§Why CasetextPricing

Porzecanski v. Burwell

Cross MOTION for Summary Judgment and Opposition to Plaintiff's Motion for Summary Judgment

59 Cited authorities

  1. Lujan v. Defs. of Wildlife

    504 U.S. 555 (1992)   Cited 27,995 times   138 Legal Analyses
    Holding that the elements of standing "must be supported in the same way as any other matter on which the plaintiff bears the burden of proof"

  2. INS v. Elias-Zacarias

    502 U.S. 478 (1992)   Cited 5,130 times
    Holding that central to the asylum statute is that persecution must be on account of a statutorily protected ground, making the assailant's "motive critical"

  3. Citizens to Preserve Overton Park v. Volpe

    401 U.S. 402 (1971)   Cited 5,975 times   8 Legal Analyses
    Holding a decision is committed to agency discretion when there is "no law to apply"

  4. Nat'l Assoc. Home v. Defenders of Wildlife

    551 U.S. 644 (2007)   Cited 873 times   8 Legal Analyses
    Holding that a stray erroneous statement in the Federal Register "which could have had no effect on the underlying agency action being challenged" is not "the type of error that requires a remand"

  5. Thomas Jefferson Univ. v. Shalala

    512 U.S. 504 (1994)   Cited 1,277 times   5 Legal Analyses
    Holding that "the agency’s interpretation must be given controlling weight unless it is plainly erroneous or inconsistent with the regulation"

  6. Heckler v. Ringer

    466 U.S. 602 (1984)   Cited 1,756 times   2 Legal Analyses
    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

  7. Burlington Truck Lines v. U.S.

    371 U.S. 156 (1962)   Cited 1,947 times   3 Legal Analyses
    Holding a rule invalid under the APA where "the Commission made no findings specifically directed to the choice between two vastly different remedies with vastly different consequences to the carriers and the public . . . [and failed to] articulate any rational connection between the facts found and the choice made"

  8. Shalala v. Guernsey Memorial Hospital

    514 U.S. 87 (1995)   Cited 424 times   8 Legal Analyses
    Holding that interpretive rules, which are not subject to the notice and comment procedure, are not accorded the weight that regulations are given

  9. PDK Laboratories Inc. v. United States Drug Enforcement Administration

    362 F.3d 786 (D.C. Cir. 2004)   Cited 537 times
    Holding that where there is ambiguity in the statutory text “it is incumbent upon the agency not to rest simply on its parsing of the statutory language. It must bring its experience and expertise to bear in light of competing interests at stake.”

  10. Kuo-Yun Tao v. Freeh

    27 F.3d 635 (D.C. Cir. 1994)   Cited 497 times
    Holding that "the First Amendment protects government employees from even an act as trivial as failing to hold a birthday party for a public employee . . . when intended to punish her for exercising her free speech rights"

  11. Rule 56 - Summary Judgment

    Fed. R. Civ. P. 56   Cited 329,613 times   158 Legal Analyses
    Holding a party may move for summary judgment on any part of any claim or defense in the lawsuit

  12. Section 405 - Evidence, procedure, and certification for payments

    42 U.S.C. § 405   Cited 156,900 times   34 Legal Analyses
    Ruling out jurisdiction under 28 U.S.C. §§ 1331, 1346

  13. Section 1331 - Federal question

    28 U.S.C. § 1331   Cited 97,806 times   136 Legal Analyses
    Finding that in order to invoke federal question jurisdiction, a plaintiff's claims must arise "under the Constitution, laws, or treaties of the United States."

  14. Section 706 - Scope of review

    5 U.S.C. § 706   Cited 20,497 times   185 Legal Analyses
    Granting courts jurisdiction to "compel agency action unlawfully held or unreasonably delayed"

  15. Section 1395 - Prohibition against any Federal interference

    42 U.S.C. § 1395   Cited 2,267 times   29 Legal Analyses
    Addressing Medicare's reimbursement for diagnostic laboratory services for hospital outpatients

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

    42 U.S.C. § 1395y   Cited 1,301 times   66 Legal Analyses
    Granting the government subrogation rights

  17. Section 1395x - Definitions

    42 U.S.C. § 1395x   Cited 1,162 times   40 Legal Analyses
    Stating that the regulations "may provide for using different methods in different circumstances"

  18. Section 1395ff - Determinations; appeals

    42 U.S.C. § 1395ff   Cited 795 times   21 Legal Analyses
    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

  19. Section 1395c - Description of program

    42 U.S.C. § 1395c   Cited 499 times
    Referring to 42 U.S.C. § 402, 414

  20. Section 1395u - Provisions relating to the administration of part B

    42 U.S.C. § 1395u   Cited 385 times   5 Legal Analyses
    Granting authority to utilize private insurance carriers for administration of Part B claims

