Skip to main content


U.S. flag
      An official website of the United States government
              Here’s how you know
        Here’s how you knowDot gov**Official websites use .gov**
                 A **.gov** website belongs to an official government organization in the United States.
                  HTTPS**Secure .gov websites use HTTPS**
                 A **lock** (A locked padlock) or **https://** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites. 
  Menu Close
          HHS Search block
    Search
        








  
  
    

  
      

                                      About HHS
    
                        
                              
      
      
      Programs & Services
    
                        
                              
      
      
      Grants & Contracts
    
                        
                              
      
      
      Laws & Regulations Breadcrumb
    Home
                              About
                              Agencies
                              DAB
                              Decisions
                              ALJ Decisions
                              2020
                              Fakhar Ijaz, M.D., DAB CR5666 (2020)
 Navigate to:
  Departmental Appeals Board (DAB)
    
                                                  
                                                    
            
      
      
      
      About DAB
                                            
            
            Organizational Overview
    
                                                  
                              
            
      
      
      
      Who are the Judges?
    
                                                  
                              
            
      
      
      
      DAB Divisions
    
                                                  
                              
            
      
      
      
      Contact DAB
    
                                                  
                                                    
            
      
      
      
      Filing an Appeal Online
                                            
            
            DAB E-File
    
                                                  
                              
            
      
      
      
      Medicare Operations Division (MOD) E-File
    
                                                  
                                                    
            
      
      
      
      Different Appeals at DAB
                                            
            
            Appeals to DAB Administrative Law Judges (ALJs)
                          
            
            Forms
    
                                                  
                              
            
      
      
      
      Procedures
    
                                                                
                                                    
            
      
      
      
      Appeals to Board
                          
            
            Practice Manual
    
                                                  
                              
            
      
      
      
      Guidelines
    
                                                  
                              
            
      
      
      
      Regulations
    
                                                  
                              
            
      
      
      
      National Coverage Determination Complaints
    
                                                                
                                                    
            
      
      
      
      Appeals to the Medicare Appeals Council (Council)
                          
            
            Forms
    
                                                  
                              
            
      
      
      
      Fully Integrated Duals Advantage (FIDA) Demonstration Project
    
                                                  
                                                    
            
      
      
      
      Alternative Dispute Resolution Services
                                            
            
            Sharing Neutrals
    
                                                  
                              
            
      
      
      
      ADR Training
    
                                                  
                              
            
      
      
      
      Other ADR Services
    
                                                  
                                                    
            
      
      
      
      DAB Decisions
                                            
            
            Board Decisions
    
                                                  
                              
            
      
      
      
      DAB Administrative Law Judge (ALJ) Decisions
    
                                                  
                              
            
      
      
      
      Medicare Appeals Council (Council) Decisions
    
                                    
                              
            
      
      
      
      Stakeholder Feedback
    
                                                  
                                                    
            
      
      
      
      Careers
                                            
            
            Open Career Opportunities
    
                                                  
                              
            
      
      
      
      Internships & ExternshipsText resize icon

                    




Fakhar Ijaz, M.D., DAB CR5666 (2020)








  
  
    

  
      
Department of Health and Human Services 
    DEPARTMENTAL APPEALS BOARD
          Civil Remedies Division





Fakhar Ijaz, M.D.,
	(NPI: 1487653820)
	(PTAN: 5N391F725),
	Petitioner,
v.
Centers for Medicare & Medicaid Services.
Docket No. C-18-512Decision No. CR5666July 24, 2020

        
              
    

