42 U.S.C. § 1395oo

Provider Reimbursement Review Board

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(a) EstablishmentAny provider of services which has filed a required cost report within the time specified in regulations may obtain a hearing with respect to such cost report by a Provider Reimbursement Review Board (hereinafter referred to as the “Board”) which shall be established by the Secretary in accordance with subsection (h) and (except as provided in subsection (g)(2)) any hospital which receives payments in amounts computed under subsection (b) or (d) of section 1395ww of this title and which has submitted such reports within such time as the Secretary may require in order to make payment under such section may obtain a hearing with respect to such payment by the Board, if—(1) such provider—(A)(i) is dissatisfied with a final determination of the organization serving as its fiscal intermediary pursuant to section 1395h of this title as to the amount of total program reimbursement due the provider for the items and services furnished to individuals for which payment may be made under this subchapter for the period covered by such report, or(ii) is dissatisfied with a final determination of the Secretary as to the amount of the payment under subsection (b) or (d) of section 1395ww of this title,(B) has not received such final determination from such intermediary on a timely basis after filing such report, where such report complied with the rules and regulations of the Secretary relating to such report, or(C) has not received such final determination on a timely basis after filing a supplementary cost report, where such cost report did not so comply and such supplementary cost report did so comply,(2) the amount in controversy is $10,000 or more, and(3) such provider files a request for a hearing within 180 days after notice of the intermediary’s final determination under paragraph (1)(A)(i), or with respect to appeals under paragraph (1)(A)(ii), 180 days after notice of the Secretary’s final determination, or with respect to appeals pursuant to paragraph (1) (B) or (C), within 180 days after notice of such determination would have been received if such determination had been made on a timely basis.(b) Appeals by groups

The provisions of subsection (a) shall apply to any group of providers of services if each provider of services in such group would, upon the filing of an appeal (but without regard to the $10,000 limitation), be entitled to such a hearing, but only if the matters in controversy involve a common question of fact or interpretation of law or regulations and the amount in controversy is, in the aggregate, $50,000 or more.

At such hearing, the provider of services shall have the right to be represented by counsel, to introduce evidence, and to examine and cross-examine witnesses. Evidence may be received at any such hearing even though inadmissible under rules of evidence applicable to court procedure.

(d) Decisions of Board

A decision by the Board shall be based upon the record made at such hearing, which shall include the evidence considered by the intermediary and such other evidence as may be obtained or received by the Board, and shall be supported by substantial evidence when the record is viewed as a whole. The Board shall have the power to affirm, modify, or reverse a final determination of the fiscal intermediary with respect to a cost report and to make any other revisions on matters covered by such cost report (including revisions adverse to the provider of services) even though such matters were not considered by the intermediary in making such final determination.

(e) Rules and regulations

The Board shall have full power and authority to make rules and establish procedures, not inconsistent with the provisions of this subchapter or regulations of the Secretary, which are necessary or appropriate to carry out the provisions of this section. In the course of any hearing the Board may administer oaths and affirmations. The provisions of subsections (d) and (e) of section 405 of this title with respect to subpenas shall apply to the Board to the same extent as they apply to the Secretary with respect to subchapter II.

(f) Finality of decision; judicial review; determinations of Board authority; jurisdiction; venue; interest on amount in controversy(1) A decision of the Board shall be final unless the Secretary, on his own motion, and within 60 days after the provider of services is notified of the Board’s decision, reverses, affirms, or modifies the Board’s decision. Providers shall have the right to obtain judicial review of any final decision of the Board, or of any reversal, affirmance, or modification by the Secretary, by a civil action commenced within 60 days of the date on which notice of any final decision by the Board or of any reversal, affirmance, or modification by the Secretary is received. Providers shall also have the right to obtain judicial review of any action of the fiscal intermediary which involves a question of law or regulations relevant to the matters in controversy whenever the Board determines (on its own motion or at the request of a provider of services as described in the following sentence) that it is without authority to decide the question, by a civil action commenced within sixty days of the date on which notification of such determination is received. If a provider of services may obtain a hearing under subsection (a) and has filed a request for such a hearing, such provider may file a request for a determination by the Board of its authority to decide the question of law or regulations relevant to the matters in controversy (accompanied by such documents and materials as the Board shall require for purposes of rendering such determination). The Board shall render such determination in writing within thirty days after the Board receives the request and such accompanying documents and materials, and the determination shall be considered a final decision and not subject to review by the Secretary. If the Board fails to render such determination within such period, the provider may bring a civil action (within sixty days of the end of such period) with respect to the matter in controversy contained in such request for a hearing. Such action shall be brought in the district court of the United States for the judicial district in which the provider is located (or, in an action brought jointly by several providers, the judicial district in which the greatest number of such providers are located) or in the District Court for the District of Columbia and shall be tried pursuant to the applicable provisions under chapter 7 of title 5 notwithstanding any other provisions in section 405 of this title. Any appeal to the Board or action for judicial review by providers which are under common ownership or control or which have obtained a hearing under subsection (b) must be brought by such providers as a group with respect to any matter involving an issue common to such providers.(2) Where a provider seeks judicial review pursuant to paragraph (1), the amount in controversy shall be subject to annual interest beginning on the first day of the first month beginning after the 180-day period as determined pursuant to subsection (a)(3) and equal to the rate of interest on obligations issued for purchase by the Federal Hospital Insurance Trust Fund for the month in which the civil action authorized under paragraph (1) is commenced, to be awarded by the reviewing court in favor of the prevailing party.(3) No interest awarded pursuant to paragraph (2) shall be deemed income or cost for the purposes of determining reimbursement due providers under this chapter.(g) Certain findings not reviewable(1) The finding of a fiscal intermediary that no payment may be made under this subchapter for any expenses incurred for items or services furnished to an individual because such items or services are listed in section 1395y of this title shall not be reviewed by the Board, or by any court pursuant to an action brought under subsection (f).(2) The determinations and other decisions described in section 1395ww(d)(7) of this title shall not be reviewed by the Board or by any court pursuant to an action brought under subsection (f) or otherwise.(h) Composition and compensation

