K and L Medical LLC, dba Koth Orthopedics and Spine, DAB CR6998 (2026)

DECISION

The Medicare enrollment and billing privileges of Petitioner are revoked pursuant to 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(23)(ii),1 effective November 22, 2025, based on violation of 42 C.F.R. § 424.57(c)(7)(i)(D) (Supplier Standard 7).

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I.  Background and Undisputed Facts

Petitioner was enrolled in Medicare as a physician or nonphysician practitioner organization and as a supplier of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).  On July 22, 2024, Petitioner filed a Medicare enrollment application to revalidate its enrollment in the Medicare program as a DMEPOS supplier.  CMS Ex. 1 at 8-16.  The application showed that the Petitioner’s DMEPOS hours of operation were Monday and Friday, 8:00 a.m. to 4:00 p.m.  Centers for Medicare & Medicaid Services Exhibit (CMS Ex.) 1 at 9.

On April 22, 2025, Novitas Solutions, a Medicare administrative contractor (MAC), notified Petitioner that a site visit at Petitioner’s office was required as part of the revalidation process.  The MAC advised Petitioner that the “hours of operation posted on location must match the information” Petitioner reported to CMS and the MAC.  CMS Ex. 1 at 17.

Site visits were made on May 6, 2025, June 5, 2025, and August 27 and 29, 2025.  The inspector observed that Petitioner had a sign showing its name but not the hours of operation.  Based on an interview, the inspector learned hours of operation were Monday to Friday, 8:00 a.m. to 4:30 p.m.  CMS Ex. 1 at 19-20.

On October 23, 2025,2 the MAC notified Petitioner of its initial determination to revoke Petitioner’s Medicare enrollment and billing privileges for DMEPOS, effective April 1, 2022.  The MAC cited 42 C.F.R. § 424.535(a)(1) as authority for the revocation based on violations of 42 C.F.R. § 424.57(c)(7) and (10) (Supplier Standards 7 and 10).  CMS Ex. 1 at 33-34.  The MAC stated that 42 C.F.R. § 424.57(c)(7) was violated because “[t]here was no permanent visible signage with the supplier’s legal business name or hours of operation posted.”  CMS Ex. 1 at 34.  The MAC stated that 42 C.F.R. § 424.57(c)(10) was violated because Petitioner’s comprehensive liability insurance policy had expired. CMS Ex. 1 at 34.  The MAC also imposed a one-year reenrollment bar.  The MAC advised Petitioner of its rights to submit a corrective action plan (CAP) and request a reconsidered determination.  CMS Ex. 1 at 35-37.

Petitioner submitted documents to the MAC on October 27 and 31, 2025, and November 5, 7, and 10, 2025, that the MAC treated as a CAP and request for reconsideration.  CMS Ex. 1 at 1, 38-62.

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On December 23, 2025, Chags Health Information Technology (C-HIT) issued a reconsidered determination on behalf of CMS.  CMS Ex. 1 at 1-7.  C-HIT determined that Petitioner’s alleged violation of 42 C.F.R. § 424.57(c)(10) (Supplier Standard 10) related to its liability insurance was corrected without any lapse in insurance coverage.  CMS Ex. 1 at 4.  But C-HIT upheld revocation based on a violation of 42 C.F.R. § 424.57(c)(7)(i)(D) (Supplier Standard 7) because Petitioner failed to show that there was permanent visible signage with Petitioner’s legal business name and posted hours of operation.  CMS Ex. 1 at 4.  C-HIT also upheld the one-year reenrollment bar.  But C-HIT determined that the effective date of revocation should be 30 days from October 23, 2025 (the date of the notice of the initial determination) rather than a retroactive date of April 1, 2022, because Petitioner was found to comply with Supplier Standard 10.  CMS Ex. 1 at 4-5.

On January 15, 2026, Petitioner requested a hearing (RFH) before an administrative law judge (ALJ).  The case was docketed and assigned to me on January 21, 2026, and my Standing Order was issued.

