When CMS Revokes or Precludes You, Time Is Everything

If you’ve received a notice that your Medicare billing privileges have been revoked or that you’ve been placed on the CMS Preclusion List, you’re not alone—and you still have options.

A CMS revocation can instantly cut off your ability to treat Medicare patients or get paid for services. Placement on the Preclusion List can go even further, blocking reimbursement through Medicare Advantage (Part C) and Part D prescription drug plans.

The key to fighting back is understanding the appeal process, acting quickly, and avoiding the common mistakes that cause many providers to lose their cases before they begin.

At National Security Law Firm (NSLF), our attorneys regularly handle CMS appeals nationwide. We know the procedures, deadlines, and decision-makers involved—because many of us have served inside the federal government ourselves.

Understanding CMS Revocation and Preclusion

CMS Revocation under 42 C.F.R. § 424.535 occurs when CMS terminates a provider’s enrollment and billing privileges.
Common reasons include:

  • Loss or suspension of a professional license

  • Submitting false or misleading information

  • Abuse of billing privileges

  • OIG exclusion

  • Failure to maintain compliance with enrollment requirements

Preclusion under 42 C.F.R. §§ 422.2, 422.222, 423.100, and 423.120(c)(6) applies mainly to Medicare Advantage and Part D plans.
If you are revoked, excluded, or deemed a program-integrity risk, your name is placed on the Preclusion List, and insurers must deny payment for your services.

The Four-Level CMS Appeal Process

The CMS appeal system is administrative, formal, and fast-moving. Missing a deadline can end your rights entirely.

1. Reconsideration by the Medicare Administrative Contractor (MAC)

You have 60 days from the date on your revocation or preclusion notice to request reconsideration.

Your request should include:

  • A detailed explanation of why the revocation is incorrect or disproportionate

  • All supporting documents (license verifications, compliance records, affidavits, etc.)

The MAC’s decision is called a “reconsideration determination.” If it upholds the revocation, you can appeal further.

2. Administrative Law Judge (ALJ) Appeal

Under 42 C.F.R. Part 498, you may request a hearing before an HHS Administrative Law Judge within 60 days of the reconsideration decision.

This is your first real chance to present evidence and cross-examine CMS’s position.
ALJ hearings are typically held by video conference and governed by tight procedural rules.

Our attorneys prepare comprehensive hearing packets, organize exhibits, and submit written briefs that highlight both factual rehabilitation and legal error.
Having counsel who understands administrative litigation can make all the difference at this stage.

3. Departmental Appeals Board (DAB)

If the ALJ upholds the revocation, you can appeal again to the HHS Departmental Appeals Board.
The DAB reviews the ALJ’s decision for legal error and procedural fairness.
This is a paper-based appeal—no hearing is held—and deadlines are strict.

At NSLF, we draft precise appellate briefs grounded in regulatory interpretation and past DAB precedent, giving our clients the strongest possible record should judicial review become necessary.

4. Federal Court Review

Once you’ve exhausted all administrative remedies, you may seek judicial review in federal district court.
The court’s review is limited—it looks only at whether CMS followed the law and whether the agency’s decision was arbitrary or capricious.
Still, a well-built administrative record from the earlier stages dramatically improves your odds.

Common Mistakes That Cost Providers Their Case

Even well-intentioned physicians lose appeals due to avoidable errors. The most common include:

  1. Missing the 60-Day Deadline
    CMS does not grant extensions without extraordinary cause.

  2. Failing to Provide Evidence Early
    New evidence may be excluded later if it wasn’t presented at reconsideration.

  3. Submitting Incomplete or Inconsistent Information
    Every fact must align across documents—license status, ownership details, practice location, NPI.

  4. Assuming OIG Reinstatement Automatically Fixes CMS Revocation
    It doesn’t. CMS and OIG actions are separate. You must pursue both.

  5. Representing Yourself
    The administrative process is technical. Many self-represented providers misunderstand evidentiary burdens or miss procedural steps.

How NSLF Builds Winning Appeals

At National Security Law Firm, we approach CMS appeals with the precision of a litigation team and the discipline of a military command.

Our process includes:

  • Immediate file review to identify procedural or jurisdictional defects in CMS’s action

  • Reconstruction of the timeline to verify compliance and pinpoint agency errors

  • Development of mitigation evidence, including compliance reforms, ethics training, and corrected enrollment filings

  • Comprehensive briefing for ALJ and DAB stages that aligns with current CMS precedent

  • Coordinated OIG/CMS strategy, ensuring reinstatement on all fronts

Because our attorneys have served as federal prosecutors, agency counsel, and military judges, we understand both the bureaucratic culture and the legal standards that govern these cases.

Led by Duane “Dak” Kees

Led by Duane “Dak” Kees, a former U.S. Attorney with strong relationships throughout the federal government as a result of his service as both a U.S. Attorney and a military judge, our team knows how to work within the system to restore eligibility and rebuild trust with federal healthcare programs.
Learn more about Dak’s background here.

Explore More Resources

If you or someone you know is facing an OIG exclusion or CMS revocation, visit our HHS Exclusion & CMS Revocation Resource Hub for step-by-step guides, timelines, and strategies from our federal healthcare defense team.

At National Security Law Firm, we help physicians, pharmacists, and healthcare providers nationwide navigate reinstatement, appeal, and compliance with precision and integrity.

Why Choose National Security Law Firm

  • Former Federal and Military Lawyers — We’ve served inside the same agencies that now regulate you.

  • Nationwide Representation — We handle CMS appeals across all 50 states.

  • 4.9-Star Google Reviews: Read Them Here

  • Proven Administrative Litigation Experience — ALJ and DAB appeals are part of our daily practice.

  • Free Consultations — Get clear, candid advice about your case before deadlines expire.

Ready to Restore Your Federal Program Eligibility?

You’ve worked too hard to let one regulatory action end your medical career. Our attorneys will review your revocation or preclusion notice, map out your appeal strategy, and handle every step—from MAC reconsideration through federal court review.

Consultations are free, confidential, and pressure-free.


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