C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED › Subpart I—Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)

42 C.F.R. § 405.940

Right to a redetermination

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A person or entity that may be a party to a redetermination in accordance with § 405.906(b) and that is dissatisfied with an initial determination may request a redetermination by a contractor in accordance with § 405.940 through § 405.958, regardless of the amount in controversy.

Notes of Decisions
Cited in 42 cases (20 in the last 5 years), 2009–2025 · leading case: D&G Holdings v. Becerra, 22 F.4th 470 (5th Cir. 2022).
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D&G Holdings v. Becerra, 22 F.4th 470 (5th Cir. 2022). · cites it 2× “20-30732 to prove that Medicare erroneously collected recoupment, and then to spend several more years of administrative appeals simply to determine the amount it is owed.”
Arturo Porzecanski v. Alex Azar, 943 F.3d 472 (D.C. Cir. 2019). “§ 1395ff(a)(3)(A); 42 C.F.R. § 405.940 . If unsuccessful, the beneficiary can seek “reconsideration” by a “qualified independent contractor” who is wholly independent of the initial determination contractor.”
Anniken Prosser v. Xavier Becerra, 2 F.4th 708 (7th Cir. 2021). “§ 1395ff(a)(3); 42 C.F.R. § 405.940 . At the second level, the ben- eficiary may seek reconsideration by a qualified independent contractor.”
Int'l Rehabilitative Sciences Inc. v. Sebelius, 688 F.3d 994 (9th Cir. 2012). “R. § 405.960 ; 42 U.S.C. § 1395ff(b)(l)(A), (c)(3)(B).”
Edwin R. Banks v. Sec'y, Dep't of Health & Human Servs., 38 F.4th 86 (11th Cir. 2022). “§ 1395ff(a)(3); 42 C.F.R. § 405.940 . Third, the beneficiary can appeal his claim to a “qualified independent contractor” for further review—known as a “reconsideration.”
Art of Healing Med., P.C. v. Burwell, 91 F. Supp. 3d 400 (E.D.N.Y 2015). · cites it 2× “42 C.F.R. § 405.940 . B. Challenging an Audit Finding: Five-Stage Appeals Process There are five levels in the Medicare Part B appeals process.”
Porzecanski v. Azar, 316 F. Supp. 3d 11 (D.C. Cir. 2018). “42 C.F.R. § 405.940 . Assuming the contractor does not reverse itself and the beneficiary remains dissatisfied, the beneficiary may request "reconsideration" by another Medicare program contractor called a "qualified independent contractor.”
Livinrite, Inc. v. Azar, 386 F. Supp. 3d 644 (E.D. Va. 2019). “See generally 42 C.F.R. §§ 405.940 -405.1140. Nor could such a challenge be legitimately made.”
True Health Diagnostics, LLC v. Azar, 392 F. Supp. 3d 656 (E.D. Tex. 2019). “§ 1395ff(a)(3)(A) ; 42 C.F.R. § 405.940 et seq. ); (2) A reconsideration by a Qualified Independent Contractor ("QIC") ( 42 U.”
North Carolina Ins. Guar. Ass'n v. Xavier Becerra, 55 F.4th 428 (4th Cir. 2022). “” 42 C.F.R. § 405.940 . “In conducting a redetermination, the contractor [3] reviews the evidence and findings upon which the initial determination was based, and any additional evidence the parties submit or the contractor obtains on its own.”
Willowood of Great Barrington, Inc. v. Sebelius, 638 F. Supp. 2d 98 (D. Mass. 2009). “§ 1395ff(a)(3) and 42 C.F.R. § 405.940 , and then a redetermination by a “qualified independent contractor” — in this case, Maximus — see 42 U.”
Trostle v. Centers for Medicare & Medicaid Servs., 709 F. App'x 736 (3rd Cir. 2017). “§ 1395ff(b); 42 C.F.R. §§ 405.940 , 405.960, 405.1000, and 405.”
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