On February 20, 2026, CMS filed its combined prehearing brief and motion for summary judgment (CMS Br.) with CMS Ex. 1.  Petitioner filed a response in opposition to the CMS motion for summary judgment on February 25, 2026, with two documents.  CMS filed no reply or written waiver of reply.  On April 16, 2026, Petitioner filed a motion requesting summary judgment in its favor on grounds that CMS failed to file a reply or a written waiver of reply.  Petitioner requested as relief that its revocation be rescinded and that Petitioner’s enrollment be reinstated as a DMEPOS supplier.  CMS failed to respond to Petitioner’s motion.  Petitioner’s motion is very brief at only three lines.  Based on the relief requested and the grounds stated, Petitioner’s motion is more accurately a motion requesting that I sanction CMS for failure to file a reply brief or a written waiver of reply as required by my Standing Order.  The extreme sanction requested by Petitioner is not appropriate, absent a more serious infraction or repeated infractions.  Therefore, Petitioner’s motion is denied to the extent it seeks a sanction against CMS.  I have considered whether summary judgment may be appropriate for Petitioner based on its motion.  I conclude that summary judgment is not appropriate for Petitioner but summary judgment for CMS is appropriate.

Petitioner did not object to my consideration of CMS Ex. 1 and it is admitted and considered as evidence.  Petitioner filed with its request for hearing five documents.  Departmental Appeals Board Electronic Filing System (DAB E-File) ## 1a, 1b, 1c, 1d, 1e.  Petitioner filed with its opposition to the CMS motion for summary judgment two documents.  DAB E-File ## 7, 7a.  Petitioner failed to mark any of the documents as exhibits.  However, Petitioner is not represented by an attorney, and I will not exclude the exhibits simply because they are not properly marked as evidence.  Following are my rulings on the admissibility of Petitioner’s offered evidence:

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DAB E-File # 1a is a copy of the CAP and reconsidered determination already in evidence as CMS Ex. 1 at 1-7.  Therefore, DAB E-File # 1a is not admitted as evidence because it is cumulative.

DAB E-File # 1b is a photograph that Petitioner represents depicts that inside of its facility and show a sign on a desk with hours of operation.  RFH at 2 (document page counter).  The sign on the desk is unreadable under any magnification and DAB E-File # 1b cannot be considered as evidence.  But I accept, for purposes of summary judgment, Petitioner’s representation that the sign does list Petitioner’s hours of operation.  Petitioner does not represent that the sign was present during the inspections.  RFH at 2; P. Br.

DAB E-File # 1c is a photograph of a video display with practitioners listed under the days of the week they are present and I infer in the specialty clinic in Suite 135.  Petitioner represents that this is permanent signage provided by Petitioner’s landlord and it is near Petitioner’s public entrance.  RFH at 2; DAB E-File # 7a.  Petitioner represents in briefing that the edge of the video display appears in the site inspection photographs (CMS Ex. 1 at 29), but the inspector failed to photograph what was on the display at the time of the site inspections, and what is depicted in DAB E-File # 1c is the same information as was displayed during the site inspections.  P. Br. at 1; DAB E-File # 7.  CMS objects to my consideration of DAB E-File 1c as evidence because Petitioner failed to present the evidence when it requested reconsideration and has failed to show good cause to offer the evidence for the first time in this proceeding.  CMS Br. at 1.  The objection is sustained under 42 C.F.R. § 498.56(e).  But I accept as true for purposes of summary judgment Petitioner’s representation that during the inspections the video display was present, operating, and contained the same information as depicted in DAB E-File # 1c.  Petitioner concedes hours of operation were not listed on the video display.  P. Br. at 2-3.  I note that Petitioner’s name is not listed on the video display.  Dr. Koth/Northcutt PA – Orthopedics is listed twice but not Petitioners name either K and L Medical LLC or, its “doing business as” name, Koth Orthopedics and Spine.  P. Br. at 1.

DAB E-File # 1d is a sign listing Petitioner’s name and hours of operation.  CMS objects to this evidence on the same grounds it objected to DAB E-File # 1c and the objection is sustained and the picture is not admitted as evidence.  But I accept, for purposes of summary judgment, Petitioner’s representation that the sign does list Petitioner’s hours of operation.  Petitioner does not represent that the sign was present during the inspections.  Petitioner states that “[t]he only item that was missing at the time was the posted hours, which has since been fully corrected.”  P. Br. at 2.  I read this statement to be a concession that hours were not posted on the video display or on a sign during the site inspections – an error that “has since

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been fully corrected” (P. Br. at 2) according to Petitioner, which I also accept as true for summary judgment.  Petitioner concedes that as evidence of compliance it posted a sign with its hours of operation on the desk for patients to see as they walk in.  RFH at 2.  I infer that the sign was visible to patients when they walked into Petitioner’s facility.  Petitioner does not assert that the sign that listed hours was visible to anyone outside its facility.