The Board shall be composed of five members appointed by the Secretary without regard to the provisions of title 5 governing appointments in the competitive services. Two of such members shall be representative of providers of services. All of the members of the Board shall be persons knowledgeable in the field of payment of providers of services, and at least one of them shall be a certified public accountant. Members of the Board shall be entitled to receive compensation at rates fixed by the Secretary, but not exceeding the rate specified (at the time the service involved is rendered by such members) for grade GS–18 in section 5332 of title 5. The term of office shall be three years, except that the Secretary shall appoint the initial members of the Board for shorter terms to the extent necessary to permit staggered terms of office.

(i) Technical and clerical assistance

The Board is authorized to engage such technical assistance as may be required to carry out its functions, and the Secretary shall, in addition, make available to the Board such secretarial, clerical, and other assistance as the Board may require to carry out its functions.

(j) “Provider of services” defined

In this section, the term “provider of services” includes a rural health clinic and a Federally qualified health center.

(Aug. 14, 1935, ch. 531, title XVIII, § 1878, as added Pub. L. 92–603, title II, § 243(a), Oct. 30, 1972, 86 Stat. 1420; amended Pub. L. 93–484, § 3(a), Oct. 26, 1974, 88 Stat. 1459; Pub. L. 96–499, title IX, § 955, Dec. 5, 1980, 94 Stat. 2647; Pub. L. 98–21, title VI, § 602(h), Apr. 20, 1983, 97 Stat. 165; Pub. L. 98–369, div. B, title III, §§ 2351(a)(1), (b)(1), 2354(b)(39), (40), July 18, 1984, 98 Stat. 1098, 1099, 1102; Pub. L. 101–508, title IV, § 4161(a)(6), (b)(4), Nov. 5, 1990, 104 Stat. 1388–94, 1388–95; Pub. L. 103–66, title XIII, § 13503(c)(1)(B), Aug. 10, 1993, 107 Stat. 579.)Editorial NotesAmendments

1993—Subsec. (f)(2). Pub. L. 103–66 substituted “the rate of interest on obligations issued for purchase by the Federal Hospital Insurance Trust Fund for the month in which” for “the rate of return on equity capital established by regulation pursuant to section 1395x(v)(1)(B) of this title and in effect at the time”.

1990—Subsec. (j). Pub. L. 101–508, § 4161(b)(4), inserted “a rural health clinic and” after “includes”.

Pub. L. 101–508, § 4161(a)(6), added subsec. (j).

1984—Subsec. (c). Pub. L. 98–369, § 2354(b)(39), substituted “inadmissible” for “inadmissable”.

Subsec. (e). Pub. L. 98–369, § 2354(b)(40), substituted “and (e)” for “, (e), and (f)”.

Subsec. (f)(1). Pub. L. 98–369, § 2351(a)(1), substituted “notification of such determination is received” for “such determination is rendered” in third sentence.

Pub. L. 98–369, § 2351(b)(1), inserted “or which have obtained a hearing under subsection (b)” after “common ownership or control” in last sentence.

1983—Subsec. (a). Pub. L. 98–21, § 602(h)(1)(A), inserted provision in introductory text that, except as provided in subsec. (g)(2) of this section, any hospital which receives payments in amounts computed under section 1395ww(b) or (d) of this title and which has submitted such reports within such time as Secretary may require in order to make payment under such section may obtain a hearing with respect to such payment by Board.

