Village of Glenview, DAB CR6993 (2026)

DECISION

I affirm the determination of the Centers for Medicare & Medicaid Services (CMS) that the effective date for the reactivation of the Medicare billing privileges for Petitioner, Village of Glenview, is August 13, 2024. 

I.  Procedural History

On May 14, 2026, Petitioner requested a hearing to dispute the reactivation effective date for its Medicare billing privileges.  On May 21, 2026, the Civil Remedies Division acknowledged receipt of the hearing request and issued my Standing Order.  On June 24, 2026, CMS filed a brief/motion for summary judgment and nine proposed exhibits.  On July 9, 2026, Petitioner submitted a brief and four proposed exhibits. 

II.  Issue

Whether August 13, 2024, is the correct effective date for the reactivation of Petitioner’s Medicare billing privileges. 

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III.  Jurisdiction

I have jurisdiction to decide the issue in this case.  42 C.F.R. § 498.3(b)(15). 

IV.  Admission of Evidence

Absent objection, I admit CMS Exhibits 1 through 9 and Petitioner Exhibits 1 through 4 into the record. 

V.  Decision on the Written Record

I directed the parties to submit written direct testimony for any witnesses they wanted to offer.  Standing Order ¶ 11; see also Civil Remedies Division Procedures (CRDP) § 16(b).  I also informed the parties as follows: 

If the parties either do not file any written direct testimony or the parties do not request to cross-examine any of the witnesses from whom written direct testimony has been submitted, I will consider such actions by the parties to serve as a constructive request for a decision on the written record because there will be no reason to hold an in-person hearing. 

Standing Order ¶ 7(g)(iii); see also CRDP § 19(b).  I further advised:  “Unless a hearing is required for cross-examination of a witness or witnesses, the record will be closed and the case will be ready for a decision after all the submission deadlines have passed.”  Standing Order ¶ 14. 

Neither party submitted written direct testimony from any witnesses, and all submission deadlines have passed.  Therefore, I decide this case on the written record.  Anil Hanuman, D.O., DAB No. 3080 at 11-12 (2022); CRDP § 19(d). 

VI.  Findings of Fact

1. Petitioner was enrolled in the Medicare program as an ambulance service supplier in 2008.  CMS Ex. 2 at 1; see also CMS Ex. 7 at 1.
2. In a February 29, 2024 notice, a CMS contractor advised Petitioner that it must revalidate the information in Petitioner’s Medicare enrollment record every five years.  The notice warned Petitioner that a failure to revalidate its enrollment information by May 31, 2024, may result in deactivation of its Medicare billing privileges.  The notice further explained that Petitioner would not be paid for services rendered during the period of deactivation, which will “cause a gap in your reimbursement.”  CMS Ex. 1 at 1. 

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3. In a June 5, 2024 notice, the CMS contractor informed Petitioner that it was placing a stay on Petitioner’s Medicare enrollment record, effective June 5, 2024, because Petitioner had not responded to the contractor’s February 29, 2024 request to revalidate enrollment information by May 31, 2024.  The CMS contractor advised that, during the stay, the contractor would reject all Medicare claims filed by Petitioner.  Finally, the CMS contractor informed Petitioner that a failure to submit a revalidation application within 30 days may result in the deactivation of Petitioner’s enrollment, which will cause a gap in Petitioner’s Medicare reimbursement because CMS cannot pay Petitioner for services rendered during the period of deactivation.  CMS Ex. 3 at 1.
4. In a July 11, 2024 notice, the CMS contractor informed Petitioner that its Medicare billing privileges were being deactivated as of June 1, 2024, “because [Petitioner has] not timely revalidated [Petitioner’s] enrollment record with us, or [Petitioner’s] revalidation application has been rejected because [Petitioner] did not timely respond to our requests for more information.  We will not pay any claims after this date.”  CMS Ex. 4 at 1.  The notice advised Petitioner that it could file a rebuttal if Petitioner believed the deactivation was incorrect.  CMS Ex. 4 at 1-2.  Finally, the notice stated that Petitioner could revalidate its Medicare enrollment record through filing an enrollment application.  CMS Ex. 4 at 2.
5. On August 13, 2024, CMS received Petitioner’s revalidation enrollment application.  CMS Ex. 5 at 1.
6. In an October 2, 2024 notice, the CMS contractor approved Petitioner’s revalidation enrollment application and reactivated Petitioner’s Medicare billing privileges; however, the CMS contractor noted that “you will have a gap in billing privileges from June 01, 2024 through August 12, 2024 for failing to fully revalidate during a previous revalidation cycle.  You will not be reimbursed for services provided to Medicare beneficiaries during this time period since you were not in compliance with Medicare requirements.”  CMS Ex. 7 at 2; P. Ex 2 at 1; P. Ex. 4 at 1.
7. On December 17, 2024, Petitioner requested reconsideration of the effective date of reactivation.  CMS Ex. 8; P. Ex. 3.
8. In a March 10, 2026 reconsideration determination, CMS affirmed August 13, 2024, as Petitioner’s reactivation effective date.  CMS Ex. 9; P. Ex. 1. 