DAB E-File # 1e is a photograph of the medical office building where Petitioner is located.  This color photograph is a closeup of the same building entrance depicted in CMS Ex. 1 at 22.  Therefore, the photograph is cumulative and not admitted as evidence.

DAB E-File # 7 is the photograph admitted as CMS Ex. 1 at 29 to which Petitioner added a red arrow pointing to the video display already discussed.  This photograph was submitted by Petitioner to demonstrate that the site inspector captured the video monitor in photographs but not what was displayed on the monitor.  DAB E-File # 7 is demonstrative evidence that is considered in support of Petitioner’s arguments which are accepted as true for purpose of summary judgment.  But DAB E-File # 7 is not admitted as substantive evidence of a material fact.

DAB E-File # 7a is a letter from the director of operations for the hospital system where Petitioner operates.  DAB E-File # 7a is admitted as evidence and the assertions of fact are accepted as true for purposes of summary judgment as CMS has made no objection to the document or its contents.  Standing Order ¶ G (“The parties [were] advised that a fact alleged and not specifically denied, may be accepted as true for purposes of a motion or cross-motion for summary judgment.  Any evidence will be considered admissible and true unless specific objection is made to its admissibility and accuracy.”)

II.  Discussion

1. Applicable Law

Section 1831 of the Social Security Act (the Act) (42 U.S.C. § 1395j) establishes the supplementary medical insurance benefits program for the aged and disabled known as Medicare Part B.  Payment under the program for services rendered to Medicare-eligible

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beneficiaries may only be made to eligible providers of services and suppliers.3  Act §§ 1835(a) (42 U.S.C. § 1395n(a)), 1842(h)(1) (42 U.S.C. § 1395u(h)(1)).  Petitioner was enrolled in Medicare as a physician or nonphysician practice group and as a DMEPOS supplier.

The Act requires the Secretary of Health and Human Services (Secretary) to issue regulations that establish a process for the enrollment in Medicare of providers and suppliers, including the right to a hearing and judicial review of certain enrollment determinations, such as revocation of enrollment and billing privileges.  Act § 1866(j) (42 U.S.C. § 1395cc(j)).  Pursuant to 42 C.F.R. § 424.505, a supplier such as Petitioner must be enrolled in the Medicare program and be issued a billing number to have billing privileges and to be eligible to receive payment for services rendered to a Medicare-eligible beneficiary.

Pursuant to 42 C.F.R. §§ 424.57(b) and 424.505, a DMEPOS supplier such as Petitioner must be enrolled in the Medicare program to be reimbursed for durable medical equipment, prosthetics, orthotics, or supplies sold or rented to Medicare beneficiaries.  The regulations establish detailed requirements that suppliers must meet and maintain to enroll in Medicare and to receive and maintain Medicare billing privileges.  42 C.F.R. pt. 424, subpt. P.  DMEPOS suppliers have additional requirements imposed by 42 C.F.R. § 424.57(b) and (c).  A DMEPOS supplier must meet and maintain the Medicare application certification standards set forth in 42 C.F.R. § 424.57(c) (the Supplier Standards) to directly bill Medicare.  A DMEPOS supplier must operate and furnish Medicare-covered items in compliance with all applicable federal and state licensure and regulatory requirements.  42 C.F.R. § 424.57(c)(1).

The Secretary has delegated the authority to revoke enrollment and billing privileges to CMS.  42 C.F.R. §§ 424.57(e)(1), 424.535.  CMS or a MAC may revoke an enrolled supplier’s Medicare enrollment and billing privileges and any related supplier agreement for any of the 23 reasons listed in 42 C.F.R. § 424.535.  Noncompliance with DMEPOS specific enrollment requirements established by 42 C.F.R. § 424.57(b) and (c) for

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DMEPOS suppliers is also a basis for revocation of Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.57(e)(1).  When Medicare enrollment and billing privileges are revoked pursuant to 42 C.F.R. § 424.57(e)(1), revocation is effective 30 days after the DMEPOS supplier is sent notice of the revocation.  If a supplier’s Medicare enrollment and billing privileges are revoked, the supplier is barred from reenrolling in the Medicare program for one to 10 years.  42 C.F.R. § 424.535(c).

