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Are you sure that CMS recieved the letter?I was never afraid of their hammers. As a matter of fact, back in 2008 I wrote a nice long letter to CMS telling them straight up that I would not follow ALL of their ignorant rules and why I wouldn't. All of the reasons why I wouldn't follow certain rules is due to doing the right thing for my client, no matter what they thought and that I would see them in court if they want to challenge me. I heard crickets.
As far as I know those rules have been taken off the books. It was about thing like the 24 hour rule on the scope, not being able to ask the client about their meds, etc.
If they would have put me in CMS jail, so be it. There is still more than one way to skin a cat. I never did need their approval to help my clients or anybody else for that matter.
I recently sent Jeff Sessions a letter to the DOJ, telling him that he needed to grow a pair.
The response I got: "Your message wasn't delivered because the recipient's mailbox is undergoing maintenance and can't accept messages now. Please try resending the message later." ...Yeah, right.