Pittsfield Medical Associates, Inc., ALJ Ruling 2026-32 (HHS-CRD July 30, 2026)

DISMISSAL

Petitioner Pittsfield Medical Associates, Inc., filed a request for hearing before an administrative law judge (ALJ) to challenge the determination of its reactivation effective date in the Medicare program. 

For the reasons set forth below, I dismiss as untimely the hearing request filed by Petitioner. 

Background

Petitioner is enrolled in the Medicare program as a clinic/group practice.  On March 31, 2025, National Government Services (NGS), the Medicare Administrative Contractor, sent a revalidation request to Petitioner.  CMS Exs. 1, 2.  The request advised Petitioner that it needed to revalidate the information in its Medicare enrollment records by June 30, 2025.  Id.  On June 9, 2025, Petitioner submitted a CMS-855B revalidation application.  CMS Ex. 3.  On June 17, 2025 and July 16, 2025, Petitioner received development letters, requesting Petitioner submit updates to its application.  CMS Exs. 4, 5.  On July 21, 2025, NGS rejected Petitioner’s revalidation application, because Petitioner failed to timely respond to

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the development requests.  CMS Ex. 6.  On July 23, 2025, NGS sent Petitioner a letter, notifying Petitioner that its enrollment was deactivated effective July 23, 2025.  CMS Ex. 7. 

On August 1, 2025, Petitioner submitted a new CMS-855B revalidation application.  CMS EX. 9.  On September 3, 2023, the application was approved, and the enrollment was reactivated with an effective date of August 1, 2025, with a gap in coverage between July 23, 2025, and July 31, 2025.  CMS Ex. 12 at 3-4. 

On October 9, 2025, Petitioner requested reconsideration of the reactivation effective date determination.  CMS Ex. 13.  In a December 29, 2025 reconsidered determination, a hearing officer upheld the reactivation effective date.  CMS Ex. 15.  The reconsidered decision provided the following notice about further appeal rights: 

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 7.  The notice also included detailed information on how to file the hearing request, both through E-File and the mail.  Id. 

On May 3, 2026, Petitioner filed a request for hearing.  E-File Doc. Nos. 1, 1a.  On May 8, 2026, I issued an Acknowledgment and Standing Order.  E-File Doc. No. 2, 2a.  On June 1, 2026, CMS filed a Motion to Dismiss (MTD) for untimeliness and 16 exhibits in support.  On the same day, I issued an order staying deadlines, and I allowed Petitioner until June 22, 2026 to file a reply to the MTD.  E-File Doc. No. 6.  Petitioner did not file a reply. 

Discussion

Section 1866(h) of the Social Security Act authorizes administrative review of determinations that a provider has failed to comply substantially with Medicare program requirements “to the same extent as is provided in section 205(b) [of the Act].”  Under section 205(b), the Secretary must provide reasonable notice and opportunity for a hearing “upon request by [the affected party] who makes a showing in writing that his or her rights may be prejudiced” by the Secretary’s decision.  The hearing request “must be filed within sixty days” after receipt of the

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notice of CMS’s determination.  Act § 205(b) (emphasis added).  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.”  On motion of a party, or on his/her own motion, the ALJ may dismiss a hearing request where that request was not timely filed and the time for filing was not extended.  42 C.F.R. § 498.70(c). 

Petitioner’s hearing request was not filed within 60 days of the notice letter.  Applying the presumption that Petitioner received the initial notice five days after December 29, 2025, I must presume that Petitioner received it on January 3, 2026.  Sixty days after that was March 4, 2026.  However, Petitioner did not file the hearing request until May 3, 2026. 

Petitioner did not request an extension nor offer any good cause explanation for its late request for hearing.  Because Petitioner’s hearing request was untimely, and because no good cause justifies extending the time for filing, I dismiss this appeal pursuant to 42 C.F.R. § 498.70(c). 

If Petitioner disagrees with this dismissal action, it may request that I vacate this action within 60 days and show good cause for vacating this dismissal.  42 C.F.R. § 498.72. 

Conclusion

I dismiss Petitioner’s hearing request for untimeliness. 

Service by DAB E-File