Excellency Medical Supplies LLC, ALJ Ruling 2026-19 (HHS CRD April 24, 2026)

DISMISSAL

Petitioner, Excellency Medical Supplies LLC, is a supplier of durable medical equipment orthotics and supplies, located in Coral Springs, Florida.  When the Medicare contractor denied its application for enrollment, Petitioner requested reconsideration.  However, the contractor dismissed its request as untimely.  Petitioner subsequently requested a hearing before an administrative law judge (ALJ).

Petitioner has no right to a hearing because it has not obtained a reconsidered determination.  I therefore dismiss this matter pursuant to 42 C.F.R. § 498.70(b).

Discussion

In a letter dated December 29, 2025, the Medicare contractor, Chags Health Information Technology, advised Petitioner that its Medicare enrollment application was denied.  Petitioner requested reconsideration, but, in a letter dated April 3, 2026, the contractor explained that it was “unable to accept” the reconsideration request because “it was not submitted in a timely manner.”1

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Petitioner requests ALJ review.  It does not deny that its request for reconsideration was untimely but argues that the contractor’s determination “does not fully reflect the circumstances” of the case.  Petitioner asks that I find good cause for the delayed submission “as the circumstances demonstrate diligence and substantial compliance.”

My authority here is limited.  I am not authorized to review this case.

To receive Medicare payments for services furnished to program beneficiaries, a Medicare supplier must be enrolled in the Medicare program.  42 C.F.R. § 424.505.  To enroll in Medicare, a prospective supplier must complete and submit an enrollment application.  42 C.F.R. §§ 424.510(d)(1); 424.515(a).  When CMS determines that a supplier meets the applicable enrollment requirements, it grants Medicare billing privileges.

CMS’s determination to deny enrollment is an “initial determination” that is subject to review under the procedures set forth in 42 C.F.R. Part 498.  42 C.F.R. §§ 498.3(a), (b)(5).  A supplier or prospective supplier dissatisfied with an initial determination may request reconsideration by filing a written request within 60 days from receipt of the notice of the initial determination.  42 C.F.R. §§ 498.5(d)(1); 498.22.  If CMS (or its contractor) receives a properly-filed request for reconsideration, it makes a reconsidered determination affirming or modifying the initial determination.  42 C.F.R. § 498.24(c).  A supplier or prospective supplier dissatisfied with a reconsidered determination is entitled to a hearing before an administrative law judge.   42 C.F.R. § 498.5(d)(2); see 42 C.F.R. § 498.40.  The regulations do not provide for a hearing in the absence of a reconsidered determination, even though this “may, in certain situations, be unfair.”  Ramaswamy v. Burwell, 83 F. Supp.3d 846, 854 (E.D. Mo. 2015); Rollington Ferguson, M.D., DAB No. 2949 (2019); Denise A. Hardy, D.P.M., DAB No. 2464 at 4-5 (2012); Hiva Vakil, M.D., DAB No. 2460 at 4-5 (2012).

Conclusion

Because neither CMS nor its contractor issued a reconsidered determination, Petitioner does not have a right to an ALJ hearing.  I therefore dismiss his hearing request pursuant to 42 C.F.R. § 498.70(b).