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Administrative Law — medicare fraud

By: WISCONSIN LAW JOURNAL STAFF//October 22, 2014//

Administrative Law — medicare fraud

By: WISCONSIN LAW JOURNAL STAFF//October 22, 2014//

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U.S. Court of Appeals for the 7th Circuit

Civil

Administrative Law — medicare fraud

A doctor whose Medicare reimbursements were terminated for fraud was required to exhaust his administrative remedies before filing suit.

“We previously applied Ringer’s holding to the precise question of the availability of mandamus relief in the context of Medicare reimbursement claims. See Burnett, 830 F.2d at 736–40. On that occasion, we joined a number of other circuits in concluding that mandamus relief is indeed available for Medicare claims that are procedural rather than substantive in nature. Id. at 738. Yet, when subsequently confronted with a case that posed the ‘procedural’ or ‘substantive’ question in Michael Reese, we did not decide it because ‘[t]he Supreme Court has recognized that mandamus relief is available only if a plaintiff “has exhausted all other avenues of relief and only if the defendant owes him a clear and nondiscretionary duty,”’ and the plaintiff had not satisfied the exhaustion requirement. Michael Reese, 427 F.3d at 441 (quoting Ringer, 466 U.S. at 616). Accordingly, ‘[b]ecause exhaustion of administrative remedies is a prerequisite of subject matter jurisdiction under … mandamus theories … and [plaintiff] failed to exhaust the review process … the district court properly rejected that basis for subject matter jurisdiction.’ Id. at 443. In short, the exhaustion requirement is still applicable to procedural challenges.”

Affirmed.

14-1934 Center for Dermatology and Skin Center, Ltd., v. Burwell

Appeal from the United States District Court for the Northern District of Illinois, Aspen, J., Manion, J.

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