Section 401 - Trust Funds

2 Analyses of this statute by attorneys

  1. A Potential Route to RADV Judicial Review: Part II

    Reed SmithJames SegrovesApril 25, 2023

    was a party, irrespective of the amount in controversy, may obtain a review of such decision by a civil action commenced within sixty days after the mailing to him of notice of such decision .... Such action shall be brought in the district court of the United States for the judicial district in which the plaintiff resides, or has his principal place of business ....(h) Finality of Commissioner’s decisionThe findings and decision of the Commissioner of Social Security after a hearing shall be binding upon all individuals who were parties to such hearing. No findings of fact or decision of the Commissioner of Social Security shall be reviewed by any person, tribunal, or governmental agency except as herein provided. No action against the United States, the Commissioner of Social Security, or any officer or employee thereof shall be brought under section 1331 ... of title 28 [i.e., the federal-question statute] to recover on any claim arising under this subchapter [i.e., subchapter II, 42 U.S.C. §§401–434].Readers of our previous installment will recall that despite its references to the “Commissioner of Social Security” and subchapter II, §405 is relevant to Medicare because the Medicare Act cross-references particular subsections of §405. See 42 U.S.C. §1395ii. Particularly astute readers, however, will recall that the first two subsections block-quoted above—subsections (b) and (g)—are not so cross-referenced by the Medicare Act. Instead, specific portions of the Medicare Act confined to particular categories of disputes expressly provide for a subsection (b) hearing and subsequent judicial review under subsection (g) by expressly cross-referencing those subsections as they appear in §405. See, e.g., 42 U.S.C. §§1395w-22(g)(5), 1395cc(h)(1)(A), 1395ff(b)(1)(A), 1395rr(g)(3).Not so in the RADV context.That fact may ultimately prove to MA organizations’ benefit. Why? Because the Supreme Court has interpreted §405(g)—which provides for judicial review “after any final decision of the [

  2. A Potential Route to RADV Judicial Review: Part I

    Reed SmithJames SegrovesApril 18, 2023

    ).So if the Medicare Act does not expressly provide for judicial review in the RADV context, what about using the so-called “federal-question statute,” 28 U.S.C. §1331? That statute provides that federal district courts “shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States.” And the Administrative Procedure Act provides that “[a] person suffering legal wrong because of agency action ... is entitled to judicial review thereof.” 5 U.S.C. §702.Reliance on the federal-question statute is potentially complicated in this instance by a statutory provision outside the Medicare Act: namely, 42 U.S.C. §405(h). Section405(h)’s third sentence states that “[n]o action against the United States, the Commissioner of Social Security, or any officer or employee thereof shall be brought under section 1331 ... of title 28 [i.e., the federal-question statute] to recover on any claim arising under this subchapter [i.e., subchapter II, 42 U.S.C. §§401–434].”But wait? What’s this about the “Commissioner of Social Security” and claims arising under subchapter II? I thought we were talking about Medicare.Well, the Medicare Act states that the “provisions of ... subsections (a), (d), (e), (h), (i), (j), (k), and (l) of section 405 of this title, shall also apply with respect to this subchapter [i.e., the Medicare Act] to the same extent as they are applicable with respect to subchapter II, except that, in applying such provisions with respect to [the Medicare Act], any reference therein to the Commissioner of Social Security or the Social Security Administration shall be considered a reference to the Secretary [of Health and Human Services] or the Department of Health and Human Services, respectively.” 42 U.S.C. §1395ii (emphasis added). And in the past, the Secretary has argued that §405(h)’s third sentence precludes reliance on the federal-question statute in the Medicare context as a whole. However, the Supreme Court of the United State