Anderson v. Liberty Lobby, Inc.

Holding that summary judgment is not appropriate if "the dispute about a material fact is ‘genuine,’ that is, if the evidence is such that a reasonable jury could return a verdict for the nonmoving party"

Matsushita Elec. Indus. Co. v. Zenith Radio

Holding that, on summary judgment, antitrust plaintiffs "must show that the inference of conspiracy is reasonable in light of the competing inferences of independent action or collusive action that could not have harmed" them

Daubert v. Merrell Dow Pharmaceuticals, Inc.

Holding that a trial judge must ensure that all admitted expert testimony "is not only relevant, but reliable"

Wal-Mart Stores, Inc. v. Dukes

Holding in Rule 23 context that “[w]ithout some glue holding the alleged reasons for all those decisions together, it will be impossible to say that examination of all the class members' claims for relief will produce a common answer”

Tyson Foods, Inc. v. Bouaphakeo

Holding "persuasiveness is, in general, a matter for the jury" and not grounds for denying class certification unless "no reasonable juror could have believed" plaintiffs' evidence of an essential element of their claim

Bowen v. Georgetown University Hospital

Holding that courts will not defer to an agency's litigating position where it contradicts the agency's prior “regulations, rulings, or administrative practice”

Thomas Jefferson Univ. v. Shalala

Holding that "the agency’s interpretation must be given controlling weight unless it is plainly erroneous or inconsistent with the regulation"

Heckler v. Ringer

Holding that plaintiffs' claims were not wholly collateral to a statutory scheme of administrative and judicial review of Medicare payment decisions, where plaintiffs' constitutional and statutory challenge to an agency's procedure for reaching payment decisions was "at bottom" an attempt to reverse the agency's decision to deny payment

Brainard v. Sec. of Health and Human Services

Defining substantial evidence as "more than a scintilla of evidence but less than a preponderance"

U.S. ex Rel. Willard v. Humana Health Plan

Holding that the district court did not abuse its discretion in not allowing the plaintiff to amend its complaint because the plaintiff had already had two opportunities to amend their complaint

Rule 56 - Summary Judgment

Holding a party may move for summary judgment on any part of any claim or defense in the lawsuit

Section 405 - Evidence, procedure, and certification for payments

Ruling out jurisdiction under 28 U.S.C. §§ 1331, 1346

Rule 702 - Testimony by Expert Witnesses

Adopting the Daubert standard

Section 3729 - False claims

Holding liable "any person" who knowingly causes false claims to be presented

Section 3730 - Civil actions for false claims

Granting the government primary responsibility for conducting suit

Section 551 - Definitions

Adopting the definition set out in the APA

Section 1320a-7b - Criminal penalties for acts involving Federal health care programs

Prohibiting the solicitation or receipt of "remuneration" in exchange for referrals

Section 1395y - Exclusions from coverage and medicare as secondary payer

Granting the government subrogation rights

Section 1395x - Definitions

Stating that the regulations "may provide for using different methods in different circumstances"

Section 1395ff - Determinations; appeals

Adopting the Social Security statute 42 U.S.C. § 405(g), which confers on federal courts the jurisdiction to hear Medicare claims after administrative review has been exhausted

Section 1001.952 - Exceptions

Concerning "payment made by a lessee to a lessor"

Section 405.940 - Right to a redetermination

Section 405.1130 - Effect of the Council's decision

Describing when an administrative appeals decision becomes binding on the parties

Section 418.22 - Certification of terminal illness

Stating "general rule" that hospice provider "must obtain written certification of terminal illness" for each claimed period of care

Section 405.902 - Definitions

Defining fiscal intermediary

Section 405.980 - Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews

Defining a reopening as "a remedial action taken to change a final determination or decision that resulted in either an overpayment or underpayment"

Section 405.926 - Actions that are not initial determinations

Providing that a determination that a claim is "incomplete, invalid, or do[es] not meet the requirements for a Medicare claim" is not appealable

Section 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services

Section 418.25 - Admission to hospice care

Establishing that, "[i]n reaching a decision to certify that the patient is terminally ill, the hospice medical direct must consider at least" the diagnosis of the patient, other health conditions, and "[c]urrent clinically relevant information supporting all diagnoses"

Section 418.26 - Discharge from hospice care