Cluster 174336

See Uhm 620 F.3d at 1141-42 (“[W]here, at bottom, a plaintiff is complaining about a denial of Medicare benefits . . . the claim ‘arises under’ the Medicare Act.”).

Bureau of Prisons, 552 U.S. 214, 219 (2008) (alteration in original) (quoting United States v. Gonzales, 520 U.S. 1, 5 (1997)); accord Olympic Forest Coal. v. Coast Seafoods Co., 884 F.3d 901, 906 (9th Cir. 2018) (collecting cases for the proposition that the “any” is “broad and all-encompassing”); Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1153 (9th Cir. 2010) (“The word ‘any’ is generally used in the sense of ‘all’ or ‘every’ and its meaning is most comprehensive.”) (quot…

See Do Sung Uhm, 620 F.3d at 1141 (“Accordingly, we must determine whether any of the Uhms’ state law claims ‘arises under’ the Medicare Act.

See, e.g., Uhm, 620 F.3d at 1142-43 (“In sum, contrary to the Uhms’ argument, our case law establishes that where, at bottom, a plaintiff is complaining about the denial of Medicare benefits—here, drug benefits under Part D—the claim ‘arises under’ the Medicare Act.”).

See Do Sung Uhm v. Humana, Inc., 620 F.3d 1134 , 1142–43 (9th Cir. 2010) (“[W]here, at bottom, a plaintiff is complaining about the denial of Medicare benefits . . . the claim ‘arises under’ the Medicare Act.”). 2.

The Medicare Act has an exhaustion requirement, “42 U.S.C. § 405(h), [which] makes judicial review under a related provision, 42 U.S.C. § 405 (g), the sole avenue for judicial review for claims arising under the Medicare Act.” Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010) (internal quotations omitted).

A. EXHAUSTION The Medicare Act has an exhaustion requirement, “42 U.S.C. § 405(h), [which] makes judicial review under a related provision, 42 U.S.C. § 405 (g), the sole avenue for judicial review for claims arising under the Medicare Act.” Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010) (internal quotations omitted).

Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010).

Do Sung Uhm v. 9 Humana, Inc. (“Uhm”), 620 F.3d 1134, 1140 (9th Cir. 2010) (quoting Heckler v. 10 Ringer, 466 U.S. 602, 614-15 (1984)).

Plaintiffs’ claims are plainly subject to the Medicare Act’s exhaustion requirement because, at bottom, they are nothing more than “cleverly concealed claims for benefits.” Potts v. Rawlings Co., LLC, 897 F. Supp. 2d 185, 192 (S.D.N.Y. 2012) (internal quotation marks omitted) (quoting Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1141 (9th Cir. 2010)).

Hill, Inc. v. Shalala, 223 F.3d 354, 363 (6th Cir. 2000); provable "without regard to any provisions of the [Medicare] Act relating to provision of benefits," Do Song Uhm v. Humana, Inc., 620 F.3d 1134, 1145 (9th Cir. 2010); or capable of being "brought without reference to the Medicare Act," Nat'l Infusion Ctr.

Do Sung Uhm v. 6 Humana, Inc. (“Uhm”), 620 F.3d 1134, 1140 (9th Cir. 2010) (quoting Heckler v. 7 Ringer, 466 U.S. 602, 614-15 (1984)).

Co. of Fla., 653 F.3d 1108, 1110 (9th Cir. 2011) (set aside default judgment); Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010) (reconsideration); Roberts v. City of Honolulu, 938 F.3d 1020 , 1023 (9th Cir. 2019) (attorney’s fees).

Wash. Mar. 22, 2018), the Court does not consider 24 this request. 1 for Medicare benefits[.]” Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1141 (2010) (quoting 2 Heckler v. Ringer, 466 U.S. 602 , 614–15 (1984)).2 Neither circumstance exists here. 3 First, Washington law provides the substantive basis for Dr. Wang’s breach of contract 4 claim.

