Glenn Alden Harrison, M.D., DAB CR5571 (2020)

DECISION

Petitioner, Glenn Alden Harrison, M.D., is a physician, practicing in Illinois, who participated in the Medicare program until July 1, 2016, when the Centers for Medicare & Medicaid Services (CMS) revoked his enrollment, citing 42 C.F.R. § 424.535(a)(1).  CMS took this action because Petitioner Harrison’s medical license had been suspended.

Petitioner now appeals the revocation. 

The undisputed evidence establishes that Petitioner’s medical license was suspended, which means that he no longer complied with Medicare enrollment requirements, and CMS appropriately revoked his enrollment pursuant to 42 C.F.R. § 424.535(a)(1).  I therefore affirm CMS’s determination.

Background

In a revocation notice, dated January 24, 2017, the Medicare contractor, National Government Services, revoked Petitioner Harrison’s Medicare enrollment, effective July 1, 2016.  As the notice letter explains, the contractor acted pursuant to 42 C.F.R.

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§ 424.535(a)(1) because Petitioner’s medical license was suspended from July 1, 2016 to July 26, 2016.  CMS Ex. 1; P. Ex. 4.  The contractor also imposed a three-year re-enrollment bar. 

Petitioner submitted a corrective action plan, which the contractor rejected, noting that Petitioner’s medical license was suspended, and he had not reported that adverse action within 30 days of its occurrence.  CMS Ex. 3; P. Ex. 5. 

Petitioner requested further review.  In a reconsidered determination, dated July 27, 2017, the contractor affirmed the revocation, noting that Petitioner’s license was suspended from July 1 to July 26, 2016; he had not reported the occurrence to Medicare; and he had filed claims for services purportedly rendered to Medicare patients during the time his license was suspended.  CMS Ex. 4; P. Ex. 7.1  The contractor affirmed the revocation.

Petitioner appealed.  The parties have filed cross-motions for summary judgment with supporting briefs (CMS Br.; P. Br.) and CMS responded to Petitioner’s motion for summary judgment (CMS Response).  With its motion and brief, CMS submits four exhibits (CMS Exs. 1-4).  With his brief, Petitioner submits nine exhibits (P. Exs. 1-9).

Discussion

1. CMS is entitled to summary judgment because the undisputed evidence
establishes that Petitioner’s medical license was suspended, putting him out of compliance with Medicare enrollment requirements.  42 C.F.R. § 424.535(a)(1).2

Statute and regulations.  CMS regulates the Medicare enrollment of providers and suppliers.  Social Security Act (Act) § 1866(j)(1)(A).  It may revoke a supplier’s enrollment in the Medicare program if he does not continue to comply with all enrollment

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requirements.  42 C.F.R. § 424.535(a)(1); Angela R. Styles, M.D., DAB No. 2882 at 2 (2018).  Among those requirements, a supplier must comply with federal and state licensure requirements for his supplier type.  42 C.F.R. § 424.516(a)(2); see 42 C.F.R. § 410.20(b) (limiting Medicare payments to physicians, legally authorized to practice by the state, who act within the scope of their licenses).   

Petitioner practiced as a physician in Illinois.  The parties agree that the Illinois Department of Financial and Professional Regulation, which regulates physician licensing, suspended his medical license from July 1 through July 26, 2016, because he failed to file and/or pay his state income taxes.  CMS Ex. 2 at 2; P. Ex. 1 at 2. 

CMS thus had the authority to revoke Petitioner’s Medicare enrollment under section 424.535(a)(1).  As the Departmental Appeals Board has repeatedly explained, if a physician is unable to practice medicine for any length of time due to a disciplinary action against him, he is noncompliant with Medicare requirements, and CMS has the authority to revoke his billing privileges.  Styles, DAB No. 2882 at 6-7; Meindert Niemeyer, DAB No. 2865 at 9 (2018); Akram A. Ismail, M.D., DAB No. 2429 at 8 (2011).  The effective date of revocation must be July 1, 2016, the date Petitioner’s license was suspended.  42 C.F.R. § 424.535(g).

Petitioner nevertheless argues that he submitted a corrective action plan, which the contractor should have accepted.  I have no authority to review the contractor’s rejection of a corrective action plan.  Mohammad Nawaz, M.D., and Mohammad Zaim, M.D., P.A., DAB No. 2687 at 15 (2016); DMS Imaging, Inc., DAB No. 2313 at 5 (2010).

Conclusion

No facts are in dispute and CMS is entitled to judgment as a matter of law.  I therefore grant CMS’s motion for summary judgment and deny Petitioner’s.  I find that CMS was authorized to revoke Petitioner Harrison’s Medicare enrollment pursuant to 42 C.F.R. § 424.535(a)(1) because the Illinois licensing agency suspended his license to practice medicine. 

• 1. The contractor pointed to no evidence establishing that Petitioner failed to report and that he continued billing while his license was suspended. Petitioner denies that he failed to report, presenting a copy of an attorney’s letter to the contractor, dated July 20, 2016, in which he advised the contractor that Petitioner’s license was temporarily suspended but would be reinstated shortly. P. Ex. 2. Petitioner also presents evidence that his billing specialist timely called the contractor to report that Petitioner’s license had been “unsuspended.” P. Ex. 3 (Baker Decl.). Petitioner says virtually nothing about billing the Medicare program for services purportedly provided while his license was suspended. But these issues are irrelevant; CMS has carefully limited the basis for the revocation to Petitioner’s license suspension, which, by itself, is sufficient to justify the revocation. See CMS Br. at 5-7; CMS Response at 3.
• 2. I make this one finding of fact/conclusion of law to support my decision.