Hemalatha Naganna, MD, and C. Naganna, MD, PA, DAB CR6271 (2023)

DECISION

The effective date of the reactivated billing privileges of Petitioner, Hemalatha Naganna, MD, and C. Naganna, MD, PA, is August 31, 2022, with retrospective billing privileges authorized beginning June 2, 2022.

I.   Background and Procedural History

C. Naganna, MD, PA, had been enrolled as a solely owned clinic/group practice in the Medicare program since August 1, 1995.  See Centers for Medicare & Medicaid Services (CMS) Ex. 1 at 1, 3 (enrollment record).  Hemalatha Naganna, MD, a cardiologist, is the current sole owner of Petitioner’s clinic/group practice.  CMS Exs. 5 at 1; 6 at 10.  I collectively refer to Dr. Naganna and her practice as Petitioner.

Petitioner’s enrollment record reflects that its practice location has a physical address of 700 Poole Road, Suite A.  CMS Ex. 15 at 3.  In additional to being a clinic/group practice, Petitioner also operates an Independent Diagnostic Testing Facility (IDTF) that does business as Carroll Precision Imaging Center.  CMS Exs. 3 at 2; 12 at 1, 3.  The

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IDTF has a different physical location than the clinic/group practice.  CMS Ex. 12 at 1, 3 (enrollment record listing a practice location of 680 Poole Road, Suite A).

On December 10, 2021, Novitas Solutions (Novitas), a Medicare administrative contractor, sent a letter to Petitioner’s clinic/group practice informing it that Chitrache Naganna “was reported as deceased” by the Social Security Administration.  CMS Ex. 14 at 1.  Citing 42 C.F.R. § 424.516, Novitas explained that Petitioner was required to report a change in ownership and authorized/delegated officials “within specified timeframes.”  CMS Ex. 14 at 1.  Novitas instructed that, “[i]n order to update this information in your enrollment record, please submit a CMS-855B change request to delete this individual as the sole owner, managing employee, and authorized official.”  CMS Ex. 14 at 1.  The letter cautioned that the Form CMS-855B should be submitted “within 90 calendar days of the date of this letter in order to avoid the deactivation of Medicare billing privileges.”  CMS Ex. 14 at 1.

After Petitioner did not submit an application to update its enrollment record as required by 42 C.F.R. § 424.516, Novitas, in a letter dated March 21, 2022, informed Petitioner that its enrollment had been deactivated, effective February 17, 2022.  CMS Ex. 13 at 1.  Novitas explained the following: 

[Novitas] has been informed that CHITRACHE NAGANNA, is deceased as of November 18, 2021.  Your Medicare enrollment application identifies CHITRACHE NAGANNA, as the sole owner, managing employee, and authorized official.  [NOVITAS] has not received a Medicare enrollment application reporting this change in ownership.

Please notify all physician assistants and/or group members who reassign benefits to your organization that, in accordance with 42 [C.F.R. § ] 424.540(a)(2), their Medicare enrollment status may be deactivated if they fail to update their enrollment record within 90 calendar days. 

CMS Ex. 13 at 1.  Novitas informed Petitioner that, pursuant to 42 C.F.R. § 424.545(b), it could submit a written rebuttal within 15 days.  CMS Ex. 13 at 1-2.  The record does not evidence that Petitioner submitted a written rebuttal. 

On March 31, 2022, Petitioner submitted an electronic Form CMS-855B application to reactivate its billing privileges as an IDTF.  CMS Ex. 12 at 1; see CMS Ex. 3 at 2-11 (copy of administrative law judge (ALJ) decision addressing the effective date of the reactivated IDTF billing privileges, which was based on the submission of a March 31,

