Federal District Court Review
Guidance for if the Medicare Appeals Council (Appeals Council) issues an adverse decision, or the Appeals Council denies the enrollee's request for review of an Administrative Law Judge's or attorney adjudicator's decision, any party, including the MA organization, may request judicial review by a Federal District Court.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 11, 2020
If the Medicare Appeals Council (Appeals Council) issues an adverse decision, or the Appeals Council denies the enrollee's request for review of an Administrative Law Judge's or attorney adjudicator's decision, any party, including the MA organization, may request judicial review by a Federal District Court.
How to Request Review by a Federal District Court
All requests must be made in writing and be filed with the proper Federal District Court within 60 calendar days after receipt of the notice of the Appeal Council's decision. To request review by a Federal District Court, the amount remaining in controversy (AIC) must meet a threshold requirement. This amount is recalculated each year and may change. For calendar year 2025, the amount in controversy threshold is $1,900. To view the Amount in Controversy Federal Register notice for calendar year 2025, see the "Related Links" section below.
For a description of the procedures an appellant must follow to request judicial review, or information about how the amount remaining in controversy is computed, go to section 70 in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance in the "Downloads" section below.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.