DAB Upholds CMS’ Revocation of Provider’s Enrollment for Failure to Timely Report Change in Practice Location

On October 4, 2011 in Izgel Medical Services, PLLC v. CMS, the Department of Health and Human Services Departmental Appeals Board (“DAB”) held that the Centers for Medicare and Medicaid Services (“CMS”) “was authorized to revoke the Medicare provider enrollment of Petitioner, Izgel Medical Services, PLLC” for its failure to timely report to CMS a change in its practice location. 42 CFR 424.516(d)(1)(iii) requires that physician practitioner organizations report changes in practice location within 30 days.

In the case at hand, Petitioner failed to notify CMS of its change in practice location. CMS was alerted to this fact when a National Government Services, Inc. (“NGS”)–the Medicare Administrative Contractor for New York–went to the premises for purposes of an inspection and discovered that Petitioner was not located there. Petitioner stated that it submitted the change of practice location, but was not able to provide any proof of such submission or application. Moreover, Petitioner argued that even if its submission was unsuccessful, it cured the failed filing by filing a Medicare enrollment application (which was submitted months later along with a request for reconsideration for the revocation of Petitioner’s Medicare enrollment) that reported the address change. The DAB disagreed, stating the following:

As for the March 25, 2010 application, I note initially that CMS is under no obligation to accept it. The regulation requires that Petitioner report a change of its practice address within 30 days from the date that it makes the change. 42 C.F.R. ยง 424.516(d)(1)(iii). Petitioner may not cure its failure to file the required report by filing one, months after the fact, in the guise of seeking reconsideration of CMS’s determination.

Reconsideration affords a party the opportunity to provide evidence that it had done what it was required to do. For example, Petitioner might have provided a copy of its purported November 9 application, assuming the application actually had been filed, to show on reconsideration that it had done what the regulation required. But, reconsideration does not afford a party the opportunity to comply with obligations that it had failed to comply with initially. Thus, filing an application untimely as part of reconsideration does not cure the failure to file the application timely.

Therefore, the DAB affirmed CMS’ decision to revoke Petitioner’s Medicare provider enrollment.

Given CMS’ aggressive approach to provider enrollment matters, all providers and suppliers must remain attentive to the reporting and notification requirements. Failure to comply could, as seen in this case, result in revocation of that provider or supplier’s enrollment. For a detailed article co-authored by Adrienne Dresevic of the HLP on Medicare enrollment and the various initiatives, please click here.

For more information, please contact Abby Pendleton, Esq., Jessica Gustafson, Esq., Adrienne Dresevic, Esq. or Carey F. Kalmowitz, Esq. at (248) 996-8510 or (212) 734-0128 or visit the HLP website.

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