Agendia, Inc. v. Becerra

Docket Number19-56516
Decision Date16 July 2021
The Ninth Circuit reversed the district court's grant of summary judgment in favor of Agendia in an action alleging that the HHS wrongfully denied its claims for reimbursement for diagnostic tests under the Medicare health insurance program. Agendia contends that the denial was improper because the local coverage determination was issued without notice and opportunity for comment in violation of a provision of the Medicare Act—specifically, 42 U.S.C. 1395hh The panel held that section 1395hh...

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4 cases
  • United States ex rel. Eastlick v. Odom
    • United States
    • U.S. District Court — District of South Carolina
    • October 28, 2021
    ...body within the United States Department of Health and Human Services. Id. § 405.904(a)(2), (b). See also Agendia, Inc. v. Becerra , 4 F.4th 896, 897 (9th Cir. 2021) (listing the four steps of administrative appeal process for claims under Medicare Parts A and B). Once a claimant has exhaus......
  • Silverado Hospice, Inc. v. Becerra
    • United States
    • U.S. Court of Appeals — Ninth Circuit
    • August 1, 2022
    ...reimbursement contained in the statute itself," so the plaintiff's "reliance on Allina [was] therefore misplaced." Agendia, Inc. v. Becerra , 4 F.4th 896, 902 (9th Cir. 2021). Here, the agency was not establishing a gap-filling policy under the Medicare statute but implementing a new direct......
  • Agendia Inc. v. Becerra
    • United States
    • U.S. District Court — District of Columbia
    • March 29, 2024
    ...asserting that the entire lawsuit, or at minimum two of Agendia's arguments, are precluded by prior litigation between the parties in Agendia I. Def.'s Cross-Mot. & Opp'n. Alternatively, the Secretary argues that there is no constitutional or statutory violation, and that each administrativ......
  • Agendia, Inc. v. Becerra
    • United States
    • U.S. District Court — District of Columbia
    • July 26, 2024
    ...asserting that the entire lawsuit, or at minimum two of Agendia's arguments, are precluded by prior litigation between the parties in Agendia I. Def.'s Cross-Mot. & Opp'n. Alternatively, the Secretary argues that there is no constitutional or statutory violation, and that each administrativ......
1 books & journal articles
  • Health Law Committee 2021 Appellate Litigation Update
    • United States
    • California Lawyers Association Business Law News (CLA) No. 2022-2, 2022
    • Invalid date
    ...records and other non-public records maintained by State agencies).IV. MEDI-CAL, MEDICARE, AND MEDICAID Agendia, Inc. v. Becerra, 4 F.4th 896 (9th Cir. 2021) (Medicare's notice-and-comment provision does not apply to local coverage determinations).Goffney v. Becerra, 995 F.3d 737 (9th Cir. ......