Glencare Hospice Services, Inc., DAB CR7006 (2026)

DECISION

Petitioner, Glencare Hospice Services, Inc., is a California provider of hospice services that, until recently, participated in the Medicare program.  Finding that the hospice had engaged in a pattern or practice of submitting claims that fail to meet Medicare requirements, the Centers for Medicare & Medicaid Services (CMS) has revoked its Medicare enrollment, imposed a ten-year re-enrollment bar, and placed the hospice on the Medicare preclusion list.

Petitioner appealed.

I affirm CMS’s determination.  I find that CMS is authorized to revoke Petitioner’s Medicare enrollment and to impose a reenrollment bar because a targeted review of claims submitted over a ten-month period showed that the hospice submitted a high percentage of claims that did not meet Medicare billing requirements, and, even after the Medicare contractor gave it an opportunity to correct its deficient billing practice, it continued to submit erroneous claims.  42 C.F.R. § 424.535(a)(8)(ii).  Having found that CMS had the authority, I may not review CMS’s exercise of its discretion to revoke.

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CMS also acted within its authority when it added Petitioner to its preclusion list because the supplier’s Medicare privileges were revoked for conduct detrimental to the best interests of the Medicare program, and it is under a reenrollment bar.

I have no authority to review CMS’s determination as to the length of the reenrollment bar or the time Petitioner remains on the preclusion list.

Background

Statutory and regulatory background.  The Medicare program, Title XVIII of the Social Security Act (Act), is a federally-subsidized insurance program that provides health care benefits to the elderly, disabled, and those suffering from end stage renal disease.  Medicare is divided into four parts:

• Part A is the hospital insurance program.  It covers hospital services, post-hospital extended care, home health services, and hospice care.  Act § 1811 (42 U.S.C. § 1395c);
• Part B, which is voluntary, is the supplementary medical insurance program, covering physician, outpatient, home health,1 and other services.  Act § 1832 (42 U.S.C. § 1395k);
• Part C is the Medicare Advantage program, which allows its participants to enroll in “Medicare + Choice” plans, managed by organizations, such as health maintenance organizations, that receive a fixed payment for each enrollee.  Act § 1851 (42 U.S.C. § 1395w-21); and
• Part D is the voluntary prescription drug benefit program.  Act § 1860D (42 U.S.C. § 1395w-101).

The program is administered by CMS, acting on behalf of the Secretary of Health and Human Services.  CMS contracts with Medicare administrative contractors, who process and pay reimbursement claims and perform other duties necessary to carry out program purposes.  Act § 1842 (42 U.S.C. § 1395u).  Contractors pay claims to “providers” (Part A) and “suppliers” (Part B).

Hospices may participate in the Medicare program as “providers” of services.  Act § 1861(u) (42 U.S.C. § 1395x(u)).  Hospice services are provided to the “terminally ill,” which means that the individual’s life expectancy is six months or less if the illness runs

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its normal course.  Act § 1861(dd)(1), (3)(A); 42 C.F.R. § 418.3 (defining “hospice,” “hospice care,” and “terminally ill”).  To qualify for coverage, a physician must certify that the covered individual is terminally ill.  42 C.F.R. § 418.22.  To meet Medicare requirements, claims must be:  for services that are reasonable and necessary; supported by documentation that substantiates medical necessity; and supported by documentation that substantiates the amount claimed.  42 C.F.R. §§ 424.5(a)(1), (6), 418.310.

As with other providers, a hospice must enroll in the Medicare program in order to receive Medicare payments for items furnished to a Medicare-eligible beneficiary.  Act § 1834(j)(1)(A); 42 C.F.R. § 424.505.  To enroll and maintain its enrollment, the provider must comply with Medicare program requirements, including the enrollment requirements set forth in 42 C.F.R. Part 424, subpart P (sections 424.500 through 424.575).  CMS may revoke a provider’s Medicare enrollment and billing privileges for any of the reasons listed in 42 C.F.R. § 424.535(a), including abuse of its billing privileges.  42 C.F.R. § 424.535(a)(8).

