§Why CasetextPricing

Prime Healthcare Services San Dimas, Llc v. Sylvia Mathews Burwell

NOTICE OF MOTION AND MOTION to Dismiss Case ; Declaration of Lynn Healey Scaduto in Support Thereof

26 Cited authorities

  1. Bell Atl. Corp. v. Twombly

    550 U.S. 544 (2007)   Cited 279,387 times   369 Legal Analyses
    Holding that allegations of conduct that are merely consistent with wrongdoing do not state a claim unless "placed in a context that raises a suggestion of" such wrongdoing

  2. Balistreri v. Pacifica Police Dept

    901 F.2d 696 (9th Cir. 1988)   Cited 16,498 times   5 Legal Analyses
    Holding that a cognizable gender discrimination claim could be brought by a female domestic violence victim where the victim alleged police denied protection and made misogynistic comments including that "he did not blame [the victim's] husband for hitting her, because of the way she was 'carrying on'"

  3. Dickinson v. Zurko

    527 U.S. 150 (1999)   Cited 1,022 times   20 Legal Analyses
    Holding that the more deferential substantial-evidence standard, and not the "stricter" and less deferential clear-error standard, applies to challenges to Patent and Trademark Office's patent denials, as it does to other agencies

  4. Usher v. City of Los Angeles

    828 F.2d 556 (9th Cir. 1987)   Cited 2,138 times
    Holding that plaintiffs significantly prejudiced where effect of new rule is to shorten limitations period such that they have no opportunity to follow new rule

  5. Levitt v. Yelp! Inc.

    765 F.3d 1123 (9th Cir. 2014)   Cited 482 times   2 Legal Analyses
    Holding that business owners failed to sufficiently allege that Yelp wrongfully threatened economic loss because Yelp had the right to charge them for legitimate advertising services

  6. Kappos v. Hyatt

    566 U.S. 431 (2012)   Cited 119 times   14 Legal Analyses
    Holding that when a federal district court reviews a decision of the USPTO Board of Patent Appeals and Interferences, the district court must make "de novo" factual findings based on the new evidence and the administrative record

  7. United States Postal Service v. Gregory

    534 U.S. 1 (2001)   Cited 148 times   1 Legal Analyses
    Holding that "a presumption of regularity attaches to the actions of Government agencies"

  8. Barnes v. United States Dep't of Transp.

    655 F.3d 1124 (9th Cir. 2011)   Cited 119 times
    Holding that issue was exhausted when agency had independent knowledge of EA flaw

  9. Monjaraz-Munoz v. I.N.S.

    327 F.3d 892 (9th Cir. 2003)   Cited 149 times
    In Monjaraz-Munoz v. INS, 327 F.3d 892 (9th Cir. 2003), the petitioner failed to appear at his hearing because he had been advised by his attorney to travel to Mexico the day before the hearing in order to validate his visa, only to be detained at the border and denied readmission into the United States.

  10. Monjaraz-Munoz v. I.N.S.

    339 F.3d 1012 (9th Cir. 2003)   Cited 51 times
    Explaining that an agency's findings are upheld "unless the evidence presented would compel a reasonable finder of fact to reach a contrary result"

  11. Rule 12 - Defenses and Objections: When and How Presented; Motion for Judgment on the Pleadings; Consolidating Motions; Waiving Defenses; Pretrial Hearing

    Fed. R. Civ. P. 12   Cited 360,917 times   954 Legal Analyses
    Granting the court discretion to exclude matters outside the pleadings presented to the court in defense of a motion to dismiss

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

    42 U.S.C. § 405   Cited 161,186 times   34 Legal Analyses
    Ruling out jurisdiction under 28 U.S.C. §§ 1331, 1346

  13. Section 701 - Application; definitions

    5 U.S.C. § 701   Cited 9,573 times   39 Legal Analyses
    Adopting the definition given in Section 551

  14. Section 1395ff - Determinations; appeals

    42 U.S.C. § 1395ff   Cited 809 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

  15. Section 1395kk-1 - Contracts with medicare administrative contractors

    42 U.S.C. § 1395kk-1   Cited 108 times   1 Legal Analyses
    Granting authority to MACs for payment functions, including the "[d]etermination of payment amounts"

  16. Section 405.1100 - Medicare Appeals Council review: General

    42 C.F.R. § 405.1100   Cited 107 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

  17. Section 405.1136 - Judicial review

    42 C.F.R. § 405.1136   Cited 72 times
    Referring to §405.1006(c)

  18. 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

  19. Section 405.1132 - Request for escalation to Federal court

    42 C.F.R. § 405.1132   Cited 36 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

  20. Section 405.968 - Conduct of a reconsideration

    42 C.F.R. § 405.968   Cited 30 times

    (a)General rules. (1) A reconsideration consists of an independent, on-the-record review of an initial determination, including the redetermination and all issues related to payment of the claim. In conducting a reconsideration, the QIC reviews the evidence and findings upon which the initial determination, including the redetermination, was based, and any additional evidence the parties submit or that the QIC obtains on its own. If the initial determination involves a finding on whether an item

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

    42 C.F.R. § 405.980   Cited 26 times   7 Legal Analyses
    Defining a reopening as "a remedial action taken to change a final determination or decision that resulted in either an overpayment or underpayment"

  22. Section 405.1006 - Amount in controversy required for an ALJ hearing and judicial review

    42 C.F.R. § 405.1006   Cited 19 times   1 Legal Analyses

    (a)Definitions. For the purposes of aggregating claims to meet the amount in controversy requirement for an ALJ hearing or judicial review: (1) "Common issues of law and fact" means the claims sought to be aggregated are denied, or payment is reduced, for similar reasons and arise from a similar fact pattern material to the reason the claims are denied or payment is reduced. (2) "Delivery of similar or related services" means like or coordinated services or items provided to one or more beneficiaries

  23. Section 405.1108 - Council actions when request for review or escalation is filed

    42 C.F.R. § 405.1108   Cited 16 times   1 Legal Analyses

    (a) Except as specified in paragraphs (c) and (d) of this section, when a party requests that the Council review an ALJ's or attorney adjudicator's decision, the Council will review the ALJ's or attorney adjudicator's decision de novo. The party requesting review does not have a right to a hearing before the Council. The Council will consider all of the evidence in the administrative record. Upon completion of its review, the Council may adopt, modify, or reverse the ALJ's or attorney adjudicator's