NeuLine Health Management LLC, ALJ Ruling 2026-17 (HHS CRD April 22, 2026)

DISMISSAL

Petitioner, NeuLine Health Management LLC, filed a request for hearing before an administrative law judge (ALJ) to challenge the determination of the Centers for Medicare & Medicaid Services (CMS) to revoke Petitioner’s enrollment in the Medicare program.  The Civil Remedies Division (CRD) assigned this case to me for adjudication.

Petitioner recognized that it filed the hearing request late but requested that I permit the late filing.  Because Petitioner failed to show good cause for the late filing, I dismiss the request for hearing as untimely.

Background

On December 16, 2024, Petitioner submitted a Change of Information (COI) application Electronic Filing (E-File) Doc. No. 1b at 1.1  On January 21, 2025, a CMS contractor conducted a site visit at Petitioner’s practice location.  E-File Doc. No. 1c.  During the site visit, Petitioner was found to be non-compliant with various enrollment requirements

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for Independent Diagnostic Testing Facilities specified under 42 C.F.R. § 410.33.  E-File Doc. No. 1b.

Therefore, in a February 11, 2025 notice, Novitas Solutions (Novitas), a CMS contractor, informed Petitioner that it was revoking Petitioner’s Medicare enrollment and Medicare billing privileges pursuant to 42 C.F.R. § 424.535(a)(1) effective March 13, 2025.  E-File Doc. No. 1d at 1-2.  Novitas also barred Petitioner from reenrollment in the Medicare program for one year.  Id.  In the same notice, Novitas informed Petitioner of its right to submit a corrective action plan (CAP) in response to the revocation.  Id. at 2.

Petitioner timely submitted a CAP and requested reconsideration of the revocation and submitted a number of exhibits.  E-File Doc. No. 1a at 1-2.  In a September 3, 2025 reconsidered determination, CMS upheld Petitioner’s revocation.  Id. at 1-5.  Although CMS stated that Petitioner corrected the deficiencies related to 42 C.F.R. §§ 410.33(g)(3), 410.33(g)(12), and 410.33(g)(14), CMS found that Petitioner did not provide any documentation to prove that it was compliant with § 410.33(g)(4)(i) at the time the application was revoked on February 11, 2025.  Id. at 4.  Therefore, CMS upheld the revocation.  Id. at 2-5.  The reconsidered determination provided the following notice:

FURTHER APPEAL RIGHTS – ADMINISTRATIVE LAW JUDGE (ALJ):

If you are satisfied with this decision, you do not need to take further action.  If you believe that this determination is not correct, you may request ALJ review for the reconsideration portion of this decision letter.  To request ALJ review, you must file your appeal with the Civil Remedies Division of the Departmental Appeals Board within 60 calendar days after the date of receipt of this decision.

Id. at 5 (emphasis added).  The reconsidered determination also provided detailed information on how to file the hearing request, both through E-File and the mail, and what Petitioner must include in the hearing request.  Id. at 5-7.

On March 2, 2026, Petitioner electronically filed a hearing request in which Petitioner argued CMS had not demonstrated a violation of § 410.33(g)(4)(i) and attached documents to support Petitioner’s claim that it was in compliance.  E-File Doc. Nos. 1, 1a-1l.  Petitioner recognized the hearing request was not timely but requested that I permit the late filing.

On March 9, 2026, I issued an Acknowledgment and Pre-hearing Order, directing CMS to file a response to Petitioner’s request for extension of the 60-day filing deadline by March 19, 2026.  E-File Doc. No. 2.  CMS did not file by that deadline.  On March 30,

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2026, I issued an Order to Show Cause, directing CMS to file its response as well as a motion to file out of time by April 9, 2026.  E-File Doc. No. 3.  On April 8, 2026, CMS filed a joint response, opposing Petitioner’s request for extension, and a motion to file out of time.  E-File Doc. No. 6.  On April 9, 2026, Petitioner filed a reply, stating it did not oppose CMS’s motion to file out of time.  E-File Doc. No. 7.

Discussion

When CMS revokes a supplier’s enrollment, the supplier has the right to request reconsideration of that determination.  42 C.F.R. §§ 405.803(a), 498.22.  A supplier dissatisfied with a reconsidered determination may request a hearing before an ALJ.  42 C.F.R. § 498.40.

