News & Perspectives

U.S. Court of Appeals Decision for Contesting Suspension of Provider Medicare Payments

17. June 2021 Sam Fish Health

The U.S. Court of Appeals for the Seventh Circuit recently announced the fundamental legal requirement that a Medicare provider must exhaust all administrative remedies before being able to bring a court action to challenge the suspension of its Medicare payments. 

On June 3, 2021, in the case, Simply Home-Health Care, LLC v. Advanced Corporation & Xavier Becerra, Secretary of the United States Department of Health and Human Services, 7th Cir. Ct. of App., No. 20-1542, the court ruled that “a home health-care provider may not proceed with a Medicare contractor for suspending its Medicare payments during an investigation because it didn’t complete an administrative review process first.” 

The court stated that “federal courts don’t have jurisdiction over claims arising under the Medicare Act unless a provider has exhausted its administrative remedies and received a final decision from the Health and Human Services secretary before filing suit.”