So long as CMS shows that one of the regulatory bases exists, I must uphold the revocation.  Salman M. Akbar, M.D., DAB No. 3227 at 9 (2026); Devine Sols. Grp., LLC, DAB No. 3159 at 12 (2024); Thomas Falls, M.D., DAB No. 3056 at 8 (2022); William Garner, M.D., DAB No. 3026 at 16 (2020); Eva Orticio Villamor-Goubeaux, DAB No. 2997 at 13 (2020); Wassim Younes, M.D. & Wassim Younes, M.D., P.L.C., DAB No. 2861 at 8 (2018); Norman Johnson, M.D., DAB No. 2779 at 11 (2017), and cases cited therein.  Although CMS itself has the discretion to consider “unique or mitigating circumstances in deciding whether, or how, to exercise its revocation authority,” I do not.  Johnson, DAB No. 2779 at 11 (citing Care Pro Home Health, Inc., DAB No. 2723 at 9 n.8 (2016)).  I may not substitute my discretion for that of CMS in determining whether a legally-sound revocation is appropriate.  Johnson, DAB No. 2779 at 11 (citing Care Pro Home Health, Inc., DAB No. 2723 at 9 n.8 (2016)); Abdul Razzaque Ahmed, M.D., DAB No. 2261 at 19 (2009), aff’d, Ahmed v. Sebelius, 710 F. Supp. 2d 167 (D. Mass. 2010).

Procedural background.  Here, in a letter dated August 5, 2024, the Medicare contractor, National Government Services, advised Petitioner Glencare that its Medicare privileges were revoked, effective September 4, 2024.  The letter explained that the contractor revoked the hospice’s Medicare billing privileges because it “engaged in a pattern or practice of submitting claims that fail to meet Medicare requirements,” violating 42 C.F.R. § 424.535(a)(8)(ii).  CMS Ex. 1 at 1.

Pursuant to 42 C.F.R. § 424.535(c), the contractor imposed a ten-year reenrollment bar, effective 30 days after the postmark date of the letter.  CMS Ex. 1 at 2.

The letter also advised Petitioner that the contractor added it to CMS’s preclusion list, as authorized by 42 C.F.R. §§ 422.2 and 422.222 (Part C).  It explained that, if Petitioner

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requested reconsideration, this action would become effective on the date the reconsidered determination was issued.  Id.

Petitioner requested reconsideration.  CMS Exs. 2, 3.

In a reconsidered determination, dated March 26, 2026, a CMS hearing officer upheld the revocation pursuant to section 424.535(a)(8)(ii).  She found that the hospice had engaged in a pattern or practice of submitting claims that failed to meet Medicare requirements.  CMS Ex. 8 at 11.  The hearing officer also upheld the ten-year reenrollment bar and the determination to include Petitioner’s name on CMS’s preclusion list.  Id.

Decision based on the written record.  CMS moves for summary judgment, which Petitioner opposes.

My initial order instructs the parties to list any proposed witnesses and to submit their written direct testimonies.  Acknowledgment and Prehearing Order at 4, 5 (¶¶ 4(c)(iv), 8) (June 10, 2026); see CRDP ¶ 16b.  The order also directs the parties to indicate which, if any, of the opposing side’s witnesses the party wishes to cross-examine and explains that an in-person hearing is needed only if a party wishes to cross-examine the opposing side’s witnesses.  Prehearing Order at 5, 6 (¶¶ 9, 10).  The parties list no witnesses.  Because there are no witnesses to be examined or cross-examined, an in-person hearing would serve no purpose, and I may decide this case based on the written record, without considering whether the standards for summary judgment are satisfied.  See CRDP ¶ 19b.2

The parties’ submissions.  CMS submitted its motion and brief (CMS Br.) with eight exhibits (CMS Exs. 1-8).  In the absence of any objections, I admit into evidence CMS Exs. 1-8.

Petitioner submitted its own brief and opposition to summary judgment (P. Br.) with four exhibits (P. Exs. 1-4).  I decline to admit the documents that Petitioner submitted.

P. Exs. 3 and 4:  not submitted at reconsideration.  I am required to examine any new documentary evidence to determine whether the provider has good cause for submitting it, for the first time, at the ALJ level of review.  If I find that good cause does not exist,

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I must exclude the evidence and may not consider it in reaching a decision.  42 C.F.R. § 498.56(e), see 42 C.F.R. § 405.803(e).

Petitioner was, or should have been, aware of this requirement.  In its August 5, 2024 notice letter, advising Petitioner of its right to request reconsideration, the contractor warned:

[I]f you have additional information that you would like a Hearing Officer to consider during the reconsideration or, if necessary, an Administrative Law Judge (ALJ) to consider during a hearing, you must submit that information with your request for reconsideration.  This is your only opportunity to submit information during the administrative appeals process unless an ALJ allows additional information to be submitted.

