42 CFR 405.968 - Conduct of a reconsideration
| Cite as | 42 CFR 405.968 |
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34 practice notes
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Agendia, Inc. v. Becerra, Nos. 19-56516
...of administrative review conducted by the qualified independent contractor, an ALJ, or the Council. Id. § 1395ff(c)(3)(B)(ii)(II) ; 42 C.F.R. §§ 405.968(b)(2)–(3), 405.1062(a) – (b). Still, qualified independent contractors, ALJs, and the Council all owe "substantial deference" to......
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In Touch Home Health Agency, Inc. v. Azar, Case No. 19 C 1545
...agree or disagree with the previous determination. See 42 U.S.C. § 1395ff(a)(5), (c)(3)(E) ; 42 C.F.R. §§ 405.946, 405.956(b), 405.966, 405.968(a), 405.976(b). If the QIC upholds an overpayment determination on reconsideration, CMS can begin recouping the overpayment even though the adminis......
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Executive Dir. Of The Office Of Vt. Health Access O/b/o Francis Carey v. Sebelius, Case No. 2:08-CV-168.
...by a qualified independent contractor (“QIC”), in this case Maximus Federal Services, see 42 U.S.C. § 1395ff(c)(3)(B)(i); 42 C.F.R. § 405.968. If the claimant is dissatisfied with the decision of the QIC, and the amount in controversy exceeds a certain threshold amount, the claimant may req......
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Willowood of Great Barrington, Inc. v. Sebelius, C.A. No. 08-CV-30076-MAP.
...then a redetermination by a "qualified independent contractor"—in this case, Maximus—see 42 U.S.C. § 1395ff(c)(3)(B)(i) and 42 C.F.R. § 405.968. If the claimant remains dissatisfied with the decision and the amount in controversy exceeds a certain threshold amount, the claimant ma......
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35 cases
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Agendia, Inc. v. Becerra, Nos. 19-56516
...of administrative review conducted by the qualified independent contractor, an ALJ, or the Council. Id. § 1395ff(c)(3)(B)(ii)(II) ; 42 C.F.R. §§ 405.968(b)(2)–(3), 405.1062(a) – (b). Still, qualified independent contractors, ALJs, and the Council all owe "substantial deference" to a relevan......
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Willowood of Great Barrington, Inc. v. Sebelius, C.A. No. 08-CV-30076-MAP.
...and then a redetermination by a "qualified independent contractor"—in this case, Maximus—see 42 U.S.C. § 1395ff(c)(3)(B)(i) and 42 C.F.R. § 405.968. If the claimant remains dissatisfied with the decision and the amount in controversy exceeds a certain threshold amount, the claimant may requ......
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Almy v. Sebelius, Civil Action No. RDB–08–1245.
...and necessary, then the QIC must consider input from a panel of physicians or other appropriate health care professionals. 42 C.F.R. §§ 405.968(a)(1) and (c)(3). The QIC's “reconsideration,” which is non-precedential, may be further appealed to an Administrative Law Judge (“ALJ”). 42 C.F.R.......
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In Touch Home Health Agency, Inc. v. Azar, Case No. 19 C 1545
...agree or disagree with the previous determination. See 42 U.S.C. § 1395ff(a)(5), (c)(3)(E) ; 42 C.F.R. §§ 405.946, 405.956(b), 405.966, 405.968(a), 405.976(b). If the QIC upholds an overpayment determination on reconsideration, CMS can begin recouping the overpayment even though the adminis......
Request a trial to view additional results