Nicholas Jauregui MD Inc. & Nicholas Jauregui, ALJ Ruling 2026-27 (HHS CRD June 4, 2026)

ORDER OF DISMISSAL

Noridian Healthcare Solutions (Noridian), an administrative contractor for the Centers for Medicare & Medicaid Services (CMS), revoked the Medicare enrollment and billing privileges of Nicholas Jauregui MD Inc. and Nicholas Jauregui (collectively “Petitioner”), a California-based practice that provides home health palliative care, hospice and transitional medical care.  Petitioner seeks to challenge its revocation but did not file its hearing request within the 60 days allotted by statute.  CMS moves to dismiss.

For the reasons discussed below, I dismiss as untimely Petitioner’s hearing request.

Petitioner’s hearing request was untimely filed, and Petitioner has not established good cause to extend the time for filing.

Section 1866(h)(1) of the Social Security Act (Act) grants hearing rights to providers and suppliers of Medicare services “to the same extent as is provided in section 205(b)” of the Act.  42 U.S.C. § 1395cc(h)(1).  Section 205(b) dictates that a petitioner’s hearing request “must be filed within sixty days” after it receives notice of an adverse decision.  42

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U.S.C. § 405(b)(1).  The 60-day time limit is thus a statutory requirement.  See Cary Health and Rehab. Ctr., DAB No. 1771 at 8-9 (2001).

Similarly, the regulations mandate that the affected party “file the request in writing within 60 days from receipt of the notice . . . unless that period is extended.”  42 C.F.R. § 498.40(a)(2).  If the request is not filed within 60 days, the party may file a written request for extension, which the ALJ may grant “for good cause shown.”  42 C.F.R. § 498.40(c).

The regulations do not define what constitutes “good cause” to extend the filing deadline for a hearing request.  The Departmental Appeals Board also “has never 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)).  “It is a decision that is committed to the ALJ’s broad discretion on a case-by-case basis.”  Christina Paylan, M.D., DAB No. 3112 at 8 (2023) (internal citations omitted).

However, the parties agree that “[g]ood cause is ordinarily found where circumstances are beyond the party’s control.”  Petitioner’s Response at 2 (citing The Brightpointe, DAB No. 3157 at 14 (2024); see also CMS’s Motion to Dismiss at 4.  I also agree.  In fact, ALJs handling Part 498 appeals have long looked to the Social Security Administration’s (SSA) regulatory definition of good cause – namely, situations outside a party’s ability to control.1  See, e.g., Hillcrest Healthcare, L.L.C., DAB CR976 (2002), aff’d DAB No. 1879 (2003).

Here, Petitioner is a group practice that provides mobile home health palliative care, hospice, and transitional medical care, with an office location in Mission Viejo, California.  DAB E-file Entry No. 1a at 4; Petitioner Response (P. Response) at 1.  On

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September 9, 2025, Noridian notified Petitioner that its Medicare billing privileges were being revoked pursuant to 42 C.F.R. § 424.535(a)(5)(i) (on-site review), and 42 C.F.R. § 424.535(a)(9) (failure to report).  DAB E-File Entry No. 1a at 3.  On October 22, 2025, Noridian received Petitioner’s reconsideration request filed on its behalf by Kathy Nicholas.  Id.  On January 20, 2026, Noridian issued an unfavorable reconsidered determination.  Id. at 1.  The notice was addressed to “Nicholas Jauregui” to the attention of “Kathy Nicholas.”  Id.  Appeal rights were provided using standard language, including instructions that appeals must be filed with the Departmental Appeals Board within 60 calendar days after the date of receipt.  Id. at 5.

Petitioner filed its Request for Hearing on April 20, 2026, and filed a request for extension the following day.  DAB E-File Entry No. 2a (Extension Request).  Petitioner explained that “Kathy Nicholas (the contact person listed in Noridian’s records) was unable to serve as our attorney of record or authorized representative in this matter.”  Id. at 1.  Petitioner further stated that this “inability directly caused a delay in our timely receipt and full review of the unfavorable reconsideration decision” and that it is “now filing this hearing request within the 60-day period required by 42 C.F.R. § 498.40(a) measured from the date we actually received the decision.”  Id.

I acknowledged Petitioner’s request for hearing and provided CMS an opportunity to file a motion to dismiss if it believed Petitioner filed an untimely hearing request without good cause.  CMS filed a Motion to Dismiss, and Petitioner filed its Opposition to CMS’s Motion (P. Opposition).

Petitioner’s opposition largely repeats the arguments made in its Extension Request.  However, Petitioner highlights that the reconsideration decision and appeal instructions were addressed exclusively to Kathy Nicholas.  P. Opposition at 2.  Petitioner maintains that Noridian’s routing of the notice to Ms. Nicholas, a person who was no longer able to act, caused the delay in filing.  Id. at 3.  Regarding CMS’s contentions that Ms. Nicholas was identified as an authorized official in Petitioner’s enrollment records and it is Petitioner’s obligation to update its enrollment information, Petitioner acknowledges that this is correct.  Id.  Nevertheless, Petitioner proffers that “the regulations do not require instantaneous updates, and Noridian’s use of the then-current information created the precise delay at issue.”  Id.

First, I clarify the date that the reconsideration notice arrived at Petitioner’s office is the date of receipt, which is presumed to be five days after mailing, and not the date on which Petitioner’s President received and reviewed the reconsideration decision.2  42

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C.F.R. § 498.22(b)(3).  Therefore, Petitioner’s hearing request should have been filed no later than March 26, 2026.

Second, I do not find good cause for Petitioner’s untimely filing.  I am at a loss to understand how directing the reconsideration notice to the authorized official listed in Petitioner’s own enrollment records (the same individual who submitted the reconsideration request on Petitioner’s behalf) could be considered a circumstance beyond Petitioner’s control.  Although Petitioner may be correct that the regulations do not require instantaneous updates to enrollment records, its failure to maintain accurate contact information was entirely within its control.  Moreover, given Petitioner’s awareness that its Medicare enrollment and billing privileges had been revoked, one would reasonably expect Petitioner to take affirmative steps to ensure that its contact information on file was accurate.

Nor do I agree with Petitioner’s argument that the reconsideration notice was “routed exclusively” to Ms. Nicholas simply because it was addressed to her attention.  The notice was sent to Petitioner at its office address.  Petitioner does not contend that the notice was not delivered timely; rather, it suggests that sending it to the attention of Ms. Nicholas caused a delay.  It is unclear whether the delay occurred because the notice went unopened due to being addressed to Ms. Nicholas or because Ms. Nicholas received the notice and was no longer available to act as Petitioner’s attorney, or for some other reason as Petitioner offers no clear explanation.  Whatever the cause, Petitioner’s failure to process its mail or act in the absence of its attorney are not circumstances beyond its control, and do not establish good cause.  See Brookeside Rehab & Care Ctr., DAB No. 1852.

Because Petitioner’s hearing request was untimely, and because no good cause justifies my extending the time for filing, I dismiss this appeal pursuant to 42 C.F.R. § 498.70(c).