An individual who has been denied coverage cannot use a tort or breach of contract claim as “a backdoor attempt to enforce the Act’s requirements and to secure a remedy for [the Medicare Advantage organization’s] alleged failure to provide benefits.” Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1143 (9th Cir. 2010).

See also 7 Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1 , 8 10 (2000) (“Section 405(h) purports to make exclusive the 9 judicial review method set forth in § 405(g)”); Do Sung Uhm v. 10 Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010) (§ 405(g) is 11 “the sole avenue for judicial review for claims arising under the 12 Medicare Act”) (citations omitted); Kaiser v. Blue Cross of 13 California, 347 F.3d 1107, 1111 (9th Cir. 2003) (“Jurisdiction 14 over cases…

“The Courts of Appeals advise that courts should be wary of claims that are ‘cleverly concealed claims for benefits.’” Potts v. Rawlings Co., LLC, 897 F. Supp. 2d 185, 192 (S.D.N.Y. 2012) (quoting Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1141 (9th Cir. 2010)).

The court 18 found federal preemption applied because the plaintiff’s claims 19 were “inextricably intertwined with a claim for Medicare 20 benefits, and as such, arise under Medicare.” Id. at 26 . 21 Here, in contrast, Plaintiff’s state law claims are based 22 on “(1) the breach of a specific contractual provision in an 23 agreement; (2) the intentional inference of existing contractual 24 relations; and (3) [Defendant’s] false and intentional 25 misrepresentations (among o…

BJY Inc., 415 F.3d 1068 , 1072 (9th Cir. 2005) (attorney’s fees award); Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010) (motion for reconsideration).

Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1141 (9th Cir. 2010) (cleaned up). 22 As Plaintiff is disputing the alleged Medicare premiums deductions from his Social 23 Security benefits, his claim “arises under” the Medicare Act.

(Quesada, supra, 62 Cal.4th at p. 308 .) The provision reads in full: “The standards established under this part shall supersede any State law or regulation (other than State licensing laws or State laws relating to plan solvency) with respect to MA plans which are offered by MA organizations under this part.” (42 U.S.C. § 1395w-26(b)(3).) Although the term “standards” is not defined in the Medicare Act, we understand the phrase “[t]he standards established under this part” …

He cannot, however, assert a “breach of contract claim [as] a backdoor attempt to enforce the Act’s requirements and to secure a remedy for [Aetna’s] alleged failure to provide [coverage].” Do Sung Uhm Humana, Inc., 620 F.3d 1134, 1143 (9th Cir. 2010).

(Notice 27 of Removal ¶ 17.) Second, Love alleges she “has the defense that she is not the real party 28 in interest to this case.” (Id. ¶ 18.) Citing cases, Love claims “the Secretary, in his or her 1 official capacity as the Secretary of the HHS, is the proper governmental defendant in 2 Medicare cases, not the contractors who administer Medicare.” (Id.) 3 These defenses relate to the Medicare Act’s “exhaustion requirement, 42 U.S.C. § 4 405(h),” which “makes judicial revi…

Md. 2015) (quoting United States v. Blue Cross and Blue Shield of Ala., Inc., 156 F.3d 1098, 1103 (11th Cir. 1998)), and to prevent plaintiffs from circumventing that process by prematurely litigating “[c]leverly concealed claims for benefits,” Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1141 (9th Cir. 2010) (quoting Kaiser v. Blue Cross of Cal., 347 F.3d 1107 , 1112 (9th Cir. 2003)); accord Hopewell, 784 F.2d at 557– 58 (cautioning against “premature interference with the a…

Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010).

Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010).

“The Supreme Court has identified two circumstances in which a claim ‘arises under’ the Medicare Act: (1) where the standing and the substantive basis for the presentation of the claims is the Medicare Act; and (2) where the claims are inextricably intertwined with a claim for Medicare benefits.” Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1141 (9th Cir. 2010) (quotations and citations omitted).

