Houston Medicare Revocation Attorneys

CMS Revoked Your Billing Privileges? Your Deadlines Started the Day the Notice Was Mailed.

Your Medicare billing privileges are your authorization to submit claims to Medicare and be paid for them. They come with enrollment, but they are not permanent. Federal regulations give the Centers for Medicare and Medicaid Services (CMS) more than 20 grounds to revoke them. 

Losing your Medicare billing privileges stops your Medicare revenue immediately. It also starts a chain of consequences most providers do not see coming: a re-enrollment bar of one to 10 years, placement on a list that cuts off Medicare Advantage and Part D payment, and no reimbursement at all while you appeal.

Your deadlines for responding are short, and they start from the postmark date, not from the day you opened the envelope. If your billing privileges are revoked, you have a few options to respond, depending on the grounds. You may be able to submit a corrective action plan, distance yourself from a bad actor, or challenge the revocation through a multi-level appeals process.

Call (713) 783-3110 or contact us online to speak with an attorney about your options to respond to a Medicare revocation. We serve providers nationwide.

On This Page

• Why CMS Revokes Billing Privileges
• When a Revocation Takes Effect
• Responding to a Revocation Notice: The First 30 Days
• How to Appeal a Medicare Revocation 
• How Long Is the Re-Enrollment Bar? 
• Placement on the CMS Preclusion List 
• Re-Enrolling After the Bar Expires 
• What's Changing in 2026
• Suspension, Recoupment, Revocation, Exclusion: Which One Are You Facing?
• Why Hendershot Cowart P.C.? 
• Medicare Revocation FAQs

Why CMS Revokes Billing Privileges

Federal enrollment regulations give CMS or its designated Medicare Administrative Contractors (MACs) more than 20 grounds to revoke a currently enrolled provider's or supplier's Medicare enrollment. The ones that come up most are:

• Noncompliance with enrollment requirements, including licensure, documentation, and standards specific to your provider type. 
• Exclusion or debarment of the provider or of any owner, managing employee, officer, director, medical director, supervising physician, or administrative personnel.
• Felony conviction within the preceding 10 years that CMS determines is detrimental to Medicare and its beneficiaries. Financial crimes, patient abuse or neglect, and offenses that put beneficiaries at risk all qualify. The conviction does not have to involve Medicare.
• False or misleading information certified as true on an enrollment application. No proof of intent to deceive is required.
• No longer operational, established by on-site review or other reliable evidence. This includes listing an address on your enrollment application that is not the actual practice location.
• Abuse of billing privileges, covering patterns of claims that fail to meet Medicare requirements.
• Failure to report an adverse legal action (such as a license suspension), ownership change, or practice location change within 30 days.
• Billing number misuse, including selling it or knowingly letting another party use it.
• Termination or revocation from a state Medicaid program or another federal healthcare program.
• Loss of DEA registration.
• Improper prescribing practices that CMS finds abusive or threatening to beneficiary health and safety.
• False Claims Act civil judgments within the previous 10 years.
• Patient harm.
• Affiliations with individuals or entities that pose an undue risk of fraud, waste, or abuse.

When Revocation Takes Effect

Generally, revocation of billing privileges takes effect 30 days after CMS or its contractor mails the notice. However, some revocations are retroactive:

• Revocation based on a license suspension or revocation is effective as of the date of the state licensing action.
• Revocation based on a felony conviction is effective as of the date of conviction.

A retroactive date means Medicare paid you during a period when you were not entitled to payment, which opens the door to recoupment of everything received in the interim. 

Responding to a Revocation Notice: The First 30 Days

The revocation notice comes from your Medicare Administrative Contractor on joint CMS and contractor letterhead. In Texas, that is Novitas Solutions. It is not a warning or a request for information – the decision has been made, and the letter exists to tell you what was decided and how long you have to respond.

The letter will list the grounds for revocation, along with a short narrative explaining the facts CMS relied on. Beyond the grounds, look for these four key pieces of information:

• The effective date. Often 30 days out. If it is retroactive to a license action or a conviction, you are also facing recoupment of payments you have already received.
• The re-enrollment bar. The letter states the length and the exact date you become eligible to reapply. That length cannot be appealed.
• Preclusion list placement. If it appears in the same letter, your appeal has to cover both actions together.
• The filing deadline, the mailing address, and the email address for appeals.

Keep the envelope. Your reconsideration deadline runs from the postmark, not from the day the letter reached your desk or the day you opened it. If the notice sat unopened for a week, that week is gone, and the envelope is often the only proof of when the clock started.

There are three primary ways you can respond:

1. If the revocation is for noncompliance, file a corrective action plan within the first 30 days. 

A corrective action plan asks CMS to reverse the revocation because you have fixed the underlying problem. It is available only for noncompliance revocations, not for revocations based on felony convictions, exclusion, or on-site review findings.

