Opinion ID: 181254
Heading Depth: 3
Heading Rank: 3

Heading: Beacon's Remaining Claims

Text: The district court dismissed Beacon's claims that were not raised before the PRRB. As the district court properly explained, 42 U.S.C. § 1395ii makes § 405(h) of the Social Security Act applicable to the Medicare Act. Section 405(h) states: The findings and decision of the Commissioner of Social Security after a hearing shall be binding upon all individuals who were parties to such hearing. No findings of fact or decision of the Commissioner of Social Security shall be reviewed by any person, tribunal, or governmental agency except as herein provided. No action against the United States, the Commissioner of Social Security, or any officer or employee thereof shall be brought under section 1331 or 1346 of Title 28 to recover on any claim arising under this subchapter. 42 U.S.C. § 405(h). This provision makes exclusive the judicial review method set forth in § 1395 oo (f), which allows for district court review of any final decision of the PRRB or of any reversal, affirmance, or modification by the Secretary. See also 42 U.S.C. § 1395ii. In Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1, 120 S.Ct. 1084, 146 L.Ed.2d 1 (2000), the Supreme Court held that, though the scope of the arising under language of § 405(h) is facially uncertain, th[e]se words clearly apply in a typical ... Medicare benefits case, where an individual seeks a monetary benefit from the agency ..., the agency denies the benefit, and the individual challenges the lawfulness of that denial. Id. at 10, 120 S.Ct. 1084. The Court observed that § 405(h) plainly bars ... § 1331 review... irrespective of whether the individual challenges the agency's denial on evidentiary, rule-related, statutory, constitutional, or other legal grounds. Id. Such is the case here, and as a consequence, Beacon was barred from joining the claims it did not bring before the PRRB to its appeal of the agency's final decision. Therefore, the district court correctly concluded it lacked jurisdiction over Beacon's unexhausted claims.