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2022 enrollment application).¹  In Section 2 of the application, “Supplier Identification Information,” Petitioner reported that the IDTF was organized as a corporation and did business as “Carroll Precision Imaging Center Carroll Heart Center” at the 680 Poole Road practice location.  CMS Ex. 12 at 2.  The IDTF reported that Dr. Naganna, who had been a director/officer² and an authorized official since January 1, 2008, became an owner, managing employee, and contracted managing employee of the IDTF, effective November 18, 2021.  CMS Ex. 12 at 5.  The IDTF reported that it operated a Siemens Biograph 16 PET/CT scanner machine and listed the CPT-4/HCPCS codes for which it billed the Medicare program.  CMS Ex. 12 at 5-6.  The IDTF also reported that Dr. Naganna was the IDTF’s “supervising physician.”  CMS Ex. 12 at 7; see 42 C.F.R. § 410.33(b), (g) (IDTF requirement for a supervising physician who “must evidence proficiency in the performance and interpretation of each type of diagnostic procedure performed by the IDTF”); see also CMS Ex. 12 at 2 (referencing receipt of attestation statement from supervising physician).³  The IDTF reported that it had mailed supporting documentation, to include a copy of its comprehensive liability insurance policy.  CMS Ex. 12 at 8-9; see 42 C.F.R. § 410.33(g)(6) (requiring an IDTF to have a comprehensive liability insurance policy of at least $300,000 per location that covers both the place of business and all customers and employees of the IDTF”).  In a letter dated May 4, 2022, Novitas approved the IDTF’s enrollment application as a “Provider/Supplier Type: 

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INDEPENDENT DIAGNOSTIC TESTING FACILTIY” and assigned PTAN 2D1366,⁴ effective April 1, 2022.⁵  CMS Ex. 11 at 1. 

On August 31, 2022, Petitioner submitted an electronic Form CMS-855B application to update its enrollment record and reactivate its billing privilege as a clinic/group practice, at which time it reported that the legal business name on the application has been changed and that it was adding a professional corporation, professional association, or limited liability company.  CMS Ex. 7 at 1.  Petitioner reported a practice location of 700 Poole Rd, Suite A, and that its organization structure was “sole ownership,” with Dr. Naganna as the sole owner.  CMS Ex. 7 at 1-4.  Shortly thereafter, on September 6, 2022, Dr. Naganna submitted a hard copy Form CMS-855I enrollment application.⁶  CMS Ex. 6.  Dr. Naganna reported that she has a primary specialty of cardiology, is the sole owner of a private practice with legal business name C. Naganna, MD, PA, and operates the practice as a sole proprietorship.  CMS Ex. 6 at 10, 15. 

In a letter dated September 9, 2022, Novitas approved Petitioner’s enrollment application and reactivated its billing privileges effective June 2, 2022.⁷  CMS Ex. 5 at 1.

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In a letter dated September 10, 2022, Petitioner requested reconsideration of the effective date of the clinic/group practice’s reactivated billing privileges.  CMS Ex. 2.  Petitioner explained that “[w]e initially submitted reenrollment paper work on April 1, 2022 with the intention to reactive both of the PTANs under our Group NPI, one for the IDTF and one for the group.”  CMS Ex. 2 at 2.  Petitioner claimed that “in relying on the [Novitas] provider enrollment specialist the process failed.”  CMS Ex. 2 at 2-3.  Petitioner requested an enrollment date of April 1, 2022, along with a “90 day retroactive billing period.”  CMS Ex. 2 at 2-3.  Petitioner supplemented its reconsideration request on September 27 and October 25, 2022.  CMS Exs. 3 (copy of ALJ decision for the IDTF); 4 (email from Dr. Naganna).

Novitas issued a reconsidered determination on December 6, 2022, in which it explained the following, in pertinent part:

On the web CMS-855B group enrollment application received August 31, 2022, the requested effective date was listed as January 1, 2022.  Per 42 C.F.R. § 424.520(d), the effective date of billing privileges is the later of (1) the date of a filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor; or (2) the date that the supplier first began furnishing services at a new practice location. Regulations found in 42 C.F.R. § 424.521(a) provide that physicians and non-physician practitioners may retrospectively bill for services when they have met all program requirements, including State Licensure requirements, and services were provided at the enrolled practice location for up to (1) 30 days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries, or (2) 90 days prior to their effective date if a Presidentially declared disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act 42 U.S.C. 5121-5206 (Stafford Act) precluded enrollment in advance of providing services to Medicare beneficiaries.  Novitas Solutions determined that C. Naganna, MD, PA qualified for retrospective billing privileges up to 90 days.  Therefore, a retrospective effective date of billing of June 2, 2022 was established correctly.

CMS Ex. 1 at 4.

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Petitioner filed a request for hearing on December 20, 2022.  The Civil Remedies Division issued my standing pre-hearing order (Pre-Hearing Order) on December 21, 2022.  CMS filed a brief and motion for summary judgment (CMS Br.), along with 16 proposed exhibits (CMS Exs. 1-16).  Petitioner filed a response, along with two exhibits (P. Exs. 1-2).  In the absence of any objections, I admit CMS Exs. 1-16 and P. Exs. 1-2 into the evidentiary record. 

