Health Law Daily Wrap Up, ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS –DAB DECISIONS: DAB affirms revocation and preclusion of dentist with a felony conviction, (Jan 20, 2026)

By Donielle Stutland

CMS had a legitimate basis to include Petitioner on the preclusion list.

A Department Appeals Board has affirmed CMS’s revocation of a Petitioner’s enrollment in the Medicare program and CMS’s placement of Petitioner’s name on the CMS Preclusion List. Petitioner’s conviction for wire fraud supported CMS’s decision to revoke enrollment, and CMS provided adequate reasoning for placing Petitioner on the preclusion list (Mathew Manas, DDS, DAB No. CR6586, Doc. No.C-22-88 (Dec. 16, 2024)).

Background. The petitioner Mathew Manas, DDS, is a dentist, who applied to the Medicare program in March 2019 for the purpose of ordering, certifying and/or prescribing Medicare Part D drugs. His application was initially approved on March 19, 2019, with an effective date of March 5, 2019. However, on April 26, 2019, CMS contractor Noridian Healthcare Solutions (“Noridian”) informed Petitioner that pursuant to 42 C.F.R. § 424.535(a)(3), his Medicare privileges were revoked effective March 13, 2019. The letter stated that CMS had been made aware of Petitioner’s July 24, 2014, felony conviction for wire fraud. Additionally, the letter confirmed that in his CMS enrollment application, signed on March 4, 2019, Petitioner had answered “no” in section three of the application, indicating that he did not have any adverse legal history, and thus a violation of 42 C.F.R. § 424.535(a)(4) in providing false or misleading information.

As a result of the felony conviction and the failure to disclose the conviction on his application, Petitioner’s Medicare enrollment was revoked, and he was placed on a three-year reenrollment bar. Petitioner was placed on the preclusion list effective February 1, 2020, because his Medicare billing privileges were revoked, and he was under a reenrollment bar. Petitioner did not request reconsideration of these decisions within the mandatory 60-day period; in a letter dated June 1, 2021, and received by CMS on June 14, 2021, Petitioner requested reconsideration of CMS’s determination.

On September 17, 2021, CMS issued a Reconsideration Decision indicating that Petitioner had failed to show good cause for his late reconsideration request. The Petitioner appealed to an ALJ.

Revocation. The DAB first analyzed whether CMS had a legitimate basis to revoke Petitioner’s Medicare enrollment and billing privileges pursuant to 42 C.F.R § 424.535(a)(3) and (4). Before beginning the analysis, the DAB indicated that it must CMS’s argument that Petitioner cannot challenge his revocation because he failed to timely submit a request for reconsideration of his Medicare billing privileges. Petitioner argued that he no longer worked at the office where correspondence was sent and the reason that his reconsideration request was outside the permitted time was because of the breakdown in communication from CMS and his prior employer and thus he has shown good cause for the delay. The DAB indicated that it has no authority to review CMS’s dismissal of Petitioner’s request for reconsideration of the revocation of his enrollment application.

Nonetheless, the DAB still noted that CMS had a legitimate basis for Petitioner’s revocation under 42 C.F.R. § 424.535(a)(3) and § 424.535(a)(4). Here, the Petitioner was convicted of wire fraud as determined by CMS. As to the Petitioner’s argument that his prior employer submitted the misleading and false information in his application, the DAB noted that “a supplier cannot escape his obligation to report a felony conviction by shifting the responsibility to someone else.” Concluded the ALJ, “despite my finding that I have no jurisdiction to review CMS’s dismissal of Petitioner’s request for reconsideration of the revocation of his Medicare billing privileges, the evidence establishes that CMS had a legitimate basis for doing so.”

Preclusion. The DAB next found that the evidence establishes that CMS had a legitimate basis to include Petitioner on the preclusion list, pursuant to the provisions of 42 C.F.R. §§ 422.2 and 423.100. It was noted that after considering the regulatory factors for preclusion, CMS has met the three factors for the inclusion of Petitioner on the preclusion list: (1) The seriousness of the conduct underlying the revocation; (2) The degree to which the individual’s conduct could affect the integrity of the Medicare program; and (3) Any other evidence that CMS deems relevant to its determination.

Here, CMS considered the felony offense of Wire Fraud to be severe in nature. Petitioner’s conviction related to a scheme he devised when in the Army National Guard (USANG) as a recruiting assistant wherein which he fraudulently nominated recruits using improperly obtained personally identifiable information (PII) without their knowledge or consent, failing to perform his duties and defrauding the program to obtain payments. With respect to the second factor, CMS also considered that the Petitioner’s actions demonstrate that he is a potential risk to the PII of Medicare beneficiaries if he is enrolled in the Medicare program. Finally, with respect to the third factor, CMS found it relevant that the felony offense that Petitioner was convicted of is deemed per se detrimental by CMS, as his conviction was for a financial crime.

The DAB concluded that reconsidered determination provided adequate reasoning for placing Petitioner’s name on the CMS Preclusion List.

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