Subsec. (a)(1)(A). Pub. L. 98–21, § 602(h)(1)(B), (C), designated existing provisions as cl. (i) and added cl. (ii).

Subsec. (a)(3). Pub. L. 98–21, § 602(h)(1)(D), substituted “(1)(A)(i), or with respect to appeals under paragraph (1)(A)(ii), 180 days after notice of the Secretary’s final determination,” for “(1)(A)”.

Subsec. (f)(1). Pub. L. 98–21, § 602(h)(2), inserted “(or, in an action brought jointly by several providers, the judicial district in which the greatest number of such providers are located)” after “the judicial district in which the provider is located”, and “Any appeal to the Board or action for judicial review by providers which are under common ownership or control must be brought by such providers as a group with respect to any matter involving an issue common to such providers.”

Subsec. (g). Pub. L. 98–21, § 602(h)(3), designated existing provisions as par. (1) and added par. (2).

Subsec. (h). Pub. L. 98–21, § 602(h)(4), substituted “payment of providers of services” for “cost reimbursement”.

1980—Subsec. (f)(1). Pub. L. 96–499 inserted provision empowering providers of services to obtain judicial review of any action of a fiscal intermediary involving a question of law or regulations relevant to matters in controversy whenever Board determined that it was without authority to decide such matters in controversy.

1974—Subsec. (f). Pub. L. 93–484 redesignated existing provisions as par. (1), inserted provisions authorizing judicial review for providers of final decisions of Board and judicial review of any affirmance by Secretary, and added pars. (2) and (3).

Statutory Notes and Related SubsidiariesEffective Date of 1993 Amendment

Amendment by Pub. L. 103–66 effective Oct. 1, 1993, see section 13503(c)(2) of Pub. L. 103–66, set out as a note under section 1395x of this title.

Effective Date of 1990 Amendment

Amendment by section 4161(a)(6) of Pub. L. 101–508 applicable to cost reports for periods beginning on or after Oct. 1, 1991, see section 4161(a)(8)(C) of Pub. L. 101–508, set out as a note under section 1395k of this title.

Amendment by section 4161(b)(4) of Pub. L. 101–508 applicable to cost reports for periods beginning on or after Oct. 1, 1991, see section 4161(b)(5) of Pub. L. 101–508, set out as a note under section 1395x of this title.

Effective Date of 1984 Amendment

Pub. L. 98–369, div. B, title III, § 2351(a)(2), July 18, 1984, 98 Stat. 1099, provided that: “The amendment made by paragraph (1) [amending this section] shall be effective with respect to any civil action commenced on or after the date of the enactment of this Act [July 18, 1984].”

Pub. L. 98–369, div. B, title III, § 2351(b)(2), July 18, 1984, 98 Stat. 1099, provided that: “The amendment made by paragraph (1) [amending this section] shall be effective with respect to any appeal or action brought on or after the date of the enactment of this Act [July 18, 1984].”

Amendment by section 2354(b)(39), (40) of Pub. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2354(e)(1) of Pub. L. 98–369, set out as a note under section 1320a–1 of this title.

Effective Date of 1983 Amendment

Amendment by Pub. L. 98–21 applicable to items and services furnished by or under arrangement with a hospital beginning with its first cost reporting period that begins on or after Oct. 1, 1983, any change in a hospital’s cost reporting period made after November 1982 to be recognized for such purposes only if the Secretary finds good cause therefor, see section 604(a)(1) of Pub. L. 98–21, set out as a note under section 1395ww of this title. See, also, section 2351(c) of Pub. L. 98–369, set out as a note below.

Effective Date of 1974 Amendment

Pub. L. 93–484, § 3(b), Oct. 26, 1974, 88 Stat. 1459, provided that: “The amendment made by subsection (a) [amending this section] shall be applicable to cost reports of providers of services for accounting periods ending on or after June 30, 1973.”

Effective Date

Pub. L. 92–603, title II, § 243(c), Oct. 30, 1972, 86 Stat. 1422, provided that: “The amendments made by this section [enacting this section and amending section 1395h of this title] shall apply with respect to cost reports of providers of services, as defined in title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], for accounting periods ending on or after June 30, 1973.”

References in Other Laws to GS–16, 17, or 18 Pay Rates

References in laws to the rates of pay for GS–16, 17, or 18, or to maximum rates of pay under the General Schedule, to be considered references to rates payable under specified sections of Title 5, Government Organization and Employees, see section 529 [title I, § 101(c)(1)] of Pub. L. 101–509, set out in a note under section 5376 of Title 5.