CMS Ex. 1 at 3.  See Mohammad Nawaz, M.D., & Mohammad Zaim, M.D., PA, DAB No. 2687 at 12-13 (2016), aff’d, Nawaz v. Price, No. 4:16CV386, 2017 WL 2798230 (E.D. Tex. 2017) (finding that the ALJ did not abuse his discretion when he did not find good cause to admit documents not offered at reconsideration because the regulation itself provided notice of the requirements to provide all documents on reconsideration).

P. Exs. 3 and 4 are the hospice’s responses to the contractor’s “ADR” (Additional Documentation Request).  Petitioner admits that it did not include them in its Request for Reconsideration or even in its Request for ALJ Review but argues that the documents should not be classified as “new documentary evidence” because “CMS should have had access to this information prior to issuance of the Reconsideration decision.”  Petitioner’s Proposed Exhibit List (E-file # 8a).

“New documentary evidence” is evidence that was not submitted at the reconsideration level, without regard to how long it has existed or who had access to it.  That CMS may have had access to the evidence by other means does not constitute good cause.  It is not the CMS hearing officer’s job to seek out additional documents that might be relevant. The Petitioner is charged with developing its case at the reconsideration level, a process that is aimed at improving the “efficiency and accuracy of the appeals process.”  72 Fed. Reg. 9,479, 9,486 (Mar. 2, 2007).  Excusing a party from this requirement because CMS purportedly has access to the information – CMS has access to an enormous quantity of information – would render the regulation virtually meaningless.

Because Petitioner has not established good cause for failing to submit P. Exs. 3 and 4 at the reconsideration stage, I must exclude the evidence and may not consider it in reaching my decision.

P. Exs. 1 and 2:  might have been submitted at reconsideration but not relevant.  Although it is not obvious from the record before me, Petitioner claims that it submitted

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P. Exs. 1 and 2 at the reconsideration level.  Petitioner points out that it submitted medical records for patients reviewed during the provisional period of enhanced oversight (PPEO) process and maintains that P. Exs. 1 and 2 were included among those records.  P. Br. at 6; see CMS Ex. 8 at 2 (Provider Exhibit 2D).  Neither party included Provider Exhibit 2D with its submissions.

With its hearing request, however, Petitioner attached supporting documents, including medical records, which may be the medical records that Petitioner refers to.  E-file # 1f.  However, the document is 872 pages long, and Petitioner does not indicate where P. Exs. 1 and 2 might be found.  It is not the judge’s job to sift through hundreds of pages of documents to discover whether a particular page or two could be found within it.

But, assuming that Petitioner submitted the documents at the reconsideration level, I would nevertheless decline to admit them because they are irrelevant.  See 42 C.F.R. § 498.60(b)(1) (directing me to receive in evidence documents that are “relevant and material.”).

I do not have the authority to re-review any individual claim denials.  Claim denials are subject to a “different and entirely separate administrative appeals process.”  Devine Sols. Grp. LLC, DAB No. 3159 at 3 (citing Act § 1869 (42 U.S.C. § 1395ff); 42 C.F.R. Part 405, Subpart I).  Each level of review is final and binding unless appealed.  42 C.F.R. §§ 405.928(b), 405.958, 405.978.  The Office of Medicare Hearings and Appeals (OMHA) provides the ALJ level of review, and a dissatisfied party may appeal the ALJ decision to the Medicare Appeals Council (MAC).  Here, it seems that Petitioner appealed four of the claims at issue through the OMHA appeals process.  Three of his appeals were unsuccessful and one was dismissed as untimely.  CMS Ex. 5 at 3.

In any event, Petitioner concedes that it cannot challenge, in this forum, the final claim denials nor establish that it is entitled to payment.  P. Br. at 8, 10, 12.  Instead, according to Petitioner, it can use this forum to challenge the bases CMS relied on in denying the claims.  Citing the Departmental Appeals Board’s decision in Devine Solutions, Petitioner argues that, even though it cannot relitigate a final claim denial, it can challenge “every subsidiary factual premise underlying a 42 C.F.R. Part 405 determination.”  P. Br. at 11.  The Board made no such ruling.  It determined that the Medicare supplier’s claims had been fully and finally adjudicated in the forum that had the authority to review them.  Devine, DAB No. 3159 at 14-16.

In Devine, the ALJ declined to review the individual claims, finding them administratively final and noting that the “Medicare claims adjudicators are in the best position to make those determinations.”  DAB No. 3159 at 10 (quoting Devine Sols. Grp. LLC, DAB CR5981 at 13-14 (2021)).  The Board affirmed the ALJ decision.  The ALJ also noted that Petitioner hadn’t even tried to show that the claims were wrongly decided.

