Health Law Daily Wrap Up, ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: CMS revocation authority for failure to timely report license suspension, (May 27, 2026)

By WK Editorial Staff

CMS did not need to independently discover adverse actions or assess underlying merits.

CMS properly exercised its revocation authority under 42 C.F.R. § 424.535(a)(9) when a physician failed to timely report a state medical license suspension. Even though the physician regained licensure and restored compliance with substantive qualifications, his initial failure to notify CMS remained a regulatory violation that warranted revocation (Richard Caesar, DAB No. CR6821, Doc. No. C-25-927 (Jan. 22, 2026)).

Background. A licensed physician who participated in Medicare, had his Florida medical license suspended effective June 24, 2022. CMS determined that the physician did not report the suspension to the Medicare contractor within the required 30-day period. Based on this omission, CMS initially revoked the physician’s Medicare enrollment on two independent grounds: (1) the license suspension itself and (2) the failure to report the suspension. However, on reconsideration, CMS withdrew the first ground after concluding that the physician had corrected the underlying licensing issue through reinstatement. CMS nevertheless upheld revocation solely on the reporting violation, confirming that timely reporting obligations operate independently of the underlying adverse action.

Under 42 C.F.R. § 424.516(d), suppliers must report certain adverse legal actions, including license suspensions, within 30 days. CMS may revoke enrollment under 42 C.F.R. § 424.535(a)(9) if a supplier fails to comply with these reporting obligations. The administrative law judge (ALJ) noted that CMS does not need to independently discover adverse actions or assess their underlying merits if the supplier fails to disclose them timely. Instead, the failure to report itself constitutes a basis for revocation.

Findings. Once an adverse legal action occurs, the supplier must notify CMS within 30 calendar days. The ALJ found that the physician did not meet this obligation and that the failure triggered CMS’s revocation authority. The ALJ declined to evaluate the merits of the underlying license suspension or the reasons for the delay in reporting. Instead, the ALJ viewed the regulatory violation as complete once the reporting deadline passed without notification.

The petitioner also challenged the five-year reenrollment bar imposed by CMS. The ALJ held that he lacked authority to review the length of the reenrollment bar. The limitation reflects the structure of the regulatory scheme, under which certain CMS determinations—particularly the duration of reenrollment bars—are not subject to ALJ review once a valid revocation basis is established. The ALJ’s jurisdiction was confined to determining whether CMS had a factual and legal basis for revocation. Once that threshold was met, the ALJ cannot second-guess CMS’s discretionary decisions regarding the severity of sanctions, including reenrollment prohibitions.

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