Review of Provider Reimbursement Review Board Decisions

Pub. L. 98–369, div. B, title III, § 2351(c), July 18, 1984, 98 Stat. 1099, provided that: “Notwithstanding section 604 of the Social Security Amendments of 1983 (Public Law 98–21) [set out as an Effective Date of 1983 Amendments note under section 1395ww of this title]—“(1) the amendments made by section 602(h)(2)(A) of that Act [amending this section] shall be effective with respect to any appeal or action brought on or after April 20, 1983; and“(2) the amendments made by section 602(h)(2)(B) of that Act [amending this section] shall be effective with respect to any appeal or action brought on or after the date of the enactment of this Act [July 18, 1984].”

Notes of Decisions

Cited in 1,099 cases (69 in the last 5 years), 1973–2026 · leading case: Sebelius v. Auburn Reg'l Med. Ctr., 133 S. Ct. 817 (2013).

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Sebelius v. Auburn Reg'l Med. Ctr., 133 S. Ct. 817 (2013). · cites it 14× “165 , 42 U. S. C. §1395oo(a)(3), sets a 180-day limit for filing appeals from the fiscal intermediary to the PRRB.”

Los Angeles Haven Hospice, Inc. v. Sebelius, 638 F.3d 644 (9th Cir. 2011). · cites it 17× “42 U.S.C. § 1395oo(a). The PRRB has the authority to affirm, modify, or reverse a final determination of the fiscal intermediary, 42 U.”

Temple Univ. Hosp. v. Sec'y United States Dept, 2 F.4th 121 (3rd Cir. 2021). · cites it 10× “1994) (recognizing that 42 U.S.C. § 1395oo “provides avenues by which a provider seeking Part A payments may contest both the amount of its payments and the methods by which those payments are calculated”).”

Full Life Hospice, LLC v. Sebelius, 709 F.3d 1012 (9th Cir. 2013). · cites it 7× “” 42 U.S.C. § 1395oo(a). Only after these preconditions are met does § 1395oo(f)(l) require the Board to render “[a] determination in writing within thirty days after the Board receives the [EJR] request.”

The EDGEWATER Hosp., INC., Plaintiff-Appellee, v. Otis R. BOWEN, M.D., Sec'y of Health & Human Servs., Defendant-Appellant, 857 F.2d 1123 (7th Cir. 1989). · cites it 16× “42 U.S.C. § 1395oo(a). The PRRB has the power to affirm, modify, or reverse decisions of a fiscal intermediary.”

Tucson Med. Ctr. v. Louis W. Sullivan, M.D., Sec'y, Dep't of Health & Human Servs., 947 F.2d 971 (D.C. Cir. 1991). · cites it 13× “See 42 U.S.C. § 1395oo (1988). Congress discovered that the problem with a system of reimbursement based on a retrospective calculation of reasonable costs was that it provided little incentive for hospitals to keep costs down.”

Banner Heart Hosp. v. Burwell, 201 F. Supp. 3d 131 (D.D.C. 2016). · cites it 11× “Plaintiffs contend that the Board’s dismissal of their appeal based on the self-disallowance regulation violates both the Medicare statute, 42 U.S.C. § 1395oo, and the Administrative Procedure Act, 5 U.”

Banner Health v. Sebelius, 905 F. Supp. 2d 174 (D.D.C. 2012). · cites it 8× “42 U.S.C. § 1395oo. A regulation also gives the provider three years within which to ask the intermediary to reopen a determination.”

Hca Health Servs. of Oklahoma, Inc. v. Donna E. Shalala, Sec'y, Dep't of Health & Human Servs., 27 F.3d 614 (D.C. Cir. 1994). · cites it 11× “42 U.S.C. § 1395oo (f)(1). Under the regulations an intermediary may reopen an NPR within three years of issuance.”

Auburn Reg'l Med. Ctr. v. Sebelius, 686 F. Supp. 2d 55 (D.D.C. 2010). · cites it 15× “They requested “equitable tolling” of the 180-day limitations period for filing such appeals, recognizing that, absent such tolling, their appeals would be barred by the 180-day deadline set forth in 42 U.S.C. § 1395oo (a). The Board dismissed their appeals as untimely, holding,…”

Affinity Healthcare Servs., Inc. v. Sebelius, 746 F. Supp. 2d 106 (D.D.C. 2010). · cites it 13× “The Administrator’s Reversal of the PRRB’s May 25, 2010 Ruling On July 19, 2010, the CMS Administrator reversed the PRRB’s May 25, 2010 decision granting the Affinity plaintiffs’ request for EJR, concluding that Affinity plaintiffs had not established that the aggregate amount…”

Loma Linda Univ. Med. Ctr. v. Leavitt, 492 F.3d 1065 (9th Cir. 2007). · cites it 9× “Federal courts “have jurisdiction over Medicare reimbursement disputes only to the extent provided by 42 U.S.C. § 1395oo.” Anaheim Mem’l Hosp. v.”

