United States Fourth Circuit

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Almy v. Sebelius, 10-2241

In a case contesting determinations of the Medicare Appeals Council (MAC) refusing to provide coverage for a device to treat osteoarthritis of the knee, the district court judgment upholding the MAC is affirmed, where: 1) the Secretary of Health and Human Services enjoys full discretion to choose to assess the Medicare Part B coverage for a device by adjudication rather than by rulemaking; 2) the Secretary's decisions were supported by substantial evidence; and 3) the plaintiff failed to demonstrate that the MAC's application of the relevant standards was plainly erroneous or inconsistent with the regulations.

Appellate Information

  • Decided 04/26/2012
  • Published 04/26/2012

Judges

  • Wilkinson

Court

  • United States Fourth Circuit

Counsel

  • For Appellant:
  • Robert Lloyd Roth, Michael Rabb

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