Health Law Daily Wrap Up, ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: Clinic’s Medicare billing reactivation date upheld by ALJ, (Mar 18, 2026)

By Patricia K. Ruiz, J.D.

The DAB found provider responsible for missed revalidation notices sent by the Medicare contractor to its listed address.

The Departmental Appeals Board (DAB) upheld the reactivation of Medicare billing privileges for Spine & Sports Medicine of Hamilton, LLC, concluding the provider bore responsibility for failing to respond to timely revalidation requests sent to the address it had on file with Medicare. The DAB noted that Medicare rules required the Medicare contractor to set the reactivation date based on when it received the provider’s revalidation application and that the contractor properly relied on the address the clinic had listed in its enrollment record (Spine & Sports Medicine of Hamilton, DAB No. CR6642, Doc. No. C-25-155 (Mar. 18, 2026)).

Revalidation. Novitas Solutions, the Medicare administrative contractor, directed the clinic on April 30, 2024, to revalidate its Medicare enrollment record by July 31, 2024. That notice—and subsequent correspondence—was mailed to the Cabot Drive address the clinic had listed as both its correspondence and practice location in its enrollment file and prior CMS 855B submissions. When the clinic did not submit the requested revalidation materials by the deadline, Novitas imposed a stay on the enrollment record effective August 8, 2024, and notified the provider the following day that claims would be rejected during the stay. The clinic’s billing privileges were formally deactivated effective August 9, 2024.

Reactivation date. Novitas received the clinic’s revalidation application on September 16, 2024, and subsequently verified operational status through a site visit on October 2. In accordance with Medicare regulations, the ALJ determined that the reactivation date is the date the contractor received the new CMS 855B application—here, September 16—regardless of when operational status was confirmed.

Correspondence address. The provider argued that its failure to receive the earlier notices should mitigate the impact of the deactivation. However, the ALJ emphasized that the contractor is permitted to rely on the correspondence address listed in the enrollment record, and the provider is responsible for ensuring that address is current and monitored. Because Novitas sent all communications to the address the clinic itself had supplied, the judge found no basis to alter the reactivation date or provide equitable relief.

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