A hearing for the purpose of cross-examination is unnecessary because neither party has identified any proposed witnesses who would testify at an oral hearing.  Pre-Hearing Order, § 12-14.  I consider the record in this case to be closed, and the matter is ready for a decision on the merits.⁸

II.   Issue

Whether the effective date of Petitioner’s Medicare enrollment and billing privileges is August 31, 2022, with retrospective billing authorized beginning June 2, 2022.  

III.   Jurisdiction

I have jurisdiction to hear and decide this case.  42 C.F.R § 498.3(b)(15); Victor Alvarez, M.D., DAB No. 2325 at 8-12 (2010); see also 42 U.S.C. § 1395cc(j)(8).  

IV.   Findings of Fact, Conclusions of Law, and Analysis⁹

1. The sole owner of Petitioner’s clinic/group practice passed away on November 18, 2021.

2. Pursuant to 42 C.F.R. § 424.516, a supplier must timely report a change in ownership.

3. After more than 90 days had elapsed following the death of Petitioner’s owner and Petitioner had not updated the enrollment record for its clinic/group practice to report a change in ownership, Novitas deactivated Petitioner’s Medicare billing privileges effective February 17, 2022.

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4. On March 31, 2022, Petitioner submitted an electronic Form CMS-855B to reactivate its IDTF’s Medicare billing privileges.

5. Petitioner did not submit a Medicare enrollment application to update its clinic/group practice’s enrollment record until August 31, 2022.

6. Pursuant to 42 C.F.R. § 424.520(d), the effective date of Petitioner’s reactivated billing privileges as a clinic/group practice is August 31, 2022, which is the date of receipt of the Medicare enrollment application that Novitas was able to process to approval.

7. Pursuant to 42 C.F.R. § 424.521(a)(2), retrospective billing privileges are authorized beginning June 2, 2022.  

As a clinic/group practice, Petitioner is a “supplier” for purposes of the Medicare program.  See CMS Ex. 8 at 1; see also 42 U.S.C. § 1395x(d); 42 C.F.R. §§ 400.202 (definition of supplier); 498.2.  A “supplier” furnishes items or services under Medicare and the term applies to physicians or other practitioners who are not included within the definition of the phrase “provider of services.”  42 U.S.C. § 1395x(d).  A supplier must enroll in the Medicare program to receive payment for covered Medicare items or services.  42 C.F.R. § 424.505.  The regulations at 42 C.F.R. Part 424, subpart P, establish the requirements for a supplier to enroll in the Medicare program.  42 C.F.R. §§ 424.510-424.516; see also 42 U.S.C. § 1395cc(j)(1)(A) (authorizing the Secretary of the U.S. Department of Health and Human Services to establish regulations addressing the enrollment of providers and suppliers in the Medicare program).  A supplier that seeks billing privileges under Medicare “must submit enrollment information on the applicable enrollment application.”  42 C.F.R. § 424.510(a)(1).  “Once the provider or supplier successfully completes the enrollment process . . . CMS enrolls the provider or supplier into the Medicare program.”  Id.; see also 42 C.F.R. § 424.510(d) (listing enrollment requirements).  When the contractor approves an enrollment application, it sets the effective date for approval of billing privileges.  See Alexander C. Gatzimos, MD, JD, LLC, DAB No. 2730 at 2 (2016).  “The effective date of a physician’s or physician organization’s enrollment in Medicare is ‘the later of the date of filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor or the date [the supplier] first began furnishing services at a new practice location.’”  Id. at 2-3 (citing 42 C.F.R. § 424.520(d)). 

Novitas deactivated Petitioner’s billing privileges as a clinic/group practice effective February 17, 2022, after it did not timely report a change in ownership following the death of its owner.  CMS Ex. 13.  Petitioner has not claimed that it updated its enrollment record to report its new ownership prior to the deactivation of its billing privileges on

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February 17, 2022, nor has it disputed that Novitas properly deactivated its billing privileges.  See Frederick Brodeur, M.D., DAB No. 2857 at 12 (2018) (“A contractor’s decision is not an initial determination subject to ALJ or Board review.”).  Rather, Petitioner disputes the effective date of its reactivated billing privileges, claiming that its submission of an enrollment application for its IDTF on March 31, 2022 should have served to reactivate the billing privileges of both the IDTF and the clinic/group practice.  P. Br. at 5. 

