Timber Ridge, Inc., ALJ Ruling 2026-39 (HHS-CRD September 29, 2026)

DISMISSAL

I dismiss the request for hearing filed by Petitioner, Timber Ridge, Inc., because I lack jurisdiction to provide the relief Petitioner seeks.  I can neither review the effective date of the reenrollment bar imposed on Petitioner nor issue a declaratory judgment as to the date on which the reenrollment bar should end.  Therefore, Petitioner has no right to a hearing. 

I. Background

Petitioner was enrolled in the Medicare program as a Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier.  In a May 7, 2026 notice, the Centers for Medicare & Medicaid Services (CMS), through a contractor, informed Petitioner that it was revoking Petitioner’s Medicare enrollment and billing privileges effective October 31, 2025, because Petitioner did not comply with two DMEPOS supplier standards.  The CMS contractor set a retroactive effective date for revocation of October 31, 2025, because Petitioner’s accreditation expired on October 31, 2025.  The CMS contractor also barred Petitioner from reenrolling in the Medicare program for one year from the effective date of revocation.  Electronic Filing System (E-File) Doc. No. 1b at 1-2. 

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Petitioner requested reconsideration.  On reconsideration, the CMS contractor only found Petitioner noncompliant with a single regulatory requirement.  However, the CMS contractor still upheld the revocation based on Petitioner’s expired accreditation.  E-File Doc. No. 1a at 1, 4. 

On August 3, 2026, Petitioner requested a hearing seeking either an order removing Petitioner’s reenrollment bar or a declaratory judgment confirming that Petitioner’s reenrollment bar expires on October 31, 2026.  H’rg Req. at 2.  Petitioner provided evidence that it was accredited again on August 1, 2026.  E-File Doc. No. 1c. 

On August 10, 2026, the Civil Remedies Division acknowledged Petitioner’s hearing request, issued my Standing Order, and provided prehearing submission deadlines to the parties.  On September 2, 2026, CMS moved for dismissal (CMS Mot.) of the hearing request and for a stay in the prehearing submission schedule pending resolution of its motion.  I granted the stay.  On September 22, 2026, Petitioner timely responded to CMS’s motion (P. Resp.).  On September 24, 2026, CMS replied (CMS Reply) to Petitioner’s response. 

II.    Discussion

The Social Security Act (Act) authorizes the Secretary of Health and Human Services (Secretary) to establish regulations for enrolling providers and suppliers in the Medicare program.  42 U.S.C. § 1395cc(j)(1)(A).  The Act also authorizes the Secretary to establish requirements for DMEPOS suppliers to obtain a supplier number.  42 U.S.C. § 1395m(j)(1)(B).  DMEPOS suppliers must enroll in the Medicare program and receive a supplier number to obtain payment for items and services provided to Medicare beneficiaries.  42 U.S.C. §§ 1395m(j)(1)(A), 1395n(a), 1395u(h)(1); 42 C.F.R. § 424.505.  To be enrolled in the Medicare program, DMEPOS suppliers must meet and remain in compliance with the DMEPOS supplier standards that the Secretary promulgated.  42 C.F.R. § 424.57(b)-(c). 

CMS revokes a DMEPOS supplier’s billing privileges if the supplier fails to meet the supplier standards.  42 C.F.R. § 424.57(e)(1).  The effective date of the revocation is the date on which noncompliance with the DMEPOS supplier standards began.  42 C.F.R. § 424.535(g)(2)(xiv); see also 42 C.F.R. § 424.57(e)(1).  When CMS revokes a supplier’s enrollment, CMS must establish a reenrollment bar that lasts at least one year.  42 C.F.R. § 424.535(c)(1)(i).  The effective date of the reenrollment bar is 30 days after the date on which CMS sends the revocation notice.  42 C.F.R. § 424.535(c)(1)(i). 

In this case, the reconsidered determination upheld Petitioner’s revocation because Petitioner did not dispute that its accreditation had lapsed on October 31, 2025.  E-File Doc. No. 1a at 4.  The Act and DMEPOS supplier standards require DMEPOS suppliers to be accredited by a CMS-approved independent accreditation organization to obtain and

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maintain enrollment.  42 U.S.C. § 1395m(a)(20)(A), (F); 42 C.F.R. §§ 424.57(a) (definition of “Accredited DMEPOS suppliers”), (c)(22), 424.58. 

Petitioner has the right to request a hearing to dispute the revocation of Medicare enrollment, 42 C.F.R. §§ 405.803(a), 424.545(a), 498.3(b)(17)(i), 498.5(l)(2), and, by extension, a right to appeal the effective date of revocation.  See Meadowmere Emergency Physicians, PLLC, DAB No. 2881 at 13 (2018); Norman Johnson, M.D., DAB No. 2779 at 18-20 (2017).  CMS moved for dismissal arguing that Petitioner only has the right to a hearing to challenge the revocation but not the effective date or duration of a reenrollment bar.  CMS Mot. at 2. 