A request for an ALJ hearing to dispute a revocation “must be filed within sixty days after notice of such decision is received by the individual making such request.”  42 U.S.C. §§ 405(b)(1), 1395cc(h)(1), (j)(8).  Or, as stated in the regulations:  “The affected party . . . must file the request [for hearing] in writing within 60 days from receipt of the notice of . . . reconsidered . . . determination unless the period is extended . . . .”  42 C.F.R. § 498.40(a)(2).  The presumed receipt date for the reconsidered determination is five days after mailing.  42 C.F.R. §§ 498.22(b)(3), 498.40(a)(2).  If a hearing request was not filed within 60 days, then the “affected party . . . may file with the ALJ a written request for extension of time stating the reasons why the request was not filed timely.”  42 C.F.R. § 498.40(c)(1).  An ALJ may extend the due date for the hearing request “[f]or good cause shown.”  42 C.F.R. § 498.40(c)(2).

In this case, Petitioner concedes that the hearing request is late.  Applying the presumption that Petitioner received the reconsidered determination five days after September 3, 2025, I must presume that Petitioner received it on September 8, 2025.  Sixty days after that was November 7, 2025.  However, Petitioner did not file the hearing request until March 2, 2026.

In the hearing request, Petitioner conceded the tardiness of the request but blamed CMS for the delay, because Petitioner requested the documentation CMS used to make the revocation determination in September 2025, but claims CMS did not produce all the requested documents until February 2026.  E-File Doc. No. 1 at 5.  The requested documents included a copy of the official site visit report from the CMS Site Visit and the COI Application petitioner submitted to CMS.  E-File Doc. Nos. 1, 1h-g.  CMS provided Petitioner a copy of the site visit on November 17, 2025, but withheld certain documents requested, citing exemptions.  E-File Doc. Nos. 1, 1h-1i.  CMS provided Petitioner a copy of its COI on February 9, 2026.  E-File Doc. Nos. 1, 1h, 1j.

The regulations do not define what constitutes “good cause” to extend the filing deadline for a hearing request and previous administrative appellate decisions have “never

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attempted to provide an authoritative or complete definition of the term ‘good cause’ in section 498.40(c)(2).”  Brookside Rehab. & Care Ctr., DAB No. 2094 at 7 n.7 (2007) (citing Glen Rose Med. Ctr. Nursing Home, DAB No. 1852 at 7 n.5 (2002)).  However, a basic definition of “good cause” means “[a] legally sufficient reason.”  Black’s Law Dictionary 11th ed. (2019) (defined under the second definition of the word “cause”).  Therefore, good cause is more than just explaining why a request for hearing is late.  See Brookside, DAB No. 2094.

In this case, Petitioner’s reason for missing the filing deadline was that the documentation it requested from CMS was necessary to file a complete and informed hearing request.  Pursuant to 42 C.F.R. § 498.40(b), a request for hearing must (1) identify the specific issues, and the findings of fact and conclusions of law with which the affected party disagrees; and (2) specify the basis for contending that the findings and conclusions are incorrect.

In its September 3, 2025 decision to uphold the revocation, Novitas clearly states the findings of fact and conclusions of law that constitute the basis for revocation.  Petitioner has not shown that it required more than the reconsidered determination to file a legally sufficient request for hearing.  Further, the reconsidered determination provided clear notice of the 60-day deadline.  Petitioner is not allowed to indefinitely delay filing a request for hearing to conduct discovery.  Especially, when the hearing process allows for discovery and submission of evidence.  See 42 C.F.R. §§ 498.58, 498.61, 498.62, 498.63.  Therefore, I cannot accept Petitioner’s explanation as a sufficient showing of good cause to file a late hearing request.2  Lakeland Health Care Ctr., DAB No. 3147 at 15-17 (2024); New Grove Manor, DAB No. 3090 at 15 (2023).

Dismissal of a hearing request is appropriate when the reconsidered determination clearly explained the filing requirements and deadlines to the petitioner.  See Vanguard Vascular & Vein, PLLC, DAB No. 2523 at 3-4 (2013) (upholding dismissal when the reconsidered determination correctly explained in “unambiguous and conspicuous language” that the petitioners had 60 calendar days from their receipt of the reconsidered determination to request a hearing before an ALJ); Waterfront Terrace, Inc., DAB No. 2320 at 6, 8 (2010) (holding that no good cause existed to justify extending the filing deadline where the notice letter reasonably informed the Petitioner of its appeal rights).  Because Petitioner has not made a showing of good cause for failing to file its hearing request within the 60-

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day period for appeal and the reconsidered determination clearly stated the deadline to request a hearing, I dismiss Petitioner’s hearing request as untimely.  42 C.F.R. § 498.70(c).

If Petitioner believes that this Dismissal is incorrect and it can show good cause for its untimely hearing request, Petitioner may file, within 60 days of receiving this Dismissal, a request that I vacate this Dismissal.  42 C.F.R. § 498.72.

III.  Conclusion

I dismiss Petitioner’s hearing request for untimeliness.