A supplier whose enrollment and billing privileges are revoked may request reconsideration and review as provided by 42 C.F.R. pt. 498.  42 C.F.R. § 424.545(a).  A supplier submits a written request for reconsideration to CMS or the MAC.  42 C.F.R. § 498.22(a).  CMS or the MAC must give notice of its reconsidered determination to the supplier, giving the reasons for its determination, specifying the conditions or requirements the supplier failed to meet, and advising the supplier of its right to an ALJ hearing.  42 C.F.R. § 498.25.  If the decision on reconsideration is unfavorable to the supplier, the supplier has the right to request a hearing by an ALJ and further review by the Board.  Act § 1866(j)(8) (42 U.S.C. § 1395cc(j)(8)); 42 C.F.R. §§ 424.545, 498.3(b)(17), 498.5.  The Board has concluded that the only determination subject to ALJ review in a provider and supplier enrollment case such as this is the reconsidered determination issued by the MAC or CMS.  Neb Group of Ariz. LLC, DAB No. 2573 at 7 (2014).  A hearing on the record, also referred to as an oral hearing, is required under the Act.  Crestview Parke Care Ctr. v. Thompson, 373 F.3d 743, 748-51 (6th Cir. 2004).  The supplier bears the burden to demonstrate that it meets enrollment requirements with documents and records.  42 C.F.R. § 424.545(c).

2. Issue

Whether there was a basis for the revocation of Petitioner’s billing privileges and enrollment in Medicare.

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

My conclusions of law are set forth in bold followed by my analysis.  My findings of undisputed facts and inferences favorable to Petitioner are set out above in Section I of this decision.

1. Summary judgment is appropriate.

CMS filed a motion for summary judgment.  Petitioner opposes granting summary judgment for CMS.

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A supplier whose enrollment has been revoked has a right to a hearing and judicial review, and a hearing on the record is required under the Act.  Act §§ 205(b) (42 U.S.C. § 405(b)), 1866(h)(1), (j) (42 U.S.C. §§ 1395cc(h)(1), (j)); 42 C.F.R. §§ 498.3(b)(17), 498.5; Crestview Parke Care Ctr, 373 F.3d 743, 748-51 (6th Cir. 2004).  A party may waive appearance at an oral hearing but must do so affirmatively in writing.  42 C.F.R. § 498.66(a).  Petitioner has not waived the right to an oral hearing.

Summary judgment is not automatic upon request but is limited to certain specific conditions.  The Secretary’s regulations that establish the procedure to be followed in adjudicating Petitioner’s case are at 42 C.F.R. pt. 498.  42 C.F.R. §§ 405.800; 405.803(a); 424.545(a); 498.3(b)(17), (20).  The regulations do not establish a summary judgment procedure or recognize such a procedure.  However, the Board has long accepted that summary judgment is an acceptable procedural device in cases adjudicated pursuant to 42 C.F.R. pt. 498.  See, e.g., Ill. Knights Templar Home, DAB No. 2274 at 3-4 (2009); Garden City Med. Clinic, DAB No. 1763 (2001); Everett Rehab. & Med. Ctr., DAB No. 1628 at 3 (1997).  The Board also has recognized that the Federal Rules of Civil Procedure (Fed. R. Civ. Pro.) do not apply in administrative adjudications such as this.  However, the Board has accepted that Fed. R. Civ. Pro. 56 and related cases provide useful guidance for determining whether summary judgment is appropriate.  Furthermore, a summary judgment procedure was adopted as a matter of judicial economy within my authority to regulate the course of proceedings and made available to the parties in the litigation of this case by my Standing Order.  The parties were given notice by the Standing Order that summary judgment is an available procedural device and that the law as it has developed related to Fed. R. Civ. Pro. 56 will be applied.  Standing Order ¶¶ D, G.