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Id. at 14.  Noting that a party failed to raise an issue is a far cry from finding that the issue is reviewable.

Moreover, based on the doctrine of issue preclusion (also known as collateral estoppel), Petitioner is precluded from relitigating, in this forum, any issue (legal or factual) that has been finally resolved in another forum (in fact, the only forum that has the authority to resolve those issues).  See Parklane Hosiery Co., Inc. v. Shore, 439 U.S. 322 (1979) (holding that, where the petitioner corporation and its officers had a “full and fair” opportunity to litigate their case in an action brought by the Securities and Exchange Commission, they were “collaterally estopped” from relitigating in an action brought by a shareholder, the issues resolved by the administrative agency).

In Rudra Sabaratnam and Robert I. Bourseau, the Board found that, because a court reached “its final, full determination of identical factual issues after they had been fully litigated,” and those issues were essential to the court’s valid final judgment, the Petitioner was precluded from relitigating them before the Departmental Appeals Board.  DAB No. 2139 at 21 (2007).

Because Petitioner offers P. Exs. 1 and 2 to re-litigate issues that were or could have been fully adjudicated in another forum (which had the authority to review them), they are irrelevant, and I decline to admit them.  42 C.F.R. § 498.60(b)(1).3

Issue

The issue before me is whether CMS was authorized to revoke Petitioner Glencare’s Medicare privileges and place it on the Medicare preclusion list pursuant to 42 C.F.R. § 424.535(a)(8)(ii).

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Discussion

1. CMS is authorized to revoke Petitioner Glencare’s Medicare enrollment and billing privileges because the hospice repeatedly submitted claims that did not meet Medicare requirements.4

CMS may find that a provider has abused its billing privileges under section 424.535(a)(8)(ii) if the provider has “a pattern or practice of submitting claims that fail to meet Medicare requirements.”

The Provisional Period of Enhanced Oversight (PPEO).  The Act directs the Secretary to establish a provisional period during which “appropriate” Medicare providers and suppliers, including categories of providers or suppliers, would be subject to enhanced oversight.  Act § 1866(j)(3); 42 U.S.C. § 1395cc(j)(3).

Responding to reports of hospice fraud, waste, and abuse, CMS placed newly-enrolled hospices located in Arizona, California, Nevada, and Texas in a “provisional period of enhanced oversight,” effective June 2024.  CMS Ex. 7 at 1.  A “new hospice” includes a hospice submitting a change-of-ownership (CHOW) that meets the requirements of 42 C.F.R. § 489.18.  42 C.F.R. § 424.527; CMS Ex. 7 at 1.

Petitioner’s practice of submitting claims.  In the summer of 2023, Petitioner Glencare underwent a change of ownership, subjecting it to enhanced oversight.  P. Br. at 1.  On November 20, 2023, the CMS contractor, National Government Services, conducted its first round of PPEO review.  CMS Ex. 4 at 1.  The contractor reviewed ten claims submitted for services provided from July 1, 2023, through September 30, 2023.  CMS Ex. 4 at 1, 5.  Of the ten submitted, seven were denied because the hospice’s documentation was not sufficient to support the hospice services billed.  CMS Ex. 4 at 1-2, 5.5

In a January 25, 2024 notice letter, the contractor advised Petitioner that it had not met the established goal error rate and that the contractor would proceed to Round 2 of the process on March 1, 2024.  CMS Ex. 4 at 3.  The letter reminded Petitioner that section 424.535(a)(8)(ii) gives CMS the authority to revoke a currently-enrolled provider’s billing privileges if the provider “has a pattern or practice of submitting claims that fail to meet Medicare requirements.”  Id.  The contractor then offered the hospice one-on-one provider education and provided directions for requesting the education.  Id.

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On March 1, 2024, the contractor completed Round two of the PPEO process.  It reviewed three claims submitted for services provided from March 1 through April 30, 2024.  CMS Ex. 2 at 220-24.  Two of the three claims were denied because the documentation the hospice submitted did not include the required certification for the dates of services billed (see 42 C.F.R. § 418.22).  CMS Ex. 2 at 21-24.

Petitioner challenges the Round 2 determinations.  As explained in some detail above, those determinations are final and binding unless successfully challenged in the forum that has the authority to review them.  Petitioner may not re-litigate, before me, issues that were or could have been fully adjudicated in the forum that has the authority to review them.  I therefore reject Petitioner’s attacks on the Round 2 determinations.