(See Roberts, supra, 2 Cal.5th at p. 149 [“[C]laims based on misrepresentations in United Healthcare's marketing materials and based on the adequacy of its plan are impliedly preempted by the Act.”]; Yarick, supra, 179 Cal.App.4th at pp. 1167-1168 [“If state common law judgments were permitted to impose damages on the basis of these federally approved contracts and quality assurance programs, the federal authorities would lose control of the regulatory authority that is at t…

Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010).

The U.S. Court of Appeals for the Ninth Circuit has held that this provision could “preempt at least some common law claims.” Do Song Uhm v. Humana, Inc., 620 F.3d 1134, 1155 (9th Cir. 2010).

Defendants counter that Davidson’s claims 24 actually arise under the Medicare Act and are a disguised claim for denial of Medicare benefits 25 since each claim effectively alleges she was entitled to limit QVMC’s lien to the amount it would 26 have been reimbursed under Medicare. 27 “The Supreme Court has identified two circumstances in which a claim ‘arises under’ the 1 is the Medicare Act; and (2) where the claims are ‘inextricably intertwined’ with a claim for 2 Medicare…

Arising Under 5 The bar to judicial review provided by section 405(h) applies only to “claim[s] 6 arising under” the Medicare Act. 42 U.S.C. § 405 (h); see also Heckler, 466 U.S. at 605. 7 The “arising under” standard is construed “quite broadly.” Heckler, 466 U.S. at 615. 8 The Supreme Court has identified two circumstances in which a claim “arises under” the Medicare Act: (1) where the “standing and the substantive 9 basis for the presentation of the claims” is the Medicar…

See 42 C.F.R. § 423.2136 (d)(1) (providing that in a civil action seeking court review of a Medicare Appeals Council decision, the Secretary of DHHS is “the proper defendant” (emphasis added)); Do Sung Uhm, 620 F.3d at 1145 (“[Appellants] cannot circumvent § 405(h)’s requirements by suing [the Part D prescription drug provider].”).

Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010) (citing Sommatino v. United States, 255 F.3d 704, 707 (9th Cir. 2001)).

“Arising Under” The Medicare Act 24 The remaining question is whether Moses’s claims arise under the Medicare Act. 25 “The Supreme Court has identified two circumstances in which a claim ‘arises under’ the 26 Medicare Act: (1) where the standing and the substantive basis for the presentation of the 27 claims is the Medicare Act; and (2) where the claims are inextricably intertwined with a 28 claim for Medicare benefits.” Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1141 (9th …

The Ninth Circuit has found that this language was “intended . . . to preempt at least some common law claims.” Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1155 (9th Cir. 2010).

Council on Long Term Care, Inc., 529 U.S. 1, 15 (2000); Heckler v. Ringer, 466 U.S. 602, 616-17 (1984); Agua Caliente Tribe of Cupeño Indians of Pala Reservation v. Sweeney, 932 F.3d 1207, 1216 (9th Cir. 2019); Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010).

See 42 U.S.C. § 14 1395w–22(g)(5) (the Medicare C enrollee may seek judicial review pursuant to 42 U.S.C. § 15 405(g) of the Social Security Act when the amount in controversy meets a certain minimum); Do 16 Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1140-41 (9th Cir. 2010); Kaiser v. Blue Cross of 17 California, 347 F.3d 1107, 1111 (9th Cir. 2003) (“[j]urisdiction over cases “arising under” 18 Medicare exists only under 42 U.S.C. § 405 (g)”).

Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1148 (9th Cir. 2010) (quoting 42 U.S.C. § 1395w-26(b)(3)); see 42 U.S.C. § 1395w-112(g).

See, e.g., Ringer, 466 U.S. at 614 ; Alvarado Hosp., 868 F.3d at 996 ; Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1142-43 (9th Cir. 2010); Midland Psychiatric Assocs., Inc. v. United States, 145 F.3d 1000, 1004 (8th Cir. 1998); Bodimetric Health Servs., Inc. v. Aetna Life & Cas., 903 F.2d 480 , 487 (7th Cir. 1990).