Summary judgment is appropriate when there is no genuine dispute as to any issue of material fact for adjudication and/or the moving party is entitled to judgment as a matter of law.  The party requesting summary judgment bears the burden of showing that there are no genuine issues of material fact for trial and/or that it is entitled to judgment as a matter of law.  In determining whether there are genuine issues of material fact for trial, the reviewer must view the evidence in the light most favorable to the non-moving party, drawing all reasonable inferences in that party’s favor.  Generally, the non-movant may not defeat an adequately supported summary judgment motion by relying upon the denials in its pleadings or briefs but must furnish evidence of a dispute concerning a material fact, i.e., a fact that, if proven, would affect the outcome of the case.  Mission Hosp. Reg’l Med. Ctr., DAB No. 2459 at 4 (2012) (and cases cited therein); Experts Are Us, Inc., DAB No. 2452 at 4 (2012) (and cases cited therein); Senior Rehab. & Skilled Nursing Ctr., DAB No. 2300 at 3 (2010) (and cases cited therein); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).

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The standard for deciding a case on summary judgment and an ALJ’s decision-making in deciding a summary judgment motion differs from that used in resolving a case on the merits after a hearing or when hearing is waived.  On summary judgment, the ALJ does not make credibility determinations, weigh the evidence, or decide which inferences to draw from the evidence, as would be done when finding facts after a hearing on the merits or when an oral hearing is waived.  Rather, on summary judgment, the ALJ construes the evidence in a light most favorable to the non-movant and avoids deciding which version of the facts is more likely true.  Holy Cross Vill. at Notre Dame, Inc., DAB No. 2291 at 5 (2009).  The Board also has recognized that on summary judgment it is appropriate for the ALJ to consider whether a rational trier of fact could find that the party’s evidence would be sufficient to meet that party’s evidentiary burden.  Dumas Nursing & Rehab., L.P., DAB No. 2347 at 5 (2010).  The Secretary has not provided in 42 C.F.R. pt. 498 for the allocation of the burden of persuasion or the quantum of evidence required to satisfy the burden.  However, the Board has provided some persuasive analysis regarding the allocation of the burden of persuasion in cases subject to 42 C.F.R. pt. 498.  Batavia Nursing & Conv. Ctr., DAB No. 1904 (2004), aff’d, 129 Fed. App’x 181 (6th Cir. 2005).

Viewing the evidence before me in a light most favorable to Petitioner and drawing all inferences in Petitioner’s favor, I conclude that there are no genuine disputes as to any material fact relevant to revocation under 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(23)(ii) based on violation of Supplier Standard 7 (42 C.F.R. § 424.57(c)(7)(i)(D)).

There is no genuine dispute of material fact related to Petitioner’s alleged violation of Supplier Standard 7.  CMS asserts and Petitioner does not deny that when the site inspections occurred there was no permanent signage at the hospital entrance, the building entrance, or the entrance to the specialty clinic where Petitioner operated two days per week that specifically listed Petitioner’s name and hours of operation.  The evidence shows that Petitioner attempted to correct the error after the revocation but attempted the correction by posting a temporary sign with its name and hours of operation on the counter within the office not outside where Medicare beneficiaries or CMS could see the sign and locate Petitioner.  The facts as they existed at the time of the initial determination to revoke are the facts I must consider to determine whether Petitioner complied with Supplier Standard 7.  Petitioner subsequent correction could have been considered by the MAC and CMS when reviewing Petitioner’s CAP.  But Petitioner has no right to request reconsideration of action on the CAP or my review of the action on the CAP.  DMS Imaging, Inc., DAB No. 2313 at 5-6 (2010); Conchita Jackson, M.D., DAB No. 2495 at 6 (2013) (action on a CAP is not an appealable initial determination listed in 42 C.F.R. § 498.3(b)).

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Petitioner has not presented evidence from which I can infer that Petitioner had a sign listing its name and hours of operation at a location where it could be seen by Medicare beneficiaries attempting to locate Petitioner.

I conclude that summary judgment is not possible for Petitioner.  But I conclude that CMS is entitled to judgment as a matter of law because the undisputed facts establish the violation of 42 C.F.R. § 424.56(c)(7)(i)(D) and that violation is a basis for revocation under 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(23)(ii).  Accordingly, summary judgment is appropriate.

2.  Petitioner was not in compliance with 42 C.F.R. § 424.57(c)(7)(i)(D) (Supplier Standard 7) because Petitioner did not have a permanent visible sign in plain view that listed Petitioner’s name or doing business as name, and hours of operation were not posted outside the office either at the main entrance of the building in which Petitioner was located or at the entrance of the supplier where a Medicare beneficiary or CMS could see the hours without the need to access the interior of the Petitioner’s facility.

