Mansur Hsin-Chia Lee, ALJ Ruling No. 2026-18 (HHS-CRD April 21, 2026)

RULING

Petitioner, Mansur Hsin-Chia Lee, is a California physician, who participated in the Medicare program as a supplier of services.  Finding that he had been affiliated with a supplier that posed an undue risk of fraud, waste, or abuse to the Medicare program, the Centers for Medicare & Medicaid Services (CMS) has revoked his Medicare enrollment, imposed a ten-year re-enrollment bar, and added his name to the Medicare preclusion list.  42 C.F.R. § 424.535(a)(19); see 42 C.F.R. § 424.519. 

Petitioner appealed.  

Shortly after filing the appeal, Petitioner requested “expedited judicial review” and asked that I stay the sanctions that CMS has imposed – revocation and his placement on the Medicare preclusion list – pending “resolution of the purely legal issues in dispute.” 

In an order issued on March 17, 2026, I directed the parties to submit pre-hearing exchanges, which must include:  briefs “addressing all issues of law and fact”; lists of proposed exhibits; copies of those exhibits; and a list of all proposed witnesses, along with their written direct testimony (submitted as a proposed exhibit).  Initially, CMS’s exchange was due no later than April 21, 2026, and Petitioner’s exchange was due no 

Page 2

later than May 26, 2026.  However, while Petitioner’s motion was pending, CMS with Petitioner’s concurrence, asked for a 21-day extension, which I granted.  CMS’s exchange is now due no later than May 12, 2026, and Petitioner’s exchange is due no later than June 16, 2026. 

I deny Petitioner’s request for expedited judicial review.  As explained below, even assuming that the Medicare statute authorizes such review, Petitioner has not established that I am an appropriate “review entity,” authorized to grant expedited judicial review.  Even if I were an appropriate review entity, Petitioner does not meet the statutory criteria for expedited judicial review.  

I also deny Petitioner’s request for a stay.  I am not authorized to stay the sanctions that CMS has imposed. 

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 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).  Physicians (such as Petitioner) and other practitioners who furnish healthcare services may participate in the program as “suppliers” of services; however, they must enroll in the program in order to receive Medicare payments.  Act §§ 1861(d), (q), (r) (42 U.S.C. §§ 1395x(d), (q), (r)); 42 C.F.R. §§ 400.202, 424.505. 

CMS may revoke a supplier’s Medicare enrollment and billing privileges on one or more of the grounds set forth under 42 C.F.R. § 424.535(a). 

Supplier appeal rights.  The Act provides that a supplier whose enrollment is denied or not renewed “may have a hearing and judicial review of such denial under the procedures that apply under subsection (h)(1)(A) to a provider of services that is dissatisfied with a determination by the Secretary.”  Act § 1866(j)(8) (42 U.S.C. § 1395cc(j)(8)) (Emphasis added). 

Section 1866(h)(1)(A) provides that a supplier dissatisfied with the Secretary’s determination is entitled to a hearing by the Secretary “to the same extent as is provided in section 205(b) of the Act, and to judicial review of the Secretary’s final decision as is provided in section 205(g).”  Act § 1866(h)(1) (42 U.S.C. § 1395cc(h)(1), citing §§ 405(b), 405(g)) (Emphasis added). 

Page 3

Under section 205(b), a party dissatisfied with the Secretary’s determination that it does not comply with Medicare’s statutory and regulatory requirements is entitled to administrative review.  If dissatisfied with the Secretary’s “final decision . . . made after a hearing,” the party is entitled to judicial review.  Act § 205(g) (Emphasis added).  The statute explicitly provides that sections 205(b) and 205(g) are the exclusive means for obtaining review of the Secretary’s determinations.  Act § 205(h); Shalala v. Illinois Council on Long Term Care, 529 U.S. 1, 13-5 (2000).  As the Federal District Court noted when it dismissed this petitioner’s Application for a Temporary Restraining Order: 

• When a claim arises under Medicare, § 405(h) eliminates federal question jurisdiction and the plaintiffs must first exhaust the appropriate administrative channels before seeking judicial review.  

CMS Ex. 4 at 3 (Lee v. Kennedy, Case No. 8:26-cv-00444-DOC-KES – Order Dismissing Case for Lack of Administrative Exhaustion (C.D. Calif. March 24 2026), quoting Neurostimulation, Inc. v. Azar, 977 F.3d 969, 975 (9th Cir. 2020)).  