The pertinent regulation with respect to the effective date of reactivation is 42 C.F.R. § 424.520(d).  Urology Grp. of NJ, LLC, DAB No. 2860 at 7 (2018) (“The governing authority to determine the effective date for reactivation of Petitioner’s Medicare billing privileges is 42 C.F.R. § 424.520(d)” (italics omitted).).  Section 424.520(d) states that “[t]he effective date for billing privileges for physicians, non-physician practitioners, physician and non-physician practitioner organizations . . . is the later of – (1) [t]he date of filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor; or (2) [t]he date that the supplier first began furnishing services at a new practice location.”  The Departmental Appeals Board (DAB) has explained that the “date of filing” is the date “that an application, however sent to a contractor, is actually received.”  Alexander C. Gatzimos, MD, JD, DAB No. 2730 at 5 (emphasis omitted).  Novitas deactivated Petitioner’s billing privileges because it did not timely update its change in ownership, and it was not until August 31, 2022, that Novitas received Petitioner’s enrollment application updating its clinic/group practice enrollment record.  CMS Ex. 7 at 1.  Based on the August 31, 2022 receipt date of the enrollment application, Novitas did not err in assigning an August 31, 2022 effective date for reactivated billing privileges.  42 C.F.R. § 424.520(d); see Urology Grp., DAB No. 2860 at 9 (“Moreover, the fact that a supplier must file a new enrollment application in order to reactivate its billing privileges is consistent with the language of section 424.520(d) and compelling evidence that the provision should apply to reactivations.”); Willie Goffney, Jr., M.D., DAB No. 2763 at 6 (2017) (“It is certainly true that [the petitioner] may not receive payment for claims for services during any period when his billing privileges were deactivated.”); Frederick Brodeur, DAB No. 2857 at 16 (“Petitioner remained enrolled in Medicare, but his deactivated status made [him] ineligible for payment for any covered services he furnished to otherwise eligible Medicare beneficiaries, pursuant to section 424.555(b), until he provided the information necessary to reactivate his billing privileges.”).

Petitioner argues that its single March 31, 2022 enrollment application should have served to reactivate the billing privileges of both its clinic/group practice and IDTF.  P. Br. at 5 (“CMS states that Petitioner failed to send a separate application to reactivate its billing privileges for the “group practice.”  It is unclear as to what CMS is referring to as “group practice.”).  Petitioner is mistaken; two different types of suppliers cannot update their enrollment records with a single shared enrollment application.

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Petitioner operates as two types of suppliers, a clinic/group practice (i.e., a medical office at 700 Poole Road where a patient/beneficiary will have a consultation with a physician) and an IDTF (a facility at 680 Poole Road where a patient/beneficiary will receive diagnostic services, such as a PET/CT scan).  Page 10 of the Form CMS-855B enrollment application instructions lists numerous types of suppliers, to include “Clinic/Group Practice” and “Independent Diagnostic Testing Facility,” and instructs the applicant to “Check one only,” indicating that the application should be submitted for only one type of supplier.  See MEDICARE ENROLLMENT APPLICATION Clinics/Group Practices and Other Suppliers, https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855b.pdf (last visited April 13, 2023).  Even if CMS’s instruction that only one type of supplier should be checked was somehow unclear (which it is not), page 10 of the application states the following: “If you are more than one type of supplier, submit a separate application for each type.” Petitioner, on March 31, 2022, submitted one enrollment application that updated its enrollment record as an IDTF.¹⁰  CMS Ex. 12 at 1-2 (listing its “Provider/Supplier Type” as an IDTF, and including Attachment 2 pertaining only to IDTFs). 

When Novitas sent May 4, 2022 correspondence that it had “approved [the] reactivation enrollment application,” it clearly stated that the approval and reactivation was for “Provider/Supplier Type:  INDEPENDENT DIAGNOSTIC TESTING FACILITY.” CMS Ex. 11 at 1.  Thus, dating back to May 4, 2022, Petitioner was on notice that its billing privileges as an IDTF had been reactivated.  However, Petitioner did not submit an enrollment application to update its enrollment record as a clinic/group practice until August 31, 2022.  CMS Ex. 7. 

