In re LCD Complaint: Cardiovascular Nuclear Medicine (L35083), DAB CR5506 (2020)

DECISION DISMISSING UNACCEPTABLE COMPLAINT

Clinton E. LeForce (the Aggrieved Party), submitted correspondence dated October 17, 2019, which the Civil Remedies Division treated as a challenge to a local coverage determination (LCD); docketed as styled above, C-20-68; and assigned to me for review.

The regulations at 42 C.F.R. § 426.410(b) require that I determine whether an aggrieved party has filed an "acceptable" and "valid" complaint. After reviewing the Aggrieved Party's filing, I concluded that it was not an acceptable and valid LCD complaint under the applicable regulations. Therefore, in an Acknowledgment of Receipt and Order to Aggrieved Party to Amend Unacceptable Complaint, dated November 7, 2019, I informed the Aggrieved Party that he had one opportunity to submit an acceptable complaint. See 42 C.F.R. § 426.410(c)(1).

My November 7 Order listed the information that was required to be included in the Aggrieved Party's LCD complaint to make it acceptable. I specifically directed the Aggrieved Party to provide all of the following information:

• LCD-identifying information. The specific provision (or provisions) of the LCD adversely affecting [the Aggrieved Party].
• Aggrieved party statement.  A statement explaining why [the Aggrieved Party] think[s] that the provision(s) of the LCD is (are) not valid under the reasonableness standard.

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• Clinical or scientific evidence. Copies of clinical or scientific evidence that support [the Aggrieved Party's] complaint and an explanation for why [the Aggrieved Party] think[s] that this evidence shows that the LCD is not reasonable.

My November 7 Order directed the Aggrieved Party to file the amended complaint by December 9, 2019. I advised the Aggrieved Party that if he did not submit an acceptable amended complaint, then I must issue a decision dismissing the unacceptable complaint. 42 C.F.R. § 426.410(c)(2).

The Aggrieved Party failed to respond to my November 7 Order. Therefore, for the reasons explained in that Order, the October 17, 2019 complaint submitted by the Aggrieved Party remains unacceptable under 42 C.F.R. § 426.410(b). I am required to dismiss the unacceptable complaint. 42 C.F.R. § 426.410(c)(2). Accordingly, I order that the complaint be dismissed.