§Why CasetextPricing

Prime Healthcare Services - Sherman Oaks, Llc v. Sylvia Mathews Burwell

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

31 Cited authorities

  1. Bell Atl. Corp. v. Twombly

    550 U.S. 544 (2007)   Cited 265,662 times   364 Legal Analyses
    Holding that a complaint's allegations should "contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face' "

  2. Balistreri v. Pacifica Police Dept

    901 F.2d 696 (9th Cir. 1988)   Cited 15,949 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 950 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. Cafasso v. General Dynamics C4 Systems

    637 F.3d 1047 (9th Cir. 2011)   Cited 2,479 times   15 Legal Analyses
    Holding a complaint failed to satisfy Rule 9(b) where the allegations were lacking in detail

  5. Usher v. City of Los Angeles

    828 F.2d 556 (9th Cir. 1987)   Cited 2,076 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

  6. Levitt v. Yelp! Inc.

    765 F.3d 1123 (9th Cir. 2014)   Cited 451 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

  7. Kappos v. Hyatt

    566 U.S. 431 (2012)   Cited 117 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

  8. United States Postal Service v. Gregory

    534 U.S. 1 (2001)   Cited 142 times   1 Legal Analyses
    Holding that "a presumption of regularity attaches to the actions of Government agencies"

  9. Greenhow v. Sec. of Health Human Services

    863 F.2d 633 (9th Cir. 1988)   Cited 269 times
    Holding that arguments raised for the first time to the district court reviewing a magistrate's report were waived explaining that the "Magistrates Act was [not] intended to give litigants an opportunity to run one version of their case past the magistrate, then another past the district court"

  10. U.S. v. Hardesty

    977 F.2d 1347 (9th Cir. 1992)   Cited 227 times
    Holding that a district court's refusal to hear a new argument not presented to the Magistrate Judge is "entirely appropriate" because "[w]e do not believe that the Magistrates Act was intended to give litigants an opportunity to run one version of their case past the magistrate, then another past the district court"

  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 344,767 times   920 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 155,985 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 9,353 times   36 Legal Analyses
    Adopting the definition given in Section 551

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

    42 U.S.C. § 1395y   Cited 1,296 times   66 Legal Analyses
    Granting the government subrogation rights

  15. Section 1395ff - Determinations; appeals

    42 U.S.C. § 1395ff   Cited 792 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

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

    42 U.S.C. § 1395kk-1   Cited 104 times   1 Legal Analyses
    Granting authority to MACs for payment functions, including the "[d]etermination of payment amounts"

  17. Section 405.1100 - Medicare Appeals Council review: General

    42 C.F.R. § 405.1100   Cited 103 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

  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 405.1136 - Judicial review

    42 C.F.R. § 405.1136   Cited 69 times
    Referring to §405.1006(c)

  20. 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

  21. Section 405.968 - Conduct of a reconsideration

    42 C.F.R. § 405.968   Cited 29 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

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

    42 C.F.R. § 405.980   Cited 25 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"

  23. 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

  24. 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