Show all 1,099 citing cases →

— 42 U.S.C. § 1395oo(F)(l) — 1 case

Cambridge Hosp. Ass'n, Inc. v. Bowen, 629 F. Supp. 612 (D. Minnesota 1986).

— 42 U.S.C. § 1395oo(a) — 329 cases

MaineGeneral Med. Ctr. v. Shalala, 205 F.3d 493 (1st Cir. 2000).

The EDGEWATER Hosp., INC., Plaintiff-Appellee, v. Otis R. BOWEN, M.D., Sec'y of Health & Human Servs., Defendant-Appellant, 857 F.2d 1123 (7th Cir. 1989). “42 U.S.C. § 1395oo(a). The PRRB has the power to affirm, modify, or reverse decisions of a fiscal intermediary.”

Los Angeles Haven Hospice, Inc. v. Sebelius, 638 F.3d 644 (9th Cir. 2011). “42 U.S.C. § 1395oo(a). The PRRB has the authority to affirm, modify, or reverse a final determination of the fiscal intermediary, 42 U.”

Banner Heart Hosp. v. Burwell, 201 F. Supp. 3d 131 (D.D.C. 2016). “Plaintiffs contend that the Board’s dismissal of their appeal based on the self-disallowance regulation violates both the Medicare statute, 42 U.S.C. § 1395oo, and the Administrative Procedure Act, 5 U.”

Loma Linda Univ. Med. Ctr. v. Leavitt, 492 F.3d 1065 (9th Cir. 2007). “Federal courts “have jurisdiction over Medicare reimbursement disputes only to the extent provided by 42 U.S.C. § 1395oo.” Anaheim Mem’l Hosp. v.”

— 42 U.S.C. § 1395oo(a)(1) — 8 cases

Salinas v. R.R. Ret. Bd., 592 U.S. 188 (2021).

In re Jackson, 585 B.R. 410 (6th Cir. BAP 2018).

Kaiser Found. Hospitals v. Michael O. Leavitt, 649 F.3d 1153 (9th Cir. 2011).

OSF Healthcare Sys. v. Sullivan, 820 F. Supp. 390 (C.D. Ill. 1993).

Bayshore Cmty. Hosp. v. Burwell (D.D.C. 2017).

— 42 U.S.C. § 1395oo(a)(1)(A) — 4 cases

Pomona Valley Hosp. Med v. Xavier Becerra, 82 F.4th 1252 (D.C. Cir. 2023).

New Jersey Speech-Language-Hearing Ass'n v. Prudential Ins. Co. of Am., 724 F.2d 383 (3rd Cir. 1983).

Shands Jacksonville Med. Ctr., Inc. v. Sebelius (D.D.C. 2021).

Ascension Providence v. Becerra (N.D. Ind. 2023).

— 42 U.S.C. § 1395oo(a)(1)(A)(i) — 16 cases

Salinas v. R.R. Ret. Bd., 592 U.S. 188 (2021).

Mercy Hosp., Inc. v. Alex M. Azar II, 891 F.3d 1062 (D.C. Cir. 2018).

Flachs v. Illinois Dep't of Human Servs., 2021 IL App (4th) 200349-U (Ill. App. Ct. 2021).

North Broward Hosp. Dist. v. Bowen, 808 F.2d 1405 (11th Cir. 1987).

Battle Creek Health Sys. v. Robert F. Kennedy Jr. (D.C. Cir. 2025).

— 42 U.S.C. § 1395oo(a)(1)(A)(ii) — 14 cases

Temple Univ. Hosp. v. Sec'y United States Dept, 2 F.4th 121 (3rd Cir. 2021). “1994) (recognizing that 42 U.S.C. § 1395oo “provides avenues by which a provider seeking Part A payments may contest both the amount of its payments and the methods by which those payments are calculated”).”

Baystate Med. Ctr. v. Leavitt, 545 F. Supp. 2d 20 (D.D.C. 2008).

Shands Jacksonville Med. v. Alex Azar, II, 959 F.3d 1113 (D.C. Cir. 2020).

Baystate Franklin Med. Ctr. v. Azar, 319 F. Supp. 3d 514 (D.C. Cir. 2018).

Battle Creek Health Sys. v. Robert F. Kennedy Jr. (D.C. Cir. 2025).

— 42 U.S.C. § 1395oo(a)(1)(B) — 2 cases

Allina Health Sys. v. Burwell, 268 F. Supp. 3d 211 (D.D.C. 2017).

Mem'l Hosp. of South Bend v. Azar (D.D.C. 2022).

— 42 U.S.C. § 1395oo(a)(1)(ii) — 1 case

Shands Jacksonville Med. Ctr., Inc. v. Sebelius (D.D.C. 2021).