Petitioner claims that it was somehow misled by Novitas representatives who did not instruct it to list its clinic/group practice PTAN on its March 31, 2022 enrollment

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application, and but for this purportedly erroneous advice, the March 31, 2022 enrollment application should have served to reactivate its billing privileges as both a clinic/group practice and an IDTF.  P. Br. at 4.  Again, Petitioner is mistaken, as it erroneously assumes that merely listing the clinic/group practice’s PTAN on the March 31, 2022 application, without submitting separate applications, would have sufficed to reactivate its billing privileges.¹¹  Petitioner failed to submit a “separate enrollment application” to update the enrollment record for each of its supplier types, and it did not submit the required enrollment application for its clinic/group practice until August 31, 2022.  Regardless of its communications with Novitas personnel,¹² Petitioner cannot blame Novitas for its own failure to follow the unambiguous instructions that it submit a separate enrollment application for each type of supplier for which it sought to be enrolled and have its billing privileges reactivated.  Even if Petitioner received incorrect information or simply misunderstood the instructions provided by Novitas personnel, the enrollment application clearly instructs, more than once, that a separate application had to be submitted for each supplier type.  Petitioner has not shown that its failure to submit an enrollment application for its clinic/group practice prior to August 31, 2022 was caused by any error on the part of Novitas.  And there is simply no provision under law that allows for an earlier effective date of reactivated billing privileges prior to a supplier’s submission of the required enrollment application.  42 C.F.R. § 424.520(d).  See Michael B. Zafrani, DAB No. 3075 at 10 (2022) (“Deactivation means that a supplier’s billing privileges “can be restored upon,” not before, “the submission of updated information.” 42 C.F.R. § 424.502 (emphasis added).”).  

I recognize that the deactivation of Petitioner’s billing privileges followed the passing of its owner, and I sympathize with Petitioner’s difficulties after it continued under new ownership.  However, I am not empowered with the discretion to grant an effective date of enrollment earlier than the date Petitioner submitted its enrollment application, and I cannot authorize billing privileges earlier than 90 days prior to the date Petitioner submitted its enrollment application, because this is the earliest date allowed by law. 

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See 42 C.F.R. § 424.521(a)(2).  To the extent that Petitioner’s request for relief is based on principles of equitable relief, I cannot grant such relief.  US Ultrasound, DAB No. 2302 at 8 (2010) (“Neither the ALJ nor the [DAB] is authorized to provide equitable relief by reimbursing or enrolling a supplier who does not meet statutory or regulatory requirements.”).  Petitioner points to no authority by which I may grant it relief from the applicable regulatory requirements, and I have no authority to declare statutes or regulations invalid or ultra vires.  1866ICPayday.com, L.L.C., DAB No. 2289 at 14 (2009) (“An ALJ is bound by applicable laws and regulations and may not invalidate either a law or regulation on any ground . . . .”).

The simple fact is that Novitas did not receive Petitioner’s enrollment application updating its enrollment record as a clinic/group practice until August 31, 2022; therefore, the pertinent regulation, 42 C.F.R. § 424.520(d), mandates that the effective date of its reactivated billing privileges is August 31, 2022.  Retrospective billing privileges are permitted no earlier than June 2, 2022, pursuant to 42 C.F.R. § 424.521(a)(2), which allows for retrospective billing privileges no more than 90 days prior to the effective date of enrollment.  Therefore, CMS properly determined that the effective date of Petitioner’s reactivated billing privileges is August 31, 2022, with retrospective billing privileges authorized beginning June 2, 2022.  CMS Ex. 1 at 4; 42 C.F.R. §§ 424.520(d), 424.521(a)(1).

V.   Conclusion

For the foregoing reasons, I uphold the August 31, 2022 effective date of Petitioner’s reactivated Medicare enrollment and billing privileges, with retrospective billing authorized beginning June 2, 2022.

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Endnotes

¹ The citation for the ALJ decision addressing the effective date of the IDTF’s reactivated enrollment is C. Naganna MD, PA d/b/a/ Carroll Precision Imaging Center, Carroll Heart Center, DAB No. CR6179 (2022).

² The Form CMS-855B instructs that “[i]f the supplier is a corporation . . . all officers of the supplier” must be listed on the application.  MEDICARE ENROLLMENT APPLICATION Clinics/Group Practices and Other Suppliers, https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855b.pdf (last visited April 13, 2023).

³ “Attachment 2” at pages 37 through 44 of the Form CMS-855B enrollment application posted on CMS’s public website pertains to IDTFs and includes an attestation statement that must be certified, signed, and submitted by the supervising physician. MEDICARE ENROLLMENT APPLICATION Clinics/Group Practices and Other Suppliers, https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855b.pdf (last visited April 13, 2023).  The final section of Attachment 2 on page 44 includes an attestation statement by the supervising physician that must be signed and dated and includes the following language:  “I hereby acknowledge that I have agreed to provide (IDTF Name) . . . with the Supervisory Physician Services checked above for all CPT-4 and HCPC5 codes and modifiers (if applicable) reported in this attachment.”

