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3. Any other evidence that CMS deems relevant to its determination.

42 C.F.R. §§ 422.2, 423.100.  Again, where the regulations have granted CMS discretion to determine whether a provider or supplier’s underlying conduct is detrimental to the Medicare program, I may not substitute my own judgment as to whether CMS properly exercised that discretion.  Brian K. Ellefsen, DO, DAB No. 2626 at 7 (2015). 

Here, CMS satisfied its regulatory obligation to consider whether the conduct underlying Petitioner’s revocation was detrimental to the best interests of the Medicare program by evaluating both the seriousness of the conduct and its potential impact on program integrity.  42 C.F.R. § 422.2, Preclusion list.  In its reconsidered determination, CMS expressly addressed these factors, stating that Petitioner’s failure to report was serious because the Medicare program relies on its providers to accurately self-report all required data on its enrollment applications to ensure proper oversight.  Reconsidered Determination at 9.  CMS explained that inaccurate or outdated information jeopardizes the Medicare Trust Funds because it allows providers to remain enrolled when administrative action may be warranted if CMS were made aware of the unreported information.  Id.  CMS also considered Petitioner’s argument that it was unaware of the reporting changes but stated that it issued several announcements and training following the January 2024 regulatory change clarifying reporting requirements for hospices.  Id. at 9-10.  CMS thus found Petitioner’s attempt to place blame on the rule change misleading, noting that Petitioner had an 18-month period to comply before it was revoked.  Id. at 10. 

This discussion reflects that CMS thoroughly evaluated the seriousness of Petitioner’s conduct and its implications for the integrity of the Medicare program.  42 C.F.R. § 422.2, Preclusion list; see also 42 C.F.R. § 423.100.  CMS’s analysis was clearly articulated and free of factual errors or misstatements; Petitioner does not contend otherwise.  P. Br. at 20-21.  While Petitioner disagrees that the underlying conduct is detrimental to the best interests of the Medicare program, the Board has affirmed that CMS must be able to rely on the accuracy and completeness of the information reported to it by its supplier and provider partners in order to effectively administer the Medicare program.  Meadowmere Emergency Physicians, PLLC, supra.  Moreover, I find Petitioner’s continued minimization of its reporting obligations, and its failure to acknowledge its responsibilities to familiarize itself with Medicare’s requirements, only underscores CMS’s program integrity concerns.  CMS therefore established that the conduct leading to revocation was detrimental to the best interests of the Medicare program.  For these reasons, I find CMS had a legitimate basis to place Petitioner on its Preclusion List. 

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VI.  CONCLUSION

I affirm CMS’s determination to revoke Petitioner’s Medicare enrollment and billing privileges and Petitioner’s placement on the Preclusion List.