  21. Section 405.1100 - Medicare Appeals Council review: General

    42 C.F.R. § 405.1100   Cited 104 times   2 Legal Analyses

    (a) The appellant or any other party to an ALJ's or attorney adjudicator's decision or dismissal may request that the Council review the ALJ's or attorney adjudicator's decision or dismissal. (b) Under circumstances set forth in §§ 405.1016 and 405.1108 , the appellant may request that a case be escalated to the Council for a decision even if the ALJ or attorney adjudicator has not issued a decision, dismissal, or remand in his or her case. (c) When the Council reviews an ALJ's or attorney adjudicator's

  22. Section 405.1130 - Effect of the Council's decision

    42 C.F.R. § 405.1130   Cited 70 times
    Describing when an administrative appeals decision becomes binding on the parties

  23. Section 405.1000 - Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule

    42 C.F.R. § 405.1000   Cited 64 times   1 Legal Analyses
    Stating that parties at a hearing before an ALJ may submit and examine evidence, and present and question witnesses

  24. Section 400.202 - Definitions specific to Medicare

    42 C.F.R. § 400.202   Cited 55 times   5 Legal Analyses
    Defining "beneficiary" as the "person who is entitled to Medicare benefits"

  25. Section 405.960 - Right to a reconsideration

    42 C.F.R. § 405.960   Cited 52 times

    A person or entity that is a party to a redetermination made by a contractor as described under § 405.940 through § 405.958 , and is dissatisfied with that determination, may request a reconsideration by a QIC in accordance with § 405.962 through § 405.966 , regardless of the amount in controversy. 42 C.F.R. §405.960

  26. Section 405.1062 - Applicability of local coverage determinations and other policies not binding on the ALJ or attorney adjudicator and Council

    42 C.F.R. § 405.1062   Cited 48 times

    (a) ALJs and attorney adjudicators and the Council are not bound by LCDs, LMRPs, or CMS program guidance, such as program memoranda and manual instructions, but will give substantial deference to these policies if they are applicable to a particular case. (b) If an ALJ or attorney adjudicator or Council declines to follow a policy in a particular case, the ALJ or attorney adjudicator or Council decision must explain the reasons why the policy was not followed. An ALJ or attorney adjudicator or Council

  27. Section 405.1132 - Request for escalation to Federal court

    42 C.F.R. § 405.1132   Cited 33 times

    (a) If the Council does not issue a decision or dismissal or remand the case to an ALJ or attorney adjudicator within the adjudication period specified in § 405.1100 , or as extended as provided in this subpart, the appellant may request that the appeal, other than an appeal of an ALJ or attorney adjudicator dismissal, be escalated to Federal district court. Upon receipt of a request for escalation, the Council may- (1) Issue a decision or dismissal or remand the case to an ALJ or attorney adjudicator

  28. Section 405.1060 - Applicability of national coverage determinations (NCDs)

    42 C.F.R. § 405.1060   Cited 32 times

    (a)General rule. (1) An NCD is a determination by the Secretary of whether a particular item or service is covered nationally under Medicare. (2) An NCD does not include a determination of what code, if any, is assigned to a particular item or service covered under Medicare or a determination of the amount of payment made for a particular item or service. (3) NCDs are made under section 1862(a)(1) of the Act as well as under other applicable provisions of the Act. (4) An NCD is binding on fiscal

  29. Section 405.1102 - Request for Council review when ALJ or attorney adjudicator issues decision or dismissal

    42 C.F.R. § 405.1102   Cited 14 times

    (a) (1) A party to a decision or dismissal issued by an ALJ or attorney adjudicator may request a Council review if the party files a written request for a Council review within 60 calendar days after receipt of the ALJ's or attorney adjudicator's decision or dismissal. (2) For purposes of this section, the date of receipt of the ALJ's or attorney adjudicator's decision or dismissal is presumed to be 5 calendar days after the date of the notice of the decision or dismissal, unless there is evidence

  30. Section 405.1048 - The effect of an ALJ's or attorney adjudicator's decision

    42 C.F.R. § 405.1048   Cited 12 times

    (a) The decision of the ALJ or attorney adjudicator on a request for hearing is binding on all parties unless- (1) A party requests a review of the decision by the Council within the stated time period or the Council reviews the decision issued by an ALJ or attorney adjudicator under the procedures set forth in § 405.1110 , and the Council issues a final decision or remand order or the appeal is escalated to Federal district court under the provisions at § 405.1132 and the Federal district court