A corrective action plan is not an argument that CMS was wrong. It is documented proof that you are compliant now.

Two things to understand before relying on it:

• The Medicare contractor has discretion to reject it, even when you have genuinely fixed the problem.
• A denied corrective action plan cannot be appealed. It is not treated as an appealable decision, so there is no review of it anywhere in the process.

2. If the revocation traces to an owner or managing employee, terminate the relationship and document your actions within 15 days. 

Some revocations are triggered by someone connected to your practice: a sanction, exclusion, or felony involving an owner, managing employee, authorized or delegated official, or other covered personnel.

In those cases, CMS may rescind the revocation entirely if you promptly: 

1. Terminate the business relationship with that individual; and 
2. Submit proof of the termination within 15 days of the revocation notification.

3. Begin the appeals process.

Even if you file a corrective action plan, you may also begin the multi-step appeals process described below by filing a reconsideration request – these are separate administrative processes that do different jobs. The corrective action plan says the problem is fixed. The reconsideration says the revocation was wrong in the first place. Filing one does not cancel out the other, and because a rejected corrective action plan cannot be appealed, pursuing both options in parallel may improve your odds of a favorable outcome. Your attorney can advise you of the best path – or paths – forward. 

Appealing a Medicare Revocation

Providers who lose their Medicare billing privileges may challenge the revocation through a multi-step administrative process: 

Step One: Reconsideration

Request reconsideration with the CMS contractor who sent your revocation notice within 65 days. The deadline is strictly enforced, and it runs from the postmark of the notice, not from receipt.

Two things make this stage decisive:

1. Review is limited to the grounds stated in your notice, as they stood when the notice issued. Evidence that you became compliant afterward belongs in a corrective action plan, not here.
2. Submit everything now. The record you build at this stage is largely the record that will be considered throughout the appeals process. 

Step Two: Administrative Law Judge Hearing

The next stage is a hearing before an administrative law judge. An administrative law judge, or ALJ, is a judge who works within a federal agency – in this case, the Department of Health and Human Services (HHS) – rather than in the traditional court system. The hearing works much like a court proceeding: both sides can submit evidence, call witnesses, and make arguments, and the ALJ issues a written decision. 

What the administrative law judge can decide: whether the elements of a basis for revocation are satisfied.

What the judge cannot decide: whether revocation was the right call. Judges may not substitute their judgment for the agency's. They also cannot review the length of your re-enrollment bar or the denial of your corrective action plan.

Step Three: Departmental Appeals Board

An unfavorable ALJ decision may be appealed to the HHS Departmental Appeals Board (DAB), which applies the same limited scope of review as the ALJ, examining only whether a legal basis for revocation exists. 

Step Four: Federal Court

As a final step, you can seek judicial review in federal district court. The court will ask whether CMS had enough evidence to reasonably reach its conclusion and whether the agency correctly interpreted the law. 

An unfavorable decision at this stage exhausts your options to appeal a revocation. The only path forward from here is to wait out the re-enrollment bar.

The Re-Enrollment Bar

A re-enrollment bar is the waiting period after a revocation before you can apply to re-enroll in Medicare. Generally, it begins 30 days after CMS mails the revocation notice.

The bar follows you under any current, former, or future name, tax identification number, or business identity. Restructuring the practice does not bypass this waiting period, and CMS may add years to your re-enrollment bar if it concludes that is what you are trying to do.

The length of the re-enrollment bar cannot be appealed.

Placement on the CMS Preclusion List

Revocation also puts you on the CMS Preclusion List for the same length of time as your re-enrollment bar. Being on that list means Medicare Advantage plans cannot pay, directly or indirectly, for items or services you furnish, and Part D plans cannot pay for drugs you prescribe. 

Re-Enrolling After the Bar Expires

There is no reinstatement process for a revocation. Once the re-enrollment bar expires, you start over: a new enrollment application, complete documentation, and validation by CMS as a new provider or supplier.

You must explicitly disclose your past revocation history. Failing to disclose a past administrative action is considered providing misleading information and can trigger a new, maximum 10-year ban. Our attorneys can help you prepare your enrollment application in compliance with CMS rules and federal regulations. 

What Is Changing in 2026

CMS Can Now Exclude, Not Just Revoke

On July 21, 2026, HHS delegated exclusion authority to CMS. Until then, exclusion belonged to the OIG alone.

What this means for you: the agency that reviews your enrollment file, processes your revalidations, and monitors your claims data now holds the authority to exclude you from all federal healthcare programs. 

