42 CFR 405.968 - Conduct of a reconsideration

Cite as42 CFR 405.968
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34 practice notes
  • Agendia, Inc. v. Becerra, Nos. 19-56516
    • United States
    • United States Courts of Appeals. United States Court of Appeals (9th Circuit)
    • 16 Julio 2021
    ...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......
  • In Touch Home Health Agency, Inc. v. Azar, Case No. 19 C 1545
    • United States
    • United States District Courts. 7th Circuit. United States District Court (Northern District of Illinois)
    • 24 Octubre 2019
    ...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......
  • Executive Dir. Of The Office Of Vt. Health Access O/b/o Francis Carey v. Sebelius, Case No. 2:08-CV-168.
    • United States
    • United States District Courts. 2nd Circuit. District of Vermont
    • 15 Marzo 2010
    ...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......
  • Willowood of Great Barrington, Inc. v. Sebelius, C.A. No. 08-CV-30076-MAP.
    • United States
    • United States District Courts. 1st Circuit. United States District Courts. 1st Circuit. District of Massachusetts
    • 28 Julio 2009
    ...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
  • Agendia, Inc. v. Becerra, Nos. 19-56516
    • United States
    • United States Courts of Appeals. United States Court of Appeals (9th Circuit)
    • 16 Julio 2021
    ...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......
  • Willowood of Great Barrington, Inc. v. Sebelius, C.A. No. 08-CV-30076-MAP.
    • United States
    • United States District Courts. 1st Circuit. United States District Courts. 1st Circuit. District of Massachusetts
    • 28 Julio 2009
    ...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......
  • Almy v. Sebelius, Civil Action No. RDB–08–1245.
    • United States
    • United States District Courts. 1st Circuit. United States District Courts. 1st Circuit. District of Massachusetts
    • 3 Septiembre 2010
    ...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.......
  • In Touch Home Health Agency, Inc. v. Azar, Case No. 19 C 1545
    • United States
    • United States District Courts. 7th Circuit. United States District Court (Northern District of Illinois)
    • 24 Octubre 2019
    ...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

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