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. § 405.960

Right to a reconsideration

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A person or entity that is a party to a redetermination made by a contractor as described under § 405.940 through § 405.958, and is dissatisfied with that determination, may request a reconsideration by a QIC in accordance with § 405.962 through § 405.966, regardless of the amount in controversy.

Notes of Decisions
Cited in 29 cases (15 in the last 5 years), 2010–2025 · leading case: Arturo Porzecanski v. Alex Azar, 943 F.3d 472 (D.C. Cir. 2019).
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Arturo Porzecanski v. Alex Azar, 943 F.3d 472 (D.C. Cir. 2019). “§ 1395ff(c)(1)–(2); 42 C.F.R. § 405.960 . If the beneficiary remains unsatisfied, he can request a hearing before an administrative law judge (ALJ).”
Int'l Rehabilitative Sciences Inc. v. Sebelius, 688 F.3d 994 (9th Cir. 2012). “42 C.F.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(c); 42 C.F.R. § 405.960 . From this stage forward, an LCD is no longer binding, even if it remains persuasive.”
True Health Diagnostics, LLC v. Azar, 392 F. Supp. 3d 656 (E.D. Tex. 2019). “§ 1395ff(c), (g) ; 42 C.F.R. § 405.960 et seq. ); (3) A de novo review and hearing before an Administrative Law Judge ("ALJ") ( 42 U.”
North Carolina Ins. Guar. Ass'n v. Xavier Becerra, 55 F.4th 428 (4th Cir. 2022). “42 C.F.R. § 405.960 . At the reconsideration stage, “a party should present evidence and allegations of fact or law related to the issue in dispute and explain why it disagrees with the initial determination, including the redetermination.”
Almy v. Sebelius, 749 F. Supp. 2d 315 (D. Maryland 2010). “42 C.F.R. § 405.960 ; 42 U.S.C. §§ 1395ff(b)(l)(A) and (C).”
B & H Med., LLC v. United States, 116 Fed. Cl. 671 (Fed. Cl. 2014). “Reconsideration by a Qualified Independent Contractor (QIC) ( 42 C.F.R. §§ 405.960 -.978); 3. Hearing before an Administrative Law Judge (ALJ) within the Office of Medicare Hearings and Appeals ( 42 C.”
True Health Diagnostics, LLC v. Azar, 392 F. Supp. 3d 666 (E.D. Tex. 2019). “§ 1395ff(c), (g) ; 42 C.F.R. § 405.960 et seq. ); (3) A de novo review and hearing before an Administrative Law Judge ("ALJ") ( 42 U.”
Morton Plant Hosp. Ass'n, Inc. v. Sebelius, 747 F. Supp. 2d 1349 (M.D. Fla. 2010). “§ 1395ff(c); 42 C.F.R. § 405.960 . A provider dissatisfied with a reconsideration may appeal to an Administrative Law Judge, and thereafter, to the Medicare Appeals Council.”
Odell v. Azar, 344 F. Supp. 3d 1192 (D. Nev. 2018). “§§ 1395ff(b) and (c) ; 42 C.F.R. § 405.960 . If the claim is denied on reconsideration, the claimant may seek a hearing before an ALJ, in which they can testify and present evidence.”
Bello v. Azar (In re Bello), 596 B.R. 41 (Bankr. E.D. Mich. 2018). “42 C.F.R. § 405.960 . If satisfaction is still not achieved, the third step is to request a hearing before an ALJ.”
First United Methodist Church v. Becerra (D. Neb. 2022). · cites it 2× “” 42 C.F.R. § 405.960 that they “do not have a legal obligation to reimburse Medicare for its alleged conditional payments under the express language of the” Medicare Secondary Payer Statute.”
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