United States Ninth Circuit

In a suit against the Department of Health and Human Services, challenging the denial of Medicare coverage for a piece of durable medical equipment used to treat osteoarthritis of the knee, district court's grant of summary judgment in favor of the plaintiff is reversed and remanded, as although various ALJ in other cases granted coverage for the device, those cases were at low levels of the agency adjudication process and thus were not binding on the Medicare Appeals Council. Here, the Medicare Appeals Council adequately explained its reasons for denying coverage and were supported by substantial evidence.

Appellate Information

• Decided 07/30/2012
• Published 07/30/2012

Judges

• Silverman

Court

• United States Ninth Circuit

Counsel