The Act also directs the Secretary to establish, by regulation, an enrollment process for Medicare suppliers.  Act § 1866(j)(1)(A) (42 U.S.C. § 1395cc(j)(1)(A)).  In keeping with the statute’s directive, CMS, acting on behalf of the Secretary, promulgated regulations establishing Medicare enrollment requirements, which are found at 42 C.F.R. Subpart P (42 C.F.R. §§ 424.500 – 424.570).  Pursuant to those regulations, 42 C.F.R. Part 498 governs the appeals process.  42 C.F.R. § 424.545(a).  The process includes the following steps: 

• CMS issues an “initial determination,” which would include revoking a supplier’s Medicare enrollment and adding his name to the preclusion list. 42 C.F.R. §§ 498.3(b)(17), (20); 498.5(l)(n).
• If the supplier is dissatisfied with an initial determination, it may request “reconsideration.” 42 C.F.R. § 498.22.
• If dissatisfied with the reconsidered determination, the supplier may request a hearing before an administrative law judge (ALJ). 42 C.F.R. § 498.40.  
• If dissatisfied with the ALJ’s decision, the supplier may request review by the Appellate Division of the Departmental Appeal Board. 42 C.F.R. §§ 498.80, 498.82.  
• If dissatisfied with the Board’s decision, the supplier has the “right to seek judicial review.” 42 C.F.R. §§ 498.5(l); 498.90(b). 

Page 4

Unlike other types of appeals brought under the Act, the regulations that govern these proceedings (Part 498) do not provide for expedited judicial review.  See, e.g., 42 C.F.R. § 405.990 (describing a process for expedited access to judicial review in cases involving Medicare benefit appeals). 

Procedural background.  Here, by letter dated May 15, 2025, the Medicare contractor, Noridian Healthcare Solutions, advised Petitioner that his Medicare enrollment and billing privileges were revoked, effective June 14, 2025.  The letter explained that the contractor revoked Petitioner’s Medicare privileges because he was affiliated with Passion and Love Hospice, Inc., an entity previously enrolled in the Medicare program.1  The hospice’s Medicare billing privileges were revoked pursuant to 42 C.F.R. § 424.535(a)(8)(ii) – abuse of billing privileges.  The contractor determined that Petitioner’s affiliation with that entity posed an undue risk of fraud, waste, or abuse to the Medicare program and that Petitioner’s participation in Medicare should therefore be revoked.  CMS Ex. 1 at 1; see 42 C.F.R. §§ 424.519; 424.535(a)(19). 

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

The letter also advised Petitioner that the contractor added him to CMS’s preclusion list, as authorized by 42 C.F.R. §§ 422.2, 422.222, 423.100, and 423.120(c)(6).  It explained that, if Petitioner requested reconsideration, this action would become effective on the date the reconsidered determination was issued.  Id. at 1-2. 

Petitioner requested reconsideration.  CMS Ex. 2. 

In a reconsidered determination, dated February 23, 2026, a CMS hearing officer upheld the revocation under sections 424.519 and 424.535(a)(19).  She found no error in CMS’s revoking Petitioner’s Medicare enrollment nor in CMS’s including him on the preclusion list.  CMS Ex. 3 at 13.  The hearing officer also upheld the ten-year reenrollment bar.  Id.  

Ruling

1. 1. Petitioner is not entitled to “expedited judicial review.”

Petitioner seeks “expedited judicial review,” claiming that section 1866(h)(1)(B) of the Act creates a right to expedited judicial review under certain circumstances.  CMS responds that section 1866(h)(1)(B) does not apply to provider enrollment appeals 

Page 5

because section 1866(j)(8) limits its review rights to the procedures listed in section 1866(h)(1)(A).  This may be so; the statute is ambiguous, and the regulations are silent. 

I need not decide that question, however.  Even if Petitioner could invoke section 1866(h)(1)(B) (and I’m not convinced that he can), other considerations preclude my authorizing expedited judicial review in this case:  1) an ALJ is not the appropriate “review entity”; and 2) Petitioner has not satisfied the statutory requirements for expedited review. 

1. a. An ALJ is not the appropriate “review entity.”

Section 1866(h)(1)(B) provides that a party “may obtain expedited access to judicial review under the process established under section 1869(b)(2)” (42 U.S.C. § 1395ff(b)(2)).  Section 1869(b)(2) authorizes expedited access to judicial review “when a review entity . . . on its own motion or at the request of the appellant” makes certain determinations (discussed below).  The statute defines “review entity” as “an entity of up to three reviewers who are administrative law judges or members of the Departmental Appeals Board selected for purposes of making” that determination.  Act § 1869(b)(2)(D). 

