42 C.F.R. § 422.608
Medicare Appeals Council (Council) review
Any party to the ALJ's or attorney adjudicator's decision or dismissal, including the MA organization, who is dissatisfied with the decision or dismissal, may request that the Council review the decision or dismissal. The regulations under part 405 of this chapter regarding Council review apply to matters addressed by this subpart to the extent that they are appropriate, except as provided in § 422.562(d)(2).
Notes of Decisions
Cited in 11
cases (6 in the last 5 years), 2006–2025 · leading case: Giesse v. Sec'y of the Dep't of Health & Human Servs., 522 F.3d 697 (6th Cir. 2008).
Giesse v. Sec'y of the Dep't of Health & Human Servs., 522 F.3d 697 (6th Cir. 2008). “42 C.F.R. § 422.608 . The enrollee may then seek judicial review of the MAC’s decision, or may seek judicial review of the ALJ’s decision if the MAC declines to review the ALJ’s decision.”
Naomi Aylward v. Selecthealth, Inc., 35 F.4th 673 (9th Cir. 2022). “42 C.F.R. § 422.608 . Finally, if the enrollee receives an adverse decision from the Medicare Appeals Council, and “[i]f the amount in controversy is $1,000 or more,” then the enrollee is “entitled to judicial review of the Secretary’s final decision” under the provisions of §…”
Matthews v. Leavitt, 452 F.3d 145 (2d Cir. 2006). “On June 19, 2000, Matthews sought appellate review by the Medicare Appeals Council of the Department of Health and Human Services, see 42 C.F.R. § 422.608 (2000) (“Any party to [a] hearing, including the [Medicare + Choice] organization, who is dissatisfied with the ALJ hearing…”
Kaiser Found. Health Plan, Inc. v. Burwell, 147 F. Supp. 3d 897 (N.D. Cal. 2015). “42 C.F.R. § 422.608 . The MAC conducts a de novo review of the ALJ’s decision considering all the evidence of record and -may-adopt, modify or reverse the ALJ’s decision or remand- the case to an ALJ for further proceedings.”
Rapport v. Leavitt, 564 F. Supp. 2d 186 (W.D.N.Y. 2008). “See 42 C.F.R. § 422.608 . If the amount in controversy is one thousand dollars ($1,000) or greater, a dissatisfied claimant or provider of services can seek federal court review of a MAC decision, or an ALJ decision if MAC declines to review the ALJ decision.”
Naomi Aylward v. Selecthealth, Inc., 31 F.4th 719 (9th Cir. 2022). “42 C.F.R. § 422.608 . Finally, if the enrollee receives an adverse decision from the Medicare Appeals Council, and “[i]f the amount in controversy is $1,000 or more,” then the enrollee is “entitled to judicial review of the Secretary’s final decision” under the provisions of §…”
Moses v. United Healthcare Corp. (D. Ariz. 2020). “600 , or requested review of the ALJ’s decision by the Medicare Appeals 6 Council (“Council”) pursuant to 42 C.F.R. § 422.608 . Because there is no final decision 7 as required by Section 405(g), the Court cannot review Moses’s claims arising under the 8 Medicare Act.”
Sarasota Cnty. Pub. Hosp. Bd. v. Blue Cross & Blue Shield of Florida, Inc. (M.D. Fla. 2021). “42 C.F.R. § 422.608 . Only after a final decision by the Medicare Appeals Council can a party seek judicial review.”
Sanderson v. Sec'y of the United States Dep't of Health & Human Servs. (D. Kan. 2022). “34 See also 42 C.F.R. § 422.608 (“The regulations under part 405 of this chapter regarding Council review apply to matters addressed by this subpart to the extent that they are appropriate, except as provided in § 422.”
Johnson v. Azar (D. Maryland 2022). “1-2 at 3; see also 42 C.F.R. § 422.608 . are “unavailable or inadequate” to meet medical needs, and second, an MA Plan must pay for out-of-network care if emergency care is needed.”
Minimally Invasive Surgery Hosp., Inc. v. United HealthCare Servs., Inc. (D. Kan. 2025). “42 C.F.R. § 422.608 . The Medicare Appeals Council will either deny the request or review the ALJ’s decision.”
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.