⁴ A PTAN is the “billing number” used by an individual or entity with billing privileges.  See, e.g.,42 C.F.R. § 424.550(a).

⁵ On July 25, 2022, Dr. Naganna submitted an application to reassign her benefits to the IDTF.  CMS Ex. 10 (listing “2D1366,” the PTAN of the IDTF, as the “Medicare Identification Number for this location – PTAN (if issued”) on the application); see CMS Ex. (letter assigning PTAN 2D1366 for the “Provider/Supplier Type:  INDEPENDENT DIAGNOSTIC TESTING FACILITY”).  Novitas initially (and erroneously) approved the reassignment request.  CMS Ex. 9.  Several weeks later, in a letter dated September 10, 2022, Novitas explained that the application had been approved in error because an “IDTF does not accept reassignment.”  CMS Ex. 8 at 1. 

⁶ The Form CMS-855I instructs that it applies to “[a]n individual practitioner . . . who has formed a professional corporation, professional association, limited liability company, etc., of which you are the sole owner” and for an individual practitioner who was “[p]reviously enrolled in Medicare and you need to reactive your billing number to resume billing.”  CMS Ex. 6 at 4 (Form CMS-855I (“WHO SHOULD COMPLETE THIS APPLICATION”)).

⁷ Although an effective date of enrollment is set in accordance with 42 C.F.R. § 424.520(d), CMS or its contractor may, as relevant here, permit retrospective billing for 90 days prior to the effective date “if a Presidentially-declared disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121-5206 (Stafford Act) precluded enrollment in advance of providing services to Medicare beneficiaries.”  42 C.F.R. § 424.521(a)(2).  Novitas used imprecise language when it stated that it had assigned a June 2, 2022 effective date of enrollment.  In actuality, Novitas assigned an August 31, 2022 effective date for enrollment, based on the receipt date of the application, pursuant to 42 C.F.R. § 424.520(d), and it authorized retrospective billing privileges beginning on June 2, 2022, pursuant to 42 C.F.R. § 424.521(a)(2). 

⁸ Because the parties have not identified any witnesses and a hearing is unnecessary, I need not address whether summary judgment is appropriate.

⁹ Findings of fact and conclusions of law are in italics and bold font.

¹⁰ I note the practicality of CMS’s requirement for a separate application from each type of supplier is evidenced by a review of the enrollment applications, which contain information for two different supplier types that could not have been coalesced into a single enrollment application.  Compare CMS Ex. 12 (IDTF enrollment application) with CMS Exs. 6-7 (clinic/group practice enrollment applications).  For example, Petitioner reported a different primary practice location for each entity.  See CMS Exs. 6 at 9 (700 Poole Road, Suite A); 12 at 3 (680 Poole Rd, Suite A).  Petitioner also reported different organizational structures—a sole proprietorship for its clinic/group practice, and a corporation with a director/officer for its IDTF.  CMS Exs. 6 at 16 (reporting sole proprietorship); 7 at 4 (reporting sole ownership); 12 at 2 (reporting a corporation with a director/officer).  Further, the IDTF application included the submission of supporting documentation not required of a clinic/group practice, such as a copy of a comprehensive liability insurance policy and Attachment 2, to include a supervisory physician’s attestation, and a site inspection was required prior to approval of the application.  See CMS Exs. 3 at 5; 2 at 2, 5-6, 9.

¹¹ Petitioner supports this allegation with unsworn statements in its brief and an unsworn “Call Log and Communication Log” (CMS Ex. 2) that does not appear to be a contemporaneous record, but rather, appears to have been created in support of its efforts to dispute the effective date assigned for its reactivated billing privileges.  Petitioner did not avail itself of the opportunity to submit sworn testimony supporting its claims.  See Standing Pre-Hearing Order § 12.

¹² It appears that Petitioner faults Novitas for erroneously approving Dr. Naganna’s application to reassign benefits to the IDTF.  P. Br. at 2-3.  Novitas later conceded this approval was erroneous.  CMS Ex. 8.  However, the erroneous approval of Dr. Naganna’s reassignment application is irrelevant to the question of whether Petitioner submitted an application to update its enrollment record as a clinic/group practice prior to August 31, 2022.