Based on these reviews, the contractor revoked Petitioner’s Medicare billing privileges, imposed a ten-year reenrollment bar, and placed it on the Medicare preclusion list.  42 C.F.R. § 424.535(a)(8)(ii); CMS Ex. 1.

CMS’s authority under section 424.535(a)(8)(ii).  In deciding whether the provider has exhibited a pattern or practice of submitting improper claims, CMS should consider:

A) the percentage of submitted claims that were denied;

B) whether the provider has a history of “final adverse actions” (see 42 C.F.R. § 424.502) and the nature of such actions;

C) the type of billing non-compliance and the specific facts surrounding said non-compliance (to the extent they can be determined); and

D) any other information regarding the provider’s specific circumstances that CMS deems relevant to its determination.

42 C.F.R. § 424.535(a)(8)(ii); see 86 Fed. Reg. 64,996, 65,334-35 (Nov. 19, 2021).

The regulation gives CMS broad discretion to evaluate each case based on these guidelines.  It does not require CMS to consider every factor in every case and does not dictate how CMS should consider and weigh the factors.

Petitioner complains, generally, that CMS failed to consider the factors listed in section 424.535(a)(8)(ii)(A)-(D) prior to revoking the hospice’s billing privileges.  P. Br. at 5.  I reject this contention.

Unless there is “clear evidence to the contrary,” I may presume that government officials “have properly discharged their official duties.” Devine Sols. Grp., LLC, DAB No. 3159

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at 18 (quoting Douglas Bradley, M.D., DAB No. 2663 at 14 (2015)).  Moreover, I am reviewing CMS’s reconsidered determination, not the contractor’s initial determination, and the reconsidered determination explicitly discusses each of the four regulatory factors listed in section 424.535(a)(8)(ii).  Devine Solutions, DAB No, 3159 at 18-19; see CMS Ex. 8 at 7-9.

Percentage of denied claims.6  CMS appropriately considered the percentage of denied claims, which was significant.  CMS Ex. 8 at 3.  Here, in Round 1 of the contractor’s review, 70% of the claims (7 out of 10) submitted were invalid (invalid or missing physician narrative; notice of election missing or invalid; physician certification missing or not timely signed).  CMS Ex.  4 at 1-2, 5; CMS Ex. 8 at 4.

Despite the contractor’s training offer, in Round 2, 66.67% of the claims (2 out of 3) were improper (documentation did not include the required certification for the dates of the service billed).  CMS Ex. 2 at 20.  These percentages alone justify CMS’s actions.  See CMS Ex. 8 at 4 (“An error rate of close to 70% is highly indicative that such a pattern [of submitting claims that did not meet Medicare requirements] did in fact exist.”).

Provider’s history of final adverse actions.  CMS considered the hospice’s history but was not aware that any other final adverse action had been taken against it at the time of the initial determination, noting that this single factor is not dispositive.  CMS Ex. 8 at 7.7

The type of billing non-compliance and facts surrounding the noncompliance.  CMS considered that the claims were denied because the hospice “did not supply sufficient documentation” demonstrating that they met Medicare hospice requirements, which shows that the hospice was not meeting basic coverage and billing requirements.  CMS Ex. 8 at 7.

In Round 1, the claims were denied based on a variety of errors:  missing or invalid physician narrative statement; missing face-to-face encounter; beneficiary notice of election not received; invalid notice of election; initial certification not timely signed by

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physician; no certification for dates billed; information did not support a terminal prognosis of six months or less.  CMS Ex. 2 at 15, 18.

In Round 2, both claims were denied based on:  no certification for dates billed.  CMS Ex. 2 at 2, 15, 24.  The enhanced oversight thus disclosed that the hospice had a repeated and significant problem with documentation.  Of the ten claims reviewed (not including the three returned to the provider), only one complied with Medicare requirements.  CMS Ex. 2 at 14, 20.  CMS thus reasonably determined that the hospice exhibited a pattern or practice of submitting claims that failed to meet Medicare requirements.  Again, this factor alone could justify CMS’s determination.

Other information CMS deems relevant.  As CMS points out, providers and suppliers must understand and comply with program rules.  CMS is not obligated to educate them.  On the other hand, CMS is obligated to protect Medicare trust funds and Medicare beneficiaries from providers and suppliers who repeatedly abuse their Medicare billing privileges by submitting non-compliant claims.  CMS Br. at 12.  Here, CMS found it “particularly relevant” that, after being put on notice that its billing practices did not comply and after being provided with individualized education on January 25, 2024, the provider did not correct its billing errors.  CMS Ex. 8 at 8.