CMS is correct that Petitioner did not request a hearing to dispute the revocation or the effective date of the revocation.  Rather, Petitioner seeks review of an “extension” of the reenrollment bar imposed on it.  See H’rg Req. at 2.  Petitioner asserts that following the issuance of the reconsidered determination, Petitioner communicated with the CMS contractor who “informed that the reenrollment bar would be extended to June 2027.  To date, Petitioner has not received notice of the extension, or basis of [the] same, in writing.”  H’rg Req. at 1.  Further, Petitioner argues that, according to the revocation notice, the revocation was retroactive to October 31, 2025, and “Petitioner was barred from reenrolling in the Medicare Program for a period of one (1) year from the effective date of revocation.  Therefore, Petitioner should be permitted to reenroll October 31, 2026.”  H’rg Req. at 1. 

In response to CMS’s motion to dismiss, Petitioner conceded that, under Lilia Gorovits, M.D., P.C., DAB No. 2985 (2020), reenrollment bars are generally not subject to review.  P. Resp. at 1.  However, Petitioner distinguishes this case from Gorovits because all Petitioner wants is the reenrollment bar to end one year after it took effect, as stated in the revocation notice.  P. Response at 1-2.  Petitioner asserts that CMS only has the authority to add time to the reenrollment bar under 42 C.F.R. § 424.535(c)(2), but when it does so, it is an appealable initial determination under 42 C.F.R. § 498.3(b)(17)(ii).  P. Resp. at 3.  Otherwise, CMS lacks the authority to add more time to the bar.  P. Resp. at 3. 

In reply, CMS asserts that the regulations require the reenrollment bar’s effective date to be 30 days after the date the CMS contactor mailed the revocation notice.  CMS Reply at 1-2.  CMS asserts that it has imposed the minimum one-year reenrollment bar and is not extending it but rather is applying the regulations.  CMS Reply at 2.  As a result, Petitioner does not have the right to a hearing.  CMS Reply at 2-3. 

I agree that Petitioner does not have the right to request a hearing to dispute the length of a reenrollment bar or the effective date of a reenrollment bar.  42 C.F.R. §§ 405.800(c)(2), 424.535(c)(2)(ii)(B); Gorovits, DAB No. 2985 at 15-16; Vijendra Dave, M.D., DAB No. 2672 at 11 (2016).  I also agree that Petitioner has a right to request a hearing if CMS extends the length of the reenrollment bar.  42 C.F.R. §§ 405.800(c)(1)(ii), 424.535(c)(2)(ii)(A), 498.3(b)(17)(ii).

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Therefore, I must determine whether CMS has extended the reenrollment bar. 

Neither party has submitted a notice from CMS or a CMS contractor stating that Petitioner’s reenrollment bar has been extended.  Such a notice is necessary to extend the length of the reenrollment bar.  42 C.F.R. § 405.800(c)(1).  Without a notice of extension or action from CMS indicating that it is extending the reenrollment bar beyond one year, I will not assume that CMS intends to extend Petitioner’s reenrollment bar.  Therefore, presently, Petitioner has no right to a hearing. 

There is no doubt that the CMS contractor erroneously set the reenrollment bar’s effective date in this case.  The revocation notice states that the effective date for the reenrollment bar is “for a period of one (1) year from the effective date of revocation.”  E-File Doc. No. 1b at 2.  However, the effective date of revocation was retroactive to October 31, 2025, a date preceding the mailing of the revocation notice.  E-File Doc. No. 1b at 1.  This conflicts with the applicable regulation that states:  “The reenrollment bar . . . [b]egins 30 days after CMS or its contractor mails notice of the revocation and lasts a minimum of 1 year.”  42 C.F.R. § 424.535(c)(1)(i); see also 79 Fed. Reg. 72,500, 72,522 (Dec. 5, 2014) (Preamble to final rule explaining that section 424.535(c)(1)(i) makes the reenrollment bar prospective even when the revocation is retroactive.).  CMS ought to correct this error.   

This Ruling is limited to the facts as they now exist.  I make no determination as to whether CMS will be considered to have “extended” the reenrollment bar should CMS fail to revise the effective date of the reenrollment bar but apply the bar to June 2027, instead of ending it on October 31, 2026.  Cf. 42 C.F.R. § 498.25(b), 498.30. 

III.    Order

I dismiss Petitioner’s hearing request because Petitioner has no right to a hearing.  42 C.F.R. § 498.70(b).