Petitioner points to no authority, and I am aware of none, suggesting that the Secretary has authorized an individual ALJ to make the determination.  The Part 498 regulations do not give anyone the authority to allow expedited access to judicial review.  Nor do they provide a process for implementing the request.  Petitioner recognizes this and asks that I include in a ruling “guidance” on how the expedited review process “may be implemented in this forum.”  As an ALJ, I am authorized to conduct hearings and issue decisions.  See 42 C.F.R. §§ 498.44, 498.60, 498.74.  I am not authorized to develop procedures for obtaining judicial review.  That undertaking is more appropriately performed by the agency through notice-and-comment rulemaking, as was done for other kinds of appeals. 

For example, unlike the Part 498 regulations, the regulations governing entitlement and claims appeals (see 42 C.F.R. § 405.904) explicitly authorize expedited access to judicial review and describe the process for implementing that authority.  42 C.F.R. § 405.990.  If, as here, an appeal is pending when the request is filed, it must be filed with the Board, which is the designated “review entity,” authorized to determine whether the request meets statutory and regulatory requirements.  42 C.F.R. §§ 405.990(d)(ii), 405.990(f).  Those regulations do not apply to this revocation-of-enrollment appeal.  Nevertheless, they offer some insight into which entity has, in a similar context, been considered appropriate to review requests for expedited access to judicial review. 

Page 6

1. b. Petitioner does not satisfy the statutory requirements for expedited judicial review.

Under section 1869(b)(2), the supplier must meet certain conditions before he has access to expedited judicial review: 

• The review entity (an ALJ or the Board) determines that the Board does not have the authority to decide the question of law or regulation relevant to the matters in controversy, and
• No material issue of fact is in dispute.

Act § 1869(b)(2)(A).  The record in this case has yet to be developed.  Nevertheless, CMS’s determination appears to be based on issues of fact and law, the majority of which the Board and I have the authority to review. 

Petitioner does not claim that no material issue of fact is in dispute.  To the contrary, he contends that CMS’s findings are “unsupported by the actual facts.”  Hearing Request at 1.  In these proceedings, the ALJ is charged with deciding the “actual facts” and determining whether they support CMS’s conclusions.  See 42 C.F.R. § 498.74.  Because the facts underlying this matter have not been developed, Petitioner is not entitled to expedited judicial review. 

Nor has Petitioner established that the ALJ and Board lack the authority to decide the questions of law or regulation that it raises.  Petitioner claims that CMS’s actions are:  “arbitrary and capricious”; “inconsistent with the required interpretation of the applicable agency rules”; and “unauthorized by the controlling Medicare statutes.”  These are all issues that the ALJ and the Board have the authority to decide.2

Petitioner also complains that he has been denied due process “under the circumstances here.”  Although neither an ALJ nor the Board can review a Constitutional claim, that claim cannot be decided in a vacuum but requires a fully-developed administrative record. 

Page 7

Petitioner has thus not met the statutory requirements for expedited judicial review.  

2. 2. I have no authority to stay the sanctions CMS has imposed.

Finally, citing the Administrative Procedures Act, 5 U.S.C. § 705, Petitioner asks that I issue a stay of the ongoing sanctions in this case, “pending the resolution of the purely legal issues in dispute.”  That provision authorizes the “agency” to postpose the effective date of the action taken by it, pending judicial review,” when it finds that “justice so requires.” 

An individual ALJ does not speak for the “agency.”  CMS may have the discretion to consider “unique or mitigating circumstances in deciding whether, or how, to exercise its revocation authority.”  I do not.  I may not substitute my discretion for that of CMS in determining whether the sanctions imposed are appropriate.  Norman 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). 

I also note that the federal district court deemed it “improper” to grant Petitioner emergency relief and denied Petitioner’s similar motion for stay pending the outcome of these proceedings.  CMS Ex. 5 (Lee v. Kennedy, Case No. 8:26-cv-00444-DOC-KES – Order Denying Plaintiff’s Emergency Request for Staying Appeal (C.D. Calif. March 30, 2026)). 

Conclusion

I deny Petitioner’s request for expedited judicial review.  I am not the appropriate review entity, and Petitioner does not meet the statutory requirements for expedited judicial review. 

I do not have the authority to stay the sanctions that CMS has imposed.