— 42 U.S.C. § 1395oo(a)(2) — 17 cases

Hospice of New Mexico, LLC v. Sebelius, 691 F. Supp. 2d 1275 (D.N.M. 2010).

Tucson Med. Ctr. v. Louis W. Sullivan, M.D., Sec'y, Dep't of Health & Human Servs., 947 F.2d 971 (D.C. Cir. 1991). “See 42 U.S.C. § 1395oo (1988). Congress discovered that the problem with a system of reimbursement based on a retrospective calculation of reasonable costs was that it provided little incentive for hospitals to keep costs down.”

Kaiser Found. Hospitals v. Michael O. Leavitt, 649 F.3d 1153 (9th Cir. 2011).

— 42 U.S.C. § 1395oo(a)(3) — 52 cases

Sebelius v. Auburn Reg'l Med. Ctr., 133 S. Ct. 817 (2013). “165 , 42 U. S. C. §1395oo(a)(3), sets a 180-day limit for filing appeals from the fiscal intermediary to the PRRB.”

Kwai Wong v. David Beebe, 732 F.3d 1030 (9th Cir. 2013).

Sikorsky Aircraft Corp. v. United States, 773 F.3d 1315 (Fed. Cir. 2014).

Your Home Visiting Nurse Servs., Inc. v. Shalala, 525 U.S. 449 (1999).

Saint Francis Med. Ctr. v. Alex M. Azar II, 894 F.3d 290 (D.C. Cir. 2018).

— 42 U.S.C. § 1395oo(a)(A)(i) — 1 case

Mem'l Hosp. of South Bend v. Azar (D.D.C. 2022).

— 42 U.S.C. § 1395oo(a)(A)(ii) — 1 case

Mem'l Hosp. of South Bend v. Azar (D.D.C. 2022).

— 42 U.S.C. § 1395oo(a)(I)(A) — 1 case

John Muir Mem'l Hosp., Inc. v. Califano, 457 F. Supp. 848 (N.D. Cal. 1978).

— 42 U.S.C. § 1395oo(a)(d) — 1 case

Acadian Homecare LLC v. Leavitt, 513 F. Supp. 2d 684 (W.D. La. 2007).

— 42 U.S.C. § 1395oo(a)(l) — 8 cases

Kaiser Found. Hospitals v. Michael O. Leavitt, 649 F.3d 1153 (9th Cir. 2011).

Three Lower Counties Cmty. Health Servs. Inc. v. U.S. Dep't of Health & Human Servs., 517 F. Supp. 2d 431 (D.D.C. 2007).

Saint Vincent Health Ctr. v. Shalala, 937 F. Supp. 496 (W.D. Pa. 1995).

Ihg Healthcare v. Sebelius, 717 F. Supp. 2d 696 (S.D. Tex. 2010).

Ozark Mountain Reg'l Rehab. Ctr., Inc. v. Dep't of Health & Human Servs., Provider Reimbursement Review Bd., 798 F. Supp. 16 (D.D.C. 1992).

— 42 U.S.C. § 1395oo(a)(l)(A) — 8 cases

Monmouth Med. Ctr. v. Thompson, 257 F.3d 807 (D.C. Cir. 2001).

BEDFORD Med. Ctr., Plaintiff-Appellant, v. Margaret M. HECKLER, Sec'y of Health & Human Servs., Defendant-Appellee, 766 F.2d 321 (7th Cir. 1985).

John Muir Mem'l Hosp., Inc. v. Califano, 457 F. Supp. 848 (N.D. Cal. 1978).

Tucson Med. Ctr. v. Heckler, 611 F. Supp. 823 (D.D.C. 1985).

Abbott-Nw. Hosp. v. Leavitt, 377 F. Supp. 2d 119 (D.D.C. 2005).

— 42 U.S.C. § 1395oo(a)(l)(A)(2) — 1 case

Baptist Mem'l Hosp.-Golden Triangle v. Leavitt, 536 F. Supp. 2d 25 (D.D.C. 2008).

— 42 U.S.C. § 1395oo(a)(l)(A)(i) — 20 cases

Maine Med. Ctr. v. Burwell, 841 F.3d 10 (1st Cir. 2016).

Your Home Visiting Nurse Servs., Inc. v. Shalala, 525 U.S. 449 (1999).

High Country Home Health, Inc. v. Thompson, 359 F.3d 1307 (10th Cir. 2004).

— 42 U.S.C. § 1395oo(a)(l)(A)(ii) — 4 cases

Abbott-Nw. Hosp. v. Leavitt, 377 F. Supp. 2d 119 (D.D.C. 2005).

Dist. Hosp. Partners, L.P. v. Sebelius, 932 F. Supp. 2d 194 (D.D.C. 2013).