3.  There is a basis for revocation of Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(23)(ii) based on Petitioner’s violation of 42 C.F.R. § 424.57(c)(7)(i)(D) (Supplier Standard 7).

4.  The effective date of revocation of Petitioner’s Medicare enrollment and billing privileges is November 22, 2025, 30 days after October 23, 2025, the date the MAC mailed the notice of the initial determination to revoke.  42 C.F.R. §§ 424.57(e)(1), 424.535(g)(1).

Revocation Authority

Pursuant to 42 C.F.R. § 424.57(e)(1), CMS revokes a DMEPOS supplier’s enrollment and billing privileges if it is determined that the supplier does not meet a supplier standard established by 42 C.F.R. § 424.57(b) and (c).  It is well established that even a single violation of a single supplier standard is a sufficient basis for revocation of Medicare enrollment and billing privileges under 42 C.F.R. § 424.57(e)(1).  1866ICPayday.com, L.L.C., DAB No. 2289 at 13 (2009).

The language of 42 C.F.R. § 424.57(e)(1) which states that “CMS revokes” arguably grants CMS no discretion not to revoke when a DMEPOS supplier is not compliant with a requirement of 42 C.F.R. § 424.57(b) or (c).  Revocation is effective 30 days after the supplier is sent notice of the revocation.  42 C.F.R. § 424.57(e)(1).  C-HIT listed

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42 C.F.R. §§  424.535(a)(1) and 424.57(e) in its reconsidered determination as authority for revocation.  Under 42 C.F.R. § 424.535(a)(1), CMS is granted discretionary authority to revoke for noncompliance with any enrollment requirement if the provider or supplier has not submitted an acceptable CAP.  42 C.F.R. § 424.535(a)(1).  C-HIT failed to cite as authority for the revocation 42 C.F.R. § 424.535(a)(23)(ii).4  Under 42 C.F.R. § 424.535(a)(23)(ii), CMS has authority to revoke a DMEPOS supplier’s Medicare enrollment and billing privilege based on the supplier’s noncompliance with any requirement of 42 C.F.R. § 424.57(c).  The language of 42 C.F.R. § 424.535 indicates that CMS has discretion to revoke or not.  Because CMS revoked, it is not necessary to resolve whether CMS has discretionary authority to revoke in this case under 42 C.F.R. § 424.535(a)(23)(ii) or whether revocation is mandatory under 42 C.F.R. § 424.57(e)(1).  But the general authority of 42 C.F.R. § 424.535(a)(1) is not the appropriate revocation authority on the facts of this DMEPOS supplier revocation, because both 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(23)(ii) specifically apply to revocation in this case.  The citation to 42 C.F.R. § 424.535(a)(1) by C-HIT is a nonprejudicial legal error that did not prevent Petitioner from requesting a hearing or obtaining my review and resulted in Petitioner’s submission of a CAP that eliminated the allegations of noncompliance with 42 C.F.R. § 424.57(c)(10) (Supplier Standard 10).

I conclude that C-HIT on behalf of CMS and the MAC had authority to revoke Petitioner’s Medicare enrollment and billing privileges under the authority granted by  42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(23)(ii).  I conclude that there is a basis for revocation based on Petitioner’s noncompliance with the accreditation requirement of 42 C.F.R. § 424.57(c)(7)(i)(D) (Supplier Standard 7).

Supplier Standard 7 – Sign Requirements

The burden is upon a provider or supplier to show that it meets enrollment requirements and to produce the documents necessary to show it complies with all enrollment requirements.  42 C.F.R. § 424.545(c).  The Board has consistently found that people and entities that enroll in Medicare are presumed to know Medicare requirements.  John Hartman, D.O., DAB 2564 at 3 (2014) (citing Heckler v. Cmty. Health Servs. of Crawford Cnty., Inc., 467 U.S. 51, 63 (1984) (“the general rule [is] those who deal with the Government are expected to know the law”)).  Moreover, providers and suppliers must, pursuant to 42 C.F.R. §§ 424.510(d)(3) and 424.516(a)(2), attest or certify that they

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meet all Medicare requirements, which is further evidence supporting the presumption of their knowledge of the requirements.