      DECISION
Petitioner, Fakhar Ijaz, M.D., is an Arkansas physician, specializing in nephrology, who participates in the Medicare program as a supplier of services.  After his Medicare billing privileges were deactivated, he applied to reenroll in the program.  The Centers for Medicare & Medicaid Services (CMS) granted the application, effective August 15, 2017.  Petitioner now challenges that effective date.
Because Petitioner filed his subsequently-approved reenrollment application on August 15, 2017, I find that August 15 is the correct effective date for his reenrollment.  *Howard M. Sokoloff, DPM, MS, Inc.*, DAB No. 2972 (2019); *Urology Grp. of NJ, LLC*, DAB No. 2860 (2018); *Willie Goffney, Jr., M.D.*, DAB No. 2763 at 7 (2017), *aff’d* *sub nom. Goffney v. Azar*, No. CV 17-8032 MRW (C.D. Cal. Sept. 25, 2019).
Background
In a letter, dated October 9, 2017, the Medicare contractor, Novitas Solutions, advised Petitioner that it approved his revalidated Medicare enrollment application.  CMS Ex. 4.  The letter does not mention the effective date of the revalidation or indicate that it
Page 2
resulted in a coverage gap.  Petitioner, nevertheless, understood that the revalidation resulted in a gap in coverage and requested reconsideration.  CMS Ex. 3.
In a reconsidered determination, dated January 22, 2018, a contractor hearing specialist determined that August 15, 2017, was the correct effective date because that was the date Petitioner Ijaz filed a revalidation application that was subsequently processed and approved.  As a result, Petitioner faced a gap in coverage from July 12 through August 14, 2017.  CMS Ex. 1.
Petitioner appealed.  CMS has moved for summary judgment, which Petitioner opposes.  Because no material facts are in dispute, and CMS is entitled to judgment as a matter of law, I grant CMS’s motion.  *Bartley Healthcare Nursing and Rehab.*, DAB No. 2539 at 3 (2013), citing*Celotex Corp. v. Catrett*, 477 U.S. 317, 322-25 (1986); *Ill. Knights Templar Home*, DAB No. 2274 at 3-4 (2009), and cases cited therein.
CMS submits its motion and brief (CMS Br.) with twelve exhibits (CMS Exs. 1-12).  Petitioner submits his opposition brief (P. Br.) with seven exhibits (P. Exs. 1-7).1
Discussion
***Petitioner filed his subsequently-approved reenrollment application on August 15, 2017, and his Medicare reenrollment can be no earlier than that date.  42 C.F.R. § 424.520(d).***2
**Enrollment**.  Petitioner Ijaz participates in the Medicare program as a “supplier” of services.  Social Security Act § 1861(d); 42 C.F.R. § 498.2.  To receive Medicare payments for the services furnished to program beneficiaries, a prospective supplier must enroll in the program.  42 C.F.R. § 424.505.  “Enrollment” is the process by which CMS and its contractors:  1) identify the prospective supplier; 2) validate the supplier’s eligibility to provide items or services to Medicare beneficiaries; 3) identify and confirm a supplier’s owners and practice location; and 4) grant the supplier Medicare billing privileges.  42 C.F.R. § 424.502.
To enroll, a prospective supplier must complete and submit an enrollment application.  42 C.F.R. §§ 424.510(d)(1), 424.515(a).  An enrollment application is either a CMS-
Page 3
approved paper application or an electronic process approved by the Office of Management and Budget.  42 C.F.R. § 424.502.3
  When CMS determines that a prospective supplier meets the applicable enrollment requirements, it grants Medicare billing privileges, which means that the supplier can submit claims and receive payments from Medicare for covered services provided to program beneficiaries.  For a physician, the effective date for billing privileges “is the *later*of the date of filing” a subsequently-approved enrollment application or “the date that the supplier first began furnishing services at a new practice location.”  42 C.F.R. § 424.520(d) (emphasis added).
**Revalidation and Deactivation**.  To maintain his billing privileges, a supplier must, at least every five years, resubmit and recertify the accuracy of his enrollment information, a process referred to as “revalidation.”  42 C.F.R. § 424.515.  In addition to periodic revalidations, CMS may, at other times and for its own reasons, ask a supplier to recertify the accuracy of his enrollment information.  42 C.F.R. § 424.515(d) and (e).  Within 60 days of receiving CMS’s notice to recertify, the supplier must submit an appropriate enrollment application with complete and accurate information and supporting documentation.  42 C.F.R. § 424.515(a)(2).
If, within 90 days from receipt of CMS’s notice, the supplier does not furnish complete and accurate information and all supporting documentation or does not resubmit and certify the accuracy of his enrollment information, CMS may deactivate his billing privileges, and no Medicare payments will be made.  42 C.F.R. §§ 424.540(a)(3); 424.555(b).  To reactivate his billing privileges, the supplier must complete and submit a new enrollment application.  42 C.F.R. §424.540(b)(1).  It is settled that, following deactivation, section 424.520(d) governs the effective date of reenrollment.  *Sokoloff*, DAB No. 2972 at 6-7; *Urology Grp.*, DAB No. 2860 at 7; *Goffney*, DAB No. 2763 at 7.
I have no authority to review a deactivation.  *Sokoloff*, DAB No. 2972 at 6; *Ark. Health Grp*., DAB No. 2929 at 7-9 (2019).
**Petitioner’s deactivation and reenrollment**.  In a notice letter, dated March 10, 2017, the contractor directed Petitioner Ijaz to revalidate his Medicare enrollment by updating or confirming the information in his record.  The letter warned that Petitioner had to revalidate by May 31, 2017, or risk his Medicare enrollment being deactivated; the letter also explained that, during the period of deactivation, Medicare would not pay for the services rendered, which would cause a gap in reimbursement.  CMS Ex. 10.
The parties agree that Petitioner timely submitted a revalidation application (CMS-855I) and that, on June 3, 2017, the contractor notified him that he needed to supplement that
Page 4
application within 30 days.  CMS Exs. 8, 9.  The parties disagree on whether Petitioner supplemented his revalidation application as required – a question that I may not review.  In any event, the contractor determined that he did not supplement as instructed, and, by letter dated July 12, 2017, advised him that his Medicare billing privileges were stopped, effective July 12, 2017.  The letter also explained how he could reactivate his enrollment.  CMS Ex. 7.
On *August 15, 2017*, Petitioner filed the required applications (CMS forms 855R and 855I), which the contractor subsequently approved.  CMS Exs. 4, 5, 6, 12; P. Br. at 2.4
  Thus, pursuant to section 424.520(d), the date Petitioner filed his subsequently-approved reenrollment applications – August 15, 2017 – is the correct effective date of reenrollment.  *Sokoloff*, DAB No. 2972 at 6-7; *Urology Grp.*, DAB No. 2860 at 7-9; *Goffney*, DAB No. 2763 at 7.
Petitioner nevertheless complains that he properly completed his revalidation application prior to July 12, 2017, and argues that the contractor’s negligence in processing the documents he submitted should not cost him a month’s worth of Medicare payments.  Regardless of the merits of Petitioner’s position, I have no authority to review a deactivation.  *Sokoloff*, DAB No. 2972 at 6; *Ark. Health Grp*., DAB No. 2929 at 7-9.  Petitioner also requests that I grant him retrospective billing up to 30 days prior to his effective date of re-enrollment.  However, nothing in the regulations gives me the authority to review CMS’s determinations regarding retrospective billing.  Nor may I grant him an earlier effective date based on any equitable or policy arguments.  *Sokoloff*, DAB No. 2972 at 9.
Conclusion
Because Petitioner filed his subsequently-approved reenrollment application on August 15, 2017, CMS properly granted his Medicare reenrollment effective that date.


