Document ID: ./input/supremecourt_opinions/opinions/boundvolumes/529bv.pdf
Page Number: 83.0

529US1

Unit: $U32

[10-04-01 09:20:53] PAGES PGT: OPIN

8

SHALALA v. ILLINOIS COUNCIL ON LONG
TERM CARE, INC.
Opinion of the Court

set of statutory provisions, which must be read together.
See Appendix, infra. The Medicare Act says that a home

“dissatisﬁed . . . with a determination described in sub-
section (b)(2) . . . shall be entitled to a hearing . . . to
the same extent as is provided in [the Social Security
Act, 42 U. S. C. § ]405(b) . . . and to judicial review of the
Secretary’s ﬁnal decision after such hearing as is pro-
vided in section 405(g) . . . .”
42 U. S. C. § 1395cc(h)(1)
(emphasis added).

The cross-referenced subsection (b)(2) gives the Secretary
power to terminate an agreement where, for example, the
Secretary

“has determined that the provider fails to comply sub-
stantially with the provisions [of the Medicare Act] and
regulations thereunder . . . .”
§ 1395cc(b)(2)(A) (empha-
sis added).

The cross-referenced § 405(b) describes the nature of the
administrative hearing to which the Medicare Act entitles a
home that is “dissatisﬁed” with the Secretary’s “determina-
tion.” The cross-referenced § 405(g) provides that a “dissat-
isﬁed” home may obtain judicial review in federal district
court of “any ﬁnal decision of the [Secretary] made after a
hearing . . . .” Separate statutes provide for administrative
and judicial review of civil monetary penalty assessments.
§ 1395i–3(h)(2)(B)(ii); §§ 1320a–7a(c)(2), (e).

A related Social Security Act provision, § 405(h), channels
most, if not all, Medicare claims through this special review
system.

It says:

“(h) Finality of [Secretary’s] decision.

“The ﬁndings and decision of the [Secretary] after a
hearing shall be binding upon all individuals who were
parties to such hearing. No ﬁndings of fact or deci-
sion of the [Secretary] shall be reviewed by any person,
tribunal, or governmental agency except as herein pro-