42 C.F.R. § 405.1002

Right to an ALJ hearing

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

(a) A party to a QIC reconsideration has a right to a hearing before an ALJ if—

(1) The party files a written request for an ALJ hearing within 60 calendar days after receipt of the notice of the QIC's reconsideration.

(2) The party meets the amount in controversy requirements of § 405.1006.

(3) For purposes of this section, the date of receipt of the reconsideration is presumed to be 5 calendar days after the date of the reconsideration, unless there is evidence to the contrary.

(4) For purposes of meeting the 60 calendar day filing deadline, the request is considered as filed on the date it is received by the office specified in the QIC's reconsideration.

(b) A party who files a timely appeal before a QIC and whose appeal continues to be pending before a QIC at the end of the period described in § 405.970 has a right to a hearing before an ALJ if—

(1) The party files a written request with the QIC to escalate the appeal for a hearing before an ALJ after the period described in § 405.970(a) and (b) has expired and the party files the request in accordance with § 405.970(d);

(2) The QIC does not issue a decision or dismissal order within 5 calendar days of receiving the request for escalation in accordance with § 405.970(e)(2); and

(3) The party has an amount remaining in controversy specified in § 405.1006.

[70 FR 11472, Mar. 8, 2005, as amended at 70 FR 37703, June 30, 2005; 74 FR 65335, Dec. 9, 2009; 82 FR 5109, Jan. 17, 2017]

Notes of Decisions

Cited in 10 cases (3 in the last 5 years), 2012–2025 · leading case: True Health Diagnostics, LLC v. Azar

Sort: Relevance Newest Treatment

True Health Diagnostics, LLC v. Azar (2019) txed “§ 1395ff(d) ; 42 C.F.R. §§ 405.1002 (a)(2), 405.1006(b) ); and (4) A review and decision by the Medicare Appeals Council ("MAC"), which is considered a final decision of the Secretary ( 42 U.”

B & H Medical, LLC v. United States (2014) uscfc “Nonetheless, there is no indication in either plaintiff’s allegations or the exhibits accompanying plaintiffs complaint that plaintiff exercised its right to request a hearing before an ALJ, after it received a denial from the QIC reconsideration, 42 C.F.R. § 405.1002 , or that…”

Sonas Medical Supply, Inc. v. Becerra (2023) txed · cites it 2× “” 42 C.F.R. § 405.1002 (a)(1). To calculate the proper date, the regulations also clarify that “receipt of the notice” is “presumed to be 5 calendar days after the date of the reconsideration, unless there is evidence to the contrary.”

Simply Home Healthcare v. AdvanceMed Corporation (2021) ca7 “§ 1395ff(d); 42 C.F.R. § 405.1002 . No. 20-1542 Page 3 And fourth, it can appeal an adverse decision to the Medicare Appeals Council, which would render a final decision for the Secretary of the Department, which is subject to judicial review.”

Acute Care Ambulance Service, LLC v. Alex M. Azar II (2020) txsd “§ 1395ff(d); 42 C.F.R. § 405.1002 (a). 178 Dkt. No. 17 at 16–17, ¶ 36.”

Prosser v. Becerra (2020) wied “42 C.F.R. § 405.1002 (a)(1). If the beneficiary wishes to challenge the ALJ’s decision, review must first be requested by the Medicare Appeals Council (Council).”

Capital Hospice v. Becerra (2025) vaed “§ 1395ff(d)(1); 42 C.F.R. § 405.1002 ; and (4) appealing any adverse ALJ decision to the HHS Departmental Appeals Board, Medicare Appeals Council (the “Council”), 42 U.”

Handron v. Secretary Department of Health & Human Services (2012) ca3 “He then requested a hearing before an ALJ pursuant to 42 C.F.R. § 405.1002 (a), which took place on June 21-22 and July 24, 2007.”

United Medical Healthcare, Inc. v. Department of Health & Human Services (2012) laed “See 42 C.F.R. § 405.1002 , et seq. If the party is displeased with the ALJ decision *843 then it may request review by the MAC.”

Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.