VII.  Conclusions of Law and Analysis

1.  The effective date for reactivation of Petitioner’s Medicare billing privileges is August 13, 2024. 

The Social Security Act (Act) authorizes the Secretary of Health and Human Services (Secretary) to promulgate regulations governing the enrollment process for providers and suppliers in the Medicare program.  42 U.S.C. §§ 1302, 1395cc(j).  A “supplier” includes “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).  For Medicare program purposes, ambulance service providers are suppliers.  42 C.F.R. § 498.2 (paragraph (3) of definition of “Supplier.”).  A supplier must enroll in the Medicare program to receive payment for covered items or services.  42 U.S.C. §§ 1395n(a), 1395u(h)(1); 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.  To enroll, the supplier must submit an enrollment application and provide all required information.  42 C.F.R. § 424.510(a). 

To maintain enrollment, a supplier must recertify the accuracy of its enrollment information every five years.  42 C.F.R. § 424.515.  To do this, a supplier “must submit to CMS the applicable enrollment application with complete and accurate information and applicable supporting documentation within 60 calendar days of [CMS’s] notification to resubmit and certify to the accuracy of its enrollment information.”  42 C.F.R. § 424.515(a)(2).  If a supplier fails to submit information required by CMS within 90 days of receiving notice from CMS to revalidate, then CMS may deactivate the supplier’s Medicare billing privileges.  42 C.F.R. § 424.540(a)(3). 

To reactivate billing privileges, the supplier must recertify that its enrollment information currently on file with CMS is correct and furnish any missing information.  42 C.F.R. § 424.540(b)(1).  When a supplier seeks reactivation, “[t]he effective date of a reactivation of billing privileges under this section is the date on which the Medicare contractor received the . . . supplier’s reactivation submission that was processed to approval by the Medicare contractor.”  42 C.F.R. § 424.540(d)(2). 

In the present case, Petitioner submitted its revalidation enrollment application on August 13, 2024, and the CMS contractor was able to process that application to approval.  Therefore, August 13, 2024, is the correct date for reactivation. 

In its reconsideration request, Petitioner asserted that it originally submitted the revalidation enrollment application in June 2024.  CMS Ex. 8 at 2.  However, there is no evidence of this.  See CMS Ex. 9 (“CMS has no record of this [June 2024] submission, nor does [Petitioner] supply evidence of this claim.”).  Although Petitioner’s exhibit list indicates that Petitioner Exhibit 4 was “Attachment to Reconsideration Request (Evidence submitted with prior appeal),” Petitioner Exhibit 4 does not include evidence that Petitioner originally filed its revalidation application in June 2024. 

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2.  I do not have the authority to grant the relief Petitioner seeks. 

Petitioner argues:  “During the Public Health Emergency and its immediate aftermath, [CMS contractors] frequently allowed additional flexibility for revalidation timing issues.  [Petitioner’s] revalidation submissions occurred during this transition period, and we did not understand that Medicare had shifted to a formal stay of Enrollment process in certain situations.”  P. Br. at 1.  Petitioner also argues that the CMS contractor took 15 months to issue the reconsidered determination, which disrupted the claims payment process for Petitioner.  P. Br. at 2.  Finally, Petitioner asserts that the gap in Medicare coverage will result in a loss of $227,500 for Petitioner, which is a significant loss for a publicly provided emergency medical service that must transport individuals regardless as to whether Medicare will provide reimbursement.  P. Br. at 2; Hr’g Req. 

My jurisdiction is limited to determining whether the reactivation date was factually and legally correct.  See 42 C.F.R. § 498.3(b)(15).  I have no authority to overturn the deactivation that CMS imposed.  42 C.F.R. § 424.546(f).  Petitioner had the right to file a rebuttal with CMS to appeal the deactivation.  CMS Ex. 4 at 1-2; 42 C.F.R. §§ 424.545(b), 424.546.  Filing a rebuttal is the exclusive administrative appeal right for deactivation.  Michael B. Zafrani, M.D., DAB No. 3075 at 3, 8 (2022).  Further, “Medicare providers and suppliers, as participants in the program, have a duty to familiarize themselves with Medicare requirements.”  Francis J. Cinelli, Sr., D.O., DAB No. 2834 at 10 (2017).  Therefore, ignorance as to CMS’s use of stays of enrollment does not provide a legal reason to change the effective date of reactivation.  In addition, I cannot change the reactivation effective date based on Petitioner’s claim of financial hardship because CMS is prohibited from paying for services that Petitioner provided during the period of deactivation.  42 C.F.R. §§ 424.540(e), 424.555(b); 86 Fed. Reg. 62,240, 62,359-60 (Nov. 9, 2021); see also Goffney v. Becerra, 995 F.3d 737, 743 (9th Cir. 2021).  Finally, I cannot provide equitable relief.  US Ultrasound, DAB No. 2302 at 8 (2010). 

VIII.  Conclusion

The effective date for the reactivation of Petitioner’s Medicare billing privileges is August 13, 2024.