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Bowen v. Mich. Acad. of Family Physicians - 476 U.S. 667, 106 S. Ct. 2133 (1986)

Rule:

There is a strong presumption that Congress intends judicial review of administrative action. Judicial review of a final agency action by an aggrieved person will not be cut off unless there is persuasive reason to believe that such was the purpose of Congress. 

Facts:

Plaintiffs Michigan Academy of Family Physicians ("Academy") and several individual doctors filed a lawsuit against defendant Otis R. Bowen, the Secretary of Health and Human Services ("Secretary"), in federal district court challenging the validity of 42 C.F.R. § 405.504(b), which authorized the payment of benefits under Part B of the Medicare program in different amounts for similar physicians' services. The district court held that the regulation, to the extent it authorized different reimbursement rates for certain physicians, contravened the governing Medicare statutes, 42 U.S.C.S. § 1395 et seq. Initially, the court of appeals affirmed, expressing the view that: (1) the regulation was invalid due to its failure to recognize a statutory mandate that similar physicians' services be considered identically, and; (2) judicial review was not precluded either by 42 U.S.C.S. § 405(h) as incorporated into the Medicare program under 42 U.S.C.S. § 1395ii, or by 42 U.S.C.S. § 1395ff. After further proceedings, the court of appeals eventually reaffirmed its conclusion that the validity of the regulation was subject to judicial review. The Secretary sought certiorari, contending that § 1395ff or § 1395ii barred judicial review of regulations promulgated under the statute.

Issue:

Was judicial review of the validity of a regulation promulgated under Part B of the Medicare program precluded by §§ 1395ff or 1395ii?

Answer:

No.

Conclusion:

The Supreme Court of the United States affirmed the judgment of the court of appeals. Beginning its analysis with the strong presumption favoring judicial review of agency action, the Court concluded that those matters that Congress did not leave to be determined in a "fair hearing" conducted by the particular private health insurance carrier, including challenges to the validity of the Secretary's instructions and regulations, were not impliedly insulated from judicial review by 42 U.S.C.S. § 1395ff. The Court further held that in § 1395ii Congress intended to foreclose review only of "amount determinations" remitted exclusively to adjudication by private insurance carriers in a "fair hearing."

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