In re LCD Complaint: Glucose Monitors (L33822), DAB CR5695 (2020)

DECISION DISMISSING UNACCEPTABLE COMPLAINT

S.G. (Aggrieved Party) filed a Complaint, dated June 15, 2020, which the Civil Remedies Division (CRD) received on June 26, 2020.  The Complaint challenged the validity of Local Coverage Determination (LCD) L33822.  CRD docketed this Complaint and assigned it to me for review.

The regulations at 42 C.F.R. § 426.410(b) require that I determine whether an aggrieved party has filed an “acceptable” and “valid” complaint.  After reviewing the Aggrieved Party’s filing, I concluded that it was not an acceptable and valid LCD complaint under the applicable regulations.  Therefore, in an Acknowledgment of Receipt and Order to Aggrieved Party to Amend Unacceptable Complaint, dated July 2, 2020, I informed the Aggrieved Party that he had one opportunity to submit an acceptable complaint.  See 42 C.F.R. § 426.410(c)(1).

My July 2 Order listed the information that was required to be included in the Aggrieved Party’s LCD complaint to make it acceptable.  I specifically directed the Aggrieved Party to provide “[c]opies of clinical or scientific evidence that support the complaint and an explanation for why the Aggrieved Party thinks that this evidence shows that the LCD is not reasonable.”

My July 2 Order directed the Aggrieved Party to file the amended complaint within 30 days of the date of the Order.  I advised the Aggrieved Party that if he did not submit an acceptable amended complaint, then I must issue a decision dismissing the unacceptable complaint.  42 C.F.R. § 426.410(c)(2).

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The Aggrieved Party failed to respond to my July 2 Order.  Therefore, for the reasons explained in that Order, the June 15 complaint submitted by the Aggrieved Party remains unacceptable under 42 C.F.R. § 426.410(b).  I am required to dismiss the unacceptable complaint.  42 C.F.R. § 426.410(c)(2).  Accordingly, I order that the complaint be dismissed.