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Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1, 8 (2000)

Legal Research Home > United States Supreme Court > 529 U.S. > Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1, 8 (2000)

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SHALALA v. ILLINOIS COUNCIL ON LONG TERM CARE, INC.

Opinion of the Court

set of statutory provisions, which must be read together. See Appendix, infra. The Medicare Act says that a home

"dissatisfied . . . with a determination described in subsection (b)(2) . . . shall be entitled to a hearing . . . to the same extent as is provided in [the Social Security Act, 42 U. S. C. § ]405(b) . . . and to judicial review of the Secretary's final decision after such hearing as is provided in section 405(g) . . . ." 42 U. S. C. § 1395cc(h)(1) (emphasis added).

The cross-referenced subsection (b)(2) gives the Secretary power to terminate an agreement where, for example, the Secretary

"has determined that the provider fails to comply substantially with the provisions [of the Medicare Act] and regulations thereunder . . . ." § 1395cc(b)(2)(A) (emphasis added).

The cross-referenced § 405(b) describes the nature of the administrative hearing to which the Medicare Act entitles a home that is "dissatisfied" with the Secretary's "determination." The cross-referenced § 405(g) provides that a "dissatisfied" home may obtain judicial review in federal district court of "any final decision of the [Secretary] made after a hearing . . . ." Separate statutes provide for administrative and judicial review of civil monetary penalty assessments. § 1395i-3(h)(2)(B)(ii); §§ 1320a-7a(c)(2), (e).

A related Social Security Act provision, § 405(h), channels most, if not all, Medicare claims through this special review system. It says:

"(h) Finality of [Secretary's] decision.

"The findings and decision of the [Secretary] after a hearing shall be binding upon all individuals who were parties to such hearing. No findings of fact or decision of the [Secretary] shall be reviewed by any person, tribunal, or governmental agency except as herein pro-

Last modified: October 4, 2007