CHARTER Med. CORP., Et Al., Plaintiffs-Appellees, v. Otis R. BOWEN, Sec'y of Health & Human Servs., Defendant-Appellant, 788 F.2d 728 (11th Cir. 1986).

Adventist Glenoaks Hosp. v. Sebelius, 663 F.3d 939 (7th Cir. 2011).

— 42 U.S.C. § 1395oo(a)(l)(a) — 1 case

Monmouth Med. Ctr. v. Thompson, 257 F.3d 807 (D.C. Cir. 2001).

— 42 U.S.C. § 1395oo(b) — 20 cases

Affinity Healthcare Servs., Inc. v. Sebelius, 746 F. Supp. 2d 106 (D.D.C. 2010). “The Administrator’s Reversal of the PRRB’s May 25, 2010 Ruling On July 19, 2010, the CMS Administrator reversed the PRRB’s May 25, 2010 decision granting the Affinity plaintiffs’ request for EJR, concluding that Affinity plaintiffs had not established that the aggregate amount…”

Cleveland Mem'l Hosp., Inc. v. Califano, 444 F. Supp. 125 (E.D.N.C. 1978).

Se. Alabama Med. Ctr. v. Sebelius, 572 F.3d 912 (D.C. Cir. 2009).

Abington Crest Nursing Rehab. Ctr. v. Sebelius, 575 F.3d 717 (D.C. Cir. 2009).

Kaiser Found. Hospitals v. Michael O. Leavitt, 649 F.3d 1153 (9th Cir. 2011).

— 42 U.S.C. § 1395oo(c) — 3 cases

John Muir Mem'l Hosp., Inc. v. Califano, 457 F. Supp. 848 (N.D. Cal. 1978).

Bd. of Regents of Florida v. Califano, 586 F.2d 451 (5th Cir. 1978).

Rocky Mountain Health Maint. Org., Inc. v. Price (D.D.C. 2019).

— 42 U.S.C. § 1395oo(d) — 71 cases

Mercy Catholic Med. Ctr. v. Tommy G. Thompson, Sec'y of Health & Human Servs., 380 F.3d 142 (3rd Cir. 2004).

Adams House Health Care v. Heckler, 604 F. Supp. 110 (N.D. Cal. 1984).

— 42 U.S.C. § 1395oo(e) — 27 cases

Sebelius v. Auburn Reg'l Med. Ctr., 133 S. Ct. 817 (2013). “165 , 42 U. S. C. §1395oo(a)(3), sets a 180-day limit for filing appeals from the fiscal intermediary to the PRRB.”

Inova Alexandria Hosp. v. Donna E. Shalala, Sec'y,Dep't of Health & Human Servs., 244 F.3d 342 (4th Cir. 2001).

Kaiser Found. Hospitals v. Michael O. Leavitt, 649 F.3d 1153 (9th Cir. 2011).

Novacare, Inc. v. Thompson, 357 F. Supp. 2d 268 (D.D.C. 2005).

V.N.A. Of Greater Tift Cnty., Inc., a Georgia Non-Profit Corp. v. Margaret M. Heckler & Blue Cross & Blue Shield of Georgia/columbus, Inc., 711 F.2d 1020 (11th Cir. 1983).

— 42 U.S.C. § 1395oo(f) — 300 cases

Via Christi Reg'l Med. Ctr., Inc. v. Leavitt, 509 F.3d 1259 (10th Cir. 2007).

Jordan Hosp. v. Leavitt, 571 F. Supp. 2d 108 (D.D.C. 2008).

Bowen v. Massachusetts, 487 U.S. 879 (1988).

Catholic Health Initiatives v. Sebelius, 617 F.3d 490 (D.C. Cir. 2010).

— 42 U.S.C. § 1395oo(f)(1) — 264 cases

Palisades Gen. Hosp. Inc. v. Leavitt, 426 F.3d 400 (D.C. Cir. 2005).

Allina Health Servs. v. Thomas Price, 863 F.3d 937 (D.C. Cir. 2017).

Empire Health Found. v. Alex Azar, II, 958 F.3d 873 (9th Cir. 2020).

— 42 U.S.C. § 1395oo(f)(2) — 50 cases

Baystate Med. Ctr. v. Leavitt, 587 F. Supp. 2d 37 (D.D.C. 2008).

Bridgeport Hosp. v. Xavier Becerra, 108 F.4th 882 (D.C. Cir. 2024).

North Iowa Med. Ctr. v. Dep't of Health & Human Servs., 196 F. Supp. 2d 784 (N.D. Iowa 2002).

Alegent Health-Immanuel Med. Ctr. v. Sebelius, 917 F. Supp. 2d 1 (D.D.C. 2012).