Proposed Changes to Medicare Revocation Rules

On July 6, 2026, CMS proposed a sweeping set of changes to how it revokes providers' Medicare billing privileges. Here is a summary of the proposed rules:

• More grounds to revoke. CMS wants authority to revoke a provider located in an area with an unusually high concentration of similar providers, such as several dozen hospices packed into a few blocks. CMS declined to set specific distance or headcount thresholds, saying a bright-line rule would just teach bad actors how to stay just outside it. CMS would also like to expand revocation authority to include misdemeanor convictions for sexual assault or financial misconduct within the past 10 years.
• Expanded grounds to revoke. CMS wants to broaden three existing revocation grounds: expanding false-or-misleading-information revocations to cover any enrollment-related document, dropping the revocation requirement that providers must exhibit a “pattern or practice” of non-compliant billing, and allowing Medicare to revoke existing billing privileges if a provider submits a new application (for another facility, for example) and that Medicare application is denied (not just revoked).
• More revocations would be retroactive. Right now, some revocations take effect 30 days after CMS mails its notice, while others reach back to the date the problem began, such as a felony conviction or license action. CMS wants to eliminate the first category almost entirely and make nearly every revocation retroactive to the date the underlying issue started.

These rules are proposed, not final. But the direction is unmistakable, and providers should treat any CMS communication, from a records request to a routine data-change notice, as something that carries real financial consequences if mishandled.

Suspension, Recoupment, Revocation, Exclusion: Which One Are You Facing?

CMS has layers of enforcement and administrative actions – from suspension to recoupments to revocation and exclusion – and the terminology can get confusing. This table lays them out in clear terms to help you know which you may be dealing with.

These often arrive in sequence. A UPIC audit triggers a payment suspension. The suspension produces an overpayment determination and a recoupment demand. The same findings then support a revocation, and the revocation can support an exclusion. Knowing which stage you are in tells you which deadlines you are up against and which defenses are still available.

Our attorneys can review any notices you have received, identify which action you are facing, and advise you on how to respond.

Why Hendershot Cowart P.C.?

Since 1987 – nearly 40 years – Hendershot Cowart P.C. has represented healthcare providers and entities before state regulators and federal agencies throughout the United States. Since 2021 alone, our attorneys have defended clients against more than 100 state and federal healthcare investigations, audits, and recoupment demands, and protected the licenses of dozens of medical professionals.

Talk to us if you:

• Received a notice of revocation
• Need a corrective action plan filed inside the 30-day window
• Are preparing a reconsideration request or a Medicare appeal
• Are facing a re-enrollment bar or placement on the preclusion list
• Are dealing with a healthcare audit or investigation 
• Are facing revocation and OIG exclusion for the same conduct

We build it, and we defend it. Most healthcare law firms either help you build your practice or defend it when things go wrong. We've done both since 1987.

Call (713) 783-3110 or contact us online to schedule a case review. Our healthcare fraud defense attorneys represent providers in Houston, throughout Texas, and nationwide.

Common Questions About Medicare Revocation

What is the difference between revocation and exclusion?

Revocation ends your Medicare enrollment and billing privileges. Exclusion bars you from Medicare, Medicaid, and every other federal healthcare program, and it reaches employment, ownership, and management roles. Both can arise from the same conduct under separate frameworks. As of July 2026, CMS holds both authorities.

What is the difference between revocation and deactivation?

Deactivation stops your billing but leaves your enrollment record intact, and it is usually resolved with a reactivation application. Revocation terminates your enrollment and imposes a re-enrollment bar. Deactivation carries no formal appeal rights.

When does a revocation take effect?

Generally 30 days after CMS mails the notice. Revocations based on a license action or a felony conviction are retroactive to the date of that underlying event, which exposes you to recoupment of payments already received.

How long is the re-enrollment bar?

One to 10 years depending on severity, up to 20 years for a second revocation, and up to three additional years if CMS concludes you tried to circumvent it. The length is not appealable.

Can I bill Medicare while my appeal is pending?

No. Payment stops when the revocation takes effect and stays stopped throughout the appeal. If you win, unpaid claims from the overturned period may be resubmitted.

Can I appeal a denied corrective action plan?

No. A Medicare contractor's refusal to reinstate billing privileges based on a corrective action plan is not an appealable decision. This is why the reconsideration request should be filed alongside it.

Does a revocation affect my Medicare Advantage and Part D business?

Yes. A revocation with a re-enrollment bar places you on the CMS Preclusion List for the same period, and Medicare Advantage and Part D plans cannot pay for your services or your prescriptions while you are on it.

Will a revocation affect my other payers?

Usually. Commercial payers and hospitals ask about Medicare enrollment status during credentialing, and many contracts require you to report an adverse action.

Do I need an attorney for a corrective action plan?

It is not required, but it is advisable. CMS gives you 30 days to submit a corrective action plan. The contractor reviewing it has full discretion to accept or reject it, and a rejection cannot be appealed. There is no resubmission, no second draft, and no do-over. 

If you've received a revocation notice, contact our healthcare regulatory attorneys before the clock runs out. Call (713) 783-3110 or contact us online.