Your Home Visiting Nurse Services, Inc. v. Donna E. Shalala, Secretary of Health and Human Services (525 U.S. 449)
U.S. Supreme Court · decided February 23, 1999 · Supreme Court Database (Spaeth)
- Citation
- 525 U.S. 449 · 119 S. Ct. 930
- Decided
- February 23, 1999
- Term
- October Term 1998
- Vote
- 9–0
- Majority author
- Justice Scalia
- Issue area
- Judicial Power
- Disposition
- Affirmed
- Outcome
- Petitioning party lost
- Ideological direction
- Conservative
Opinion excerpt
Justice Scalia delivered the opinion of the Court. Under the Medicare Act, Title XVIII of the Social Security Act, 79 Stat. 290, as amended, 42 U. S. C. § 1395 et seq. (1994 ed. and Supp. II), the Secretary of Health and Human Services reimburses the providers of covered health services to Medicare beneficiaries, see §§ 1395f(b)(l), 1395h, 1395x(v)(l)(A). A provider seeking such reimbursement submits a yearly cost report to a fiscal intermediary (generally a private insurance company) that acts as the Secretary’s agent. See 42 CFR § 405.1801(b) (1997). The intermediary analyzes the cost report and issues a Notice of Program Reimbursement (NPR) determining the amount of reimbursement to which the provider is entitled for the year. See §405.1803. As is relevant here, a dissatisfied provider has two ways to get this determination revised. First, a provision of the Medicare Act, 42 U. S. C. § 1395oo, allows a provider to appeal, within 180 days, to the Provider Reimbursement Review Board (Board) — an administrative review panel that has the power to conduct an evidentiary hearing and affirm, modify, or reverse the intermediary’s NPR determination. The Board’s decision is subject to judicial review in federal district court. § 1395oo(f). Second, one of the Secretary’s regulations, 42 CFR §405.1885 (1997), permits a provider to request the intermediary, within three years, to…
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