Based on these factors, CMS reasonably determined that the hospice engaged in a pattern or practice of submitting claims that failed to meet Medicare requirements.  CMS was therefore authorized to revoke its Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.535(a)(8)(ii).  Having determined that CMS had a legal basis for denying enrollment, I must uphold that determination.  Cardiac Imaging Assocs. A Med. Corp., DAB No. 3133 at 16 (2024); Thomas Falls, M.D., DAB No. 3056 at 8 (2022); Vamet Consulting & Med. Servs., DAB No. 2778 at 6 (2017).

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

When a provider’s billing privileges are revoked, it may not participate in the Medicare program until the end of the reenrollment bar, which must be for a minimum of one year but no more than ten years (except under circumstance that don’t apply here), depending on the severity of the underlying offense.  42 C.F.R. § 424.535(c)(1).  Because the length of a reenrollment bar is not listed as an appealable determination, I have no authority to review it.  42 C.F.R. § 498.3(b); Linda Silva, P.A., DAB No. 2966 at 11 (2019); Vijendra Dave, M.D., DAB No. 2672 at 9-12 (2016); accord, William Garner, M.D., DAB No. 3026 at 16 (2020), Lilia Gorovits, M.D., P.C., DAB No. 2985 at 15-16 (2020).

3. CMS acted within its authority when it added Petitioner to its preclusion list because Petitioner’s Medicare privileges were revoked for conduct detrimental to the best interests of the Medicare program, and the hospice

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3. is under a reenrollment bar.  I have no authority to review CMS’s determination as to the length of time it remains on the preclusion list.

The preclusion list.  Effective January 1, 2019, CMS implemented a “preclusion list” as part of its effort to “prevent fraud, waste, and abuse, and to protect Medicare enrollees,” particularly with respect to prescription drug abuse.8  Pursuant to 42 C.F.R. § 422.2 (Part C) and 42 C.F.R. § 423.100 (Part D) CMS’s “preclusion list” includes individuals and entities that:

• are currently revoked from Medicare enrollment, are under an active reenrollment bar, and CMS determines that the underlying conduct leading to the revocation is detrimental to the best interests of the Medicare program; or
• have engaged in behavior for which CMS could have revoked the prescriber, individual, or entity had it been enrolled in the Medicare program, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare program.

Review of Petitioner’s inclusion on the preclusion list.  My review here is limited to whether CMS had the authority to include Petitioner on the preclusion list.  42 C.F.R. § 498.3(b)(20); see 83 Fed. Reg. 16,440, 16,642-16,643 (Apr. 16, 2018) (explaining that appeals are limited to the individual’s inclusion on the preclusion list).

As discussed above, Petitioner abused its billing privileges because it engaged in a pattern or practice of submitting claims that failed to meet Medicare requirements.  Posing an “undue risk of fraud, waste, or abuse” is necessarily detrimental to the best interests of the Medicare program and its beneficiaries.  Because its enrollment was revoked for conduct deemed detrimental to the best interests of the Medicare program and its beneficiaries and because Petitioner is under a reenrollment bar, CMS is authorized to add it to the Medicare preclusion list, and I must uphold its determination to do so.  42 C.F.R. §§ 422.2, 423.100; see Wendell Foo, M.D., DAB No. 2904 at 3 (2018), aff’d, 420 F. Supp. 3d 1100 (D. Haw. 2019); Wassim Younes, M.D., P.L.C., DAB No. 2861 at 8 (2018) (citing Patrick Brueggeman, D.P.M., DAB No. 2725 at 15 (2016)).

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Having determined that CMS properly added Petitioners to the preclusion list, I have no authority to review CMS’s determination as to how long it remains there.  See 42 C.F.R. § 498.3(b); Vijendra Dave, M.D., DAB No. 2672 at 9-12 (2016) (limiting ALJ review to the determinations listed in section 498.3(b)).

Conclusion

I affirm CMS’s determinations.

CMS justifiably revoked Petitioner’s Medicare enrollment and imposed a re-enrollment bar because its enrollment posed an undue risk of fraud, waste and abuse to the Medicare program.  42 C.F.R. § 424.535(a)(8)(ii).

CMS was authorized to include Petitioners on the preclusion list because its Medicare enrollment was revoked for conduct detrimental to the best interests of the Medicare program, and because it is under a reenrollment bar.

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