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From Health Law Daily, September 25, 2015

Sauce for the goose: contractor lost application, ALJ reverses enrollment date

By Michelle L. Oxman, J.D., LL.M.

Applying the same rules to the contractor that are applied to providers and suppliers, an administrative law judge (ALJ) overturned the CMS determination of the enrollment date of a physician. The ALJ found that the sworn testimony of two witnesses that they had mailed the physician’s completed application on June 6, 2014, was more credible than the contractor’s testimony that it had not received the application based on a search of its database (Dolce v. CMS, Docket No. C-15-2116, Decision No. CR4150, August 21, 2015).

The evidence. In addition to his own sworn statement and a copy of the completed application dated June 5, 2014, the physician submitted the affidavit of an employee that she had mailed two physicians’ applications, one of which was the complaining physician’s, on June 6, 2014. The contractor, Novitas, received the other physician’s application on June 10, 2014 and processed it to completion. The physician contended that the contractor must have lost his application.

The regulations. The ALJ noted that 42 C.F.R. sec. 498.22(b)(3) provides that documents that are mailed are presumed to have been received five days later unless there is proof to the contrary. The ALJ found no reason to disbelieve the physician and his employee. The contractor’s testimony that the application was not in its database was consistent with its having lost the application. The two copies in evidence were identical. Therefore, the ALJ found that the physician had mailed his application on June 6 and that it had been received five days later.

Date of enrollment. 42 C.F.R. sec. 424.520(d) provides that the effective date of enrollment is the later of the date that the physician submits an application which is ultimately approved or the date that the physician begins practicing at the location. Because the physician began practicing at the location on August 6, 2014, after the June 6 application, his enrollment was effective August 6, 2014.

Companies: Novitas

MainStory: TopStory ProviderNews CMSNews

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