Due to Health Law Alliance’s advocacy, a prominent DME vendor in Texas had their billing privileges reinstated this week, without having to jump through the arduous, costly hoops of a fair hearing in front of an Administrative Law Judge or a Departmental Appeals Board review.

Medicare Durable Medical Equipment (DME) providers across the country often face the sudden and perplexing revocation of their billing privileges. Frustratingly, these revocations are often wholly unjustified. Medicare National Provider Enrollment (NPE) contractors Palmetto GBA (Palmetto) and Novitas Solutions (Novitas) are empowered to strip DME providers of their ability to bill Medicare for the supplies they provide their clients for trivial violations of complex regulatory requirements. Their abrupt decisions can be devastating, halting business operations and jeopardizing patient care.

Successful Reinstatement of Medicare Enrollment and Billing Privileges

In April 2025, Palmetto, Medicare’s NPE for the West region, revoked the billing privileges of Health Law Alliance’s client on the basis that one of its practice locations was “not operational,” purportedly because Palmetto had conducted a site visit to the location during business hours and discovered that it was closed. Palmetto also issued the DME vendor a one-year ban on re-enrollment in the Medicare program. On both counts, Palmetto’s actions were baseless.

Health Law Alliance promptly filed a reconsideration request, arguing that Palmetto’s determination was erroneous and should be rescinded. Our advocacy centered on a few key points:

• “By Appointment Only” Status: Our client operates as a “By Appointment Only” facility, specializing in custom-made orthotics and prosthetics. This status was registered with CMS in their registration form.
• Lack of Scheduled Site Visits: Palmetto failed to schedule its site visits in advance with our client, as required for all “By Appointment Only” facilities.
• Clear Facility Signage: Our client maintained clear signage on the facility door and adjacent wall, including instructions for obtaining entry, clearly demonstrating that the client was open and operational.

Health Law Alliance's Advocacy Leads to Overturn

On June 9, 2025, Chags Health Information Technology, LLC (C-HIT) overturned Palmetto’s revocation of Medicare enrollment and billing privileges. C-HIT's review of our reconsideration request confirmed that the site visits were indeed attempted without a scheduled appointment. Consequently, C-HIT overturned both the revocation and the re-enrollment bar.

This favorable determination means our client's Medicare enrollment and billing privileges were reinstated back to February 20, 2025, when Palmetto’s contractors attempted to conduct a site visit in violation of federal regulations.

The Importance of Diligent Advocacy

This case highlights a pervasive issue within the DME supplier community: Palmetto and Novitas revoke Medicare provider billing privileges without adequate notice, sometimes based on incomplete or misunderstood information. These companies’ actions are arbitrary and capricious, severely impacting providers’ business operations. However, as this favorable result demonstrates, these decisions can be challenged and overturned with zealous legal representation.

While our client's Medicare enrollment and billing privileges will be reinstated backdated to February 20, 2025, a crucial next step remains. Our client must rebill Medicare for the services rendered since February 20, 2025, and collect reimbursement for the services rendered after Palmetto unjustly canceled their billing privileges.

Seeking Assistance for Medicare Billing Privilege Reinstatement

If you are a DME vendor or other Medicare provider facing the daunting challenge of revoked Medicare enrollment or billing privileges, please be assured that you do not have to navigate this complex process alone. Health Law Alliance specializes in DME audits and appeals. We have a deep understanding of Medicare regulations and have a proven track record of successfully advocating for our clients.

Just as we did for this client, we can help you defend your Medicare billing privileges quickly and affordably, ensuring your practice can continue to serve patients without interruption. Do not let an arbitrary revocation jeopardize your livelihood. Contact Health Law Alliance today to discuss your options and learn how we can assist you.