The requirement of 42 C.F.R. § 424.57(c)(7)(i)(D) at the time of the initial and reconsidered determination was:

(c) Application certification standards.  The supplier must meet and must certify in its application for billing privileges that it meets and will continue to meet the following standards:

* * * *

(7) Maintains a physical facility on an appropriate site.  An appropriate site must meet all of the following:

(i) Must meet the following criteria:

* * * *

(D) Maintains a permanent visible sign in plain view and posts hours of operation.  If the supplier’s place of business is located within a building complex, the sign must be visible at the main entrance of the building or the hours can be posted at the entrance of the supplier.

42 C.F.R. § 424.57(c)(7)(i)(D).  The regulation requires that Petitioner operate from a physical facility on an appropriate site that meets the requirement of Supplier Standard 7.  It is not necessary to describe all the facility and site requirements.  The focus in this case is the requirement for signs.  The regulation requires a sign that is:

- Permanent 
- Visible 
- In Plain View 
- Visible At Main Entrance of Building If Supplier Is Within Building Complex

The regulation also requires that hours of operation be posted either at the entrance of the supplier or the entrance of the main building if the supplier is within a building complex.  The regulation could be clearer.  For example, the regulation does not specify that the hours of operation be posted on the permanent sign, that is in plain view and visible, if the sign is at the main entrance of a building complex.  The regulation does not specify

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that when the supplier is in a building complex and a sign is posted at the main entrance a sign with the supplier’s name should also be posted at the supplier’s entrance.  The regulation does not specify that posted hours of operation be on a permanent sign that is visible outside the entrance to the supplier.  But the lack of clarity provides no defense n this case.  When CMS issued the regulation, it commented:

The supplier location must be accessible during posted business hours to beneficiaries and to CMS, and must maintain a visible sign and posted hours of operation.  We believe that all DMEPOS suppliers must have a permanent, durable sign that is visible at the main entrance of the facility and positioned so that it is visible to the public, including customers using wheelchairs.

75 Fed. Reg.52,629 at 52,630-631 (Aug. 27, 2010).  Clearly the purpose of the requirement for a sign and posted hours is to permit Medicare beneficiaries, CMS, and others to locate a DMEPOS supplier and inform them of the hours they may access the supplier.  Therefore, common sense dictates that placing a sign on a counter within the office with posted hours is inadequate if the sign is not visible without requiring a beneficiary, CMS, or others to enter the facility to see the sign.  A permanent visible sign, whether at the entrance to the supplier or the main entrance to a building complex, is also inadequate if it does not list the DMEPOS supplier’s name that may be recognized as such by a Medicare beneficiary, CMS, or others.  In short, the adequacy of the sign and the posted hours must be assessed from the perspective of whether the signs and posted hours satisfy the intended purpose, that is, informing Medicare beneficiaries, CMS, and others where the DMEPOS supplier is and when it is open to access.

In this case, Petitioner’s legal business name is K and L Medical LLC.  CMS Ex. 1 at 1, 8.  The CMS enrollment record for Petitioner does not show Petitioner reported a “doing business as” name.  CMS Ex. 1 at 8-9.  But Petitioner informs me that it uses the “doing business as” name Koth Orthopedics and Spine.  P. Br. at 1.  Neither K and L Medical LLC nor Koth Orthopedics and Spine appear in the image of the video screen in DAB E-File # 1c.  Although DAB E-File # 1c was not admitted as evidence, I accepted for purposes of summary judgment that the video screen was adjacent to Petitioner’s entrance (P. Br. at 1; DAB E-File # 7; CMS Ex. 1 at 29) and displayed the same information as on the dates of the site inspections.  Because Petitioner’s name is not listed, the sign cannot satisfy the requirement for a permanently visible sign sufficient to inform a Medicare beneficiary, CMS, or others of Petitioner’s location.  The sign also does not list any hours of operation.  Petitioner has offered no evidence from which I can infer that its hours of operation were posted anywhere outside its office where the posted hours could be seen by a Medicare beneficiary, CMS, or others.  DAB E-File ## 1d, 1e, 7a; RFH at 2 (“hours posted on our desk for patients to see as they walk in”).  Moreover, Petitioner concedes in briefing that it did not post its hours of operation until after the site visits and the site inspections and then the evidence only shows that hours were posted on a desk within the Petitioner’s facility.  P. Br.; DAB E-File # 1b, 1d; RFH at 2 (“hours posted on our desk for patients to see as they walk in”).  The requirement that when a supplier is located within a building complex a permanent sign with

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the DMEPOS supplier’s name must be at the entrance to the building is also not satisfied in this case.  Petitioner does not allege that there was a sign at the building entrance and the photographs from the site inspections and those submitted by Petitioner show no sign listing Petitioner’s name at the building entrance.  CMS Ex. 1 at 21- 25; DAB E-File ## 1e.

