Brief Fact Summary. Michigan Academy of Family Physicians (Respondents) filed suit
to challenge the validity of Section:405.504(b) of Title 42 of the United States Code (Code),
which authorized the payment of benefits in different amounts for similar physicians’
services. The Secretary of Health and Human Services (Secretary) contended that
Congress had forbidden judicial review of all questions affecting the amount of benefits
payable under Part B of the Medicare program.
Synopsis of Rule of Law. The Court begins with the strong presumption that Congress
intends judicial review of administrative action. This presumption will not be overcome
without “persuasive reason to believe that such was the purpose of Congress.”
The Manual provides, in pertinent part: the hearing officer may not overrule the provisions of the law or interpret them in a way different than HCFA does when he disagrees with their intent; nor may he use hearing decisions as a vehicle for commenting upon the legality, constitutional or otherwise, of any provision of the Act or regulations relevant to the Medicare Program.View Full Point of Law
Both the District Court and the Court of Appeals rejected the Secretary’s contention of
Issue. Did Congress, in either Code Section:1395ff or Section:1395ii, bar judicial review of
regulations promulgated under Part B of the Medicare program?
Held. Affirmed. No.
A careful analysis of the statutory provisions and legislative history of
Section:1395ff revealed that Congress intended to bar judicial review only of
determinations of the amount of benefits to be awarded under Part B.
A review of the legislative history of SSA Section:405(h) and Code Section:1395ii revealed
that Congress intended to foreclose review only of “amount determinations.”
Discussion. This was a unanimous decision regarding express preclusion by the