§ 1320c–4. Right to hearing and judicial review

703 words·~3 min read·/usc/title-42/section-1320c-4

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Any beneficiary who is entitled to benefits under subchapter XVIII, and, subject to section 1320c–3(a)(3)(D) of this title , any practitioner or provider, who is dissatisfied with a determination made by a contracting quality improvement organization in conducting its review responsibilities under this part, shall be entitled to a reconsideration of such determination by the reviewing organization. Where the reconsideration is adverse to the beneficiary and where the matter in controversy is $200 or more, such beneficiary shall be entitled to a hearing by the Secretary (to the same extent as beneficiaries under subchapter II are entitled to a hearing by the Commissioner of Social Security under section 405(b) of this title ).

For purposes of the preceding sentence, subsection ( l ) of section 405 of this title shall apply, except that any reference in such subsection to the Commissioner of Social Security or the Social Security Administration shall be deemed a reference to the Secretary or the Department of Health and Human Services, respectively. Where the amount in controversy is $2,000 or more, such beneficiary shall be entitled to judicial review of any final decision relating to a reconsideration described in this subsection.

( Aug. 14, 1935, ch. 531 , title XI, § 1155, as added Pub. L. 97–248, title I, § 143 , Sept. 3, 1982 , 96 Stat. 388 ; amended Pub. L. 101–239, title VI, § 6224(b)(2) , Dec. 19, 1989 , 103 Stat. 2257 ; Pub. L. 103–296, title I, § 108(b)(14) , Aug. 15, 1994 , 108 Stat. 1485 ; Pub. L. 112–40, title II, § 261(a)(2)(C) , Oct. 21, 2011 , 125 Stat. 423 .)

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

16 references not yet in our index

Pub. L. 97-248
96 Stat. 388
Pub. L. 101-239
103 Stat. 2257
Pub. L. 103-296
108 Stat. 1485
Pub. L. 112-40
125 Stat. 423
Pub. L. 92-603
86 Stat. 1433
Pub. L. 95-142
91 Stat. 1184
Pub. L. 96-499
94 Stat. 2629
Pub. L. 97-35
95 Stat. 793

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cites case law

§ 1320c–4

Right to hearing and judicial review

Fed. Reg.×1

Pub. L.Pub. L. 97-248

Stat.96 Stat. 388

Pub. L.Pub. L. 101-239

Stat.103 Stat. 2257

Pub. L.Pub. L. 103-296

Cites 16 · showing 5Cited by 1 across 1 source