these the courts does an alliance for the secretary of health and human services i would like to reserve five minutes for about oh there are a number of issues before the court at this time i would like to address first the issue raised by the secretary on appeal determination is a listing of discrete items of cost that's the it's a final determination of the whole program reimbursement as to which the provider has to be disgruntled items and comes up with the n p r which is again a listing of the individual items so when you get the total amount of program reimbursement what you have is a number of different items that result in a total non program reimbursement and this this court has not has not if not to providers arguments that the phrase total amount of program reimbursement basically trumps the secretary's statutory interpretation and the cost reopening total amount in the revised n p r you can go to all the aspects that make up that total and this court rejected that interpretation the d c circuit also rejected that interpretation i think the reasoning in the d c circuit speech to this issue here this is hospital you deny having it is dealing unless you find a satisfaction under a so that's where it doesn't really add anything to the analysis to look at first you have to decide whether or not it is issue specific and then if you find that the provider express the board exercises the power given to it under deep to consider refer to revisions what's wrong with that because of the way the medicare system works because you have this in p r which is number of issues because  conclusion that it looks that it is you specific and that loma linda had not claimed dissatisfaction with this particular issue the secretary's interpretation was clearly reasonable the medicare system is a massive program and it needs to be orderly  nice to have lines and these providers as recognized by the supreme court in your home are sophisticated they have lawyers they have consultants the secretary has regulations out there for them to refer to the secretary has reimbursement manos for them to look at what they are seeking to do here by trying to make their appeal to just one final total number is to get another bite at the apple they have everything they need  playing but the board here exercised its power to consider a revision and said sure isn't easy the board does not have the power if there was not decisive action in the first place that the provider was satisfied as can't do is giving guidance to the secretary well well maybe but why isn't that perfectly consistent with the notion even though those matters were not considered by the intermediary in making a final term because subsection deed is not coached that were jurisdictions so you have to get a border station before you get to do i understand them but there's no question here the board had jurisdiction well a simple matter of statutory interpretation that starts and largely ends with the plain language of statute thirteen ninety five double oh ok under thirteen ninety five double o n a a provider may have  prerequisite is the dissatisfaction criteria that we've been talking about today under the dissatisfaction criteria as your questioning pointed out the question is whether the provider is satisfied with the final determination of provider also michael still be dissatisfied with the final determination the supreme court nowhere in bethesda so that the provider who fails to claim a cost which you could have claimed is has given example that the provider is automatically satisfied with everything in the constable that's not what bethesda said so as to also is not dealing with the situation doesn't even attempt to address the situation in which a provider appeals i final determination list specific aspects of that determination with which i loma linda certainly had no motivation to forget to claim the interest expense we're here twenty two years later and level in this now still attempting to get reimbursed for that interest expense more melinda would've been much better off if it had included the c someone in loma linda has position who made a mistake and realizes while hostile courts don't play to raise that issue with the board and give the board the authority to deal with that issue well let me turn for a moment to the double duty said these cuts are allowed but the secretary had decided there was no jurisdiction of the p r b and we were before the court i would think we would be able to argue convincingly that there is nothing left that the decision has in fact been made this is not a case in which a decision has not been made on the merits even though the secretary would like to state the decision has been made that the decision has been made by virtue of the stipulation that the purchase of the secretary's agent agreeing as to the final result so we would all i would argue that there is a final decision even though it is to the secretary would protest but the sector has not made what the secretary through the secretary's agent has made that final decision and therefore this court going towards a second is to illinois counsel makes it clear that all aspects of the decision have to be channeled through the agency here the administrator very few of the board's decision and did not reach the merits the district court had no jurisdiction and we're a little bit crazy i mean why would you have a final there be no reason to go to the boys you had a final version this agency is there isn't in the form of the stipulation there are is a number of cases out there and we cite them in our police showing that the secretary is not bound by