— 42 U.S.C. § 1395oo(f)(3) — 1 case

OSF Healthcare Sys. v. Sullivan, 820 F. Supp. 390 (C.D. Ill. 1993).

— 42 U.S.C. § 1395oo(f)(A) — 1 case

Child.'s Hosp. of Buffalo v. Apfel, 110 F. Supp. 2d 158 (W.D.N.Y. 2000).

— 42 U.S.C. § 1395oo(f)(Z) — 1 case

Alegent Health - Immanuel Med. Ctr. v. Sebelius, 34 F. Supp. 3d 160 (D.D.C. 2014).

— 42 U.S.C. § 1395oo(f)(i) — 2 cases

Rhode Island Hosp. v. Leavitt, 501 F. Supp. 2d 283 (D.R.I. 2007).

Lutheran Med. Ctr. v. Thompson, 520 F. Supp. 2d 414 (E.D.N.Y 2007).

— 42 U.S.C. § 1395oo(f)(l) — 349 cases

Full Life Hospice, LLC v. Sebelius, 709 F.3d 1012 (9th Cir. 2013). “” 42 U.S.C. § 1395oo(a). Only after these preconditions are met does § 1395oo(f)(l) require the Board to render “[a] determination in writing within thirty days after the Board receives the [EJR] request.”

Clarian Health West, LLC v. Eric Hargan, 878 F.3d 346 (D.C. Cir. 2017).

— 42 U.S.C. § 1395oo(f)(l)(1993) — 1 case

Jeanes Hosp. v. SIBELIUS, 747 F. Supp. 2d 416 (E.D. Pa. 2010).

— 42 U.S.C. § 1395oo(g) — 12 cases

Saint Francis Med. Ctr. v. Alex M. Azar II, 894 F.3d 290 (D.C. Cir. 2018).

Mem'l Hosp., Cross-Appellees v. Margaret M. Heckler, Sec'y, Dep't of Health & Human Servs., Cross-Appellant, 706 F.2d 1130 (11th Cir. 1983).

Arlington Hosp. v. Schweiker, 547 F. Supp. 670 (E.D. Va. 1982).

St. James Hosp. v. Harris, 535 F. Supp. 751 (N.D. Ill. 1981).

9 soc.sec.rep.ser. 114, Medicare&medicaid Gu 34,538 Bedford Cnty. Gen. Hosp. v. Margaret Heckler, Sec'y of Health & Human Servs., 757 F.2d 87 (6th Cir. 1985).

— 42 U.S.C. § 1395oo(g)(1) — 4 cases

Fairview Deaconess Hosp. v. Heckler, 749 F.2d 1256 (8th Cir. 1984).

Holy Cross Hosp.-Mission Hills v. Heckler, 749 F.2d 1340 (9th Cir. 1984).

Curators, Univ. of Missouri v. Sullivan, 963 F.2d 220 (8th Cir. 1992).

Rencare, Ltd. v. United Med. Resources, Inc., IASIS Healthcare Corp., & Sw. Gen. Hosp., L.P. (Tex. App. 2005).

— 42 U.S.C. § 1395oo(g)(2) — 2 cases

Raizel Blumberger v. Ian Tilley, 115 F. 4th 1113 (9th Cir. 2024).

St. Marys Reg'l Med. Ctr. v. Xavier Becerra (D.D.C. 2024).

— 42 U.S.C. § 1395oo(g)(l) — 3 cases

RenCare, Ltd. v. United Med. Resources, Inc., 180 S.W.3d 160 (Tex. App. 2005).

Jigc Nursing Home Co., Inc. v. Bowen, 667 F. Supp. 949 (E.D.N.Y 1987).

Greater Cleveland Hosp. Ass'n Grp. Appeal v. Schweiker, 599 F. Supp. 1000 (N.D. Ohio 1984).

— 42 U.S.C. § 1395oo(h) — 18 cases

Rhode Island Hosp. v. Leavitt, 548 F.3d 29 (1st Cir. 2008).

Sun Towers, Inc. v. Heckler, 725 F.2d 315 (5th Cir. 1984).

Home Health Servs. of the U. S., Inc., Etc. v. Richard S. Schweiker, Sec'y of the Dep't of Health & Human Servs., 683 F.2d 353 (11th Cir. 1982).

Bd. of Trs. of State Institutions of Higher Learning v. Sullivan, 763 F. Supp. 178 (S.D. Miss. 1991).

Baptist Mem'l Hosp.-Golden Triangle v. Leavitt, 536 F. Supp. 2d 25 (D.D.C. 2008).

— 42 U.S.C. § 1395oo(i) — 1 case

APPALACHIAN Reg'l HEALTHCARE, INC., Plaintiff-Appellee, v. the UNITED STATES, Defendant-Appellant, 999 F.2d 1573 (Fed. Cir. 1993).

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