SUBJECT:

Mega Medical Supplies Corp.,

Petitioner,

Palmetto GBA and The National Supplier Clearinghouse

DECISION

I reverse the determination of the Carrier Hearing Officer (Hearing Officer) to deny reinstatement of the supplier number assigned to Mega Medical Supplies Corp. (Petitioner). I find that while the Hearing Officer's decision affirming the National Supplier Clearinghouse (NSC or Respondent) was proper at the time it was issued, Petitioner has corrected all deficiencies and is entitled to receive a Medicare supplier enrollment number (supplier number). ⁽¹⁾

I. Background

Petitioner applied to the NSC for a Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) billing number. By a letter dated March 15, 2004, the NSC notified Petitioner that its application for a DMEPOS billing number was denied because Petitioner failed to meet supplier standards 7, 8, and 9. By a letter received by the NSC on April 2, 2004, Petitioner requested that NSC reopen Petitioner's application for a DMEPOS billing number. On May 4, 2004, ⁽²⁾ NSC notified Petitioner that its application for a supplier number would remain denied because a site inspection was not completed and Petitioner remained out of compliance with supplier standards 7, 8, and 9. In addition, NSC notified Petitioner that it was also out of compliance with standards 1, 4, 5, 6, 10, 11, 12, 13, 14, 15, 16, 18, 19, 20, and 21. By a letter received August 2, 2004, Petitioner requested a hearing by the NSC. Subsequently, the NSC was able to complete a site investigation of Petitioner on September 13, 2004. On December 7, 2004, the Hearing Officer held a telephone hearing in this matter. He determined through oral testimony and by reviewing Petitioner's enrollment application, in conjunction with reviewing documentation related to the site investigation, that Petitioner met all standards except supplier standards 1, 4, and 12 of 42 C.F.R. � 424.57. He issued his finding by decision dated December 8, 2004 (December decision). By an undated letter received February 11, 2005, Petitioner filed a timely appeal of the NSC's denial.

II. Issue, findings of fact and conclusions of law

A. Issue

The issue in this case is whether Petitioner is entitled to a supplier number.

B. Findings of fact and conclusions of law

Petitioner has corrected all outstanding deficiencies, is in compliance with all 21 Medicare supplier standards, and is entitled to a Medicare supplier enrollment number.

To qualify for a DMEPOS supplier number, a supplier must meet certain standards. Specifically, 42 C.F.R. � 424.57(c) requires that the supplier:

(1) Operates its business and furnishes Medicare-covered items in compliance with all applicable Federal and State licensure and regulatory requirements;

(4) Fills orders, frabicates [sic], or fits items from its own inventory or by contracting with other companies for the purchase of items necessary to fill the order. If it does, it must provide, upon request, copies or contracts or other documentation showing compliance with this standard. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal Government Executive Branch procurement or nonprocurement program or activity;

(12) Must be responsible for the delivery of Medicare covered items to beneficiaries and maintain proof of delivery. . . .

The Hearing Officer noted in his December decision that Petitioner's Medicare Federal Health Care Provider/Supplier Enrollment Application dated August 29, 2003, indicated the Petitioner would furnish Medicare beneficiaries with diabetic equipment and supplies and diabetic footwear. According to Florida law, "[a] person may not: [p]ractice orthotics, prosthetics, or pedorthics without a license issued pursuant to this act unless otherwise exempt." F.S.A. � 468.809(1)(b). Petitioner, a Florida business, did not employ or contract a person to fit diabetic shoes and/or inserts. Therefore, the Hearing Officer determined that Petitioner was not in compliance with supplier standard 1.

Additionally, the Hearing Office noted in his December decision that in testimony given during a December 7, 2004 NSC telephone hearing, Petitioner indicated that it would furnish diabetic shoes and inserts by referral to another organization. The Hearing Officer determined that Petitioner did not meet supplier standard 4 because Petitioner did not have a contract with such an organization.

Further, during the NSC telephone hearing, Petitioner indicated that it would not deliver diabetic shoes and/or inserts to Medicare beneficiaries. Consequently, the Hearing Officer determined that Petitioner was also out of compliance with supplier standard 12, since a supplier must deliver items if it furnishes them.

On March 10, 2005, Petitioner submitted a Revised Enrollment Application in which Petitioner indicated it would not furnish or deliver diabetic footwear to Medicare beneficiaries. Based on Petitioner's revised fully acceptable application, Petitioner is in compliance with supplier standard 1, standard 4, and standard 12. ⁽³⁾

I find that Petitioner is in compliance with all 21 Medicare supplier standards, and is entitled to a Medicare supplier enrollment number.

Marion T. Silva

Chief Administrative Law Judge

1. NSC submitted the Hearing Officer's Administrative Record, which I admit as Respondent's Exhibit (R. Ex.) 1. Petitioner submitted its revised Medicare Federal Health Care Provider/Supplier Enrollment Application (Revised Enrollment Application), which I admit as Petitioner's Exhibit (P. Ex.) 1.

2. This date was erroneously stated as May 5, 2004 in the Hearing Officer's decision.

3. A copy of the Revised Enrollment Application was faxed to NSC.