Petitioner argued in the request for hearing that the October 23, 2025 notice of the initial determination did not advise Petitioner that its Medicare enrollment and billing privileges as a DMEPOS supplier were revoked because Petitioner did not have the required sign and posted hours of operation.  RFH at 1.  But Petitioner concedes in its brief that the notice of the initial determination included notice that the revocation was based on the absence of a sign and posted hours required by Supplier Standard 7 in addition to Supplier Standard 10 (liability insurance requirement).  I note that the April 22, 2025 MAC notice that it would be doing a site inspection advised Petitioner that posted hours must match those listed in Petitioner’s Medicare enrollment application.  CMS Ex. 1 at 17.  The October 23, 2025 notice of initial determination included italicized language on the second page that advised Petitioner revocation was based on noncompliance with 42 C.F.R. § 424.57(c)(7)(i)(D) because Petitioner did not have the required sign or posted hours.  CMS Ex. 1 at 33-34.

Petitioner advised me in its request for hearing that it was required to reimburse CMS $123,819.28 due to the alleged violation of Supplier Standard 10 that was overturned by the reconsidered determination.  Petitioner requests that the amount be refunded.  RFH at 3.  I have no authority to review or grant any relief related to an overpayment and that matter must be addressed with the MAC or whomever CMS’ counsel in this matter may recommend to Petitioner.  Petitioner argues that revocation has caused great distress and severe financial hardship.  RFH at 3; P. Br. at 1.  Petitioner also notes that the revocation has been a hardship on Petitioner’s patients who needed orthotic braces, slings, and related durable medical equipment.  P. Br. at 2.  Petitioner’s arguments may be construed to be a request for equitable relief that I have no authority to grant.  US Ultrasound, DAB No. 2302 at 8 (2010) (neither the ALJ nor the Board is authorized to provide equitable relief).  I am bound to follow the Act and regulations, and I have no authority to declare statutes or regulations invalid or ultra vires or ignore their application.  1866ICPayday.com, L.L.C., DAB No. 2289 at 14.

I conclude that CMS had a basis to revoked Petitioner’s Medicare enrollment and billing privileges as a DMEPOS supplier.  I have no authority to review the exercise of discretion by CMS to revoke a DMEPOS supplier’s Medicare enrollment and billing privileges once I have found that a basis for revocation exists, in this case, the violation of Supplier Standard 7.  The scope of my authority is limited to determining whether there is a legal basis for revocation of Petitioner’s Medicare enrollment and billing privileges.  Abdul Razzaque Ahmed, M.D., DAB No. 2261 at 19, aff’d, Ahmed v. Sebelius,

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710 F. Supp. 2d 167 (D. Mass. 2010).  Once I determine there is a basis for revocation, I do not consider whether CMS should have revoked.

Pursuant to 42 C.F.R. § 424.57(e)(1), revocation for noncompliance with the supplier standards established by 42 C.F.R. § 424.57(c) is effective 30 days after the supplier is sent notice of the revocation.  Pursuant to 42 C.F.R. § 424.535(g)(2)(viii)(D), the effective date of revocation is determined pursuant to 42 C.F.R. § 424.535(g)(1), if none  of the listed exceptions apply, and they do not in this case.  Revocation under 42 C.F.R. § 424.535(g)(1) is effective 30 days after CMS or the MAC mailed the notice of the initial determination to revoke.  Under either regulation the correct effective date for revocation of Petitioner’s Medicare enrollment and billing privileges is 30 days after the notice of the revocation was issued or mailed.  Accordingly, I conclude that the effective date of revocation of Petitioner’s Medicare enrollment and billing privileges was November 22, 2025, which is 30 days after the October 23, 2025 notice of revocation was mailed.

III.  Conclusion

For the foregoing reasons, I conclude that Petitioner’s Medicare enrollment and billing privileges are revoked pursuant to 42 C.F.R. §§ 424.57(e)(1) and 424.535(a)(23)(ii), effective November 22, 2025, for violation of 42 C.F.R. § 424.57(c)(7)(i)(D) (Supplier Standard 7).