Significantly, the Ninth Circuit had previously stated that “where, at bottom, a plaintiff is complaining about the denial of Medicare benefits—here, drug benefits under Part D—the claim ‘arises under’ the Medicare Act.” Uhm v. Humana, Inc., 620 F.3d 1134, 1142-43 (9th Cir. 2010).

Significantly, the Ninth Circuit had previously stated that “where, at bottom, a plaintiff is complaining about the denial of Medicare benefits—here, drug benefits under Part D—the claim ‘arises under’ the Medicare Act.” Uhm v. Humana, Inc., 620 F.3d 1134, 1142-43 (9th Cir. 2010).

As required by the policy, Lincoln Benefit sent the notice to Elhouty’s “most 15 See Goodman v. Staples The Office Superstore, LLC, 644 F.3d 817, 822 (9th Cir. 2011) (reviewing discovery rulings for abuse of discretion); Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010) (reviewing the denial of a motion for reconsideration for abuse of discretion). 16 See Nat’l Union Fire Ins.

Through its requirement that creditors pay interest “in the manner as prescribed by” the relevant state law, Congress demonstrated an awareness of, and intent to address, the differences among state escrow interest laws. 15 U.S.C. § 1639d(g)(3). “[W]e may reasonably presume that Congress was aware of [existing law when it legislated],” Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1155 (9th Cir. 2010), and that it used the term “applicable” to refer to state escrow interest la…

Uhm v. Humana, Inc., 620 F.3d 1134, 1140 (9th Cir. 2010) (quoting Heckler v. Ringer, 466 U.S. 602, 614-15 , 104 S.Ct. 2013 , 80 L.Ed.2d 622 (1984)); see § 405(h) (“No findings of fact or decision of the [Secretary] shall be reviewed by any person, tribunal, or governmental agency except as herein provided.”); § 405(g) (providing that review may be sought in district court only “after any final decision of the [Secretary] made after a hearing”).

In ruling that plaintiff’s claims are expressly preempted, we part company with Cotton v. StarCare Medical Group, Inc. (2010) 183 Cal.App.4th 437, 447-454 [ 107 Cal.Rptr.3d 767 ] (Cotton) and Yarick v. PacifiCare of California (2009) 179 Cal.App.4th 1158, 1165-1167 [ 102 Cal.Rptr.3d 379 ] (Yarick), and join with the later-decided Do Sung Uhm v. Humana, Inc. (9th Cir. 2010) 620 F.3d 1134, 1148-1157 (Uhm).

Louis Effort for AIDS v. Huff, 782 F.3d 1016, 1024 (8th Cir.2015); Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1155-56 (9th Cir.2010).

Congressional Regulation of Medicare Part C Coverage ¶ 20 Congress and the Secretary of HHS 2 have promulgated numerous statutes and regulations concerning standards for Medicare Part C coverage. 3 Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1150 (9th Cir.2010); Mass. Ass’n of Health Maint.

The “task is to ‘identify the domain expressly pre-empted by that language.’ That task must ‘in the first instance focus on the plain wording of the clause, which necessarily contains the best evidence of Congress’ pre-emptive intent.’ We may find preemption only where it is the ‘clear and manifest purpose of Congress.’ ” Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1148 (9th Cir.2010), quoting Medtronic, Inc. v. Lohr, 518 U.S. 470, 484 , 116 S.Ct. 2240 , 135 L.Ed.2d 700 (199…

Therefore, 'all [s]tate standards, including those established through case law, are preempted to the extent they specifically would regulate MA plans.'" Id. (alteration in original) (quoting Do Sung Uhm v. Humana, Inc., 620 F.3d 1134, 1156 (9th Cir. 2010) (internal quotations omitted)).