          /s/
        Carolyn Cozad Hughes

                      Administrative Law Judge
      1. CMS has objected to one of Petitioner’s witnesses and to my admitting some of Petitioner’s exhibits.  Because I decide this case on summary judgment, I need not address the issue.  Sunsites Pearce Fire Dist., DAB No. 2926 at 12 n.11 (2019). back to note 1
                      2. I make this one finding of fact/conclusion of law. back to note 2
                      3. CMS’s electronic process is referred to as PECOS (Provider Enrollment, Chain, and Ownership System). back to note 3
                      4. The top of each page of the form CMS-855I application (CMS Ex. 6) is stamped with a number beginning with “170815.”  The first two digits indicate the year in which the contractor received the application, 2017, and the subsequent four digits indicate the month and day of receipt (08/15), or August 15. back to note 4 Back to top
    Contact HHS
    
                        
                                            
      
      
      Careers
    
                        
                                            
      
      
      HHS FAQs
    
                        
                                            
      
      
      Nondiscrimination NoticeHHS Archive
    
                        
                                            
      
      
      Accessibility Statement
    
                        
                                            
      
      
      Privacy Policy
    
                        
                                            
      
      
      Viewers & PlayersBudget/Performance
    
                        
                                            
      
      
      Inspector General
    
                        
                                            
      
      
      Web Site Disclaimers
    
                        
                                            
      
      
      EEO/No Fear ActFOIA
    
                        
                                            
      
      
      The White House
    
                        
                                            
      
      
      USA.gov
    
                        
                                            
      
      
      Vulnerability Disclosure Policy
        Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases.

Sign Up
  HHS Headquarters
          200 Independence Avenue, S.W.
                  Washington, D.C. 20201
                  Toll Free Call Center: 1-877-696-6775​ Disclaimer Policy: Links with this icon () mean that you are leaving the HHS website. The Department of Health and Human Services (HHS) cannot guarantee the accuracy of a non-federal website.
                  Linking to a non-federal website does not mean that HHS or its employees endorse the sponsors, information, or products presented on the website. HHS links outside of itself to provide you with further information.
                  You will be bound by the destination website's privacy policy and/or terms of service when you follow the link.
                  HHS is not responsible for Section 508 compliance (accessibility) on private websites. For more information on HHS's web notification policies, see Website Disclaimers.
 Continue
                  Go back