Gregg J. Williams, DPM, MBA, DAB CR5536 (2020)

DECISION

I sustain the determination of a Medicare contractor, as affirmed on reconsideration, to revoke the Medicare enrollment and billing privileges of Petitioner, Gregg J. Williams, DPM, MBA. The contractor, acting on behalf of the Centers for Medicare & Medicaid Services (CMS), may revoke Petitioner’s participation because Petitioner failed to comply with regulatory reporting requirements. Specifically, on two occasions Petitioner failed to report that his license to provide health care was suspended.

I. Background

Pursuant to my initial pre-hearing order, CMS filed a motion for summary judgment or, alternatively, for a decision based on the written record.  CMS filed a brief, incorporating a motion for summary judgment, and proposed exhibits that it identified as CMS Ex. 1-CMS Ex. 13.  In response, Petitioner filed two documents that he identified as “outlines” of his arguments along with 47 separate documents that he intends I receive as exhibits.  He did not place exhibit numbers on these documents.  However, they are entered into the Departmental Appeals Board e-filing system as exhibits 1-46 and 43A.

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Neither CMS nor Petitioner offered the sworn testimony of a proposed witness or witnesses.

I find it unnecessary that I decide whether the criteria are met for summary judgment.  There is no need to convene an in-person hearing inasmuch as neither CMS nor Petitioner offered testimony.  I decide this case based on the parties’ written exchanges.  I receive CMS Ex. 1-CMS Ex. 13 and all of Petitioner’s exhibits into the record.

II.  Issue, Findings of Fact and Conclusions of Law

A.   Issue

The issue is whether a contractor, acting on behalf of CMS, may revoke Petitioner’s Medicare participation and billing privileges.

B.   Findings of Fact and Conclusions of Law

CMS may revoke a supplier’s Medicare participation and billing privileges for failing to comply with reporting requirements as stated at 42 C.F.R. § 424.516(d).  42 C.F.R. § 424.535(a)(9).  The reporting requirements explicitly instruct a participating supplier to report any adverse legal action to a contractor or CMS within 30 days of its occurrence.  42 C.F.R. § 424.516(d)(1)(ii).  An adverse action for which reporting is mandatory includes suspension or revocation by any state authority of a license to provide health care.  42 C.F.R. § 424.502.

Effective April 6, 2018, the Louisiana State Board of Medical Examiners suspended Petitioner’s license to provide health care.  CMS Ex. 4.  The reporting requirements that I have discussed imposed on Petitioner the duty to report his license suspension to the contractor or to CMS within 30 days.  Failure to do so would be a basis to revoke Petitioner’s Medicare participation and billing privileges.

Petitioner failed to report the license suspension.  Moreover, on two occasions subsequent to April 6, 2018, Petitioner affirmatively denied to the contractor and to CMS that he was subject to an adverse action.  On November 13, 2018 and on January 4, 2019, Petitioner signed and filed Medicare enrollment applications.  CMS Exs. 5 and 12.  On each occasion Petitioner checked “no” as a response to a question asking him whether he had been subject to any adverse actions.  CMS Exs. 5 at 29; 12 at 25.

Petitioner’s failure to report suspension of his license and his subsequent misrepresentations provided the contractor with authority to revoke Petitioner’s participation and billing privileges.  The contractor’s action plainly is authorized by the facts and law.

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I have considered Petitioner’s arguments, made in his request for reconsideration, his hearing request, and in the statements he submitted in reply to CMS’s hearing exchange, and I find them to be without merit.

At no point does Petitioner credibly deny that he failed to report his license suspension or that he misrepresented to the contractor that he was not subject to adverse actions. Petitioner admits that he knew, prior to submitting the November 13, 2018, and January 4, 2019 applications, that his health care license had been suspended. Indeed, Petitioner concedes that, on April 27, 2018, he was told by a hospital administrator that he could no longer see patients in that hospital due to the suspension of his license. Petitioner’s Hearing Request at 1. He thus admits knowledge of his license suspensBion prior to falsely representing – on November 13, 2018, and January 4, 2019 – that he was not subject to any adverse action.

Petitioner’s arguments fall into two categories. First, Petitioner asserts, in his hearing request, that a representative of the contractor did not deal with him in a professional manner. As a corollary to this argument, Petitioner contends that the contractor’s procedures are overly bureaucratic and not informative. These arguments do not respond at all to the undenied facts of this case. Whatever the status of Petitioner’s relationship with the contractor and its employees, the facts are that Petitioner failed to comply with reporting requirements and, on two occasions, knowingly misrepresented whether his license had been suspended.

Second, Petitioner discusses at considerable length disruptive events in his personal life, events that include: a difficult divorce and subsequent legal entanglements and problems associated with maintaining his podiatric practice. These arguments are essentially equitable. What Petitioner seems to be saying is that he merits forbearance due to the hardships and personal problems that he has encountered.

I have no authority to address these arguments. US Ultrasound, DAB No. 2302 at 8 (2010).

I note that the State of Louisiana reinstated Petitioner’s health care license effective May 22, 2019. CMS Ex. 2 at 4. That action does not derogate from the contractor’s or CMS’s authority to revoke Petitioner’s Medicare participation and billing privileges. The authority to revoke flows from Petitioner’s failure to comply with Medicare reporting requirements and misrepresentations in the November 13, 2018, and January 4, 2019 enrollment applications.

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Finally, I note that the contractor imposed a three-year bar on reenrollment. CMS Ex. 3 at 2. I have no authority to address the length of a debarment action. 42 C.F.R. §§ 424.535(c), 498.3(b).